Cardiac rehabilitation for the treatment of women with chest pain and normal coronary arteries

In Brief Objective: To explore cardiac rehabilitation (CR) as a treatment for psychological and physiological morbidity in women with chest pain and normal coronary arteries (cardiac syndrome X). Design: Sixty-four women aged 57.3 ± 8.6 years (mean ± SD) with cardiac syndrome X were randomly assigned to an 8-week phase III CR exercise program or symptom monitoring control. All women completed the Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, and Short Form-36 before and after intervention and at the 8-week follow-up. CR patients underwent physical assessment before and after CR. Results: After CR, patients demonstrated improved symptom severity (2.0 ± 0.8 vs 1.26 ± 1.1, P = 0.009), Hospital Anxiety and Depression Scale depression score (8.0 ± 3.4 vs 6.4 ± 3.1, P = 0.04), total Health Anxiety Questionnaire score (12.0 ± 5.5 vs 9.5 ± 6.0, P = 0.008), health worry (4.5 ± 3.1 vs 3.52 ± 2.4, P = 0.025) and interference (2.4 ± 1.8 vs 1.6 ± 1.8, P = 0.004), SF-36 physical functioning (53.1 ± 20.4 vs 62.3 ± 23.9, P = 0.006), energy (36.3 ± 20.7 vs 49.8 ± 19.1, P < 0.001), pain (49.9 ± 20.7 vs 58.1 ± 22.9, P = 0.028), and general health (48.8 ± 17.9 vs 57.6 ± 17.0, P = 0.01) not found among the control women. Improvements were maintained at follow-up. CR patients showed significant improvements in Shuttle Walk Test performance (326.8 ± 111.0 vs 423.6 ± 133.2 m, P < 0.001), diastolic blood pressure (84.7 ± 9.4 vs 79.7 ± 7.3 mm Hg, P = 0.007), and body mass index (29.1 ± 6.0 vs 28.4 ± 6.17 kg/m2, P = 0.003). Conclusions: An 8-week phase III CR program improves exercise tolerance, quality of life, psychological morbidity, symptom severity, and cardiovascular risk factors in women with cardiac syndrome X. The triad of angina pectoris, a positive exercise test for myocardial ischaemia and angiographically smooth coronary arteries, often referred to as Cardiac Syndrome X, is a debilitating condition with few successful treatment options. The presented study demonstrates that the standard Phase III Cardiac Rehabilitation program not only improves physical fitness, time to pain, symptom severity and frequency among women with Syndrome X, but also produces a marked improvement in psychological morbidity and quality of life.