title: Web-Based Mindfulness Intervention in Heart Disease: A Randomized Controlled Trial.
abstract: BACKGROUND
  Evidence is accumulating that mindfulness training has favorable effects on psychological outcomes, but studies on physiological outcomes are limited. Patients with heart disease have a high incidence of physiological and psychological problems and may benefit from mindfulness training. Our aim was to determine the beneficial physiological and psychological effects of online mindfulness training in patients with heart disease.
  
  
  METHODS
  The study was a pragmatic randomized controlled single-blind trial. Between June 2012 and April 2014 we randomized 324 patients (mean age 43.2 years, 53.7% male) with heart disease in a 2:1 ratio (n = 215 versus n = 109) to a 12-week online mindfulness training in addition to usual care (UC) compared to UC alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were other physiological parameters (heart rate, blood pressure, respiratory rate, and NT-proBNP), subjective health status (SF-36), perceived stress (PSS), psychological well-being (HADS), social support (PSSS12) and a composite endpoint (all-cause mortality, heart failure, symptomatic arrhythmia, cardiac surgery, and percutaneous cardiac intervention). Linear mixed models were used to evaluate differences between groups on the repeated outcome measures.
  
  
  RESULTS
  Compared to UC, mindfulness showed a borderline significant improved 6MWT (effect size, meters: 13.2, 95%CI: -0.02; 26.4, p = 0.050). There was also a significant lower heart rate in favor of the mindfulness group (effect size, beats per minute: -2.8, 95%CI: -5.4;-0.2, p = 0.033). No significant differences were seen on other outcomes.
  
  
  CONCLUSIONS
  Mindfulness training showed positive effects on the physiological parameters exercise capacity and heart rate and it might therefore be a useful adjunct to current clinical therapy in patients with heart disease.
  
  
  BACKGROUND
  Dutch Trial Register 3453.
authors.affiliation: Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: John O
authors.initials: JO
authors.lastname: Younge
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Machteld F
authors.initials: MF
authors.lastname: Wery
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Psychiatry (Section Medical Psychology and Psychotherapy), Erasmus MC Rotterdam, University Medical Center, Rotterdam, The Netherlands.|Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Rinske A
authors.initials: RA
authors.lastname: Gotink
authors.affiliation: Department of Adolescent Psychiatry/Psychology, Erasmus MC Rotterdam, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Elisabeth M W J
authors.initials: EM
authors.lastname: Utens
authors.affiliation: Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Michelle
authors.initials: M
authors.lastname: Michels
authors.affiliation: Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Rizopoulos
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Elisabeth F C
authors.initials: EF
authors.lastname: van Rossum
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
authors.affiliation: Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006304:Health Status; D006331:Heart Diseases / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D056152:Respiratory Rate / Q000502:physiology; D016037:Single-Blind Method