the traditional risk factors of cardiovascular disease ( cvd ) are age , smoking , 
 hypertension , hypercholesterolemia , family history , and obesity1 .
but these factors can explain the morbidity of cvd in only 
 50% of cases , and it is not known for certain how well any factor can accounts for the 
 morbidity of cvd2 . in recognition of this , 

type d personality is characterized by both normal and stable personality traits , negative 
 affectivity ( na , tendency to experience negative emotions ) , and social inhibition ( si , 
 tendency to inhibit self - expression in social interaction)4 , 5 . with reference to type d 
 personality , it has been reported that the health conditions of people with a type d 
 personality are not six times better than those of people with a non - type d personality 
 based on a study intended for chronic cardiac disease patients6 the results of studies intended for heart attack patients revealed 
 that type d personality was highly related to the onset of cvd prognosis and death rate and 
 caused a falling off in the quality of life .
regular aerobic exercise reduces cvd risk 
 factors and levels of oxidative stress and has a positive influence on lipoprotein 
 metabolism7 .
also , it is reported that 
 meditation increases the level of a strong vasodilator , nitrogen oxide , in the body improves 
 cardiovascular functioning , and reduces arteriosclerosis8 .
the results of previous studies have been difficult to apply because the main subjects in 
 the studies were patients with the disease .
also , previous studies9 , 10 in patients with 
 the disease investigated the relation between type d personality and risk factors of cvd , 
 and no previous study has shown type d personality to be associated with increased cvd risk 
 in healthy populations .
therefore , the aim of this study was to search for the association 
 of type d personality and cvd risk factors through comparison of the association of exercise 
 participation with cvd risk factors in women .
the 48 
 participants were classified into one of the following four groups : type d+exercise ( n=12 ) , 
 type d+non - exercise ( n=12 ) , non - type d+exercise ( n=12 ) , and non - type d+non - exercise ( n=10 ) . 

two subjects refused to participate , and so the final sample consisted of 46 participants . 

characteristics of the participants are shown in table 
 1table 1.characteristics of the subjectsvariablesgroupssmage ( years)type dexercise47.81.8non - exercise47.62.5non - type dexercise46.62.4non - exercise46.71.9height ( cm)type dexercise156.64.9non - exercise157.24.7non - type dexercise157.36.2non - exercise157.95.3weight ( kg)type dexercise69.210.0non - exercise66.88.0non - type dexercise66.44.0non - exercise66.93.7 .
all participants completed a 
 14-item type d scale ( ds14 ) to whether they had a type d personality4 .
the ds14 consists of two subscales , negative affectivity 
 ( na ) and social inhibition ( si ) , both of which comprise 7 items .
a standardized cutoff score 
  10 on both subscales is used to classify a person as having a type d personality . in this 
 study , a korean version of the ds14 developed by lim et al .
the cronbach s alpha was 0.82 for the na subscale and 
 0.80 for the si subscale , respectively .
subjects who reported going through menopause , 
 drinking , smoking , and getting regular exercise in the past 6 months were excluded from this 
 study .
the sample size of this study was estimated prior to data collection by using a power 
 analysis method as previously suggested12 . assuming a medium effect size of 0.25 and an alpha level of 0.05 , 

