The influence of Type A behavior pattern on the response to the panicogenic agent CCK-4

OBJECTIVES: Review of the literature equivocally suggests that subjects with Type A behavioral pattern (TABP) compared to subjects with Type B behavioral pattern display an increased sympathetic activity, a condition associated with sudden cardiac death. The objective of this study was to determine whether healthy subjects classified as Type A or Type B differed in their reactivity to the beta 1 and beta 2 receptor agonist isoproterenol and to the panicogenic agent cholecystokinin-tetrapeptide (CCK-4). By comparing reactivity to CCK-4 after pretreatment with placebo or propranolol, a beta 1 and beta 2 receptor antagonist, the role of the beta adrenergic system in the hypothesized increased response of Type A subjects to CCK-4 was also assessed. METHODS: The study used a randomized, double-blind, placebo-controlled design. Twenty-seven Type A or B subjects were included in the study. The reactivity to isoproterenol was assessed with the CD25 of isoproterenol (i.e., the intravenous dose of isoproterenol necessary to increase the heart rate of 25 bpm). The panic symptom response and the cardiovascular response to bolus injection of 50 microg of CCK-4 was assessed in subjects pretreated with either propranolol or placebo infusions prior to the CCK-4 challenge. An additional group of subjects was recruited and these subjects received a placebo infusion pretreatment before an injection of placebo. RESULTS: The CD25 was significantly greater in Type A subjects than in Type B subjects. No difference was found among the groups on behavioral sensitivity to the CCK-4 challenge. However, CCK-4-induced maximum increase in heart rate was greater in Type A subjects. CONCLUSION: Our finding that Type A subjects exhibited greater CD25 of isoproterenol and greater increases in heart rate following CCK-4 administration compared to Type B subjects suggests that peripheral beta-receptor sensitivity may be increased in individuals with TABP.     

Program participation and physical activity maintenance after cardiac rehabilitation

This study examined exercise maintenance among patients after completing cardiac rehabilitation. Subjects were men and women who had completed a Phase II Cardiac Rehabilitation Program approximately 12 months previously. Subjects were classified according to whether they had (a) never participated in a Phase III program (G-I) (N = 37), (b) enrolled and completed a Phase III program (G-II) (N = 30), or (c) were currently enrolled in a Phase III maintenance program (G-III) (N = 33). Subjects were significantly more likely to be participating in regular exercise if they had participated in a Phase III program (p < .05). Individuals in G-II and G-III engaged in more minutes of physical activity per week and were more likely to meet recommended levels of physical activity compared to G-1 subjects. G-1 individuals who had longer Phase II programs were more likely to maintain their exercise habits following graduation (p < .05). Results suggest that Phase III maintenance programs and longer Phase II participation improved exercise maintenance following rehabilitation.     

Operant self-control procedure in modifying type A behavior

A multiple-baseline across subjects design was used to evaluate the effects of operant self-control procedure on altering speed/impatient behaviors of the Type A behavior pattern (TABP). The operant-self-control procedure consisted of self-monitoring, self-evaluation, and self-reinforcement. The results demonstrated empirically significant decreases in S/I behaviors of the TABP following transfer to the self-reinforcement condition. Significant reductions in the Jenkins Activity Survey and physical symptoms scores additionally evidenced the effects of the operant self-control procedure. The possibility of pathogenic factors of the TABP varying with culture, and the advantages of the operant self-control procedure are discussed.     

Japanese Type A behavior pattern is associated with "typus melancholicus": a study from the sociocultural viewpoint.

An examination of the relationship between Type A behavior pattern (TABP) and "Typus Melancholicus" (TM) in 212 coronary heart disease (CHD) patients in Japan revealed that: CHD patients with TABP were significantly more likely to have a depression-prone personality, what Tellenbach calls "Typus Melancholicus"; this tendency was observed not only in CHD patients but also among healthy Type A subjects; and TM is positively correlated with Type A. The results of our studies from a comparative sociocultural viewpoint indicate that TM may be involved in Japanese TABP, suggesting the possibility that driving, self-sacrificing and obsessional traits are related to Type A behavior in a variety of different cultural contexts.     

