Meditation as a stress management strategy in cardiac rehabilitation for coronary artery disease patients: a randomized controlled trial

Abstract

Background: There is a growing body of empirical research that shows that psychological risk factors such as stress, type D personality, anger and hostility can lead to depression, anxiety, social isolation, and low socio-economics status. Psychological risk factors increase the risk of coronary artery disease (CAD) and contribute to a poorer quality of life (QoL) and worst cardiovascular prognosis. Stress, anxiety, and depression deteriorate the cardiovascular (CV) system through psycho-neuro-immunoendocrinology system and behavioural pathways. Meditation, as a form of body-mind interaction for primary and secondary prevention in CV disease has been discussed critically in the past and has been growing as a therapeutic practice. However, in CV rehabilitation programmes, more studies are needed to demonstrate meditation as a complementary therapy for CV patients. Purpose: To evaluate the benefits of meditation as a stress management strategy, in a traditional CV rehabilitation programme, in terms of stress, anxiety, depression and QoL for people with CAD. Methods: Eighty CAD patients were invited to join the meditation programme, 48 (60%) accepted and attended the initial assessment and 32 (40%) declined participation. The patients who accepted were attending for at least 6 months a 3x week exercise-based CV rehabilitation programme (usual care) and were randomized (1:1) into two distinct groups: the intervention group (IG) with meditation practice for 4 months and the control group (CG), usual care. In the IG, for one month, participants had a weekly session of 90 minutes consisting of Conscient breathing and Compassion Meditation (Karuna). During the next 3 months, all participants at the IG were asked to practice daily for 20 minutes alone or with the support material (video), with a weekly follow-up call. At the end of the 4th month, it was offered to the CG the same meditation programme. Outcome measures were assessed at the beginning (M0) and 4 months after (M1) including stress (Perceived Stress Scale), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and QoL (HeartQoL questionnaire). Results: Forty patients (65 ± 8 years, 80% male) completed all study requirements and were included in analyses. The IG reduced 44% of the depression levels when compared to the CG (-44.0 ± 32.0% vs -2.9 ± 5.0%; p<0.001). There were 30% (p=0.04) and 31% (p=0.05) reductions in anxiety and stress levels in the IG, respectively. The emotional dimension of QoL increased 60% in the IG, p<0.001. In contrast, physical QoL did not change between groups. Conclusion: Meditation has proved to be an additional practice with effective reduction on stress, anxiety, and depression levels, as well as increasing QoL for patients with CAD who are attending a long-term CV rehabilitation programme.