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Enhancing standard cardiac rehabilitation with stress management training: background, methods, and design for the enhanced study.

Publication ,  Journal Article
Blumenthal, JA; Wang, JT; Babyak, M; Watkins, L; Kraus, W; Miller, P; Hinderliter, A; Sherwood, A
Published in: J Cardiopulm Rehabil Prev
2010

PURPOSE: Enhancing Standard Cardiac Rehabilitation with Stress Management Training in Patients with Heart Disease (ENHANCED) is a randomized clinical trial funded by the National Heart Lung and Blood Institute to evaluate the effects of stress management training (SMT) on changes in biomarkers of risk and quality of life for patients enrolled in traditional exercise-based cardiac rehabilitation (CR). METHODS: One hundred fifty cardiac patients recruited from Duke University and the University of North Carolina will be evaluated and randomized to CR enhanced by SMT (including sessions devoted to relaxation training, cognitive restructuring, communication skills, and problem solving) or to standard exercise-based CR. Before and after 12 weeks of treatment, patients will undergo a battery of psychometric questionnaires and evaluation of cardiovascular biomarkers, including measures of flow-mediated dilation, heart rate variability, baroreflex sensitivity, platelet function and inflammation, and ischemia during laboratory mental stress testing. The primary outcomes include a composite measure of stress (distress, depression, anxiety, and hostility and 24-hour urinary catecholamines and cortisol) and a composite measure of cardiac biomarkers of risk (vascular endothelial function, cardiac vagal control, inflammation, platelet function, and mental stress-induced myocardial ischemia). Secondary outcomes include measures of quality of life as well as clinical events, including death, hospitalizations, myocardial infarction, and revascularization procedures. RESULTS: This article reviews prior studies in the area and describes the design of the ENHANCED study. Several key methodological issues are discussed including the assessment of biomarkers of risk and barriers to the integration of SMT into traditional CR. CONCLUSIONS: The ENHANCED study will provide important information by determining to what extent SMT combined with exercise-based CR may improve prognosis and quality of life in vulnerable cardiac patients.

Duke Scholars

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Published In

J Cardiopulm Rehabil Prev

DOI

EISSN

1932-751X

Publication Date

2010

Volume

30

Issue

2

Start / End Page

77 / 84

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Stress, Psychological
  • Risk Factors
  • Research Design
  • Quality of Life
  • Psychometrics
  • Platelet Function Tests
  • Myocardial Ischemia
  • Male
  • Intention to Treat Analysis
 

Citation

APA
Chicago
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Blumenthal, J. A., Wang, J. T., Babyak, M., Watkins, L., Kraus, W., Miller, P., … Sherwood, A. (2010). Enhancing standard cardiac rehabilitation with stress management training: background, methods, and design for the enhanced study. J Cardiopulm Rehabil Prev, 30(2), 77–84. https://doi.org/10.1097/HCR.0b013e3181d0c1d3
Blumenthal, James A., Jenny T. Wang, Michael Babyak, Lana Watkins, William Kraus, Paula Miller, Alan Hinderliter, and Andrew Sherwood. “Enhancing standard cardiac rehabilitation with stress management training: background, methods, and design for the enhanced study.J Cardiopulm Rehabil Prev 30, no. 2 (2010): 77–84. https://doi.org/10.1097/HCR.0b013e3181d0c1d3.
Blumenthal JA, Wang JT, Babyak M, Watkins L, Kraus W, Miller P, et al. Enhancing standard cardiac rehabilitation with stress management training: background, methods, and design for the enhanced study. J Cardiopulm Rehabil Prev. 2010;30(2):77–84.
Blumenthal, James A., et al. “Enhancing standard cardiac rehabilitation with stress management training: background, methods, and design for the enhanced study.J Cardiopulm Rehabil Prev, vol. 30, no. 2, 2010, pp. 77–84. Pubmed, doi:10.1097/HCR.0b013e3181d0c1d3.
Blumenthal JA, Wang JT, Babyak M, Watkins L, Kraus W, Miller P, Hinderliter A, Sherwood A. Enhancing standard cardiac rehabilitation with stress management training: background, methods, and design for the enhanced study. J Cardiopulm Rehabil Prev. 2010;30(2):77–84.

Published In

J Cardiopulm Rehabil Prev

DOI

EISSN

1932-751X

Publication Date

2010

Volume

30

Issue

2

Start / End Page

77 / 84

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Stress, Psychological
  • Risk Factors
  • Research Design
  • Quality of Life
  • Psychometrics
  • Platelet Function Tests
  • Myocardial Ischemia
  • Male
  • Intention to Treat Analysis