Psychological and Quality-of-Life Outcomes from a Comprehensive Stress Reduction and Lifestyle Program in Patients with Coronary Artery Disease: Results of a Randomized TrialMichalsen A.a · Grossman P.b · Lehmann N.c · Knoblauch N.T.M.a · Paul A.a · Moebus S.c · Budde T.d · Dobos G.J.a
aKliniken Essen-Mitte, Chair of Complementary and Integrative Medicine of the University Duisburg-Essen, Department of Internal Medicine V and Integrative Medicine, Essen, Germany; bUniversity Hospital Basel, Department of Psychosomatic & Internal Medicine, Basel, Switzerland; cUniversity of Duisburg-Essen, Institute for Medical Informatics, Biometry and Epidemiology, and dAlfried Krupp Krankenhaus, Department of Cardiology, Essen, Germany
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Background: Stress reduction and comprehensive lifestyle modification programs have improved atherosclerosis and cardiac risk factors in earlier trials. Little is known about the impact of such programs on quality-of-life (QoL) and psychological outcomes. Given recent significant improvements in cardiac care, we evaluated the current benefit of stress reduction/lifestyle modification on QoL and emotional distress in patients with coronary artery disease (CAD). Methods: 101 patients (59.4 ± 8.6 years, 23 female) with CAD were randomized to a 1-year lifestyle/stress management program (n = 48) or written advice (n = 53). QoL and psychological outcomes were assessed with the SF-36, Beck Depression, Spielberger State/Trait Anxiety, Spielberger State/Trait Anger and Perceived Stress Inventories. Group repeated-measures analyses of variance were performed for all measures. Results: Adherence to the program was excellent (daily relaxation practice 39 ± 5vs. 5 ± 8 min, respectively; p < 0.001). Both groups improved comparably in most dimensions of QoL, and significantly greater improvements for the lifestyle group were found for physical function and physical sum score (p = 0.046 and p = 0.045). Depression, anxiety, anger and perceived stress were reduced similarly in both groups. However, intervention × gender interaction effects revealed greater benefits among women in the lifestyle intervention vs. advice group for depression and anger (p = 0.025 and p = 0.040), but no effects for men. Conclusions: A comprehensive lifestyle modification and stress management program did not improve psychological outcomes in medically stable CAD patients. The program did appear to confer psychological benefits for women but not men. Further trials should investigate gender-related differences in coronary patient responses to behavioral interventions.
© 2005 S. Karger AG, Basel
- Frasure-Smith N, Lesperance F, Talajic M: Depression and 18-month prognosis after myocardial infarction. Circulation 1995;91:999–1005.
- Ladwig KH, Kieser M, Konig J, Breithardt G, Borggrefe M: Affective disorders and survival after acute myocardial infarction. Results from the post-infarction late potential study. Eur Heart J 1991;12:959–964.
- Denollet J, Sys SU, Stroobant N, Rombouts H, Gillebert TC, Brutsaert DL: Personality as independent predictor of long-term mortality in patients with coronary heart disease. Lancet 1996;347:417–421.
Kawachi I, Sparrow D, Spiro A 3rd, Vokonas P, Weiss ST: A prospective study of anger and coronary heart disease. The Normative Aging Study. Circulation 1996;94:2090–2095.
- Barefoot JC, Schroll M: Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996;93:1976–1980.
- Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S: Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): Case-control study. Lancet 2004;364:953–962.
- Rafanelli C, Roncuzzi R, Finos L, Tossani E, Tomba E, Mangelli L, Urbinati S, Pinelli G, Fava GA: Psychological assessment in cardiac rehabilitation. Psychother Psychosom 2003;72:343–349.
- Sullivan MD, LaCroix AZ, Spertus JA, Hecht J: Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease. Am J Cardiol 2000;86:1135–1138, A6, A9.
- Rozanski A, Blumenthal JA, Kaplan J: Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192–2217.
- Blumenthal JA, Jang W, Babyak MA, Krantz DS, Frid DJ, Coleman RE, Waugh R, Hanson M, Appelbaum M, O’Connor CM, Morris JJ: Stress management and exercise training in cardiac patients with myocardial ischemia. Arch Intern Med 1997;157:2213–2223.
- Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, Czajkowski SM, DeBusk R, Hosking J, Jaffe A, Kaufmann PG, Mitchell P, Norman J, Powell LH, Raczynski JM, Schneiderman N: Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289:3106–3116.
- Jones DA, West RR: Psychological rehabilitation after myocardial infarction: Multicentre randomised controlled trial. BMJ 1996;313:1517–1521.
- Frasure-Smith N, Lesperance F, Prince RH, Verrier P, Garber RA, Juneau M, Wolfson C, Bourassa MG: Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. Lancet 1997;350:473–479.
- Haskell WL, Alderman EL, Fair JM, Maron DJ, Mackey SF, Superko HR, Williams PT, Johnstone IM, Champagne MA, Krauss RM, Farquhar JW: Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994;89:975–990.
- Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129–133.
- Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ: Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001–2007.
- Schuler G, Hambrecht R, Schlierf G, Niebauer J, Hauer K, Neumann J, Hoberg E, Drinkmann A, Bacher F, Grunze M, Kübler W: Regular physical exercise and low fat diet: Effects on progression of coronary artery disease. Circulation 1992;86:1–11.
- Patel C, Marmot MG, Terry DJ, Carruthers M, Hunt B, Patel M: Trial of relaxation in reducing coronary risk: Four-year follow-up. BMJ 1985;290:1103–1106.
- Toobert DJ, Glasgow RE, Nettekoven LA, Brown JE: Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease. Patient Educ Couns 1998;35:177–188.