French version of the video structured interview designed for type A behavior pattern assessment

The current controversy on the predictive value of the Type A Behavior Pattern (TABP) as a coronary risk factor brought into a reconsideration of the assessment methods of this pattern. The Video Structured Interview (VSI) is a scoring method of TABP by a trained investigator, consisting of a rating scale based both on the content of the answers and on the psychomotor signs, with regard to the two main components of the TABP: sense of time urgency and hostility. The VSI appears a more objective instrument than self-assessment questionnaires, avoiding the bias of denial, a coping mechanism widely used by type A subjects. The VSI proved more sensitive and more specific than the self-assessment methods or the structured interview (SI), the initial instrument aimed to assess TABP among coronary risk patients in american populations. We here present the french version of the VSI, the technical modes of the interview and the principles of this scoring method, in order to introduce in France its use in further studies related with coronary risk factors.     

Hard-driving and speed-impatience components of the type A behavior pattern as predictors of physiological arousal, subjective arousal and challenge seeking

Male and female subjects first worked on a cognitive task under conditions of either low or high challenge followed by a physical exercise task. Heart rate, systolic blood pressure, diastolic blood pressure, subjective arousal, subjective fatigue, and preferred levels of challenge for subsequent tasks were assessed. The results indicated that subjects with high Hard-Driving scores reported lower subjective arousal while working on the cognitive tasks and preferred to work on more challenging cognitive and physical exercise tasks in a subsequent phase of the experiment. In contrast, subjects with high Hard-Driving scores, high Speed-Impatience scores, or high overall Type A scores did not evidence higher physiological arousal in response to either the cognitive or the physical exercise tasks. Utilization of the components of the Type A pattern yielded greater specificity of results and suggests that Type A's are at greater risk from coronary disease for reasons other than those that have been traditionally hypothesized.     

The acute antipanic activity of aerobic exercise

OBJECTIVE: Regular physical activity is anxiolytic for both healthy subjects and patients with panic disorder. However, the acute antipanic activity of exercise has not yet been studied systematically. METHOD: The effects of quiet rest or aerobic treadmill exercise (30 minutes at 70% of maximum oxygen consumption) on cholecystokinin tetrapeptide (CCK-4)-induced panic attacks were studied in a crossover design in 15 healthy subjects. The effects were measured with the Acute Panic Inventory. RESULTS: Panic attacks occurred in 12 subjects after rest but in only six subjects after exercise. In both conditions, CCK-4 administration was followed by a significant increase in Acute Panic Inventory scores; however, prior exercise resulted in significantly lower scores than quiet rest. CONCLUSIONS: Aerobic exercise has an acute antipanic activity in healthy subjects. If the authors' results are confirmed in patients, the optimum intensity and duration of acute exercise for achieving antipanic effects will have to be characterized.     

Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation

Background: Regular physical activity has been consistently related to improvements in health- related quality of life (HRQL) in older adults. Nevertheless, systematic investigations of the influence of exercise therapy on older men and women enrolled in cardiac rehabilitation remain sparse.Purpose: The primary purpose of this investigation was to compare the effects of a group-mediated cognitive behavioral physical activity intervention program (GMCB) to a traditional cardiac rehabilitation program (CRP) with regard to changes in HRQL in a community-dwelling sample of older adults.Methods: This randomized clinical trial assigned 147 participants who were eligible for inclusion in cardiac rehabilitation to the GMCB or traditional CRP arms. Changes in HRQL at 3 and 12 months were assessed using the Short Form-36 (SF-36) from the Medical Outcomes Study.Results: Mixed-model analyses yielded significant Baseline × Gender × Treatment interactions for the self-reported mental health component and the Vitality subscale of the SF-36. Decomposition of these interactions revealed that men in both exercise therapy groups and women in the GMCB treatment with low baseline values demonstrated more favorable improvements in the HRQL perceived mental health measures than women in the CRP treatment.Conclusions: Improvements in HRQL among older adults enrolled in cardiac rehabilitation differ as a function of treatment, gender, and initial mental health status. Results are discussed in terms of the implications for the design of future physical activity interventions among older adults with cardiovascular disease and the measurement of their HRQL. Support for this study was provided by grants from the National Institutes for Aging AG14131 and 5P60 AG10484 and General Clinical Research Center Grant M01-RR007122.     

