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.

The Impact of Mindfulness Treatment on Maternal Inflammation and Fetal Neurodevelopment Among Participants with Histories of Hypertensive Disorders.

This was a secondary analysis of a prenatal mindfulness training (MT) RCT versus treatment as usual (TAU) on neutrophil-to-lymphocyte ratio (NLR), a measure of maternal inflammation, and fetal head circumference. Fifteen participants were randomized to MT and 14 to TAU. NLR in third trimester was significantly lower in the MT group (F = 7.11, p = 0.019) relative to those in TAU. Higher NLR values in second (r = -0.644, p = 0.013) and third trimesters (r = -0.601, p = 0.030) were associated with lower fetal HC%. There was no group difference in fetal HC%. A future, fully powered study is needed to replicate these findings. Clinical Trials Number: NCT03679117.

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.

Feasibility, acceptability, and preliminary effects of mindfulness training on antenatal blood pressure.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are one of the greatest causes of perinatal morbidity and mortality. Mindfulness training (MT) significantly reduces blood pressure in non-pregnant adults, yet MT has not been tested to reduce blood pressure in the prenatal period. OBJECTIVES: The objectives of this pilot randomized clinical trial were to test the feasibility, acceptability, and effects of MT on rates of HDP among pregnant participants at risk for HDP. Exploratory analyses examined effects of MT on antenatal blood pressure. STUDY DESIGN: Participants were randomized to an 8-week phone-delivered MT intervention or usual care. Feasibility was defined by MT completion. Acceptability was defined by participants' satisfaction with the intervention. HDP outcomes were collected by medical chart review. Antenatal blood pressure values were extracted from medical records. RESULTS: Twenty-nine participants were randomized to phone-based MT (N = 15) or usual care (N = 14). 73% participants completed >5 MT sessions, indicating that MT was feasible. One hundred percent of participants indicated they were "satisfied" or "very satisfied" with the intervention, suggesting the intervention was acceptable. Rates of HDP were lower in the MT vs. usual care condition (9% vs. 29%; OR: 0.25, 95% C.I.: 0.02-2.65) although this did not reach statistical significance. Systolic and diastolic blood pressure levels were significantly lower at follow up among those randomized to MT vs. usual care. CONCLUSIONS: Results from this pilot trial suggest that prenatal MT is feasible and acceptable and may be a useful adjunctive preventative treatment for HDP among at-risk pregnant patients. CLINICALTRIALS: gov identifier is NCT03679117.

Mental and Physical Health Impacts of Mindfulness Training for College Undergraduates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Universities increasingly offer mindfulness-based programs (MBPs) to improve student health and reduce their impact on overburdened psychological services. It is critical for evidence-based policy to determine for what health outcomes mindfulness programs are effective and under what conditions. Objectives were to: (a) perform a comprehensive analysis of the effects of mindfulness interventions on physical, mental, and behavioral health outcomes in college undergraduate students, and (b) examine moderators of intervention effects to identify factors that may help improve existing university mindfulness programs and guide the design of new programs. Method: Systematic searches of five databases identified MBP randomized controlled trials for undergraduate students, measuring any health outcome. Analyses using robust variance estimation focused on standardized mean differences for outcomes between groups and modeled through coded study features. Results: The 58 studies in the review primarily focused on mental health with fewer assessments of physical health or health behaviors. Overall, mindfulness interventions significantly outperformed both active and inactive controls (ps<.05), with the most marked effects on anxiety symptoms, depressive symptoms, and mindfulness; greater success appeared for clinical populations. Online programs performed equivalent to in-person, and non-MBP programs were equivalent to MBP programs after controlling for other factors. Publication bias and other quality issues also emerged. Conclusions: Mindfulness programs improve well-being in college students, with the strongest evidence for reducing anxiety and depressive symptoms. More studies utilizing stronger methods are needed to evaluate mindfulness programs' effects on additional health outcomes and online interventions in clinical populations.

Mind Your Heart: Exploring Feasibility, Acceptability, and Preliminary Effects of Phone-Delivered Mindfulness Training on Medication Adherence in Outpatients With Chronic Heart Failure.

BACKGROUND: Mindfulness training (MT) may promote medication adherence in outpatients with heart failure. OBJECTIVE: The aims of this study were to determine the feasibility and acceptability of MT (primary outcomes) and explore effects on medication adherence, functional capacity, cognitive function, depression, and mindfulness skills (secondary outcomes). METHODS: In this pre/post-design study, participants received a 30-minute phone-delivered MT session weekly for 8 weeks. RESULTS: We enrolled 33 outpatients (32% women; 69.7 White; mean age, 60.3 years). Retention was 100%, and session attendance was 91%. Overall, participants (97%) rated MT as enjoyable. Objectively assessed ( P < .05) adherence decreased post intervention, whereas improvements were noted in functional capacity ( P = .05), mindfulness ( P < .05), and cognitive function (reaching significance for Flanker scores). CONCLUSIONS: Phone-delivered MT was feasible and acceptable. Whereas no improvements were noted in medication adherence and depression, cognitive function, functional capacity, and mindfulness levels increased post intervention, suggesting MT may have beneficial effects in outpatients with heart failure.