- Welty FK, Stuart E, O’Meara M, Huddleston J: Effect of addition of exercise to therapeutic lifestyle changes diet in enabling women and men with coronary heart disease to reach Adult Treatment Panel III low-density lipoprotein cholesterol goal without lowering high-density lipoprotein cholesterol. Am J Cardiol 2002;89:1201–1204.
- Fields JZ, Walton KG, Schneider RH, Nidich S, Pomerantz R, Suchdev P, Castillo-Richmond A, Payne K, Clark ET, Rainforth M: Effect of a multimodality natural medicine program on carotid atherosclerosis in older subjects: A pilot trial of Maharishi Vedic Medicine. Am J Cardiol 2002;89:952–958.
- Blumenthal JA, Babyak M, Wei J, O’Connor C, Waugh R, Eisenstein E, Mark D, Sherwood A, Woodley PS, Irwin RJ, Reed G: Usefulness of psychosocial treatment of mental stress-induced myocardial ischemia in men. Am J Cardiol 2002;89:164–168.
Spielberger C: Stait-Trait Anger, Research Edition, Professional Manual. Odessa/Fla, Psychological Assessment Resources, 1986.
- Hautzinger M: The Beck Depression Inventory in clinical practice (in German). Nervenarzt 1991;62:689–696.
Spielberger C, Gorsuch R, Lushene R: STAI, Manual for the Stait-Trait-Anxiety Inventory. Palo Alto, Consulting Psychologist Press, 1970.
- Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav 1983;24:385–396.
- Ware JEJ, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473–481.
Benson H, Stuart M: The Wellness Book. Mind-Body Medicine. New York, Fireside, 1999.
- Miller JJ, Fletcher K, Kabat-Zinn J: Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry 1995;17:192–200.
- Richardson MT, Leon AS, Jacobs DR Jr, Ainsworth BE, Serfass R: Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire. J Clin Epidemiol 1994;47:271–281.
- Trzcieniecka-Green A, Steptoe A: The effects of stress management on the quality of life of patients following acute myocardial infarction or coronary bypass surgery. Eur Heart J 1996;17:1663–1670.
- Munro BH, Creamer AM, Haggerty MR, Cooper FS: Effect of relaxation therapy on post-myocardial infarction patients’ rehabilitation. Nurs Res 1988;37:231–235.
- Erdman R, Duivenvoorden H, Verhage F, et al: Predictability of beneficial effects in cardiac rehabilitation: A randomized clinical trial of psychosocial variables. J Cardiopulm Rehab 1986;6:206–213.
- Schneider RH, Staggers F, Alexander CN, Sheppard W, Rainforth M, Kondwani K, Smith S, Gaylord King C: A randomized controlled trial of stress reduction for hypertension in older African-Americans. Hypertension 1995;26:820–827.
- Linden W, Stossel C, Maurice J: Psychosocial interventions for patients with coronary artery disease: A meta-analysis. Arch Intern Med 1996;156:745–752.
- Von Kanel R, Kudielka BM, Schulze R, Gander ML, Fischer JE: Hypercoagulability in working men and women with high levels of panic-like anxiety. Psychother Psychosom 2004;73:353–360.
- Castillo-Richmond A, Schneider RH, Alexander CN, Cook R, Myers H, Nidich S, Haney C, Rainforth M, Salerno J: Effects of stress reduction on carotid atherosclerosis in hypertensive African-Americans. Stroke 2000;31:568–573.
- Caine N, Harrison SC, Sharples LD, Wallwork J: Prospective study of quality of life before and after coronary artery bypass grafting. BMJ 1991;302:511–516.
- King KB, Reis HT, Porter LA, Norsen LH: Social support and long-term recovery from coronary artery surgery: Effects on patients and spouses. Health Psychol 1993;12:56–63.
- Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, Hosmer D, Bernhard JD: Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med 1998;60:625–632.
- Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert L, Lenderking WR, Santorelli SF: Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 1992;149:936–943.
- Van Andel P, Erdman RA, Karsdorp PA, Appels A, Trijsburg RW: Group cohesion and working alliance: Prediction of treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy. Psychother Psychosom 2003;72:141–149.
- Fava GA, Ruini C, Rafanelli C: Psychometric theory is an obstacle to the progress of clinical research. Psychother Psychosom 2004;73:145–148.
- Demyttenaere K, De Fruyt J: Getting what you ask for: on the selectivity of depression rating scales. Psychother Psychosom 2003;72:61–70.
- Emery CF, Frid DJ, Engebretson TO, Alonzo AA, Fish A, Ferketich AK, Reynolds NR, Dujardin JP, Homan JE, Stern SL: Gender differences in quality of life among cardiac patients. Psychosom Med 2004;66:190–197.
- Moser DK, Dracup K, McKinley S, Yamasaki K, Kim CJ, Riegel B, Ball C, Doering LV, An K, Barnett M: An international perspective on gender differences in anxiety early after acute myocardial infarction. Psychosom Med 2003;65:511–516.
- Schuster PM, Waldron J: Gender differences in cardiac rehabilitation patients. Rehabil Nurs 1991;16:248–253.
- Lavie CJ, Milani RV: Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women. Am J Cardiol 1995;75:340–343.
- Kennedy MD, Haykowsky M, Daub B, Van Lohuizen K, Knapik G, Black B: Effects of a comprehensive cardiac rehabilitation program on quality of life and exercise tolerance in women: A retrospective analysis. Curr Control Trials Cardiovasc Med 2003;4:1.
- Toobert DJ, Glasgow RE, Strycker L, Barrera M, Radcliffe JL, Wander RC, Bagdade JD: Biologic and quality-of-life outcomes from the Mediterranean lifestyle program. Diabetes Care 2003;26:2288–2293.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.