Abstract
There is increasing evidence that mindfulness can reduce stress, and thereby affect other psychological and physiological outcomes as well. Earlier, we reported the direct 3-month results of an online modified mindfulness-based stress reduction training in patients with heart disease, and now we evaluate the effect at 12-month follow-up. 324 patients (mean age 43.2 years, 53.7% male) were randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were blood pressure, heart rate, respiratory rate, NT-proBNP, cortisol levels (scalp hair sample), mental and physical functioning (SF-36), anxiety and depression (HADS), perceived stress (PSS), and social support (PSSS12). Differences between groups on the repeated outcome measures were analyzed with linear mixed models. At 12-months follow-up, participants showed a trend significant improvement exercise capacity (6MWT: 17.9 meters, p = 0.055) compared to UC. Cohen’s D showed significant but small improvement on exercise capacity (d = 0.22; 95%CI 0.05 to 0.39), systolic blood pressure (d = 0.19; 95%CI 0.03 to 0.36), mental functioning (d = 0.22; 95%CI 0.05 to 0.38) and depressive symptomatology (d = 0.18; 95%CI 0.02 to 0.35). All other outcome measures did not change statistically significantly. In the as-treated analysis, systolic blood pressure decreased significantly with 5.5 mmHg (p = 0.045; d = 0.23 (95%CI 0.05–0.41)). Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care.Trial registration: www.trialregister.nl NTR3453
Highlights
In recent decades, Mindfulness-Based Stress Reduction (MBSR) has grown to be a well-known adjunct intervention in Western healthcare with reproducible significant psychological improvements in multiple patient populations regarding depressive symptomatology, anxiety, stress, and quality of life [1]
Stress from the mindfulness perspective refers to the tension that arises when we have negative experiences that we do not want [3] : MBSR teaches acceptance of negative emotions or thoughts as passing experiences and thereby reducing the stress associated with them [4]
People with chronic conditions are prone to having negative thoughts and feelings they do not want and MBSR has been found to positively affect psychological outcomes in patients with chronic pain, obesity, hypertension, depression, anxiety and cardiovascular disease [7,8,9,10,11]
Summary
Mindfulness-Based Stress Reduction (MBSR) has grown to be a well-known adjunct intervention in Western healthcare with reproducible significant psychological improvements in multiple patient populations regarding depressive symptomatology, anxiety, stress, and quality of life [1]. People with chronic conditions are prone to having negative thoughts and feelings they do not want (depression and anxiety comorbidity is high [5, 6]) and MBSR has been found to positively affect psychological outcomes in patients with chronic pain, obesity, hypertension, depression, anxiety and cardiovascular disease [7,8,9,10,11]. Low and variable heart rate and low blood pressure are associated with long-term survival and according to the ESC Guidelines cardiovascular patients are recommended to reduce stress in order to favorably affect these risk factors [16]
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