Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial
Open accessAbstract
Background—: Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease. Despite considerable epidemiological evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR. Methods and Results—: One hundred fifty-one outpatients with coronary heart disease who were 36 to 84 years of age were randomized to 12 weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and coronary heart disease biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR made up the no-CR comparison group. All participants were followed up for up to 5.3 years (median, 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone ( P =0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in coronary heart disease biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with those in the CR-alone group (18% versus 33%; hazard ratio=0.49; 95% confidence interval, 0.25–0.95; P =0.035), and both CR groups had lower event rates compared with the no-CR group (47%; hazard ratio=0.44; 95% confidence interval, 0.27–0.71; P <0.001). Conclusions—: CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00981253.
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A second trial adding stress management training to cardiac rehabilitation led to lower rates of major adverse cardiac events compared with those receiving cardiac rehabilitation alone (18% versus 33%; HR, 0.49; 95% CI, 0.25-0.95) at follow-up.
“but a second trial adding stress management training to cardiac rehabilitation led to lower rates of major adverse cardiac events compared with those receiving cardiac rehabilitation alone (18% versus 33%; HR, 0.49 [95% CI, 0.25-0.95]) at follow-up. 201”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [201]
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Experimental — accuracy not yet measuredThe goal of SMT interventions is to reduce the intensity of demands and increase coping resources.
“The goal of SMT interventions is to reduce the intensity of demands and increase coping resources [26].”
From A conversational artificial intelligence agent for a mental health care app: Evaluation study of its participatory design (2021) · cites this paper as [26]
Some previous successful psychological interventions (with high adherence) for cardiac patients have been group-based CBT with a process-oriented focus.
“Furthermore, some previous successful psychological interventions (with high adherence) for cardiac patients [40-42] have been group-based CBT with a process-oriented focus.”
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- Authors
- Blumenthal, J. A., Sherwood, A., Smith, P. J., Watkins, L., Mabe, S., Kraus, W. E., Ingle, K., Miller, P., & Hinderliter, A.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- ORCID
- Venue
- Circulation
- Published
- 2016-04-05
- Volume
- 133
- Issue
- 14
- Pages
- 1341-1350
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC4824555
- OpenAlex
- W2304409582
- Cited by
- 257
- References
- 54
- Citations by year
- 2026: 18 · 2025: 30 · 2024: 25 · 2023: 27 · 2022: 24 · 2021: 32 · 2020: 26 · 2019: 25 · 2018: 19 · 2017: 25 · 2016: 6
- FWCI
- 20.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Heart, Lung, and Blood Institute (R01HL093374, HL093374)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- cardiac rehabilitation, stress management training, coronary artery disease, psychological stress, anxiety, perceived stress, clinical events, outpatients
- MeSH terms
- Aged, Angina, Unstable, C-Reactive Protein, Cardiovascular Agents, Combined Modality Therapy, Coronary Disease, Counseling, Exercise Test, Female, Humans, Lipids, Male, Middle Aged, Myocardial Infarction, Psychological Tests, Psychometrics, Psychotherapy, Group, Social Support, Stress, Psychological, Vascular Surgical Procedures, Cognitive Behavioral Therapy, Proportional Hazards Models, Single-Blind Method, Baroreflex, Stroke
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