The Stress-release Effects of Exercise in Obese Are Determined by DS14 Score and T-cell Activation Status
Condition: Obesity; Type D Personality; Coronary Heart Disease
MeSH terms: Heart Diseases; Coronary Disease; Coronary Artery Disease; Myocardial Ischemia
Study type: Observational

Summary: 
      The purpose of the study was to analyze negative affectivity (NA) and social inhibition (SI)
      inquired by DS14 score in type D personality (distressed personality) to the relation of
      autonomic regulation of heart function (HRV) and immune response (T lymphocyte) among obese
      patients within coronary heart disease group (CHD). As stress is the key psychological
      activator of the hypothalamic-pituitary-adrenal axis (HPA axis) and therefore an important
      risk factor for diminished immune competency and prevalence of chronic conditions such as
      obesity, investigators chose exercise as the stress release intervention, especially as
      chronic stress may have a role in obesity, related to initiation or exacerbation of the
      condition. Abnormal regulation of the hypothalamic-pituitary-adrenal axis is additionally
      associated with chronic inflammatory conditions. Proinflammatory T-lymphocytes are present in
      visceral adipose tissue and may contribute to local inflammatory cell activation before the
      appearance of macrophages, suggesting that these cells could play an important role in the
      initiation and perpetuation of adipose tissue inflammation.
    

Detailed description: 
      This study was performed at The Institute for Preventive Medicine in cooperation with The
      Institute of Microbiology and Immunology at the Medical Faculty of Ljubljana/University of
      Ljubljana in a clinical setting as an observational type. In the group of examinees the
      investigators chose only those obese without detectable complications of coronary heart
      disease while admitted. Obese patients with angina pectoris, myocardial infarction, valvular
      heart disease and congestive heart disease had been excluded from the research. Since
      personality is the major determinant of chronic stress, according to the investigators
      hypothesis, further division on two global traits Negative affectivity (NA) and Social
      inhibition (SI) structured by Denollet has been positioned in the study. A total of 30
      patients with CHD were divided in two groups. Participants who were obese with high DS14
      score matched obese controls with normal DS14 score. In all subjects the investigators also
      observed white blood cell counts with a detailed lymphocyte analysis using flow cytometry and
      C-reactive protein (CRP) as the indicator of inflammation. Besides body mass (BM), body mass
      index (BMI) systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and heart rate
      variability (HRV) were measured before and after three months period, while all subjects had
      been already exercising 4 times weakly (moderate walking of 5km/h) for an hour. Additionally
      STAIX-1, SWLS and QOLLTI-P questionnaires had been used.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        30 examinees, 14 men of average age 56,3 ± 15,5 years old and 16 women of average age of
        53,5. ± 4,2 years old made the owerweight/obese group of chronic (coronary heart disease)
        patients. Subjects were matched by gender, age, body mass index and had all been regular
        visitors (patients) of The Institute of Preventive Medicine.
      
Keywords: psychoneuroimmunology; stress; lymphocyte population; personality type; obesity; heart rate variability; awareness