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Adding stress management to cardiac rehab may improve recovery
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Patients who underwent cardiac rehabilitation and stress management had a 50% lower risk for cardiac events than patients who only participated in cardiac rehabilitation, according to the results from the ENHANCED trial published in Circulation.
“Cardiac rehabilitation programs do not routinely offer stress management, but this may change should demand increase. And because patients may be reluctant to ask for the programs themselves, the onus is on the physicians to recognize that stress management is important for the optimal medical management of patients,” James A. Blumenthal, PhD, professor of psychiatry and behavioral sciences at Duke University School of Medicine, said in a press release.
James A. Blumenthal
The researchers randomly assigned 151 patients with CHD (aged 36-84 years) into two groups: exercise-based cardiac rehabilitation and exercise-based rehabilitation with stress management. Both programs lasted for 12 weeks. These two groups were then compared with a group of 75 patients who had no cardiac rehabilitation at all. Follow-up lasted for up to 5.3 years (median, 3.2 years). Stress levels and CHD biomarkers were measured at baseline and again at follow-up.
The primary endpoint was a composite psychometric measure of stress. CHD biomarkers and adverse CV events were secondary endpoints.
According to the data, patients who participated in both rehabilitation and stress management had greater reduction in composite stress levels than those who only engaged in rehabilitation (P = .022).
Additional analyses showed that those in the rehabilitation plus stress management group had greater improvements in anxiety (State-Trait Anxiety Inventory; P = .025) and distress (General Health Questionnaire; P = .049) and greater reductions in perceived stress (Perceived Stress Scale; P = .063) compared with the rehabilitation-only group.
Blumenthal and colleagues also found that larger reductions in stress were associated with a lower rate of clinical events (HR = 0.58; P = .048). Patients who participated in stress management and cardiac rehabilitation experienced fewer events than those who only did the rehabilitation (18% vs. 33%; P = .035), whereas those patients with no rehabilitation experienced the most cardiac events (47%; P < .001).
Blumenthal said approximately 20% to 30% of patients eligible for cardiac rehabilitation choose not to participate, with some planning on doing rehabilitation on their own. “Despite their good intentions, making lifestyle changes is not any easy thing to do without assistance,” he said in the release.
According to the press release, the findings contradicted the results of a British study that reported that cardiac rehabilitation alone or with stress management did not have a significant effect on the health of cardiac patients. Blumenthal said the different results may stem from how the programs were implemented. In the British study, the program met weekly or biweekly and only lasted for 6 to 8 weeks. – by Tracey Romero
Disclosure : The researchers report no relevant financial disclosures.
Perspective
Back to TopDavid X. Zhao, MD
I do think stress plays a critical role in the onset and incidence of CVD and the same holds true in cardiac rehab and recovery of CV events. This is one thing that we as a profession have not focused enough on. Partially, this is because the science is just starting to come out. There has been a lot of intuitive thinking about the importance of stress management, but very little data to support it. The key thing is that we recognize that stress is one of the most critical components of CVD as well as CVD recovery.
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