Aerobic exercise and stress management training can reduce levels of depression and emotional distress as well as improve standard markers of cardiovascular risk in patients with ischemic heart disease, according to an article in the April 6th issue of the Journal of the American Medical Association.

Psychosocial factors are now recognized as playing a significant and independent role in the development of ischemic heart disease and its complications. Consequently, efforts to alter psychosocial risk factors, particularly in the setting of cardiac rehabilitation, have received increased attention. However, effects of behavioral interventions to reduce adverse cardiac events have been uncertain.

James A. Blumenthal, PhD, and his American colleagues compared the impact of two behavioral intervention programs, aerobic exercise and stress management training, with routine medical care on psychosocial function and select markers of cardiovascular risk. The randomized controlled trial included 134 patients (92 male, 42 female; age 40-84 years) with stable disease and exercise-induced myocardial ischemia.

Participants received routine medical care (usual care), usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks, or usual care plus weekly 1.5-hour stress management training for 16 weeks.

Patients in the exercise and stress management groups had lower average depression scores and reduced distress scores compared with patients who received usual care only. Exercise and stress management training were also associated with favorable improvements in certain cardiovascular risk markers compared with usual care patients. In particular, patients in both behavioral groups had smaller decreases in left ventricular ejection fraction with mental stress, lower levels of wall motion abnormalities during exercise, and better heart rate variability.

“Results of this randomized controlled trial demonstrate that behavioral treatments provide added benefits to routine medical management in patients with stable ischemic heart disease,” the authors wrote.

However, they added that “caution should be exercised in interpreting the clinical significance of improvements in intermediate end points. In the absence of clinical standards for these measures, the clinical significance of these changes is uncertain. Ultimately, the long-term effects of exercise training or stress management will need to be evaluated prospectively in a larger sample of patients with ischemic heart disease. However, the present study provides insight into potential mechanisms by which exercise or stress management training may be of benefit. Our results suggest that exercise and stress management training offer considerable promise to patients with stable ischemic heart disease through improvement in psychosocial adjustment and by modification of disease risk markers that may translate into improved clinical outcomes.”