***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: OBJECTIVES To examine the effects of progressive muscle relaxation and guided imagery on psychological and physiologic outcomes in adults with cardiovascular disease who were participating in a phase II cardiac rehabilitation program . To examine tension levels , practice patterns , and perceived helpfulness of the intervention reported by subjects . DESIGN Prospect i ve , quasi-experimental , with r and om group assignment within sites . Independent replication and extension of a study by Bohachik ( 1984 ) . SETTING Four midwestern hospital-based phase II cardiac rehabilitation programs . PATIENTS Fifty patients who within the preceding 12 weeks had had acute myocardial infa rct ion or coronary artery bypass surgery or both , studied during 6 weeks of participation in a phase II cardiac rehabilitation program . OUTCOME MEASURES Psychological measures included state and trait anxiety scores on the State-Trait Anxiety Inventory and reported symptoms on the Symptom Checklist-90-Revised . Physiologic measures were resting heart rate and blood pressure . Subjective tension levels before and after home practice , practice patterns , and perceived helpfulness of the intervention were examined . INTERVENTION Individual instruction session in progressive muscle relaxation and guided imagery at the phase II cardiac rehabilitation program , followed by daily home practice with audiotape instructions over a 6-week period . RESULTS No statistical differences at the p < or = 0.05 level were found in state anxiety scores or reported symptoms at study exit . However , reductions in mean subscale scores for interpersonal sensitivity ( t [ 19 ] = 2.11 , p < or = 0.05 ) and depression ( t [ 19 ] = 2.07 , p < or = 0.05 ) by paired t tests were found for the relaxation group ( RG ) . The two groups differed at study exit in resting heart rate ( t [ 42 ] = -2.02 , p < or = 0.05 ) by independent t tests and in systolic blood pressure ( F [ 1,42 ] = 5.13 , p < or = 0.05 ) by analysis of covariance . The RG had a mean resting heart rate 8.6 beats/min lower than that of the control group ( CG ) and also had within-group reductions in mean heart rate ( t [ 19 ] = 2.09 , p < or = 0.05 ) by paired t tests . Contrary to expectation , the CG had a 3.5 mm Hg lower mean systolic blood pressure and within-group reductions in systolic ( t [ 22 ] = 3.02 , p < 0.01 ) and diastolic ( t [ 22 ] = 3.83 , p < 0.01 ) blood pressure by paired t tests . CG subjects had a greater number of dose increases in cardiac medications and fewer dose reductions than did RG subjects , who also had a higher number of dose reductions . RG subjects reported frequent practice of the technique , rated it as helpful , and reported lower subjective tension levels after practice . CONCLUSIONS Findings in this study did not support those of Bohachik ( who reported lowered state anxiety and fewer somatization , interpersonal sensitivity , and depression symptoms ) . More instruction sessions on the relaxation method may have result ed in more positive outcomes . However , the within-group scores for interpersonal sensitivity and depression , the reduction in heart rate , and the receptivity of subjects to this intervention suggest that it may be a feasible and helpful adjunctive therapy for participants in a phase II cardiac rehabilitation program BACKGROUND There have been six r and omized controlled trials of psychological therapy with generalized anxiety disorder ( GAD ) using DSM-III-R and DSM-IV . All have used the Trait version of the Spielberger State-Trait Anxiety Inventory ( STAI-T ) as one of several outcome measures . Each study , however , employed different methods of calculating the clinical significance of outcomes making it difficult to reach a balanced appraisal of the efficacy of psychological treatment . METHODS Raw data on STAI-T scores at pre- , post- and follow-up were obtained for each of the six studies ( total N = 404 ) . Jacobson methodology for defining clinical ly significant change ( criterion c , reliable change index = 8 , cut-off point = 46 ) was used to allocate each patient to one of four outcomes : worse , unchanged , improved and recovered . The proportion of patients in each category was calculated for treatment conditions in each study and also for aggregate data across types of treatment . RESULTS A recovery rate of 40 % was found for the sample as a whole with 12 of the 20 treatment conditions obtaining very modest recovery rates of 30 % or less . Two treatment approaches -- individual cognitive behavioural therapy and applied relaxation -- do relatively well with overall recovery rates at 6-month follow-up of 50 - 60 % . CONCLUSIONS Jacobson methodology , in distinguishing between improvement and recovery on a st and ardized measure of general vulnerability to anxiety , provides a stringent but clinical ly more meaningful evaluation of the efficacy of psychological therapies with GAD than has been available hitherto . Systematic focus on either excessive worry or