A treatment in search of a disease? Challenges in mindfulness research and practice.

'Mindfulness' has become a mainstream component of American culture and a successful business worth more than 1 billion dollars. Born out of Buddhist contemplative traditions that reached the West in the mid-1960s, secular mindfulness programs have spread both geographically (to the US and Europe) and socially (to healthcare, academia, politics, the military, and finance). The diffusion of mindfulness practice to domains that are culturally and socially so different from its original Buddhist context has had important consequences. This manuscript will examine some of these consequences as well as some challenges generated by the encounter between the American culture and Eastern millennial contemplative traditions. With the purpose of increasing awareness about these issues and to generate a debate within the mindfulness community, some suggestions on how to face such challenges are then offered to mindfulness researchers, instructors, and health care providers interested in alleviating the suffering of their patients using mindfulness meditation.

Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: A Feasibility, Proof-of-Concept Study.

OBJECTIVES: This study sought to explore feasibility, acceptability, and preliminary effects of aerobic training (AT), mindfulness training (MT), or both (MT + AT) on cognitive function in older individuals at risk of dementia. METHOD: Participants were randomized to AT, MT, both, or usual care (UC). Z-scores of attention, verbal fluency, and episodic memory for non-demented adults (ZAVEN) were computed at baseline, end of treatment (EOT), and 6 months since baseline. RESULTS: Of the 36 enrolled participants (12 M, 24 F, mean age = 70.1 years), 97% were retained in the study at 6 months. At EOT, MT had higher ZAVEN scores than UC (b = .43, P =.03) and AT (b = .26, P = .10), while no differences were seen with MT + AT. A similar pattern was observed at a 6 month follow-up (all P values = .10). DISCUSSION: MT may improve cognitive function in older individuals at risk of dementia. These preliminary findings need to be confirmed in a fully powered RCT.

Telephone-delivered behavioral health interventions for people living with HIV: patients' perspectives from a qualitative study.

People living with HIV (PLWH) often experience mental health concerns as well as difficulties with medication adherence; they also report barriers to receipt of health services. Telephone-delivered interventions can overcome some of these barriers. To obtain patients' perspectives on telephone-delivered behavioral health services, we conducted a qualitative study with patients who participated in one of two telephone-delivered interventions (mindfulness training, health coaching) in a research trial. Patients (N = 42; M age = 46 years, 50% female, 26% Black) participated in semi-structured qualitative interviews after completing the study. They identified several advantages (e.g., being able to schedule sessions more flexibly compared to in-person appointments, ease of developing rapport with interventionists) as well as occasional challenges of phone delivery (e.g., network connectivity). Overall, PLWH view telephone-delivery as a convenient and flexible method to engage in behavioral health interventions.

Tai Chi practice and change in exercise habits in survivors of acute coronary syndromes: Is mindfulness a possible mechanism?

BACKGROUND: Mechanisms by which mind-body practice may improve exercise behaviors in patients with coronary heart disease (CHD) are unknown. PURPOSE: To identify predictors of exercise behaviors developed in response to a tai chi intervention. METHODS: We conducted an exploratory analysis using data from a pilot study of tai chi for physically inactive patients with CHD. We used Latent Class Analysis to identify patterns of moderate to vigorous physical activity (MVPA) (accelerometry-assessed, average min/week) over the 9-month study period. Logistic regression was used to evaluate associations between MVPA patterns and changes in exercise self-efficacy (Self-efficacy for exercise scale), social support (Multidimensional Scale of Perceived Social Support), resilience (Brief Resilience Survey), and mindfulness (Five Facets of Mindfulness) at 6 months. RESULTS: Data supported a 3-class model over time: 31% of participants were in class 1 (high and sustained MVPA, > 200 min/week), 21% were in class 2 (low and decreasing MVPA, < 100 > 50 min/week), and 48% in class 3 (low and stable MVPA, < 50 min/week). Higher mindfulness scores at 6 months were associated with a high and sustained MVPA pattern (b = 1.89, SE = 0.15, p = .01). Social support was inversely associated with low and decreasing MVPA (b = -0.72, SE = 0.34, p = .04). No associations were noted with the other factors. CONCLUSIONS: Improvements in mindfulness were associated with a distinct high and sustained MVPA pattern. Although only hypothesis-generating, these findings suggest that improvements in mindfulness skills could be a mechanism for the possible effect of Tai Chi in the promotion of MVPA.

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.

Telephone-Delivered Mindfulness Training to Promote Medication Adherence and Reduce Sexual Risk Behavior Among Persons Living with HIV: An Exploratory Clinical Trial.