Does atenolol improve physical and psychological function after coronary artery bypass surgery: a controlled study

A double-blind prospective randomized trial of atenolol (100 mg once daily) was carried out on 88 patients (78 men) awaiting coronary artery bypass graft surgery. Standardized ratings of both psychiatric morbidity and functional capacity were made before, 3 months (n = 82) and 12 months (n = 81) after surgery. One year after surgery men in the atenolol group had a significantly shorter treadmill exercise time than those on placebo (7.21 +/- 0.28 min vs 8.32 +/- 0.40 min; p less than 0.05), but the frequency of reported anginal attacks during the year was similar in both drug groups. Improvement in functional capacity (measured in exercise time) in the 71 men following surgery was related to both physical and psychological variables assessed before the operation. Men with more severe occlusive disease, lower neuroticism and higher extraversion scores pre-operatively showed greater percentage improvement in exercise time after surgery. Women had significantly levels of psychiatric morbidity and shorter treadmill exercise time than men both before and after surgery. Of the psychiatric and psychological variables, only ratings of Type A behaviour fell significantly in the atenolol group (170.9 +/- 5.3 vs 163.0 +/- 5.2; p less than 0.05). This change, which is probably not clinically important, occurred independently of any reduction in either overall psychiatric morbidity score or ratings of somatic symptoms mediated by beta-adrenergic receptors. The atenolol group reported more side-effects of both psychological and physical symptoms than the placebo group. We do not recommend the routine use of atenolol after bypass graft surgery. Our findings failed to support the suggestion that Type A characteristics may reflect an underlying sympathetic nervous system reactivity.     

Usefulness of hand rehabilitation after carpal tunnel surgery

The purpose of this randomized trial was to assess the clinical evolution after carpal tunnel release in subjects with long-term carpal tunnel syndrome. The evaluation criteria were symptom occurrence, motor performance, and delay in returning to work. A total of 100 subjects were assessed four times (prior to surgery, and 12 days, 1 month, and 3 months after surgery) using the Boston carpal tunnel questionnaire, the nine-hole peg test (NHPT), and the Jebsen-Taylor test (JTT). Subjects were randomized to a rehabilitation program or to a progressive home exercise program. No difference in symptom occurrence between the two groups was detected after 1 and 3 months. One month after surgery, only patients in the first group showed motor dexterity improvement according to NHPT and JTT scores. At the 3-month follow-up, the two groups did not differ but the group undergoing rehabilitation showed a shorter return-to-work interval. A rehabilitation approach after hand surgery is clinically relevant to accelerate recovery but neither modifies functional recovery nor reduces symptom occurrence.     

Effects of a Group-Based Aerobic Exercise Program on the Cognitive Functions and Emotions of Substance Use Disorder Patients: a Randomized Controlled Trial

To examine, from behavioral perspectives, the feasibility of applying group-based aerobic exercise as an adjunct to treatment aimed at improving the cognitive functions and emotions of substance use disorder (SUD) patients. Eighty-three male methamphetamine use disorder patients recruited through an isolated detoxification centers (IDCs) were assigned into either an exercise group or control group. The exercise group participated in a group-based aerobic exercise intervention involving moderate-intensity exercises for 3 months. The cognitive functions, emotions, drug cravings, and physical fitness of the patients in both groups were measured at the baseline, 1 months, 2 month, and 3 months time points. After the 3 months intervention, the exercise group exhibited significant improvements in SSRT, HAMA and BDI scores, and physical fitness scores (i.e., BMI, vital capacity, flexibility, and balance) relative to the control group. Furthermore, the exercise group exhibited significantly reduced VAS scores for craving in comparison to the control group after only 2 months of the intervention. The 3 months group-based aerobic exercise program showed beneficial effects for cognitive functions, emotions, cravings, and physical fitness among SUD patients (i.e., methamphetamine use disorder patients), and can thus be considered as a potential therapeutic candidate for addiction rehabilitation.

