Psychological effects of training in coronary patients: a critical review of the literature.

Past studies have claimed that vigorous exercise programmes have positive effects on postinfarction patients' mental health. Results of controlled studies suggest that a significant antidepressant effect of exercise on postinfarction patients has not been shown reliably. The evidence also suggests that in the long run neither anxiety and pain threshold nor social anxiety are reduced by physical exertion. Furthermore, sustained exercise may cause some psychological harm, and it seems that adherence to exercise is difficult for those patients who feel uncomfortable in social interactions and whose capacities to cope with stressful life events are relatively impaired. A comprehensive treatment package which includes exercising as one component among other techniques is recommended for the improvement of patients' status of mental health.

Psychological and vocational long-term outcomes of cardiac rehabilitation with postinfarction patients under the age of forty.

70 male postinfarction patients, who were under 40 years of age at the time of transmural myocardial infarction, participated in an inpatient control examination 3.8 years following first hospitalization (mean age: 40 years, SD = 3.5 years). A multivessel disease occurred in 52% of the patients, in 80% a multilocular disease was diagnosed and in 25% coronary angiography indicated a progression in coronary sclerosis. Coronary risk factors had been considerably reduced. 78% were capable of working. Job-related stress factors of at least moderate intensity were present in about 30% of the jobs now held by the patients. Progressive morphological change occurred in patients who are older, have a multilocular disease, are subjected to more frequent and more intensive job-related stress factors, show less concern for their health and tend to leave their old living habits unchanged. In patients with multivessel disease, time pressure elicited more psychophysiological activation; furthermore, doing too many tasks at the same time and a reduced control over vocational success, together with sufficient self-confidence and an exaggerated job devotion are found in these patients. Retired patients differ from those who went back to work in cardiological, psychological and psychophysiological aspects. The importance of psychological and psychophysiological findings for a successful vocational reintegration is emphasized by these results.

Type A behavior pattern in a German sample of post-infarction patients below age 40.

While Type A is predominant in 62 coronary subjects below age 40, its specificity is to be questioned because for controls the A:B ratio is very similar. Cases display significantly more hostility and loud/explosive speech than controls. During the interview, cases belonging to different Type A categories did not differ in heart rate, skin resistance responses and blood pressure, when task values are used. Furthermore, no differences between coronary A and B subjects are found on cardiological findings, inclusive severity of coronary atherosclerosis.

The Type - A behavior pattern applied to problems in the rehabilitation of MI - patients below age 40: associations with personality dimensions and psychophysiological parameters essential to CHD.

In a sample of 60 MI-patients below age 40 there were mainly found correlations between the component "hostility" and personality dimensions indicating job stress and problems in the patients adjustment to their new situation as chronically ill persons. Whereas self- and expert ratings do not differentiate between Type A1 and B subjects psychophysiological testing reveals a groups difference between both groups in Ps. Therefore it can be assumed, that in daily life Type A MI-patients are prone to respond with an elevated Ps.

Coronary prone behavior and cardiovascular reactions during the German version of the type A interview and during a quiz.

Type A behavior (TABP) was assessed in 212 German policemen using the structured interview (Si), whereby 10% were classified as A1 (= extreme type A), 48% as A2 (= moderate), 13% as X (= indefinite), and 29% as B (= non type A) by two independent raters. Moreover, traditional risk factors were assessed: serum cholesterol (CHOL) including high density (HDL) and low density cholesterols (LDL), cigarette smoking habits; at rest, during the Si and during a quiz systolic (SBP), and diastolic blood pressure (DBP), as well as heart rate (HR) were measured, and pressure-rate-index (PRi) was calculated. As in this group of policemen TABP and many of the investigated parameters were dependent on age, in a preliminary data analysis 18 type A1 subjects (group A) were compared to 18 age matched type B or X subjects (group B). Between group A and B no differences were found in CHOL as well as HDL and LDL, cigarette smoking, SBP, DBP, HR, and PRi at rest. During the Si group A exhibited a higher rise in SBP, HR, and PRi as well as higher maximal reactions in SBP and PRi. No differences were found during the quiz. This investigation gives some further evidence that the TABP has to be regarded as an independent risk factor; moreover, in specific situations like the Si it is associated with higher cardiovascular reactions independent of language and culture. This cardiovascular hyperreactivity might be regarded as one of the mediators between TABP and CHD.

[A set of questionnaires for the assessment (screening) of psychological disorders and social problems in cardiac rehabilitation patients]. / Ein Fragebogenset zur Erfassung (Screening) psychischer Störungen und sozialer Probleme von Patienten in der kardiologischen Rehabilitation.

A set of questionnaires for the assessment (screening) of psychological and social problems in cardiac rehabilitation patients is analyzed for its psychometric properties. The test battery had before been consented by a task force of the German Association for the Prevention and Rehabilitation of Cardiovascular Disease, DGPR. It integrates generally approved and well-tried assessments for depression/anxiety, social isolation (vocational) stress, and subjective vocational disability. The questionnaire was administered to a convenience sample of 426 patients undergoing inpatient cardiac rehabilitation. Results on the psychometric properties, a comparison of the cardiac sample to the general population, as well as distributions of quartile ranges are reported. Also, a preliminary appraisal of the need for further assessment or treatment is made. The results confirm that the short test battery is suited for assessing psychological and social problems in cardiac rehabilitation patients.