***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*** 
    ***EXAMPLES*** 
    Input: Objective : The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematic ally explored . We performed a r and omized , controlled study on the effects on brain and immune function of a well‐known and widely used 8‐week clinical training program in mindfulness meditation applied in a work environment with healthy employees . Methods : We measured brain electrical activity before and immediately after , and then 4 months after an 8‐week training program in mindfulness meditation .  Twenty‐five subjects were tested in the meditation group . A wait‐list control group ( N = 16 ) was tested at the same points in time as the meditators . At the end of the 8‐week period , subjects in both groups were vaccinated with influenza vaccine . Results : We report for the first time significant increases in left‐sided anterior activation , a pattern previously associated with positive affect , in the meditators compared with the nonmeditators . We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait‐list control group . Finally , the magnitude of increase in left‐sided activation predicted the magnitude of antibody titer rise to the vaccine . Conclusions : These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function . These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research Background — Although numerous studies have reported that cardiac rehabilitation ( CR ) is associated with reduced mortality after myocardial infa rct ion , less is known about its association with mortality after percutaneous coronary intervention . Methods and Results — We performed a retrospective analysis of data from a prospect ively collected registry of 2395 consecutive patients who underwent percutaneous coronary intervention in Olmsted County , Minnesota , from 1994 to 2008 . The association of CR with all-cause mortality , cardiac mortality , myocardial infa rct ion , or revascularization was assessed with 3 statistical techniques : propensity score – matched analysis ( n=1438 ) , propensity score stratification ( n=2351 ) , and regression adjustment with propensity score in a 3-month l and mark analysis ( n=2009 ) . During a median follow-up of 6.3 years , 503 deaths ( 199 cardiac ) , 394 myocardial infa rct ions , and 755 revascularization procedures occurred in the study subjects . Participation in CR , noted in 40 % ( 964 of 2395 ) of the cohort , was associated with a significant decrease in all-cause mortality by all 3 statistical techniques ( hazard ratio , 0.53 to 0.55 ; P<0.001 ) . A trend toward decreased cardiac mortality was also observed in CR participants ; however , no effect was observed for subsequent myocardial infa rct ion or revascularization . The association between CR participation and reduced mortality rates was similar for men and women , for older and younger patients , and for patients undergoing elective or nonelective percutaneous coronary intervention . Conclusions — We found that CR participation after percutaneous coronary intervention was associated with a significant reduction in mortality rates . These findings add support to published clinical practice guidelines , performance measures , and insurance coverage policies that recommend CR for patients after percutaneous coronary intervention CONTEXT Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality , but the effects of behavioral interventions on psychosocial and medical end points remain uncertain . OBJECTIVE To determine the effect of 2 behavioral programs , aerobic exercise training and stress management training , with routine medical care on psychosocial functioning and markers of cardiovascular risk . