Meditation as a Stress Management Strategy in Cardiac Rehabilitation for Coronary Artery Disease Patients: A Pilot Randomized Controlled Trial (MED-CR-CAD)

June 9, 2026 updated by: DeAsís-Fernández, Francisco, Universidad Rey Juan Carlos
The aim of this pilot randomized controlled trial was to evaluate whether adding a 16-week structured meditation intervention to a long-term (phase III) cardiac rehabilitation program reduces perceived stress and improves anxiety, depression, and health-related quality of life in patients with stable coronary artery disease. Patients were randomized 1:1 to standard cardiac rehabilitation plus meditation (experimental group) or standard cardiac rehabilitation alone (control group). The meditation intervention consisted of four weekly 90-minute group sessions followed by 12 weeks of daily individual practice supported by weekly follow-up calls. Outcomes were assessed at baseline and after 16 weeks.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Despite advances in cardiac care, psychological stress, anxiety, and depression remain common in patients with coronary artery disease (CAD) and contribute to worse cardiovascular outcomes. Exercise-based cardiac rehabilitation (CR) programs are effective in reducing physical risk factors but often do not adequately address the psychological burden of CAD. Mind-body interventions such as meditation have been suggested as cost-effective adjuncts to CR, but evidence in long-term phase III CR programs remains limited.

This pilot randomized controlled trial was designed to evaluate the additive effect of a structured meditation intervention combining Karuna (compassion) and Metta (loving-kindness) practices, integrated into a long-term CR program. The intervention included four weekly 90-minute group sessions led by a physiotherapist trained in meditation techniques, followed by 12 weeks of daily individual practice (20 minutes/day) supported by recorded video material and weekly follow-up telephone calls. Outcomes were measured at baseline (M0) and after 16 weeks (M1), using validated psychometric instruments administered by telephone interview by a blinded health professional.

Study Type

Interventional

Enrollment (Actual)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Portugal
      • Lisbon, Portugal
        • Cardiovascular Rehabilitation Centre of the University of Lisbon (CRECUL)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age ≥ 18 years (male or female).
  • Clinically stable coronary artery disease, documented by previous myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or angina pectoris.
  • Active participation in the long-term cardiac rehabilitation program for at least 3 months.
  • Access to a smartphone, tablet, or computer for telephone follow-up and meditation video materials.
  • Written informed consent.

Exclusion Criteria:

  • Cognitive impairment that prevents informed consent or questionnaire completion.
  • Symptomatic heart failure.
  • Cardiac implantable defibrillators or resynchronization devices.
  • Lack of access to the technology required for the intervention.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Standard CR + Meditation
Participants received the standard exercise-based cardiac rehabilitation program plus a 16-week structured meditation intervention. The meditation component included four weekly 90-minute group sessions during the first month (led by a physiotherapist trained in meditation), followed by 12 weeks of daily individual practice (20 minutes/day) supported by a recorded video and weekly follow-up telephone calls. Each group session included a thought-sharing moment (30 min), a conscious breathing protocol - diaphragmatic 1:2 and heart-focused breathing (30 min), and a guided Karuna (compassion) and Metta (loving-kindness) meditation (30 min).
Other: Meditation Program
A 16-week structured meditation program added to standard cardiac rehabilitation. During the first month, participants attended four weekly 90-minute group sessions led by a physiotherapist trained in meditation techniques. Each session included: (1) a 30-minute thought-sharing and Q&A moment; (2) a 30-minute conscious breathing protocol combining diaphragmatic abdominal breathing in a 1:2 inhale-to-exhale ratio and heart-focused breathing; and (3) a 30-minute guided meditation combining Karuna (compassion) and Metta (loving-kindness) practices. During the subsequent 12 weeks, participants practised individually for 20 minutes per day, supported by a recorded video by the same instructor and weekly follow-up telephone calls to maintain engagement and address questions.
Active Comparator: Standard CR
Participants received the standard exercise-based cardiac rehabilitation program without the meditation component. The standard CR program consisted of supervised group exercise sessions three times per week (60 min per session), with combined aerobic and resistance training prescribed according to European Society of Cardiology guidelines. After completing the 16-week assessment, control-group participants were offered the same breathing and meditation protocol.
Other: Exercise-based Cardiac Rehabilitation (standard)
Standard long-term (phase III) exercise-based cardiac rehabilitation program delivered three times per week (60 minutes per session) on non-consecutive days, supervised by exercise physiologists. Each session included a 10-minute warm-up and cool-down. Moderate continuous aerobic training was prescribed at 40-75% of heart rate reserve for 20-25 minutes per session using cycle ergometers or treadmills. Resistance training was performed after the aerobic component (1-2 sets of 8-12 repetitions at approximately 60-80% of one-repetition maximum, with 2-3 minutes rest between sets), according to European Society of Cardiology guidelines. Heart rate was monitored with a chest band.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Perceived Stress (PSS-10)
Time Frame: baseline and 16 weeks
The Perceived Stress Scale is a 10-item self-report questionnaire (score range 0-40) assessing the extent to which life events over the previous month are perceived as unpredictable, uncontrollable, and overloading. Higher scores indicate greater perceived stress.
baseline and 16 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Anxiety (Beck Anxiety Inventory, BAI)
Time Frame: baseline and 16 weeks
21-item self-report measure of anxiety symptom severity, score range 0-63. Severity categories: minimal (0-7), mild (8-15), moderate (16-25), severe (26-63).
baseline and 16 weeks
Depression (Beck Depression Inventory-II, BDI-II)
Time Frame: baseline and 16 weeks
21-item self-report measure of depressive symptom severity, score range 0-63. Severity categories: minimal (0-13), mild (14-19), moderate (20-28), severe (29-63)
baseline and 16 weeks
Health-Related Quality of Life (HeartQoL)
Time Frame: baseline and 16 weeks
14-item disease-specific HRQoL questionnaire for ischaemic heart disease, providing Physical (10 items), Emotional (4 items), and Global scores. Higher scores indicate better HRQoL.
baseline and 16 weeks
Physical Activity Level (IPAQ-SF)
Time Frame: baseline and 16 weeks
International Physical Activity Questionnaire - Short Form. 9-item self-report measure categorizing participants into low, moderate, or high physical activity levels based on the past 7 days.
baseline and 16 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Universidad Rey Juan Carlos

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2021

Primary Completion (Actual)

June 1, 2023

Study Completion (Actual)

June 1, 2023

Study Registration Dates

First Submitted

June 9, 2026

First Submitted That Met QC Criteria

June 9, 2026

First Posted (Actual)

June 15, 2026

Study Record Updates

Last Update Posted (Actual)

June 15, 2026

Last Update Submitted That Met QC Criteria

June 9, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CCUL-MED-CR-2021

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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