Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: a systematic review and meta-analysis.

Meta-analysis was used to investigate the potential benefits of stress management interventions (SMIs) on vagally-mediated heart rate variability (HRV) in adults with cardiovascular disease. Electronic bibliographic databases were searched through August 2022. Randomized controlled trials and quasi-experimental studies assessing effects of SMIs on HRV were included. Methodological quality was assessed with a standardized checklist. A pooled effect size was calculated for vagally-mediated HRV indices (standard deviation of normal-to-normal intervals, root mean square of the successive differences, and high frequency power) using random effects models. Fourteen studies (1202 participants, Mage: 59 ± 6.25 years; 25% ± 16% women; 61% ± 22% White) were included. Ten studies (11 effects) reported short-term HRV assessment; a small between-group difference emerged for vagally-mediated HRV (d+ = .27, 95% confidence interval [CI] 0.01-0.52, k = 11). Most interventions examined biofeedback; these studies yielded a small between-group difference on vagally-mediated HRV (d+ = 0.31, 95% CI 0.09-0.53, k = 7, Q [6] = 3.82, p = .70, I2 = 11%). This is the first systematic examination of the effect of SMIs on HRV in adults with CVD. Findings suggest a small effect of SMIs on vagally-mediated HRV, with biofeedback likely driving the effect. More research is required to fully understand whether this benefit on vagally-mediated HRV applies to other SMIs.

Mindfulness-Based Interventions for Patients with Cardiovascular Disease: A Focused Review for Practicing Clinicians.

PURPOSE OF REVIEW: With growing scientific and public interest in the health benefits of mindfulness, clinicians increasingly face questions and solicitations for advice from patients about the efficacy of mindfulness-based interventions (MBIs) for cardiovascular disease (CVD). In this clinician-focused review, we aim to revisit empirical studies on MBIs for CVD with the purpose of informing clinicians' decisions on how to provide recommendations consistent with updated scientific findings to patients interested in MBIs. RECENT FINDINGS: We start by defining MBIs and identifying the possible physiological, psychological, behavioral, and cognitive mechanisms underlying the potentially positive effects of MBIs for CVD. Potential mechanisms include the reduction of sympathetic nervous system activity, improved vagal control, and biological markers (physiological); psychological distress and cardiovascular health behaviors (psychological and behavioral); and executive function, memory, and attention (cognitive). Then, we summarize the extant evidence to identify gaps and limitations in MBI research for the purpose of informing future directions for cardiovascular and behavioral medicine researchers. We conclude with practical recommendations for clinicians communicating with patients with CVD who are interested in MBIs.

Mind Your Heart-II: Protocol for a behavioral randomized controlled trial of mindfulness training to promote self-care in patients with comorbid heart failure and cognitive impairment.

BACKGROUND: Heart failure (HF) self-care is a robust predictor of prognosis in HF patients. Cognitive impairment is a common comorbidity in HF patients and constitutes a major challenge to HF self-care. Mindfulness training (MT) has been shown to improve cognitive function and interoception, two components essential to promoting effective HF self-care. OBJECTIVES: The aims of the Mind Your Heart-II (MYH-II) study are to investigate the effects of MT on HF self-care via changes in cognitive function and interoception in patients with comorbid HF and cognitive impairment, and to study the process by which MT can improve cognitive function via vagal control. We hypothesize that MT will improve cognitive function, interoception, and vagal control, resulting in enhanced HF self-care, compared to control participants. METHODS: MYH-II is a mechanistic parallel phase II behavioral randomized controlled trial. We will enroll 176 English or Spanish-speaking patients with comorbid chronic HF and mild cognitive impairment. Participants will be randomized to either: (1) 8-week phone-delivered MT + Enhanced Usual Care (EUC), or (2) EUC alone. Participants will complete baseline, end-of-treatment (3 months), and follow-up (9 months) assessments. The primary outcome is cognitive function (NIH Toolbox Fluid Cognition Composite Score). Additional key outcomes include: interoception (heartbeat tracking task, Multidimensional Assessment of Interoceptive Awareness), HF self-care (Self-Care of Heart Failure Index v7.2), and vagal control (high-frequency heart rate variability). IMPLICATIONS: If study hypotheses are confirmed, phone-based MT may be a key tool for improving HF self-care, and possibly clinical outcomes, in HF patients with comorbid cognitive impairment.

