Meditation as a stress management strategy in cardiac rehabilitation for coronary artery disease patients: a randomized controlled trial

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a growing body of empirical research that shows that psychological risk factors such as stress, type D personality, anger and hostility can lead to depression, anxiety, social isolation, and low socio-economics status. Psychological risk factors increase the risk of coronary artery disease (CAD) and contribute to a poorer quality of life (QoL) and worst cardiovascular prognosis. Stress, anxiety, and depression deteriorate the cardiovascular (CV) system through psycho-neuro-immunoendocrinology system and behavioural pathways. Meditation, as a form of body–mind interaction for primary and secondary prevention in CV disease has been discussed critically in the past and has been growing as a therapeutic practice. However, in CV rehabilitation programmes, more studies are needed to demonstrate meditation as a complementary therapy for CV patients. Purpose To evaluate the benefits of meditation as a stress management strategy, in a traditional CV rehabilitation programme, in terms of stress, anxiety, depression and QoL for people with CAD. Methods Eighty CAD patients were invited to join the meditation programme, 48 (60%) accepted and attended the initial assessment and 32 (40%) declined participation. The patients who accepted were attending for at least 6 months a 3x week exercise-based CV rehabilitation programme (usual care) and were randomized (1:1) into two distinct groups: the intervention group (IG) with meditation practice for 4 months and the control group (CG), usual care. In the IG, for one month, participants had a weekly session of 90 minutes consisting of Conscient breathing and Compassion Meditation (Karuna). During the next 3 months, all participants at the IG were asked to practice daily for 20 minutes alone or with the support material (video), with a weekly follow-up call. At the end of the 4th month, it was offered to the CG the same meditation programme. Outcome measures were assessed at the beginning (M0) and 4 months after (M1) including stress (Perceived Stress Scale), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and QoL (HeartQoL questionnaire). Results Forty patients (65 ± 8 years, 80% male) completed all study requirements and were included in analyses. The IG reduced 44% of the depression levels when compared to the CG (-44.0 ± 32.0% vs -2.9 ± 5.0%; p<0.001). There were 30% (p=0.04) and 31% (p=0.05) reductions in anxiety and stress levels in the IG, respectively. The emotional dimension of QoL increased 60% in the IG, p<0.001. In contrast, physical QoL did not change between groups. Conclusion Meditation has proved to be an additional practice with effective reduction on stress, anxiety, and depression levels, as well as increasing QoL for patients with CAD who are attending a long-term CV rehabilitation programme.