Mindfulness in Cardiac Obesity Rehabilitation Using E-health

The number of cardiac patients with obesity is rising, however, their number of
referral to cardiac rehabilitation (CR) is not. Obesity is a complex,
multifactorial disease that should be viewed as a heterogeneous problem. Obese
patients report a higher level of anxiety, a greater fear of movement after a
cardiac event, a poor relationship with food and frequently a negative body and
self-image. These challenges and behavioural patterns could be the obstacle for
obese patients in obtaining and maintaining a healthy lifestyle after
completing the regular CR program after a cardiac event. Mindfulness Based
Stress Reduction (MBSR) training is a promising treatment that has not been
investigated in this population. MBSR is an 8-week evidence-based group program
that employs mindfulness meditation, breathing exercises, body awareness, and
exploration of patterns of behaviour. MBSR could support cardiac obese patients
in improving their lifestyle decisions. By exploring patterns of fear and
anxiety, increasing awareness and friendliness towards oneself through guided
mindful exercises, cardiac obese patients could be offered the tools that are
needed to maintain a healthy lifestyle in the long-term.

Primary Objective: To determine the feasibility and protocol implementation of
a specially designed MBSR training in CR for obese patients.


Secondary Objective(s):
1) To explore the potential effect of MBSR on kinesiophobia in obese patients
who are referred to CR.

2) To explore the possible effect of MBSR on eating behaviour in obese patients
referred to CR.

3) To explore whether MBSR in obese patients referred to CR leads to an
improvement in HRV.

The mindfulness CR study is an investigator driven observational, exploratory
pilot study to assess the feasibility of a specially designed MBSR training for
obese patients attending CR.

In a period of 4 months, a total of 20 patients will be prospectively recruited
for participation at locations of *Capri Hartrevalidatie* in Rotterdam and The
Hague. The program for obese patients, OPTICARE-XL, consists of different
phases, including exercise training, lifestyle counselling, dietary
counselling, risk factor control and patient education and can include a
stress-management program as well. The MBSR training will be offered as an
additive after the regular supervised CR program is completed. It will be given
in a group format and will be designed for obese patients with a focus on fear
of movement and mindful eating. Training will be given online through Zoom once
a week for a total of 8 weeks. The duration of each training will be 2 hours.
The MBSR training will be given by a certified MBSR trainer with experience in
healthcare. During the weekly training, mindfulness exercises will be practiced
and discussed with the group. Participants will receive a specially designed
workbook with information and exercises to do at home in between the training
sessions. All patients will receive a smartwatch (CardioWatch, Corsano) to wear
for the duration of 8 weeks during the MBSR training and one month after
completing MBSR to track changes in steps per day, heart rate, and heart rate
variability (HRV). Patients will receive questionnaires at baseline, after
completion of MBSR, and at 1-, 3- and 6-month follow-up.

The intervention is a 8 week MBSR training. Weekly 2 hour sessions will be
given digitally through the platform Zoom. During the sessions meditation
techniques will be practiced. The sessions will be given by a certified
mindfulness trainer. The participants will receive the MBSR workbook which
contains exercises and additional information for each session. Participants
will be asked to practice meditation at home in between the weekly sessions.

For this study, patients will receive an 8-week MBSR training and will have to
fill out questionnaires and wear a bracelet to monitor their physical activity
and heart rate. The MBSR training and questionnaires can be time consuming, but
do not imply any risk for the patient. The MBSR training that will be offered
can be of benefit for the patients, as it helps to deal with stressful and
negative thoughts and feelings and can help improve and maintain a healthy
lifestyle for obesity patients after a cardiac event. With the rising
prevalence of obesity and subsequent cardiac disease and referral to CR, the
risk to and burden for the subjects will be in proportion to the potential
benefit for the patient and value of this research.