Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial

• Published in: PloS one Vol. 12; no. 5; p. e0175923
• Main Authors: Gotink, Rinske A, Younge, John O, Wery, Machteld F, Utens, Elisabeth M W J, Michels, Michelle, Rizopoulos, Dimitris, van Rossum, Liesbeth F C, Roos-Hesselink, Jolien W, Hunink, Myriam M G
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.05.2017; Public Library of Science (PLoS)
• Subjects: Accessibility; Adhesion; Adult; Adults; Age; Anxiety; Biology and Life Sciences; Blood; Blood Pressure; Breathing; Cardiology; Cardiomyopathy; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Case-Control Studies; Chronic conditions; Clinical trials; Cognitive ability; Computer programs; Congestive heart failure; Coronary artery disease; Cortisol; Death; Emotions; Epidemiology; Exercise; Feasibility studies; Female; Guidelines; Hair; Health aspects; Health care; Heart diseases; Heart Diseases - physiopathology; Heart Diseases - psychology; Heart Rate; Humans; Hydrocortisone - analysis; Hypertension; Inflammation; Internet; Intervention; Laboratories; Long-term effects; Male; Measuring instruments; Medicine and Health Sciences; Mental depression; Mental disorders; Messages; Methods; Middle Aged; Mind body relationship; Mindfulness; Mindfulness meditation; Myocardial infarction; Online Systems; Pain; Patient education; Physical training; Physiological effects; Populations; Psychiatry; Psychology; Public health; Quality of life; Radiology; Respiration; Respiratory Rate; Risk factors; Social interactions; Social Sciences; Social Support; Statistical analysis; Stress; Stress management; Stress, Psychological; Stresses; Tension; Training; United States > US; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0175923

There is increasing evidence that mindfulness can reduce stress, and thereby affect other psychological and physiological outcomes as well. Earlier, we reported the direct 3-month results of an online modified mindfulness-based stress reduction training in patients with heart disease, and now we evaluate the effect at 12-month follow-up. 324 patients (mean age 43.2 years, 53.7% male) were randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were blood pressure, heart rate, respiratory rate, NT-proBNP, cortisol levels (scalp hair sample), mental and physical functioning (SF-36), anxiety and depression (HADS), perceived stress (PSS), and social support (PSSS12). Differences between groups on the repeated outcome measures were analyzed with linear mixed models. At 12-months follow-up, participants showed a trend significant improvement exercise capacity (6MWT: 17.9 meters, p = 0.055) compared to UC. Cohen's D showed significant but small improvement on exercise capacity (d = 0.22; 95%CI 0.05 to 0.39), systolic blood pressure (d = 0.19; 95%CI 0.03 to 0.36), mental functioning (d = 0.22; 95%CI 0.05 to 0.38) and depressive symptomatology (d = 0.18; 95%CI 0.02 to 0.35). All other outcome measures did not change statistically significantly. In the as-treated analysis, systolic blood pressure decreased significantly with 5.5 mmHg (p = 0.045; d = 0.23 (95%CI 0.05-0.41)). Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care. www.trialregister.nl NTR3453.