Stress management and exercise training in chronic stable angina pectoris

Patients suffering from chronic stable angina pectoris were allocated to one of four conditions: stress management training, exercise training, combined stress management and exercise, or waiting list control. Patients undertook an exercise tolerance test before and after intervention, and at follow-up assessment eight weeks later. They also kept a daily diary of the frequency, duration and intensity of all angina episodes, and recorded the amount of medication taken, for the week preceding and the week following intervention, as well as for the eighth week of follow-up. Patients who undertook the combined stress management and exercise programme faired best. They showed sustained gains in achieved workload on the exercise tolerance test at no cost in terms of ischaemia, as measured by ST-segment depression. They also registered less frequent angina attacks following intervention than the exercise only and waiting list control patients, and reported reduced reliance on medication; the latter benefit was sustained at follow-up. These clinical dividends invite further study of combined stress management and exercise training in angina pectoris.