Favourable effects of breathing and relaxation instructions in cardiac rehabilitation: A 5-year randomised follow-up and relaxation instruction of patients after a myocardial infarction on the occurrence of cardiac events during 5 years. DESGIN: Prospective randomised. SETTING: Kennemer Gasthuis, Haarlem, The Netherlands. METHOD: In the period 1981 to 1983, 156 myocardial infarction patients were randomly assigned to either rehabilitation plus relaxation therapy (six weekly sessions of breathing and relaxation instruction (n = 76) or cardiac events and the amount of medical consumption of the two treatments was compared during 5 years. RESULTS: At five-year follow-up, 12 cardiac deaths had occurred, 5 in the relaxation group and 7 in the control group, re-infarction was observed in 10 and 12 patients, and cardiac surgery was performed in 2 an 11 respectively. In total, 15 (20%) and 26 patients (33%), respectively had at least one of these events (odds ratio (OR)) for the relaxation group: 0.51; 95% confidence interval (CI): 0.25 to 1.06. Medical consumption (counted as cardiac events and cardiac hospitalisations) was 30 patients (39%), experiencing 52 cardiac events in the relaxation group, for which the patients were hospitalised for a total of 476 days, and 38 patients (48%) experiencing 78 cardiac events in the control group (OR 0.72; 95% CI 0.38 to 1.36) with a total of 719 hospitalisation days; the total number of hospitalisations was reduced by 31% by relaxation instruction. CONCLUSION: In the long run, the disease course after myocardial infarction is probably influenced favourably by adding relaxation instruction to cardiac rehabilitation. The extra costs are compensated for be a decrease in hospitalisation for cardiac problems.

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