physiological arousal gives worthwhile results The purpose of this study was to evaluate the effect of stress management training on quality of life , functional capacity , and heart rate variability in elderly patients with New York Heart Association class I-III congestive heart failure ( CHF ) . While substantial research exists on stress management training for patients with coronary heart disease , there are few data on the value of psychosocial training on patients with CHF . Thirty-three multiethnic patients ( mean age , 66+/-9 years ) were assigned through incomplete r and omization to one of two treatment groups or a wait-listed control group . The 14 participants who completed the treatment attended eight training sessions during a 10-week period . The training consisted of 75-minute sessions adapted from the Freeze-Frame stress management program developed by the Institute of HeartMath . Subjects were assessed at baseline and again at the completion of the training . Depression , stress management , optimism , anxiety , emotional distress , and functional capacity were evaluated , as well as heart rate variability . Significant improvements ( p<0.05 ) were noted in perceived stress , emotional distress , 6-minute walk , and depression , and positive trends were noted in each of the other psychosocial measures . The 24-hour heart rate variability showed no significant changes in autonomic tone . The authors noted that CHF patients were willing study participants and their emotional coping and functional capacity were enhanced . This program offers a simple and cost-effective way to augment medical management of CHF . Given the incompleteness of CHF medical management and the exploding interest in complementary medical intervention , it seems imperative that further work in psychosocial treatment be undertaken One hundred fifty-six myocardial infa rct ion patients were r and omly assigned to either exercise plus relaxation and breathing therapy ( treatment A , n = 76 ) or to exercise training only ( treatment B , n = 80 ) . Effects on exercise testing showed a more pronounced training bradycardia and a remarkable improvement in ST abnormalities in treatment A ( p less than 0.005 ) . A model was developed to integrate the various exercise parameters into a single measure for training benefit . Approximately half the patients showed a training success , with a more positive and less negative outcome in treatment A ( p = 0.09 ) . The odds for failure were 0.25 for treatment A and 0.51 for treatment B ( odds ratio : 2.04 ; 95 % confidence interval , 0.94 to 4.6 ) . Thus the risk of failure was reduced by half when relaxation was added to exercise training . These results indicate that exercise training is not successful in all MI patients and that relaxation therapy enhances training benefit The objective of this study was to assess the impact of group-based stress management training on emotional well-being , functional status , social activity and chest pain in cardiac patients , within a r and omized controlled trial . Fifty acute myocardial infa rct ion and 50 coronary artery bypass patients were r and omized to experimental ( 27 myocardial infa rct ion and 23 coronary artery bypass ) and control ( 23 myocardial infa rct ion and 27 coronary artery bypass ) groups 3 months after infa rct ion or surgery . Experimental patients underwent a 10-week relaxation-based stress management programme , while the controls received normal care . Following assessment at the end of the treatment period , controls were offered the stress management programme . Follow-up data were collected 6 months post-treatment from both groups . Significantly greater improvements in emotional well-being as assessed on the Hospital Anxiety and Depression scale ( P < 0.005 ) and the Psychological General Well-being Index ( P < 0.001 ) were found in the experimental than control groups , and improvements were maintained at 6 month follow-up . Greater improvements were also recorded in experimental than control groups in activities of daily living ( P < 0.005 ) , satisfaction with health ( P < 0.025 ) , reports from spouses or relatives of patients ' emotional state ( P < 0.001 ) , and in disruption due to chest pain ( P < 0.001 ) . Similar responses to stress management were observed in myocardial infa rct ion and coronary artery bypass patients . When controls underwent treatment , they too showed significant reductions in anxiety and depression , but no changes in social or functional status . We conclude that stress management training may lead to improvements in the quality of life of myocardial infa rct ion and coronary artery bypass patients . Such programmes might usefully be made available even to patients who have participated in formal rehabilitation The authors report on the influence of autogenous training on blood pressure at rest and under stress conditions in patients with coronary heart disease following coronary bypass operation . We investigated the influence of autogenous training on the microcirculation and the