title: Psychological and quality-of-life outcomes from a comprehensive stress reduction and lifestyle program in patients with coronary artery disease: results of a randomized trial.
abstract: BACKGROUND
  Stress reduction and comprehensive lifestyle modification programs have improved atherosclerosis and cardiac risk factors in earlier trials. Little is known about the impact of such programs on quality-of-life (QoL) and psychological outcomes. Given recent significant improvements in cardiac care, we evaluated the current benefit of stress reduction/lifestyle modification on QoL and emotional distress in patients with coronary artery disease (CAD).
  
  
  METHODS
  101 patients (59.4 +/- 8.6 years, 23 female) with CAD were randomized to a 1-year lifestyle/stress management program (n = 48) or written advice (n = 53). QoL and psychological outcomes were assessed with the SF-36, Beck Depression, Spielberger State/Trait Anxiety, Spielberger State/Trait Anger and Perceived Stress Inventories. Group repeated-measures analyses of variance were performed for all measures.
  
  
  RESULTS
  Adherence to the program was excellent (daily relaxation practice 39 +/- 5 vs. 5 +/- 8 min, respectively; p < 0.001). Both groups improved comparably in most dimensions of QoL, and significantly greater improvements for the lifestyle group were found for physical function and physical sum score (p = 0.046 and p = 0.045). Depression, anxiety, anger and perceived stress were reduced similarly in both groups. However, intervention x gender interaction effects revealed greater benefits among women in the lifestyle intervention vs. advice group for depression and anger (p = 0.025 and p = 0.040), but no effects for men.
  
  
  CONCLUSIONS
  A comprehensive lifestyle modification and stress management program did not improve psychological outcomes in medically stable CAD patients. The program did appear to confer psychological benefits for women but not men. Further trials should investigate gender-related differences in coronary patient responses to behavioral interventions.
authors.affiliation: Kliniken Essen-Mitte, Chair of Complementary and Integrative Medicine of the University Duisburg-Essen, Department of Internal Medicine V and Integrative Medicine, Essen, Germany. andreas.michalsen@uni-essen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
authors.forename: Paul
authors.initials: P
authors.lastname: Grossman
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.forename: Nicola T M
authors.initials: NT
authors.lastname: Knoblauch
authors.forename: Anna
authors.initials: A
authors.lastname: Paul
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.forename: Thomas
authors.initials: T
authors.lastname: Budde
authors.forename: Gustav J
authors.initials: GJ
authors.lastname: Dobos
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000523:psychology* / Q000534:rehabilitation*; D003863:Depression; D004644:Emotions; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D013315:Stress, Psychological / Q000517:prevention & control*; D016896:Treatment Outcome