Ischemic heart disease (IHD) is the leading cause of death in the United States and is rapidly becoming the leading cause of death in developing countries around the world, according to background information in the article. Psychosocial factors are now recognized as playing a significant and independent role in the development of IHD and its complications. Consequently, efforts to alter psychosocial risk factors, particularly in the setting of cardiac rehabilitation, have received increased attention. However, the effects of behavioral interventions to reduce adverse cardiac events has been uncertain.
James A. Blumenthal, Ph.D., of Duke University Medical Center, Durham, N.C., and colleagues compared the impact of two behavioral intervention programs, aerobic exercise and stress management training, with routine medical care on psychosocial functioning and select markers of cardiovascular risk. The randomized controlled trial included 134 patients (92 male and 42 female; aged 40-84 years) with stable IHD and exercise-induced myocardial ischemia (decreased blood supply to the heart muscle). The trial was conducted from January 1999 to February 2003.
Participants received either routine medical care (usual care); usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks; or usual care plus weekly 1.5-hour stress management training for 16 weeks.
The researchers found that patients in the exercise and stress management training groups exhibited lower average depression scores and reduced distress scores compared with patients receiving usual care only. Exercise and stress management training were also associated with favorable improvements in certain cardiovascular risk markers, compared with usual care patients.
"Results of this randomized controlled trial demonstrate that behavioral treatments provide added benefits to routine medical management in patients with stable IHD," the authors write.
But the authors add that "caution should be exercised in interpreting the clinical significance of improvements in intermediate end points. In the absence of clinical standards for these measures, the clinical significance of these changes is uncertain. Ultimately, the long-term effects of exercise training or stress management will need to be evaluated prospectively in a larger sample of patients with IHD. However, the present study provides insight into potential mechanisms by which exercise or stress management training may be of benefit. Our results suggest that exercise and stress management training offer considerable promise to patients with stable IHD through improvement in psychosocial adjustment and by modification of disease risk markers that may translate into improved clinical outcomes."
(JAMA. 2005;293:1626-1634. Available post-embargo at JAMA.com)
Editor's Note: This study was supported by grants from the National Institutes of Health.
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JAMA