Document Detail


Enhancing standard cardiac rehabilitation with stress management training: background, methods, and design for the enhanced study.
MedLine Citation:
PMID:  20216360     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Enhancing Standard Cardiac Rehabilitation with Stress Management Training in Patients with Heart Disease (ENHANCED) is a randomized clinical trial funded by the National Heart Lung and Blood Institute to evaluate the effects of stress management training (SMT) on changes in biomarkers of risk and quality of life for patients enrolled in traditional exercise-based cardiac rehabilitation (CR).
METHODS: One hundred fifty cardiac patients recruited from Duke University and the University of North Carolina will be evaluated and randomized to CR enhanced by SMT (including sessions devoted to relaxation training, cognitive restructuring, communication skills, and problem solving) or to standard exercise-based CR. Before and after 12 weeks of treatment, patients will undergo a battery of psychometric questionnaires and evaluation of cardiovascular biomarkers, including measures of flow-mediated dilation, heart rate variability, baroreflex sensitivity, platelet function and inflammation, and ischemia during laboratory mental stress testing. The primary outcomes include a composite measure of stress (distress, depression, anxiety, and hostility and 24-hour urinary catecholamines and cortisol) and a composite measure of cardiac biomarkers of risk (vascular endothelial function, cardiac vagal control, inflammation, platelet function, and mental stress-induced myocardial ischemia). Secondary outcomes include measures of quality of life as well as clinical events, including death, hospitalizations, myocardial infarction, and revascularization procedures.
RESULTS: This article reviews prior studies in the area and describes the design of the ENHANCED study. Several key methodological issues are discussed including the assessment of biomarkers of risk and barriers to the integration of SMT into traditional CR.
CONCLUSIONS: The ENHANCED study will provide important information by determining to what extent SMT combined with exercise-based CR may improve prognosis and quality of life in vulnerable cardiac patients.
Authors:
James A Blumenthal; Jenny T Wang; Michael Babyak; Lana Watkins; William Kraus; Paula Miller; Alan Hinderliter; Andrew Sherwood
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of cardiopulmonary rehabilitation and prevention     Volume:  30     ISSN:  1932-751X     ISO Abbreviation:  J Cardiopulm Rehabil Prev     Publication Date:    2010 Mar-Apr
Date Detail:
Created Date:  2010-03-10     Completed Date:  2011-06-02     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101291247     Medline TA:  J Cardiopulm Rehabil Prev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  77-84     Citation Subset:  IM    
Affiliation:
Department of Psychiatry and Behavioral Sciences, PO Box 3119, Duke University Medical Center, Durham, NC 27710, USA. Blume003@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adaptation, Psychological
Adult
Biological Markers
Coronary Artery Disease / psychology,  rehabilitation*,  therapy
Endothelium, Vascular
Female
Heart Rate
Humans
Inflammation
Intention to Treat Analysis
Male
Myocardial Ischemia
Platelet Function Tests
Psychometrics
Quality of Life
Questionnaires
Research Design
Risk Factors
Stress, Psychological / complications,  therapy*
Grant Support
ID/Acronym/Agency:
HL093374/HL/NHLBI NIH HHS; R01 HL093374-01A2/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers
Comments/Corrections

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