Collins J A, Rice V H
University of Michigan Medical Center, Ann Arbor 48109-0378, USA.
Heart Lung. 1997 Jan-Feb;26(1):31-44. doi: 10.1016/s0147-9563(97)90007-8.
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.
Prospective, quasi-experimental, with random group assignment within sites. Independent replication and extension of a study by Bohachik (1984).
Four midwestern hospital-based phase II cardiac rehabilitation programs.
Fifty patients who within the preceding 12 weeks had had acute myocardial infarction or coronary artery bypass surgery or both, studied during 6 weeks of participation in a phase II cardiac rehabilitation program.
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.
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.
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.
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 resulted 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.
探讨渐进性肌肉松弛和引导式意象对参加二期心脏康复计划的心血管疾病成年人心理和生理结局的影响。研究受试者报告的干预的紧张水平、练习模式和感知的帮助程度。
前瞻性、准实验性研究，在各研究地点内进行随机分组。对Bohachik（1984年）的一项研究进行独立复制和扩展。
四个位于中西部的医院二期心脏康复项目。
50名在之前12周内发生急性心肌梗死或接受冠状动脉搭桥手术或两者皆有的患者，在参加二期心脏康复项目的6周期间进行研究。
心理指标包括状态-特质焦虑量表上的状态和特质焦虑得分以及症状自评量表-90修订版上报告的症状。生理指标为静息心率和血压。研究家庭练习前后的主观紧张水平、练习模式以及干预的感知帮助程度。
在二期心脏康复项目中进行渐进性肌肉松弛和引导式意象的个体指导课程，随后在6周内通过录音带指导进行每日家庭练习。
在研究结束时，状态焦虑得分或报告的症状在p≤0.05水平上未发现统计学差异。然而，通过配对t检验发现，放松组（RG）的人际敏感性（t[19]=2.11，p≤0.05）和抑郁（t[19]=2.07，p≤0.05）平均分量表得分有所降低。通过独立t检验，两组在研究结束时的静息心率（t[42]=-2.02，p≤0.05）存在差异，通过协方差分析，收缩压（F[1,42]=5.13，p≤0.05）也存在差异。RG的平均静息心率比对照组（CG）低8.6次/分钟，通过配对t检验，RG组内平均心率也有所降低（t[19]=2.09，p≤0.05）。与预期相反，CG的平均收缩压低3.5 mmHg，通过配对t检验，CG组内收缩压（t[22]=3.02，p<0.01）和舒张压（t[22]=3.83，p<0.01）有所降低。CG受试者心脏药物剂量增加的次数比RG受试者多，剂量减少的次数比RG受试者少，而RG受试者剂量减少的次数更多。RG受试者报告经常练习该技术，认为其有帮助，并报告练习后主观紧张水平较低。
本研究的结果不支持Bohachik的研究结果（他报告状态焦虑降低，躯体化、人际敏感性和抑郁症状减少）。关于放松方法的更多指导课程可能会带来更积极的结果。然而，人际敏感性和抑郁的组内得分、心率的降低以及受试者对该干预的接受程度表明，它可能是二期心脏康复项目参与者可行且有益的辅助治疗方法。