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 134 patients ( 92 male and 42 female ; aged 40 - 84 years ) with stable ischemic heart disease ( IHD ) and exercise-induced myocardial ischemia . Conducted from January 1999 to February 2003 . INTERVENTIONS Routine medical care ( usual care ) ; usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks ; usual care plus weekly 1.5-hour stress management training for 16 weeks . MAIN OUTCOME MEASURES Self-reported measures of general distress ( General Health Question naire [ GHQ ] ) and depression ( Beck Depression Inventory [ BDI ] ) ; left ventricular ejection fraction ( LVEF ) and wall motion abnormalities ( WMA ) ; flow-mediated dilation ; and cardiac autonomic control ( heart rate variability during deep breathing and baroreflex sensitivity ) . RESULTS Patients in the exercise and stress management groups had lower mean ( SE ) BDI scores ( exercise : 8.2 [ 0.6 ] ; stress management : 8.2 [ 0.6 ] ) vs usual care ( 10.1 [ 0.6 ] ; P = .02 ) ; reduced distress by GHQ scores ( exercise : 56.3 [ 0.9 ] ; stress management : 56.8 [ 0.9 ] ) vs usual care ( 53.6 [ 0.9 ] ; P = .02 ) ; and smaller reductions in LVEF during mental stress testing ( exercise : -0.54 % [ 0.44 % ] ; stress management : -0.34 % [ 0.45 % ] ) vs usual care ( -1.69 % [ 0.46 % ] ; P = .03 ) . Exercise and stress management were associated with lower mean ( SE ) WMA rating scores ( exercise : 0.20 [ 0.07 ] ; stress management : 0.10 [ 0.07 ] ) in a subset of patients with significant stress-induced WMA at baseline vs usual care ( 0.36 [ 0.07 ] ; P = .02 ) . Patients in the exercise and stress management groups had greater mean ( SE ) improvements in flow-mediated dilation ( exercise : mean [ SD ] , 5.6 % [ 0.45 % ] ; stress management : 5.2 % [ 0.47 % ] ) vs usual care patients ( 4.1 % [ 0.48 % ] ; P = .03 ) . In a subgroup , those receiving stress management showed improved mean ( SE ) baroreflex sensitivity ( 8.2 [ 0.8 ] ms/mm Hg ) vs usual care ( 5.1 [ 0.9 ] ms/mm Hg ; P = .02 ) and significant increases in heart rate variability ( 193.7 [ 19.6 ] ms ) vs usual care ( 132.1 [ 21.5 ] ms ; P = .04 ) . CONCLUSION For patients with stable IHD , exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone PURPOSE Patients with various medical conditions benefit from eliciting the relaxation response ( RR ) , using a variety of techniques , but few studies have focused on chronic heart failure ( CHF ) . We evaluated the efficacy of an RR intervention program on the quality of life ( QOL ) and exercise capacity of CHF patients by conducting a single-blind , 3-arm , r and omized , controlled trial . METHODS Between April 2000 and June 2002 , we enrolled 95 patients with moderate severity CHF from the Veterans Affairs Boston Healthcare System . Patients in the study intervention group attended a weekly RR group for 15 weeks and were requested to practice the techniques at home twice a day . A 15-week cardiac education ( EDU ) program was used as an alternative intervention , and usual care ( UC ) was the control group . The  QOL question naires and a bicycle test were administered at baseline and after intervention or 15 to 19 weeks . RESULTS Eighty-three ( 87 % ) of the 95 enrolled patients completed both baseline and post-intervention QOL measures ( 31 RR , 24 EDU , and 28 UC ) . No dropout bias was observed . The RR group had significantly better QOL change scores in peace-spiritual scales than did the UC group ( P = .02 ) , adjusting for baseline scores , time between assessment s , age , education , diet , and medication , whereas no significant difference was observed between the EDU and UC groups . A similar trend was observed in emotional QOL ( RR and UC group comparison , P = .07 ) . No statistically significant intervention effect on physical QOL or exercise capacity was observed . CONCLUSIONS A short RR intervention can improve some aspects of QOL in CHF patients OBJECTIVES This study sought to estimate the extent to which behavioral and pathophysiological risk factors account for the association between  psychological distress  and incident cardiovascular events . BACKGROUND The intermediate processes through which psychological distress increases the risk of cardiovascular disease ( CVD ) are incompletely understood . An underst and ing of these processes is important for treating psychological distress in an attempt to reduce CVD risk . METHODS In a prospect i ve study of 6,576 healthy men and women ( ages 50.9 + /- 13.1 years ) , we measured psychological distress ( using the 12-item version of the General Health Question naire > or=4 ) and behavioral ( smoking , alcohol , physical activity ) and pathophysiological ( C-reactive protein , fibrinogen , total and high-density lipoprotein cholesterol , obesity , hypertension ) risk factors at baseline . The main outcome was CVD events ( hospitalization for nonfatal myocardial infa rct ion , coronary artery bypass , angioplasty , stroke , heart failure , and CVD-related mortality ) . RESULTS Cigarette smoking , physical activity , alcohol intake , C-reactive protein , and hypertension were independently associated with psychological distress . There were 223 incident CVD events ( 63 fatal ) over an average follow-up of 7.2 years . The risk of CVD increased in relation to presence of psychological distress in age- and sex-adjusted models ( hazard ratio : 1.54 , 95 % confidence interval : 1.09 to 2.18 , p = 0.013 ) . In models that were adjusted for potential mediators , behavioral factors explained the largest proportion of variance ( approximately 65 % ) , whereas pathophysiological factors accounted for a modest amount ( C-reactive protein approximately 5.5 % , hypertension , approximately 13 % ) . CONCLUSIONS The association between psychological distress and CVD risk is largely explained by behavioral processes . Therefore , treatment of psychological distress that aims to reduce CVD risk should primarily focus on health behavior change BACKGROUND Previous studies demonstrated the effects of progressive muscle relaxation training ( PMRT ) on improvements in the health outcomes of cardiac patients . This study examined the effects of PMRT on the psychologic status and symptoms of older Chinese patients with heart failure . METHODS In a longitudinal , r and omized , and controlled study , 59 patients were allocated to receive a PMRT program and 62 were provided with the attention placebo .  The PMRT program included two PMRT sessions , one revision workshop , twice-daily PMRT home practice s , and a biweekly telephone follow-up call . The attention placebo included a regular telephone call at a schedule similar to that made by the interventionist of the PMRT program with the intervention group . Main outcome measures , including psychologic distress , dyspnea , and fatigue , were taken at baseline , the 8th week , and the 14th week . RESULTS A medium effect on psychologic distress in favor of the PMRT program was detected . Patients practicing PMRT however only demonstrated a nonsignificant trend of greater improvement in symptom status . CONCLUSION Progressive muscle relaxation training seems to be useful as an adjunctive nonpharmacologic treatment modality in the management of heart failure Background Mental stress has been linked to increased morbidity and mortality in coronary artery disease and to atherosclerosis progression . Experimental studies have suggested that damage to the endothelium may be an important mechanism . Methods and Results Endothelial function was studied in 10 healthy men ( aged 50.4±9.6 years ) and in 8 non – insulin-dependent diabetic men ( aged 52.0±7.2 years ) . Brachial artery flow-mediated dilation ( FMD , endothelium dependent ) and response to 50 & mgr;g of sublingual glyceryl trinitrate ( GTN , endothelium independent ) were measured noninvasively by use of high-resolution ultrasound before and after ( 30 , 90 , and 240 minutes ) a st and ardized mental stress test . The same protocol without mental stress was repeated on a separate occasion in the healthy men . In healthy subjects , FMD ( 5.0±2.1 % ) was significantly ( P < 0.01 ) reduced at 30 and 90 minutes after mental stress ( 2.8±2.3 % and 2.3±2.4 % , respectively ) and returned toward normal after 4 hours ( 4.1±2.0 % ) . Mental stress had no effect on the response to GTN . In the repeated studies without mental stress , FMD did not change . The diabetic subjects had lower FMD than did the control subjects ( 3.0±1.5 % versus 5.0±2.1 % , respectively;P = 0.02 ) but showed no changes in FMD ( 2.7±1.1 % after 30 minutes , 2.8±1.9 % after 90 minutes , and 3.1±2.3 % after 240 minutes ) or GTN responses after mental stress . Conclusions These findings suggest that brief episodes of mental stress , similar to those encountered in everyday life , may cause transient ( up to 4 hours ) endothelial dysfunction in healthy young individuals . This might represent a mechanistic link between mental stress and atherogenesis Background —Blacks have disproportionately high rates of 
    Output:
    
Conclusions Mind – body practice s have encouraging results for patients with cardiac disease .