Effects of mindfulness-based intervention combined with aerobic training on Kinesiophobia and heart rate variability after percutaneous coronary intervention: a randomized controlled trial

OBJECTIVE: To evaluate the effectiveness of mindfulness-based intervention (MBI) combined with aerobic training on treatment adherence, kinesiophobia (an excessive fear of movement), heart rate variability (HRV), exercise tolerance, and psychological stress response in patients with coronary heart disease (CHD) post-percutaneous coronary intervention (PCI). METHODS: Post-PCI patients (n = 150) were randomly assigned to an intervention group (receiving combined MBI and aerobic training) and a control group (receiving aerobic training only). Treatment adherence, the Tampa Scale for Kinesiophobia-Heart (TSK-SV Heart), HRV parameters, exercise tolerance, and psychological stress responses were assessed before and after the intervention. Psychological assessments included the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Repeated-measures mixed analysis of variance was used to evaluate changes in outcomes between groups and across time points. RESULTS: A total of 150 post-PCI patients were enrolled, including 97 males and 53 females, with a mean age of 50.79 ± 6.83 years. Baseline demographic and clinical characteristics were comparable between the two groups (P > 0.05). After the intervention, the intervention group showed significantly greater improvements than the control group in treatment adherence, HRV indices (standard deviation of all normal-to-normal RR intervals, standard deviation of the average normal-to-normal RR intervals in all 5-minute segments, and percentage of successive normal-to-normal RR intervals that differ by more than 50 milliseconds), exercise tolerance (6-minute walk test, peak oxygen uptake, and anaerobic threshold oxygen uptake), as well as reductions in kinesiophobia scores, anxiety and depression scores (SAS, SDS) (p < 0.001). CONCLUSION: An adapted MBI combined with aerobic training can significantly improve treatment adherence and exercise tolerance, while reducing kinesiophobia and psychological stress in post-PCI patients. This combined rehabilitation strategy may provide additional benefits beyond conventional aerobic rehabilitation alone.