Effect of relaxation therapy on cardiac events after
myocardial infarction: a 5-year follow-up study.
Authors van Dixhoorn JJ. Duivenvoorden HJ.
Institution Kennemer Hospital, Haarlem, The Netherlands.
Source Journal of Cardiopulmonary Rehabilitation. 19(3):178-85,
Abstract BACKGROUND: Evidence suggests that breathing
and relaxation therapy may influence cardiac events
in persons after acute myocardial infarction (MI). The
authors studied the effects of breathing and relaxation
therapy on rates of cardiac events and cost effectiveness
in past MI patients. METHODS: Patients (n = 156) were
chosen randomly to receive either exercise training
plus relaxation therapy (relaxation group; n = 76) or
exercise training only (control group; n = 80). The
occurrence of major cardiac events and cardiac rehospitalizations
in the two treatment groups was compared. RESULTS: At
5-year follow-up, 12 cardiac deaths had occurred, 5
in the relaxation group and 7 in the control group,
reinfarction occurred in 10 and 12 patients, and cardiac
surgery was performed in 2 and 11, respectively. In
total, 15 (20%) and 26 (33%) patients, respectively,
experienced at least one cardiac event (odds ratio [OR]
for the relaxation group: 0.55, 95% confidence interval
[CI] 0.29-1.05; adjusted for risk factors OR 0.52, 95%
CI 0.28-0.99). Regarding all cardiac rehospitalizations,
in the relaxation group, 30 patients (39%) had experienced
52 cardiac events, for which the patients were hospitalized
for a total of 476 days. In the control group, 38 patients
(48%) had experienced 78 cardiac events (OR 0.72; 95%
CI 0.38-1.36), comprising 719 days of hospitalization.
The total number of hospitalizations was reduced by
31% as a result of relaxation instruction. CONCLUSIONS:
In the long-term, the disease course after myocardial
infarction is influenced favorably by giving relaxation
therapy in addition to cardiac rehabilitation. The extra
costs of the therapy are compensated by a decrease in
hospitalization for cardiac problems.
Psychological, clinical and pathological effects
of relaxation training and guided imagery during primary
Authors Walker LG. Walker MB. Ogston K. Heys SD. Ah-See
AK. Miller ID. Hutcheon AW. Sarkar TK. Eremin O.
Institution Behavioural Oncology Unit, University of
Aberdeen, Medical School, Foresterhill, UK.
Source British Journal of Cancer. 80(1-2):262-8, 1999
Abstract The diagnosis and treatment of breast cancer
are stressful, and stress may be associated with a poorer
response to chemotherapy. There is a need, therefore,
to develop and evaluate interventions that might enhance
quality of life and, possibly, improve treatment response.
The effects of relaxation combined with guided imagery
(visualizing host defences destroying tumour cells)
on quality of life and response to primary chemotherapy,
to date, have not been adequately evaluated. Ninety-six
women with newly diagnosed large or locally advanced
breast cancer (T2 > 4 cm, T3, T4, or TxN2 and M0) took
part in a prospective, randomized controlled trial.
Patients were randomized following diagnosis to a control
condition (standard care) or to the experimental condition
(standard care plus relaxation training and imagery).
Psychometric tests to evaluate mood and quality of life
were carried out before each of the six cycles of chemotherapy
and 3 weeks after cycle 6: tests of personality and
coping strategy were carried out prior to cycles one
and six. Clinical response to chemotherapy was evaluated
after six cycles of chemotherapy using standard UICC
criteria and pathological response was assessed from
the tissue removed at surgery. As hypothesized, patients
in the experimental group were more relaxed and easy
going during the study (Mood Rating Scale). Quality
of life was better in the experimental group (Global
Self-assessment and Rotterdam Symptom Checklist). The
intervention also reduced emotional suppression (Courtauld
Emotional Control Scale). The incidence of clinically
significant mood disturbance was very low and the incidence
in the two groups was similar. Finally, although the
groups did not differ for clinical or pathological response
to chemotherapy, imagery ratings were correlated with
clinical response. These simple, inexpensive and beneficial
interventions should be offered to patients wishing
to improve quality of life during primary chemotherapy.
Guided imagery and relaxation therapy can modify
host defences in women
Authors Walker, L.G. Walker, M.B. Simpson, E. Fielden,
S. Ogston, K. Segar, A. Heys, S.D. Ah-See, A.K. Hutcheon,
A.W. Eremin, O.
Institution Behavioural Oncology Unit, Department of
Surgery, and Department of Medicine and Therapeutics,
University of Aberdeen Medical School, Aberdeen.
receiving treatment for locally advanced breast cancer
Sources The British Journal of Surgery. Volume 84(1S)
Supplement 1.May 1997.31
Abstract Background: The aim of this study was to evaluate
the psychoneuroimmunological effects of relaxation training
and guided imagery.
Method: Eighty women with locally advanced breast cancer
took part in a randomized, parallel group clinical trial
to evaluate the psychoneuroimmunological effects of
relaxation therapy and guided imagery. Women randomized
to the experimental treatment were asked to practise
relaxation and visualization at least daily during chemotherapy
and to keep detailed records of practice, image intensity,
etc. Patients assigned to the control treatment received
a high level of support and a similar amount of staff
contact in the unit. All women were given six cycles
of CHOP neoadjuvant chemotherapy every 3 weeks followed
by surgery (lumpectomy or mastectomy) and 20 fractions
of radiotherapy. Sixty ml peripheral blood were removed
at trial entry, prior to the 1st, 2nd, 4th and 6th cycles
of radiotherapy, before and after surgery, and 4 weeks
and 12 weeks after radiotherapy. The primary outcome
measures were natural killer (NK) and lymphokine-activated
killer (LAK) cell activity. Interleukins 1, 2, 4 and
6, tumour necrosis factor-alpha (TNF-alpha), gamma-interferon
and CD profiles were also assayed using standard techniques.
Results: At the final follow-up (12 weeks after radiotherapy),
women in the experimental group had higher LAK cell
activity than those in the control group. Although the
two groups did not differ in NK cell activity, within
the experimental group, relaxation frequency and self-rated
imagery quality were positively correlated with NK cell
activity at final follow-up (partial correlation coefficients
= 0.365 (P < 0.05) and 0.521 (P < 0.05), respectively).
In addition, those who practised more than once daily
during chemotherapy had higher NK cell activity during
chemotherapy. Repeated measures (ANCOVAs and ANOVAs)
showed that, compared with control patients, women in
the experimental group had higher absolute numbers and
percentages of CD 25 (activated T cells), a higher percentage
of CD 2 and lower levels of circulating TNF-alpha.
Conclusion: Even in patients receiving immunosuppressive
treatments for large or locally advanced tumours (chemotherapy,
surgery, radiotherapy), relaxation and imagery can produce
immunological changes which may have clinical relevance.