Psychodynamic Motivation and Training Program

Johannes Gutenberg University Mainz90 enrolled

Overview

The purpose of this study is to examine the effectiveness of a Psychodynamic Motivation and Training Program (PMT) for the improvement of physical fitness in patients with stable coronary heart disease as compared to advice in exercise training or treatment as usual.

Nonpharmacological secondary prevention of coronary heart disease is considered to be a safe and effective measure for reducing mortality substantially. Major targets are the improvement of physical activity and dietary habits, smoking cessation and stress reduction. Despite the effectiveness of life style changes, the compliance rate of patients is very low. To improve compliance with life style change programs psychotherapeutic interventions appear to have significant potential. Against this background our study aims to examine the effectiveness of a Psychodynamic Motivation and Training Program (PMT) in addition to one session of advice in exercise training based on the results of spiroergometry (+EX) and usual cardiological care (TAU). PMT will be compared with +Ex and TAU. N = 90 patients with stable coronary artery disease class, low physical activity, class I to III angina pectoris will be randomly assigned to the three treatment conditions. The Primary efficacy endpoint is change in the anaerobic threshold from baseline to 6 month follow-up. The results of the study will 1) help to determine the effectiveness of a psychodynamic life style change programs for the secondary prevention of cardiovascular disease and 2) will help to identify measures for designing specifically tailored interventions to improve compliance with cardiovascular prevention.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Coronary Heart Disease Physical Activity

Interventions

Psychodynamic Motivation and Training Program (PMT)BEHAVIORAL

The Psychodynamic Motivation and Training Program (PMT) is a psychodynamic stepped care approach. Depending on the individual needs PMT consists of 3 to 8 sessions of individual psychodynamic psychotherapy. If appropriate session 4 - 8 may be conducted by a nurse. PMT targets the mental and external barriers to improve physical activity by focusing on affects, interpersonal relations and maladaptive self- and other representations. PMT will be offered in addition to +Ex.

Advice in Exercise Training (+Ex)BEHAVIORAL

Advice in Exercise Training consists of one individual session of advice in exercise training based on the results of the spiroergometry.

Treatment as usual (TAU)OTHER

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Stable coronary heart disease with CCS functional classification of angina class I-III * Low self rated physical activity * Condition after percutaneous coronary intervention \> 4 weeks until \< 26 weeks or \> 52 weeks after index percutaneous coronary intervention * Residence \< 50 km radius of Mainz * If treatment with betablockers or ivabradine then stable \> 4 weeks Exclusion Criteria: * Acute coronary sydnrome or myocardial infarction \< 8 weeks * Coronary stenosis of the dominant vessel \> 25% or high grade stenosis of the left coronary artery * Heart failure with left ventricular ejection fraction \< 40% * NYHA III-IV * Severe heart valve disorder * Insulin dependent diabetes * Orthopedic disorders or other disorders, which preclude regular physical activity * Coronary artery bypass surgery \< 6 months before index PCI * Severe obesity (BMI ≥ 40) * Need for systemic immunosuppression with cortisone or methotrexate * Kidney failure with need for dialysis * Intake of nitrates \< 12 hours

Locations (1)

University Medical Center Mainz

Mainz, Germany

Outcomes

Primary Outcomes

Change in individual anaerobic threshold according to lactate kinetics during spiroergometry

Time frame: 6 months

Secondary Outcomes

Change in quality of life according to the EQ-5D

Time frame: 6 months

Change in the severity of impairment by angina symptoms according to the Seattle Angina Questionnaire

Time frame: 6 Months

Change in the self-rated habitual physical activity according to the Habitual Physical Activity Questionnaire

Time frame: 6 months

Change in endothelial function according to the flow mediated dilatation

Time frame: 6 months

Change in high density lipoprotein levels

Time frame: 6 months

Change in biomarkers of inflammation and oxidative burst

Time frame: 6 months

Change in fatigue according to the Maastricht Questionnaire

Time frame: 6 months

Change in illness perception

(Illness perception as measured with the Brief Illness Perception Questionnaire)

Time frame: 6 months

Change in maximal aerobic capacity (VO2 max)

Time frame: 6 months

Change in body mass index

Data from ClinicalTrials.gov

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