Favourable effects of breathing and relaxation instructions in cardiac rehabilitation: A 5-year randomised follow-up study

Objective. To determine the effect of breathing and relaxation instruction of patients after a myocardial infarction on the occurrence of cardiac events during 5 years. Design. Prospective randomised. Setting. Kennemer Gasthuis, Haarlem, the Netherlands. Method. In the period 1981-1983, 156 myocardial infarction patients were randomly assigned to either rehabilitation plus relaxation therapy (six weekly sessions of breathing and relaxation instruction) (n = 76) or cardiac rehabilitation alone (n = 80). The occurrence of cardiac events and the amount of medical consumption on the two treatments was compared during 5 years. Results. At five-year follow-up, 12 cardiac deaths had occurred, 5 in the relaxation group and 7 in the control group, reinfarction was observed in 10 and 12 patients, and cardiac surgery was performed in 2 and 11, respectively. In total 15 (20%) and 26 patients (33%), respectively, had at least one of these events (odds ratio (OR) for the relaxation group: 0.51; 95% confidence interval (CI): 0.25-1.06). Medical consumption (counted as cardiac events and cardiac hospitalisations) was 30 patients (39%) experiencing 52 cardiac events in the relaxation group, for which the patients were hospitalized for a total of 476 days, and 38 patients (48%) experiencing 78 cardiac events in the control group (OR: 0.72, 95% CI: 0.38-1.36) with a total of 719 hospitalisation days; the total number of hospitalisations was reduced by 31% by relaxation instruction. Conclusion. In the long run, the disease course after myocardial infarction is probably influenced favourably by adding relaxation instruction to cardiac rehabilitation. The extra costs are compensated for by a decrease in hospitalisation for cardiac problems.