Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease - A randomized controlled trial
Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease - A randomized controlled trial
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DOI：
10.1001/jama.293.13.1626
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发表时间：
2005-04-06
影响因子：
120.7
通讯作者：
Hinderliter, A
中科院分区：
文献类型：
--
作者：
Blumenthal, JA;Sherwood, A;Hinderliter, A
背景
观察性研究表明，心理社会因素与心血管疾病发病率和死亡率的风险增加有关，但行为干预对心理社会和医学终点的影响仍不确定。
目的
确定有氧运动训练和压力管理训练这两种行为方案以及常规医疗护理对心理社会功能和心血管风险标志物的影响。
设计、地点和患者
对134例患有稳定型缺血性心脏病（IHD）且运动诱发心肌缺血的患者（92例男性和42例女性；年龄40 - 84岁）进行随机对照试验。试验于1999年1月至2003年2月进行。
干预措施
常规医疗护理（常规治疗）；常规治疗加上每周3次、每次35分钟、持续16周的有监督的有氧运动训练；常规治疗加上每周1.5小时、持续16周的压力管理训练。
主要观察指标
一般痛苦的自我报告测量（一般健康问卷[GHQ]）和抑郁（贝克抑郁量表[BDI]）；左心室射血分数（LVEF）和室壁运动异常（WMA）；血流介导的舒张；以及心脏自主神经控制（深呼吸时的心率变异性和压力反射敏感性）。
结果
运动组和压力管理组患者的平均（标准误）BDI评分较低（运动组：8.2[0.6]；压力管理组：8.2[0.6]），而常规治疗组为10.1[0.6]；P = 0.02；通过GHQ评分衡量的痛苦减轻（运动组：56.3[0.9]；压力管理组：56.8[0.9]），常规治疗组为53.6[0.9]；P = 0.02；在精神压力测试期间LVEF的降低幅度较小（运动组：-0.54%[0.44%]；压力管理组：-0.34%[0.45%]），常规治疗组为-1.69%[0.46%]；P = 0.03。在基线时有显著压力诱发WMA的一部分患者中，运动和压力管理与较低的平均（标准误）WMA评分相关（运动组：0.20[0.07]；压力管理组：0.10[0.07]），常规治疗组为0.36[0.07]；P = 0.02。运动组和压力管理组患者在血流介导的舒张方面有更大的平均（标准误）改善（运动组：平均值[标准差]，5.6%[0.45%]；压力管理组：5.2%[0.47%]），常规治疗组患者为4.1%[0.48%]；P = 0.03。在一个亚组中，接受压力管理的患者压力反射敏感性平均（标准误）有所提高（8.2[0.8]毫秒/毫米汞柱），常规治疗组为5.1[0.9]毫秒/毫米汞柱；P = 0.02，心率变异性显著增加（193.7[19.6]毫秒），常规治疗组为132.1[21.5]毫秒；P = 0.04。
结论
对于稳定型IHD患者，运动和压力管理训练比单独的常规医疗护理更能减轻情绪痛苦并改善心血管风险标志物。
Context Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality, but the effects of behavioral interventions on psychosocial and medical end points remain uncertain.Objective To determine the effect of 2 behavioral programs, aerobic exercise training and stress management training, with routine medical care on psychosocial functioning and markers of cardiovascular risk.Design, Setting, and Patients Randomized controlled trial of 134 patients (92 male and 42 female; aged 40-84 years) with stable ischemic heart disease (IHD) and exercise-induced myocardial ischemia. Conducted from January 1999 to February 2003.Interventions Routine medical care (usual care); usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks; usual care plus weekly 1.5-hour stress management training for 16 weeks.Main Outcome Measures Self-reported measures of general distress (General Health Questionnaire [GHQ]) and depression (Beck Depression Inventory [BDI]); left ventricular ejection fraction (LVEF) and wall motion abnormalities (WMA); flow-mediated dilation; and cardiac autonomic control (heart rate variability during deep breathing and baroreflex sensitivity).Results Patients in the exercise and stress management groups had lower mean (SE) BDI scores (exercise: 8.2 [0.6]; stress management: 8.2 [0.6]) vs usual care (10.1 [0.6]; P = .02); reduced distress by GHQ scores (exercise: 56.3 [0.9]; stress management: 56.8 [0.9]) vs usual care (53.6 [0.9]; P = .02); and smaller reductions in LVEF during mental stress testing (exercise: -0.54% [0.44%]; stress management: -0.34% [0.45%]) vs usual care (-1.69% [0.46%]; P = .03). Exercise and stress management were associated with lower mean (SE) WMA rating scores (exercise: 0.20 [0.07]; stress management: 0.10 [0.07]) in a subset of patients with significant stress-induced WMA at baseline vs usual care (0.36 [0.07]; P = .02). Patients in the exercise and stress management groups had greater mean (SE) improvements in flow-mediated dilation (exercise: mean [SD], 5.6% [0.45%]; stress management: 5.2% [0.47%]) vs usual care patients (4.1% [0.48%]; P = .03). In a subgroup, those receiving stress management showed improved mean (SE) baroreflex sensitivity (8.2 [0.8] ms/mm Hg) vs usual care (5.1 [0.9] ms/mm Hg; P = .02) and significant increases in heart rate variability (193.7 [19.6] ms) vs usual care (132.1 [21.5] ms; P = .04).Conclusion For patients with stable IHD, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.