Complementary and integrative health approaches to manage chronic pain in U.S. military populations: Results from a systematic review and meta-analysis, 1985-2019.

The objective of this study was to examine the efficacy of complementary and integrative health (CIH) approaches for reducing pain intensity (primary outcome) and depressive symptoms (secondary outcome) as well as improving physical functioning (secondary outcome) among U.S. military personnel living with chronic pain. Studies were retrieved from bibliographic databases, databases of funded research, and reference sections of relevant articles. Studies that (a) evaluated a CIH approach to promote chronic pain management among military personnel, (b) used a randomized controlled trial design, and (c) assessed pain intensity were included. Two coders extracted data from each study and calculated effect sizes. Discrepancies between coders were resolved through discussion. Comprehensive searches identified 12 studies (k = 15 interventions) that met inclusion criteria. CIH practices included cognitive-behavioral therapies (k = 5), positive psychology (k = 3), yoga (k = 2), acupuncture (k = 2), mindfulness-based interventions (k = 2), and biofeedback (k = 1). Across these studies, participants who received the intervention reported greater reductions in pain intensity (d+ = 0.44, 95% CI [0.21, 0.67], k = 15) compared to controls. Statistically significant improvements were also observed for physical functioning (d+ = 0.36, 95% CI [0.11, 0.61], k = 11) but not for depressive symptoms (d+ = 0.21, 95% CI [-0.15, 0.57], k = 8). CIH approaches reduced pain intensity and improved physical functioning. These approaches offer a nonpharmacological, nonsurgical intervention for chronic pain management for military personnel. Future studies should optimize interventions to improve depressive symptoms in military populations experiencing chronic pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mindfulness-Based Interventions for Adults with Cardiovascular Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Individuals with cardiovascular disease (CVD) report psychological distress and poor physical functioning and may benefit from mindfulness training. PURPOSE: To examine the effects of mindfulness-based interventions (MBIs) on psychological and physiological measures in adults with CVD using meta-analysis. METHODS: Comprehensive searches identified studies that (a) evaluated MBIs in adults with CVD or who had experienced a cardiac event, (b) included a comparison condition, and (c) assessed psychological (e.g., anxiety and depression) or physiological (e.g., systolic or diastolic blood pressure [BP]) outcomes. Independent raters coded methodological (e.g., design and quality) and intervention features (e.g., intervention content) as potential moderators. Weighted mean effect sizes (d+), using full information maximum likelihood estimation, were calculated. RESULTS: Of the 1,507 records reviewed, 16 studies met inclusion criteria (N = 1,476; M age = 56 years; 40% women). Compared to controls, participants who received an MBI reported greater improvements in psychological outcomes (i.e., anxiety, depression, distress, and perceived stress: d+s = 0.49 to 0.64). MBI recipients also reduced their systolic (d+ = 0.89, 95% confidence interval [CI] = 0.26, 1.51; k = 7) but not diastolic (d+ = 0.07, 95% CI = -0.47, 0.60; k = 6) BP relative to controls. CONCLUSIONS: MBIs demonstrated favorable effects on psychological and physiological outcomes among adults with CVD. Future research should investigate if such benefits lead to improvements in disease outcomes in studies with longer follow-ups.

The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: A systematic review and meta-analysis.

BACKGROUND: Transcendental Meditation (TM) as a stress management technique may offer an adjunctive strategy to improve health and well-being in adults with cardiovascular disease (CVD). OBJECTIVES: To examine the efficacy of TM to improve aspects of cardiovascular health and psychological functioning in adults with CVD. METHOD: Studies (a) evaluating TM in adults with hypertension or CVD and (b) assessing a physiological or psychological outcome were retrieved and meta-analyzed. Weighted mean effect sizes were computed to assess between- and within-group changes. RESULTS: Nine studies met inclusion criteria (N = 851; mean age = 60 ±â€¯8 years; 47% women). Between-group analyses revealed no differences between TM and control groups. However, within-group (i.e., pre- to post-intervention) analyses revealed reductions in systolic (d+ = 0.31) and diastolic (d+ = 0.53) blood pressure (BP) for the TM group. There were no changes in depressive symptoms for TM or control participants. CONCLUSIONS: TM was associated with within-group (but not between-groups) improvements in BP. Continued research using randomized controlled trials with larger samples, and measuring psychophysiological outcomes at longer follow-up intervals is recommended.