all experiments were 
 reviewed and approved by the committee of the kangwon national university .
they were processed under the same conditions before 
 exercise and 10 months after exercise .
the concentrations of triglyceride ( tg ) and 
 high - density lipoprotein ( hdl ) cholesterol were determined enzymatically using a clinical 
 chemistry analyzer ( hitachi high - technologies corporation , tokyo , japan ) .
stretching 
 was performed for 10  min as a warm - up , and then walking and running on a treadmill at 60 to 
 70% of hrmax7 , 14 were performed for 40  min three times a week . in order to 
 accurately check whether the exercise was conducted within the set range of exercise 
 intensity , we monitored the exercise intensity by having the subjects wear an automatic 
 portable heart rate meter ( polar electro , kempele , finland ) .
two - way repeated anova was performed to examine differences 
 between type d personality and non - type d personality for 10 months . when a significant 
 interaction effect was found between main effects ,
the paired t - test was applied to compare 
 the effect between groups by time ; for comparison between groups by time , one - way anova and 
 duncan s post hoc test were performed .
spss for windows version 20.0 was used for 
 statistical analysis , and p<0.05 was considered statistically significant .
the changes in body composition and risk factors for cvd after 10 months of exercise are 
 shown in table 2table 2.the changes in body composition and risk factors of cvdvariablesgroupsbeforeafterdifferenceduncanpercent fat ( % ) type dexercise38.05.033.45.74.6***non - exercise37.54.337.44.20.0non - type dexercise36.73.533.33.73.3***non - exercise37.13.037.13.30.1waist circumference ( cm)type dexercise95.17.190.95.74.2non - exercise96.86.697.36.80.5c < a < d , bnon - type dexercise90.46.687.34.93.1non - exercise95.57.795.78.00.2triglyceride ( mg / dl)type dexercise173.49.8157.810.315.7***non - exercise176.811.5176.211.00.7c < a < d , bnon - type dexercise161.313.3146.111.115.3***non - exercise167.518.1167.716.70.3hdl cholesterol ( mg / dl)type dexercise44.05.850.45.66.4***non - exercise45.84.945.64.60.2b , d < a , cnon - type dexercise47.25.552.34.85.1***non - exercise45.85.645.65.30.2systolic blood pressure ( mmhg)type dexercise137.16.6132.55.84.6non - exercise137.18.1135.07.12.1c , d < a , bnon - type dexercise132.58.1127.16.95.4non - exercise127.314.7129.112.61.8diastolic blood pressure ( mmhg)type dexercise88.83.883.83.85.0non - exercise85.06.484.25.60.8d < c , a , bnon - type dexercise86.77.282.56.94.2non - exercise79.610.479.17.70.5number of cvd risk factors ( n)type dexercise2.71.01.70.737.5*non - exercise2.81.12.81.00.0c < a < d , bnon - type dexercise1.90.51.10.943.8**non - exercise2.450.72.40.83.7meansd . * * * p<0.001 ; * * p<0.01 ; * p<0.05 ( by paired t - test ) . a , type 
 d+exercise ( n=12 ) ; b , type d+non - exercise ( n=12 ) ; c , non - type d+exercise ( n=12 ) ; d , 
 non - type d+non - exercise ( n=10 ) .
the percentage of body fat ( p=0.025 ) showed a significant difference between 
 measurement times , and the values groups were significantly lower than those of the 
 non - exercise group .
waist circumference ( p<0.001 ) showed a significant difference between 
 groups , and the values of the exercise group were significantly decreased compared with 
 those of the non - exercise group ; the value of the non - type d+exercise group ( 87.344.87 cm ) 
 was significantly smaller than that of the type d+exercise group ( 90.945.67 cm ) .
the 
 triglyceride concentration showed significant interaction effect between groups 
 ( p<0.001 ) , times ( p=0.004 ) , and grouptime ( p=0.049 ) , and in the post - exercise results , 
 the triglyceride concentrations of the exercise groups were decreased compared with the 
 non - exercise group ; that of the non - type d+exercise group ( 146.0811.12 mg / dl ) was lower 
 than that of the type d+exercise group ( 157.7510.25 mg / dl ) .
the hdl cholesterol 
 concentration showed significant differences between groups ( p=0.030 ) and times ( p=0.012 ) , 
 and it was significantly increased in the type d+exercise group ( 50.425.62 mg / dl ) and 
 non - type d+exercise group ( 52.334.79 mg / dl ) compared with in the non - exercise groups . 