This study explored whether telephone-delivered mindfulness training (MT) to promote medication adherence and reduce sexual risk behavior was feasible for and acceptable to people living with HIV. Participants (N = 42; 50% female; M age = 47.5 years) were randomized to MT or health coaching (HC). Pre- and post-intervention, and at 3-month follow-up, we assessed adherence to ART, sexual risk behavior, and hypothesized mediators; we also conducted individual interviews to obtain qualitative data. Results showed that 55% of patients assigned to MT completed ≥ 50% of the training calls compared with 86% of HC patients (p < .05). Most patients reported satisfaction with their intervention (MT = 88%, HC = 87%). Patients in MT and HC reported improvements in medication adherence, mindfulness, and sexual risk reduction as well as reductions in anxiety, depressive symptoms, perceived stress, and impulsivity over time; however, no between-groups differences were observed.

Association of Dietary Magnesium Intake with Fatal Coronary Heart Disease and Sudden Cardiac Death.

Background: Postmenopausal women represent the highest population-based burden of cardiovascular disease, including sudden cardiac death (SCD). Our understanding of the etiology and risk factors contributing to fatal coronary heart disease (CHD) and SCD, particularly among women, is limited. This study examines the association between dietary magnesium intake and fatal CHD and SCD. Materials and Methods: We examined 153,569 postmenopausal women who participated in the Women's Health Initiative recruited between 1993 and 1998. Magnesium intake at baseline was assessed using a validated food frequency questionnaire, adjusting for energy via the residual method. Fatal CHD and SCD were identified over an average follow-up of 10.5 years. Results: For every standard deviation increase in magnesium intake, there was statistically significant risk reduction, after adjustment for confounders, of 7% for fatal CHD (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.89-0.97), and 18% risk reduction for SCD (HR 0.82, 95% CI 0.58-1.15) the latter of which did not reach statistical significance. In age-adjusted quartile analysis, women with the lowest magnesium intake (189 mg/day) had the greatest risk for fatal CHD (HR 1.54, 95% CI 1.40-1.69) and SCD (HR 1.70, 95% CI 0.94-3.07). This association was attenuated in the fully adjusted model, with HRs of 1.19 (95% CI 1.06-1.34) for CHD and 1.24 (95% CI 0.58-2.65) for SCD for the lowest quartile of magnesium intake. Conclusions: This study provides evidence of a potential inverse association between dietary magnesium and fatal CHD and a trend of magnesium with SCD in postmenopausal women. Future studies should confirm this association and consider clinical trials to test whether magnesium supplementation could reduce fatal CHD in high-risk individuals.

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.

The benefits of yoga for people living with HIV/AIDS: A systematic review and meta-analysis.

BACKGROUND: People living with HIV/AIDS (PLWHA) often experience psychological stress associated with disease management. This meta-analysis examines the benefits of yoga interventions on psychological distress among PLWHA. METHODS: Included were studies that (a) evaluated a yoga intervention in PLWHA; (b) provided between-group or within-group changes; and (c) assessed a psychological, physiological, or biomedical outcome. RESULTS: Seven studies sampling 396 PLWHA (M age = 42 years, SD = 5 years; 40% women) met inclusion criteria. PLWHA who received yoga interventions reported significant improvements in perceived stress (d+ = 0.80, 95% Confidence Interval [CI] = 0.53, 1.07), positive affect (d + = 0.73, 95% CI = 0.49, 0.98), and anxiety (d+ = 0.71, 95% CI = 0.27, 1.14) compared to controls. CONCLUSION: Yoga is a promising intervention for stress management. However, the literature is limited by the small number of studies. Randomized controlled trials with objective measures of HIV-related outcomes are needed to further evaluate the benefits of yoga.

Beneficial Effects of School-based Mindfulness Training On Impulsivity in Healthy Adolescents: Results From a Pilot Randomized Controlled Trial.

BACKGROUND: Since impulsivity is associated with unhealthy behaviors in adolescents, interventions targeting impulsivity could positively affect such behaviors. Whether integrating mindfulness training (MT) into standard school-based health education could improve impulsivity is unknown. PURPOSE: To obtain preliminary estimates of effect of MT integrated in standard high school health education on impulsivity. METHODS: Two high schools in Massachusetts were randomized to school-based health education plus MT (HE-MT) or to health education plus attention control (HE-AC). The outcome was change in impulsivity at end of treatment (EOT) and 6 months after EOT. RESULTS: Students (n = 53; 30 HE-MT, 23 HE-AC) were on average 14.5 years old and 40% belonged to ethnic minorities. Compared to the control condition, HE-MT had significant effects on impulsivity at EOT (beta = -9.7; SE = 3.8, p = 0.01), while smaller, non-significant differences were seen 6 months after EOT. CONCLUSION: This rigorous pilot study suggests that MT could have a beneficial effect on impulsivity in adolescents. Improvements in impulsivity could have important implications should future larger studies show that such improvements result in healthier behaviors.