title: The association between insomnia symptoms and cardiovascular risk factors in patients who complete outpatient cardiac rehabilitation.
abstract: OBJECTIVE
  The present study investigated whether completion of an exercise-based cardiac rehabilitation (CR) program was associated with improvements in both traditional cardiovascular risk factors and insomnia symptoms, and whether degree of improvement in insomnia symptom severity was associated with degree of improvement in cardiovascular risk.
  
  
  METHODS
  Participants (N = 80) with cardiovascular disease completed a 12-week outpatient CR program involving supervised moderate-intensity exercise sessions held twice weekly. Insomnia symptom severity, blood pressure, body mass index, psychological distress, and lipid profile were measured at baseline and after completion of the program.
  
  
  RESULTS
  Nearly 40% reported mild to moderate insomnia symptom severity at baseline. There were improvements in insomnia symptom severity, anxious and depressive symptoms, low-density lipoprotein levels, triglycerides, and total cholesterol from baseline to post-program. After statistical adjustment for age, sex, and functional capacity, greater improvement in insomnia symptom severity was associated with greater improvements in total cholesterol and symptoms of anxiety and depression.
  
  
  CONCLUSIONS
  Completion of CR may contribute to improved sleep that, in turn, is associated with improvements on some indices of cardiovascular risk. Future research should examine the direction of the association between insomnia and cardiovascular risk, including whether efforts to alleviate insomnia may bolster the cardiovascular benefits of CR.
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB, Canada.
authors.forename: Codie R
authors.initials: CR
authors.lastname: Rouleau
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB, Canada.
authors.forename: Kirsti
authors.initials: K
authors.lastname: Toivonen
authors.affiliation: TotalCardiology Rehabilitation & Risk Reduction, Calgary, AB, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB, Canada. Electronic address: campbet@ucalgary.ca.
authors.forename: Tavis S
authors.initials: TS
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation / Q000379:methods*; D002318:Cardiovascular Diseases / Q000150:complications*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*
keywords: Cardiac rehabilitation; Cardiovascular disease; Cardiovascular risk factors; Exercise; Insomnia symptom severity