left ventricular ejection fraction ( LVEF ) as well . The results showed a significant decrease in blood pressure at rest and also an increase of muscle circulation F and of LVEF OBJECTIVES To determine if cardiorespiratory biofeedback increases heart rate variability ( HRV ) in patients with documented coronary artery disease ( CAD ) . BACKGROUND Diminished HRV has been associated with increased cardiac morbidity and mortality . Evidence suggests that various lifestyle changes and pharmacologic therapies can improve HRV . The objective of this study was to determine if biofeedback increases HRV in patients with CAD . METHODS Patients with established CAD ( n = 63 ; mean age , 67 years ) were r and omly assigned to conventional therapy or to 6 biofeedback sessions consisting of abdominal breath training , heart and respiratory physiologic feedback , and daily breathing practice .  HRV was measured by the st and ard deviation of normal-to-normal QRS complexes ( SDNN ) at week 1 ( pretreatment ) , week 6 ( after treatment ) , and week 18 ( follow-up ) . RESULTS Baseline characteristics were similar for the treatment and control groups . The SDNN for the biofeedback and control groups did not differ at baseline or at week 6 but were significantly different at week 18 . The biofeedback group showed a significant increase in SDNN from baseline to week 6 ( P < .001 ) and to week 18 ( P = .003 ) . The control subjects had no change from baseline to week 6 ( P = .214 ) and week 18 ( P = .27 ) . CONCLUSIONS Biofeedback increases HRV in patients with CAD and therefore may be an integral tool for improving cardiac morbidity and mortality rates OBJECTIVES Autogenic training ( AT ) is a method of autosuggestion with some potential for reducing anxiety . This study tests whether AT lowers anxiety levels experienced by patients undergoing coronary angioplasty . METHODS Fifty-nine patients were r and omly assigned to receive regular AT or no such therapy as an adjunct to st and ard care for 5 months . The primary outcome measure was State Anxiety at 2 months . Qualitative information was generated by face-to-face interviews . RESULTS State Anxiety showed a significant intergroup difference both at 2 and 5 months . This finding was corroborated by secondary outcome measures , for example , quality of life , and by qualitative information about patients ' experiences . The results do not allow us to determine whether the observed effects are specific to AT or of a nonspecific nature . CONCLUSIONS Our results suggest that AT may have a role in reducing anxiety of patients undergoing coronary angioplasty OBJECTIVE To conduct a feasibility study on stress management for patients with heart disease ; more specifically , to test the availability of patients , determine dropout rates , and investigate the sensitivity to change of a large number of psychologic and biologic stress indexes . DESIGN R and om assignment , two-group clinical trial . SETTING Pacific Northwest university-affiliated teaching hospital . PATIENTS Forty-five patients with heart disease ( mean age 56 years ) , who either had a myocardial infa rct ion or coronary bypass surgery . OUTCOME MEASURES Hostility , subjective distress , resting electrocardiogram , resting blood pressure and blood pressure reactivity to a psychologic stressor , and blood lipid , cortisol , and catecholamine levels . INTERVENTION Patients were r and omly assigned to either ( 1 ) exercise rehabilitation ( ER ) and an 8-week stress management ( SM ) program ( ER + SM ) or ( 2 ) ER only . Although the recruitment rate was satisfactory , 67 % of patients assigned to the control condition and 40 % of the SM subjects were not available for posttesting . RESULTS Computed effect sizes indicated that blood pressure reactivity to a psychologic challenge was reduced after treatment in the ER + SM group but not in ER group . The ER + SM group showed improvement in perceived health status and had clinical ly meaningful reductions in triglyceride levels , whereas the ER group did not . The ER group had a reduction in high-density lipoproteins , whereas the high-density lipoprotein levels of the ER + SM group did not change . CONCLUSIONS Patients r and omly assigned to a control condition may be less 
    Output:
    
No effect was found on blood pressure or cholesterol .
Psychological outcome : state anxiety was reduced , trait anxiety was not , depression was reduced .
Cardiac effects : the frequency of occurrence of angina pectoris was reduced , the occurrence of arrhythmia and exercise induced ischaemia were reduced .
Return to work was improved .
Cardiac events occurred less frequently , as well as cardiac deaths .
With the exception of resting heart rate , the effects were small , absent or not measured in studies in which abbreviated relaxation therapy was given .
No difference was found between the effects of full or exp and ed relaxation therapy .
Conclusion Intensive supervised relaxation practice enhances recovery from an ischaemic cardiac event and contributes to secondary prevention .