     

On the validity of an Augmented Structured Interview for measuring subcomponents of the Type A behavior pattern.

This study was designed to provide validity data for the Augmented Structured Interview (ASI), which has been developed to measure subcomponents (as opposed to the global) Type A behavior pattern (TABP). Eighty subjects from a large private southwestern medical center were administered a self-report measure of the TABP (the Jenkins Activity Survey--JAS) and the ASI. Forty of the subjects were being treated for post-infarction coronary heart disease (CHD). The remaining forty subjects did not possess documented CHD. The obtained ratings for all the six ASI-measured Type A subcomponents were significantly higher for the CHD than for the non-CHD group. A discriminant functions analysis revealed that the ASI was superior to the JAS in correctly classifying CHD and non-CHD subjects. These outcomes are interpreted as providing initial support for the validity of the ASI.     

ACTH and beta-endorphin responses to physical exercise in adolescent women tested for anxiety and frustration.

Thirty healthy adolescent women (age: 14 years), high school students without clinical signs of psychiatric or major affective disorders, received psychological and endocrinological examinations. Two psychological tests were used: the Anxiety Score Test for Adolescents and the Pictures Frustration Test for Adolescents of Rosenzweig. On the basis of the results of these tests, subjects were divided into two groups: A (n = 21), normal subjects; B (n = 9), subjects with evidence of anxiety (n = 1), frustration (n = 1), or both (n = 7). Plasma levels of adrenocorticotropic hormone (ACTH) and beta-endorphin were measured under basal conditions and after physical exercise (Step Test) in all subjects. Hormonal responses in groups A and B were compared. Basal concentrations of ACTH and cortisol were similar in the two groups, whereas basal beta-endorphin levels were significantly higher in group B than in group A. Exercise induced a slight but significant increase in plasma concentrations of both ACTH (32% increase) and beta-endorphin (60% increase) in group A. A striking increase in plasma ACTH (100% increment) and a slight increase of beta-endorphin (60% increment) levels were observed in group B after exercise. Absolute levels of ACTH and beta-endorphin after physical exercise were significantly higher in group B than in group A. These findings indicate increased levels of adrenocorticotropic and opioid activity in adolescent women with high scores on psychological measures of anxiety and frustration.     

Exercise and its role in the prevention and rehabilitation of cardiovascular disease

The purpose of this article is to review the beneficial effects of regular exercise in the primary and secondary prevention of coronary artery disease (CAD). Epidemiologic studies indicate that a physically inactive life-style is associated with twice the risk of developing CAD. The magnitude of risk is similar to that of other modifiable risk factors. Meta-analysis of studies of cardiac rehabilitation after myocardial infarction demonstrate that cardiac rehabilitation participants lower their risk of death by 20% to 25% compared to controls. Exercise training results in several beneficial physiological changes including an increase in exercise endurance, higher resting and exercise stroke volumes, lower resting and submaximal exercise heart rates, and increased capillary density and oxidative enzyme capacity in skeletal muscle. In patients with established CAD, exercise training improves symptoms of angina and congestive heart failure and attenuates the severity of exercise-induced ischemia. Regular exercise can favorably modify other risk factors, but the benefits are modest. Reductions in systolic and diastolic blood pressure readings average 6 to 9 mm Hg; decreases in total and low-density lipoprotein (LDL) cholesterol approximate 5 to 10 mg/dL; and increases in high-density lipoprotein (HDL) cholesterol approximate 2 mg/dL. Exercise training as a sole intervention does not appear to enhance smoking cessation. Regular exercise does improve psychosocial well-being. Most studies of physical activity have enrolled predominantly middle-aged men; however, available evidence suggests similar cardiovascular benefits for women, the elderly, and children and youth. Physical activity levels decrease substantially during the school-age-adolescent transition in both males and females. More than half of the adult population is sedentary or inactive. Collectively, accumulated data suggest the need for both individualized/high-risk and population-based approaches to increasing physical activity across the life span. *** DIRECT SUPPORT *** A00FV011 00005     

Effects of a 14-day healthy longevity lifestyle program on cognition and brain function.