systolic blood pressure showed a significant difference between groups ( p=0.010 ) and was 
 significantly higher in the type d groups than in the non - type d groups .
diastolic blood 
 pressure showed a significant difference between groups ( p=0.005 ) and was lowest in the 
 non - type d+non - exercise group compared with the other three groups .
it was found that the 
 participants with a type d personality had two or more cvd risk factors before exercise , 
 such as obesity , high blood pressure , or diabetes .
the number of cvd risk factors showed a 
 significant difference between groups ( p<0.001 ) and times ( p=0.007 ) , and it was 
 significantly decreased in the type d+exercise group ( 1.670.65 n ) compared with in the 
 non - type d+exercise groups ( 1.080.90 n ) .
meansd . * * * p<0.001 ; * * p<0.01 ; * p<0.05 ( by paired t - test ) . a , type 
 d+exercise ( n=12 ) ; b , type d+non - exercise ( n=12 ) ; c , non - type d+exercise ( n=12 ) ; d , 
 non - type d+non - exercise ( n=10 )
the prevalence rate of chronic diseases such as high blood pressure , diabetes , increases 
 from the age of 40 onwards15 , and 
 considering that the onset and progression of most diseases that are the leading causes of 
 death in domestic women can be prevented through early screening and the practice of a 
 healthy lifestyle , such as cancer and cerebrovascular diseases16 , it can be said that the role of exercise is 
 important .
studies have shown that regular walking and running for 10 months are significantly 
 effective in improving obesity indicators including weight , body mass index ( bmi ) , and waist 
 circumference .
it has been reported that as excessive accumulation of body fat causes the imbalance 
 symptoms of insulin sensitivity and insulin resistance cytokine expression , it plays a role 
 in inducing the inflammatory response .
therefore , in this respect , the results of this study 
 indicate that reduction of abdominal obesity and cvd risk factors through walking and 
 running exercise is significantly effective in reducing serum levels of insulin 
 resistance .
the blood pressure and heart rate of type d personality subjects increase by more than 
 those of the non - type d personality subjects when under stress17 , and secretion of the precursor of the inflammatory 
 response cytokine is increased5 . in this 
 respect ,
the results of this study indicate that the phenomenon of reduction blood levels 
 after exercise may be a secondary outcome due to the decrease in body fat and waist 
 circumference resulting from exercise , and it is judged that the phenomenon of reduction of 
 insulin resistance cytokine expression improves insulin sensitivity and contributes a 
 decrease in cvd risk factors .
after exercise training in this study , although the exercise groups showed a decrease in 
 the degree of anxiety and depression , the non - exercise groups showed a significant increase . 

we found that aerobic exercise and meditation were effective in decreasing anxiety and 
 depression .
depression and anxiety are more highly apparent in the cvd group than the 
 healthy group , but it is ambiguous whether this is the result of illness or the result of 
 the original personality traits .
but , like this study , depression and anxiety of ordinary 
 individuals , not those of cvd patients , can be interpreted as the results of personality 
 maladjustment irrelevant to disease .
programs need to be developed that can raise the 
 awareness associated with dietary habits , health - related behaviors , effort to improve health 
 through the diet , etc . , and to manage stress
. the limitations of this study include the fact that the number of subjects was small , and 
 thus the results can not be extrapolated to all women .
 [ purpose ] the purpose of this study was to search for the association of type d 
 personality and cvd risk factors through comparison of the association of exercise 
 participation with cvd risk factors in women . [ subjects ] the research subjects were 
 randomly assigned to four groups : type d+exercise ( n=12 ) , type d+non - exercise ( n=12 ) , 
 non - type d+exercise ( n=12 ) , and non - type d+non - exercise ( n=10 ) . 
 the study consisted of 46 
 participants . 
 [ methods ] an aerobic exercise program and meditation were conducted in 
 parallel for 10 months . 
 stretching was performed for 10  min as a warm - up , and then walking 
 and running on a treadmill at 60 to 70% of hrmax were performed for 40  min three times a 
 week . 
 blood samples were processed according to standard laboratory procedures . 
 the 
 concentrations of tg and hdl cholesterol were determined enzymatically using a clinical 
 chemistry analyzer ( hitachi high - technologies corporation , tokyo , japan ) . 
 [ results ] the 
 weight , percentage of body fat , waist circumference , triglyceride concentration , hdl 
 cholesterol concentration , systolic blood pressure , and diastolic blood pressure showed a 
 significant difference between measurement times in the exercise groups . 
 [ conclusion ] in 
 conclusion , there were significant differences between groups in terms of cardiovascular 
 disease risk factors . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION