Coronary Heart Disease, Physical Activity
Conditions
Keywords
psychodynamic psychotherapy, coronary heart disease, physical activity, secondary prevention
Brief summary
The purpose of this study is to examine the effectiveness of a Psychodynamic Motivation and Training Program (PMT) for the improvement of physical fitness in patients with stable coronary heart disease as compared to advice in exercise training or treatment as usual.
Detailed description
Nonpharmacological secondary prevention of coronary heart disease is considered to be a safe and effective measure for reducing mortality substantially. Major targets are the improvement of physical activity and dietary habits, smoking cessation and stress reduction. Despite the effectiveness of life style changes, the compliance rate of patients is very low. To improve compliance with life style change programs psychotherapeutic interventions appear to have significant potential. Against this background our study aims to examine the effectiveness of a Psychodynamic Motivation and Training Program (PMT) in addition to one session of advice in exercise training based on the results of spiroergometry (+EX) and usual cardiological care (TAU). PMT will be compared with +Ex and TAU. N = 90 patients with stable coronary artery disease class, low physical activity, class I to III angina pectoris will be randomly assigned to the three treatment conditions. The Primary efficacy endpoint is change in the anaerobic threshold from baseline to 6 month follow-up. The results of the study will 1) help to determine the effectiveness of a psychodynamic life style change programs for the secondary prevention of cardiovascular disease and 2) will help to identify measures for designing specifically tailored interventions to improve compliance with cardiovascular prevention.
Interventions
BEHAVIORALPsychodynamic Motivation and Training Program (PMT)
The Psychodynamic Motivation and Training Program (PMT) is a psychodynamic stepped care approach. Depending on the individual needs PMT consists of 3 to 8 sessions of individual psychodynamic psychotherapy. If appropriate session 4 - 8 may be conducted by a nurse. PMT targets the mental and external barriers to improve physical activity by focusing on affects, interpersonal relations and maladaptive self- and other representations. PMT will be offered in addition to +Ex.
BEHAVIORALAdvice in Exercise Training (+Ex)
Advice in Exercise Training consists of one individual session of advice in exercise training based on the results of the spiroergometry.
OTHERTreatment as usual (TAU)
Usual care by family doctor, cardiologist
Sponsors
Johannes Gutenberg University Mainz
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Stable coronary heart disease with CCS functional classification of angina class I-III * Low self rated physical activity * Condition after percutaneous coronary intervention \> 4 weeks until \< 26 weeks or \> 52 weeks after index percutaneous coronary intervention * Residence \< 50 km radius of Mainz * If treatment with betablockers or ivabradine then stable \> 4 weeks
Exclusion criteria
* Acute coronary sydnrome or myocardial infarction \< 8 weeks * Coronary stenosis of the dominant vessel \> 25% or high grade stenosis of the left coronary artery * Heart failure with left ventricular ejection fraction \< 40% * NYHA III-IV * Severe heart valve disorder * Insulin dependent diabetes * Orthopedic disorders or other disorders, which preclude regular physical activity * Coronary artery bypass surgery \< 6 months before index PCI * Severe obesity (BMI ≥ 40) * Need for systemic immunosuppression with cortisone or methotrexate * Kidney failure with need for dialysis * Intake of nitrates \< 12 hours
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in individual anaerobic threshold according to lactate kinetics during spiroergometry | 6 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in the severity of impairment by angina symptoms according to the Seattle Angina Questionnaire | 6 Months | — |
| Change in the self-rated habitual physical activity according to the Habitual Physical Activity Questionnaire | 6 months | — |
| Change in endothelial function according to the flow mediated dilatation | 6 months | — |
| Change in high density lipoprotein levels | 6 months | — |
| Change in quality of life according to the EQ-5D | 6 months | — |
| Change in fatigue according to the Maastricht Questionnaire | 6 months | — |
| Change in illness perception | 6 months | (Illness perception as measured with the Brief Illness Perception Questionnaire) |
| Change in maximal aerobic capacity (VO2 max) | 6 months | — |
| Change in body mass index | 6 months | (BMI kg/m²) |
| Change in biomarkers of inflammation and oxidative burst | 6 months | — |
Countries
Germany
Outcome results
None listed