OBJECTIVE: The objective of this study was to determine the effects of a 14-day healthy longevity lifestyle program on cognition and cerebral metabolism in people with mild age-related memory complaints. METHODS: Seventeen nondemented subjects, aged 35-69 years (mean: 53 years, standard deviation: 10) with mild self-reported memory complaints but normal baseline memory performance scores were randomly assigned to 1) the intervention group (N = 8): a program combining a brain healthy diet plan, relaxation exercises, cardiovascular conditioning, and mental exercise (brain teasers and verbal memory training techniques); or 2) the control group (N = 9): usual lifestyle routine. Pre- and postintervention measures included self-assessments of memory ability, objective tests of cognitive performance, and determinations of regional cerebral metabolism during mental rest with [fluorine-18]fluorodeoxyglucose (FDG) positron emission tomography (PET). RESULTS: Subjects in the intervention group objectively demonstrated greater word fluency. Concomitantly, their FDG-PET scans identified a 5% decrease in activity in the left dorsolateral prefrontal cortex. The control group showed no significant change in any of the measures. CONCLUSIONS: A short-term healthy lifestyle program combining mental and physical exercise, stress reduction, and healthy diet was associated with significant effects on cognitive function and brain metabolism. Reduced resting activity in left dorsolateral prefrontal cortex may reflect greater cognitive efficiency of a brain region involved in working memory.     

Exercising,sleep-EEG patterns,and psychological functioning are related among adolescents

Abstract

Objectives. Lay and scientific opinion alike hold that physical activity is efficient as both remedy and preventative measure for poor sleep. There is evidence that strenuous exercising of adolescent elite athletes leads to favourable sleep patterns. However, research on this in non-elite athletes is limited. The aim of the present study was to compare sleep-EEG patterns of higher leisure time exercisers and controls. Methods. A total 38 adolescents (M = 18.59) took part in the study; 17 were high, and 21 were low exercisers. Mean weekly exercise duration was 8.5 h for high and 2 h for low exercisers. Sleep-EEG recordings were performed following a day without exercise. Participants also completed questionnaires regarding their psychological functioning. Results. Compared to low exercisers, high exercisers had more slow wave sleep, and less light and REM sleep, higher scores for positive coping and curiosity, and lower scores for depressive symptoms and somatosensory amplification. Multiple regression analyses showed that weekly exercise duration predicted shortened SOL, low number of awakenings, and increased slow wave sleep. Conclusion. Regular, though not necessarily vigorous, exercise is related to improvement in objective sleep patterns and better psychological functioning. Regular physical activity should be promoted and access to sports facilities should be facilitated.     

An augmented structured interview for measuring subcomponents of the Type A behavior pattern

The authors note an increasing interest in certain subcomponents of the Type A behavior pattern (TABP) such as time urgency, perpetual activation, and anger in versus anger out. Based on that observation they pilot tested twenty-four newly created interview items designed to augment those of the commonly employed Structured Interview (SI). Nineteen of the twenty-four items were then selected for use in more precise assessment of the four TABP subcomponents mentioned above. These new items, in combination with those of the existing SI, were labeled the Augmented Structured Interview (ASI). Obtained data on the ASI items support the need for assessing Type A subcomponents (instead of relying solely on a global measure of the TABP). The data also suggest that TABP subcomponents are best assessed by means of interview items rather than self report measures. The ASI is recommended for both clinical and research purposes as a supplement to the SI, which to date has proven to be the best means for measuring global Type A tendencies.     

