Methods

• A randomized, controlled, repeated-measures design-Data collected at baseline, 4 weeks, 8 weeks, 12 weeks and 24 weeks

• Recruited from two phase II CR programs in Southeastern NCInclusion criteria: Age 18 or older, read, write and speakEnglish and able to give consentExclusion criteria: Diagnosis of thought disorder, bipolar disorder, borderline personality disorder, or illicit substance abuse/dependence; already practice mindfulness or other types of meditation, or who attended 4 classes in such practices within the past; visual, hearing or cognitive impairments

Intervention: Received 8, one hour weekly mindfulness sessions, asked to practice 20 minutes daily at home and record practice, also received mindfulness book & MP3 player with guided meditations Control: Treatment as usual

To avoid contamination groups were not run concurrently; Fidelity was maintained by using one interventionalist for all training

Results

Results

Conclusion

A

Background

Purpose

Cardiac rehabilitation (CR) is a professionally supervised program to help people recover from cardiovascular events.

CR programs provide education and counseling to help patients increase physical fitness, reduce cardiac symptoms, improve health and reduce the risk of future heart problems (AHA, 2015).

Holistic modalities, such as mindfulness, that integrate mind/body approaches have the potential to improve outcomes as well as help one to calm the mind and body (Casey et al., 2009). Recent studies indicate that the use of such practices is promising in helping CR participants to cope with stress, anxiety and depression (Casey et al., 2009; Nyklíček et al., 2014, Parswani et al., 2013).

Additionally, there is evidence to suggest that mindfulness also positively affects physiological outcomes such as blood pressure, body mass index (BMI) and hemoglobin A1c (HgbA1c) levels (Hartmann et al., 2012; Hughes et al., 2010; Parswani et al., 2013.

However, few CR programs offer these practices (AHA, 2015)

Abbott and colleagues (2014) in a systematic review with meta-analysis recommend further studies with longer follow up to firmly establish the benefits.

The purpose of this pilot study was to:• assess the effectiveness of a mindfulness

intervention compared to a non-intervention, control group (treatment as usual) on physiological (blood pressure, BMI & program completion) and psychosocial outcomes (anger, depression, anxiety, heart disease health related quality of life, affect, & perceived stress) in a sample of cardiac rehabilitation participants

• determine the feasibility of the intervention and sampling plan

Acknowledgements: This study was funded by a Charles Cahill Award; we thank the RA’s Natalie Swiger, Martina Mirabito and Ann Weatherby, the administrators for allowing us access and all those who participated.

• Preliminary findings indicate that participants increased in positive affect over time and decreased in anger control regardless of group

• There were no differences in anger in/anger out , but there was a trend suggesting increases in both over time

• There were no differences for perceived stress or anxiety.

• Preliminary results suggest positive trends in the data. Larger more diverse sample is needed and will require a multi-site study that includes larger CR programs

• Participation in CR alone may affect the mind body connection

• Mindfulness is a feasible intervention to implement in CR

• Attrition was a factor in this longitudinal study, with unique issues impacting participation: ill spouses, other commitments (work, doctor’s appointments, travel), comfort with intervention

• Lessons learned-Offer training at multiple times in conjunction with CR class-Quiet designated space is essential

• Individuals in the intervention group expressed wanting ongoing training and refreshers

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Abbott, R., Whear, R., Rodgers, L., Bethel, A., Coon, J.T., Kuyken, W., Stein, K., & Dickens, C. (2014). Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: A systematic review and meta-analysis of randomized controlled trials. Journal of Psychosomatic Research, 76, 341-351.American Heart Association (2015). What is cardiac rehabilitation? Retrieved 9/5/2015 from http://www.heart.org/HEARTORG/Conditions/More/CardiacRehab/What-is-Cardiac Rehabilitation_UCM_307049_Article.jsp Casey, A. Chang, BH., Huddleston, J., Virani, N., Benson, H., & Dusek, J. (2009). A model for Integrating a mind/body approach to cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, 29, 230-238.Hartmann, M., Kopf, S., Kircher, C., Faude-Lang, V., Djuric, Z., Augstein, F., …Nawroth, P. (2012). Sustained effects of a mindfulness-based stress-reduction intervention in type 2 diabetic patients. Diabetes Care, 35, 945-947.Hughes, J., Fresco, D. Myerscough, R., van Dulmen, H., Carlson, L., Josephson, R. (2013). Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosomatic Medicine, 75, 721-728.Nyklíček,I., Dijksman, S., Lenders, P., Fonteijn, W., & Koolen, J. (2014). A brief mindfulness intervention for increase in emotional well-being and quality of life in percutaneous coronary intervention (PCI) patients: The mindfulheart randomized controlled trial. Journal of Behavioral Medicine, 37, 135-144. Parswani, M., Sharma, M., & Iyengar SS. (2013). Mindfulness-based stress reduction program in coronary heart disease: A randomized control trial. International Journal of Yoga, 6, 111-117.

• Between April 2016 and June 2017 28 participants recruited into the study; 10 completed through week 8, 7 completed through week 24 in the intervention group, 9 completed through week 8 and 9 finished through week 24

• 26 cases analyzed with multilevel modeling using maximum likelihood estimation

Variable Mindfulness

Intervention

Control

Age (Mean) 67.6 years 70 years

Gender: Male 4 (40%) 5 (50%)Gender: Female 6 (60%) 5 (50%)Educational Level (% total)

High school diploma 40% 30%Community college 20% 30%Baccalaureate degree 30% 40%

Graduate degree 10% 0Marital StatusMarried 90% 80%Divorced 0 10%Widowed 10% 10%RaceCaucasian 100% 100%Income level (% total)

$25,001-$50,000 50% 30%$50,0001-$75,000 20% 20%$75,001-$100,000 10% 40%> $100,000 20% 10%Number of RX medications Mean (range) 7.8 (2-12) 5.1 (2-9)

Number of OTC or Supplemental

medications Mean (range)

4.1 (0-9) 4.5 (0-8)

Years with heart disease Mean (range) 62.25 months (1.5-

264)

50.88 months

(2-192)

Demographic Data

References