A model for integrating a mind/body approach to cardiac rehabilitation: outcomes and correlators

Although cardiac rehabilitation programs have been shown to decrease cardiovascular risk, morbidity, and mortality, few programs have integrated a balanced mind/body approach in which patients are taught the relaxation response and utilize cognitive behavior skills for stress management, along with diet and exercise. We examined the medical and psychological outcomes of patients treated in such a cardiac rehabilitation program in a general hospital setting.

From 1997 to 2005, outcomes were measured in 637 patients with coronary artery disease at baseline and after a 3-month program. Components of the intervention included smoking cessation, moderate aerobic exercise, nutrition counseling, relaxation response training, and cognitive/behavioral skills.

Men and women improved significantly with respect to medical outcomes (blood pressure, lipids, weight, exercise conditioning, frequency of symptoms of chest pain and shortness of breath) and psychological outcomes (general severity index, depression, anxiety, and hostility) (P < .0001). Patients considered "at higher risk" for cardiac events due to high baseline measures improved their measures to a less than "at higher risk" level. Data indicate that specific components of the intervention, that is, increased relaxation response practice and exercise, significantly contributed to these improvements (P < .05). Furthermore, age and gender differences, particularly for psychological measures, were found; younger patients and female patients had greater improvements than older patients and male patients.

This study provides preliminary data for a subsequent randomized control trial to test mind/body-based interventions to determine the most effective outcomes at an affordable cost.