Investigating the Effects of a Combined Stress Management and Exercise Training Intervention in Cardiac Rehabilitation

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Stress management, Cardiac rehabilitation, Cardiovascular disease, Exercise







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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.


Effective cardiac rehabilitation (CR) programming is essential to minimizing cardiovascular disease (CVD) burden. Although high levels of stress are associated with increased onset and progression of CVD, stress management training (SMT) is not routinely included in traditional CR. This dual approach study explored the potential added benefits of combining SMT with exercise-based CR from both a quantitative and qualitative perspective. First, anonymized data from 1184 participants (Mean (M) ± Standard Deviation (SD); Age: 65.1±10.4 years) were extracted from the participating CR program's database and grouped into CR-alone (n=1003; Age: 64±11.1 years) and CR+SMT (n=181; Age: 64.0±10.1 years). Significant increases (p=0.029) in the CR+SMT group (pre: 6.83±3.03 to post: 9.27±3.49) was observed in MET levels compared to the CR-alone group (pre: 6.19±2.68 to post: 8.31±3.18). Comparable improvements (all p>0.05) were found between groups in all other CR outcome measures (e.g., HDL, LDL, DBP, SBP, non-HDL, TG). Next, semi-structured interviews were conducted in a sub-set of CR+SMT participants (n=9; Age: 69.6 years±12.2 years). Following the thematic analysis, three key themes emerged. Participants: 1) had developed and sustained a healthier lifestyle, 2) valued the support provided to them, and 3) vocalized a wish for more (e.g., more flexibility in scheduling, more proof, and more guidance) throughout SMT programming. The results of this study are encouraging, demonstrating that the inclusion of SMT in CR programming may benefit participants beyond the physical and clinical outcomes, and provides an opportunity for intellectual, perceived, and social improvements. These findings indicate that the widespread inclusion of SMT offers much promise as a standard care practice and should be included routinely in CR programming.