title: Stress management for patients with heart disease: a pilot study.
abstract: OBJECTIVE
  To conduct a feasibility study on stress management for patients with heart disease; more specifically, to test the availability of patients, determine dropout rates, and investigate the sensitivity to change of a large number of psychologic and biologic stress indexes.
  
  
  METHODS
  Random assignment, two-group clinical trial.
  
  
  METHODS
  Pacific Northwest university-affiliated teaching hospital.
  
  
  METHODS
  Forty-five patients with heart disease (mean age 56 years), who either had a myocardial infarction or coronary bypass surgery.
  
  
  METHODS
  Hostility, subjective distress, resting electrocardiogram, resting blood pressure and blood pressure reactivity to a psychologic stressor, and blood lipid, cortisol, and catecholamine levels.
  
  
  METHODS
  Patients were randomly assigned to either (1) exercise rehabilitation (ER) and an 8-week stress management (SM) program (ER + SM) or (2) ER only. Although the recruitment rate was satisfactory, 67% of patients assigned to the control condition and 40% of the SM subjects were not available for posttesting.
  
  
  RESULTS
  Computed effect sizes indicated that blood pressure reactivity to a psychologic challenge was reduced after treatment in the ER + SM group but not in ER group. The ER + SM group showed improvement in perceived health status and had clinically meaningful reductions in triglyceride levels, whereas the ER group did not. The ER group had a reduction in high-density lipoproteins, whereas the high-density lipoprotein levels of the ER + SM group did not change.
  
  
  CONCLUSIONS
  Patients randomly assigned to a control condition may be less willing to participate in time-consuming and invasive posttests than treated patients. Reducing the invasiveness of measurement may increase cost-effectiveness and reduce the dropout rate under controlled conditions. Blood pressure reactivity to a psychologic stress test and changes in serum lipid levels may be sensitive and cost-effective measures to include in future studies of cardiac rehabilitation.
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Turner
authors.forename: W
authors.initials: W
authors.lastname: Linden
authors.forename: R
authors.initials: R
authors.lastname: van der Wal
authors.forename: W
authors.initials: W
authors.lastname: Schamberger
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D003327:Coronary Disease / Q000150:complications / Q000523:psychology* / Q000601:surgery; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000534:rehabilitation*; D010865:Pilot Projects; D016037:Single-Blind Method; D013315:Stress, Psychological / Q000628:therapy*; D016896:Treatment Outcome