Table 2.

Summary of Studies Reviewed

Author	Sample	N	Treatment	Length / Frequency of Practice	Symptom and Quality of Life Measures	Timing	Results related to Relaxation
Relaxation
Chang et al., 200547 Chang et al., 200446	Adults with Class II–III HF	95 (57)	Relaxation Cardiac education	90-minute training session, once/week × 15 weeks plus 15–20 minutes twice daily home practice sessions	Symptoms Self-report comments from a subsample of 57 participants QoL MLWHFQ – physical subscale	Before starting treatment 15-weeks post-treatment	Between Groups No difference in physical QoL Within Group Decreased chest pain Easier breathing Less fatigue Increased ability to sleep
Cully et al., 201058	Adults with CHF and/or COPD with ≥ mild functional impact and concurrent depression or anxiety	23	Combined cognitive-behavioral strategies using relaxation	50-minute sessions, once/week × 6 weeks plus 10–15 minute booster phone calls × 3 at 8-, 10-, and 12-weeks	Symptoms Chronic Respiratory Questionnaire	Before starting treatment 8-weeks post-treatment 3-months post-treatment	Within Group Reduction in fatigue at 8 weeks, but no change at 3 months. No change in dyspnea
Swanson et al., 200952	Adults with Class I-III HF	35	Biofeedback-assisted relaxation Attention control (placebo biofeedback)	45-minute training sessions, once / week × 6 weeks plus 20-minute daily home practice sessions	Symptoms Dyspnea – Borg scale Fatigue – Borg scale QoLMLWHFQ – physical subscale	Before starting treatment 6-weeks post-treatment (week 6) 18-weeks post-treatment	Between Groups No differences in dyspnea, fatigue, or physical QoL
Yu et al., (200754, 200756, 201055)	Adults with HF, admitted to the hospital	153	Progressive Muscle Relaxation Exercise Attention control (general greetings)	60-minute training sessions × 2 and one skills re-training session plus Twice daily home practice sessions × 12 weeks	SymptomsChronic Heart Failure Questionnaire QoLWorld Health Organization QoL – Brief questionnaire – physical subscale	Before starting treatment 8 weeks post-treatment 12-weeks post-treatment 14-weeks post-treatment	Between Groups – Relaxation vs. attention control Significantly lower dyspnea in relaxation group – 12 weeks No difference in dyspnea – 8 or 14 weeks No difference in fatigue - 8, 12, or 14 weeks No difference in physical QoL – 8 or 14 weeks
Wang et al., 201351	Adults hospitalized with Class II-III HF and report of insomnia	128	Biofeedback-assisted relaxation at 9:00am Biofeedback-assisted relaxation at 9:00pm Biofeedback-assisted relaxation at 9:00am and 9:00pm Usual care (sleep hygiene)	20-minute nurse-led biofeedback session once or twice/day × up to 6 days	Symptoms Pittsburgh Sleep Quality Index	Before starting treatment Average over 6-days post-treatment	Between Groups Significantly shorter sleep latency, fewer awakenings, and better sleep quality in the 9:00pm and 9:00am and pm groups compared to 9:00am only and usual care.
Meditation
Curiati et al., 200553	Adults with Class I-II HF	19	Meditation Attention control (talking about stress)	60-minute training sessions × 2 plus 30-minute twice daily home practice sessions × 12 weeks	QoL MLWHFQ – physical subscale	Before starting treatment 12–14 weeks post-treatment	Between Groups Significantly better physical QoL in meditation group
Jayadevappa et al., 200750	African American adults with Class II–III HF	23	Transcendental meditation HF education	90-minute training sessions × 7 consecutive days plus Bi-weekly refresher meetings × 3 months plus Monthly meetings × another 3 months plus 15–20 minute twice daily home practice	Symptoms Pain – SF-36 Bodily pain subscale QoL MLWHF – physical subscale	Before starting treatment 3-months post-treatment 6-months post-treatment	Between Groups No differences in bodily pain or physical QoL at 3- or 6-months Within Group No reduction in bodily pain or improvement in physical QoL at 3- or 6-months
Sullivan et al., 200957	Adults with Class I or greater HF	217	Mindfulness meditation Usual care	2 ¼ hour training sessions, once/week × 8 weeks plus 30-minutes daily home practice	QoL KCCQ – symptom score	Before starting treatment 3-months post-treatment 6-months post-treatment 12-monts post-treatment	Between Groups Significantly better symptom QoL scores in meditation group at 6- and 12-months. No difference at 3-months
Guided Imagery
Beniaminovitz et al., 200249 and Klaus et al., 200048	Adults with Class III HF	29 (8)	Guided imagery Exercise (Guided imagery)	90-minute training sessions, once/week × 1 month plus 15-minute daily home practice sessions	Symptoms Dyspnea – Guyatt Respiratory Scale, Transitional Dyspnea Scale QoL MLWHFQ – physical subscale	Before starting treatment 1-month post-treatment	Between Groups No difference in dyspnea or physical QoL Within Group Significant improvement in physical QoL No reduction in dyspnea

HF = heart failure; KCCQ = Kansas City Cardiomyopathy Questionnaire; MLWHFQ = Minnesota Living with Heart Failure Questionnaire; QoL = Quality of life