Effects of cardiac rehabilitation and exercise training programs on coronary patients with high levels of hostility

Objective: To determine the effects of cardiac rehabilitation interventions an patients with hostility, or unexpressed anger, a coronary heart disease risk factor that adversely affects morbidity and mortality after major cor onary heart disease events. Methods: Using validated questionnaires to evaluate behavioral characterist ics and quality of life, we studied 500 consecutive patients before and aft er cardiac rehabilitation and compared a group of 65 patients with high lev els of hostility with 435 patients with low levels of hostility. Results: After rehabilitation, statistically significant improvements occur red in the total cohort in scores for anxiety, depression, and somatization , as well as total quality of life, but not in hostility score (-20%; P=.07 ). Patients with high levels of hostility had significant improvements in h ostility scores as well as other behavioral characteristics (anxiety, depre ssion, and somatization) and all quality-of-life components. These patients also improved exercise capacity, percent body fat, body mass index, and to tal cholesterol and high-density lipoprotein cholesterol levels. Compared w ith patients with low levels of hostility, those with high levels of hostil ity had greater relative improvements in hostility scores, as well as anxie ty, general health, energy, mental health, and total quality-of-life scores , and had similar improvements in exercise capacity, obesity indexes, lipid levels, and other behavioral characteristics and quality-of-life measureme nts. After cardiac rehabilitation, the prevalence of high levels of hostili ty decreased by 40%,from 13% to 8% (P<.01). Conclusions: These data suggest that cardiac rehabilitation reduces hostili ty and significantly improves quality of life and other behavioral characte ristics in patients with high levels of hostility. We believe that greater attention should be directed at behavioral characteristics, including hosti lity, to enhance the primary and particularly the secondary prevention of c oronary heart disease.