Effects of a CHANGE intervention to increase exercise maintenance following cardiac events

Background: Despite participation in a cardiac rehabilitation program, there is a downward trajectory of exercise participation during the year following a cardiac event.Purpose: The purpose of this study was to test the effectiveness of CHANGE (Change Habits by Applying New Goals and Experiences), a lifestyle modification program designedto increase exercise maintenance in the year following a cardiac rehabilitation program. The CHANGE intervention consists of 5 small-group cognitive-behavioral change counseling sessions in which participants are taught self-efficacy enhancement, problem-solving skills, and relapse prevention strategies to address exercise maintenance problems.Method: Participants (N = 250) were randomly assigned to the CHANGE intervention (supplemental to usual care) or a usual-care-only group. Exercise was measured using portable wristwatch heart rate monitors worn during exercise for 1 year. Cox proportional hazards regression was used to determine differences in exercise over the study year between the study groups.Results: Participants in the usual-care group were 76% more likely than those in the CHANGE group to stop exercising during the year following a cardiac rehabilitation program (hazard ratio = 1.76, 95% confidence interval = 1.08–2.86, p = .02) when adjusting for the significant covariates race, gender, comorbidity, muscle and joint pain, and baseline motivation. Most participants, however, had less than recommended levels of exercise amount and intensity.Conclusions: Counseling interventions that use contemporary behavior change strategies, such as theCHANGEintervention, can reduce the number of individuals who do not exercise following cardiac events. This study was funded by a grant from the National Institute of Nursing Research at the National Institutes of Health R01-NR04704. We acknowledge the contributions of the cardiac rehabilitation staff at Parma Community Hospital, University Hospitals of Cleveland, and the Cleveland Clinic Foundation.     

Associations between type A behaviour pattern and psychological distress

Objective To investigate the relationships between type A behaviour pattern (TABP) and psychological distress measured in middle aged men participating in two surveys 28 years apart. Design and subjects Men residing in Oslo and born in 1923–1952 (all men aged 40–49 years and 7% of those aged 20–39 years—30,016 altogether) were invited to a cardiovascular screening in 1972/1973—asking about risk factors, symptoms and diseases. All the 17,972 participants were also asked questions about TABP (two items) and psychological distress (one item). Of the original invited cohort, those who still lived in Oslo or its vicinity in 2000 were invited to a new health examination carried through by similar procedures. Among other questions the participants answered ten items about psychological distress (Hopkins Symptoms Checklist: HSCL-10). Altogether 7,393 men participated in both surveys. Results In 1972/1973 almost 57% of those participating twice considered themselves as a person who stresses himself and chooses high speed and at the same time denied that they rather preferred a tranquil and quiet life—a combination of answeres defined as type A behavior pattern. The corresponding TABP in 2000, when most of the men were retired, was 27%. A confirmatory factor analyses based on questions asked in 2000, verified that the HSCL/distress items reflected one underlying latent factor, and that this was a different factor than the one reflected in the two TABP items. The cross-sectional association between TABP and distress in 1972/1973 was highly significant (P < 0.001)—the odds ratio for psychological distress adjusted for background variables was 2.23 (95% confidence interval 1.98, 2.50). The corresponding association in 2000 showed a higher mean HSCL-10 score and a higher proportion with HSCL-score ≥1.85 in men with TABP compared with men without (P < 0.001 and P < 0.05, respectively), but the odds ratio in 2000 was lower than the result 28-years earlier. When those reporting psychological distress in 1972/1973 were excluded, TABP in 1972/1973 predicted psychological distress (HSCL-10) in the follow-up survey when adjusted for background variables (P < 0.05) using structural equation modelling. Conclusion Type A behaviour pattern and psychological distress reflect two different latent factors. TABP seems to be associated with psychological distress, both cross-sectionally and prospectively. This knowledge permits early detection of individuals who have a higher probability of experiencing psychological distress over a considerable period of time.     

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program

OBJECTIVE: To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. METHOD: The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. RESULTS: Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. CONCLUSION: These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.