Circulatory effects of mental stress during exercise in coronary artery disease patients

We examined the effects of mental stress during steady-state exercise on heart rate, blood pressure, pressure-rate product, and oxygen uptake in 10 coronary artery disease patients. Subjects walked at three mph with grade increases of 4% every two minutes until the target heart rate (60% peak heart rate from a previous symptom-limited exercise test) was reached. A computerized Stroop-Color-Word Test (mental stress) was added one minute after the subject reached steady-state exercise and lasted 11 +/- 4 minutes. When mental stress was added to steady-state exercise it significantly (p less than 0.01) increased the heart rate (101 +/- 15 to 108 +/- 19 beats per min), systolic (154 +/- 26 to 170 +/- 26 mmHg) and diastolic (86 +/- 10 to 92 +/- 13 mmHg) blood pressure, and pressure-rate product (158 +/- 42 to 179 +/- 48 x 10(-2)). This increase in the mean response during exercise and mental stress was not observed for oxygen uptake (17 +/- 6 to 18 +/- 5 ml/kg/min). The circulatory changes probably reflect increased sympathetic activity with both centrally mediated cardioacceleratory (and probably cardiac output) and vasoconstrictor effects during the combination of mental stress and steady-state exercise. The altered hemodynamics without concomitant changes in oxygen uptake has major implications concerning the safety of competitive exercise for people with coronary artery disease.