A clinical trial explores new intervention for cardiac patients 

During a cardiac rehab session, a Rutgers research team works with patient Lynette Kirkland. From left, Samantha Farris, Sayaka Carpenter, Kirkland, and Brittany Keller.

Valerie Haynie knew after suffering a blocked artery that she had to change.

“I was retired, and I sat at home,” the Central Jersey woman said. “I watched TV and used my computer. I wasn’t doing any exercise.”

Change is never easy, and for people with heart problems especially, vigorous exercise can be scary.

But Haynie soon found a way forward. While attending an outpatient cardiac rehab program, Haynie joined a clinical trial by Rutgers University psychologists seeking to treat symptoms of exercise anxiety, which are common among people with heart ailments.

Samantha Farris“For these patients, exercise has been prescribed to re-strengthen their heart,” said Samantha Farris, a professor of psychology in the School of Arts and Sciences who is leading the project. “The problem is that for some, exercise can feel uncomfortable, and the sensations of exertion can create anxiety powerful enough to make them avoid exercise or opt out of cardiac rehab altogether.”

If Haynie is any indication, however, the psychological approach developed by Farris—called Behavioral Exposure for Interoceptive Tolerance, or Be-Fit—can help patients face their fears, build tolerance for the sensations, and gradually step up their exercise.

On a recent Friday morning, Haynie was smiling broadly and peddling vigorously on a NuStep recumbent cross trainer while Mindy Kibbey, a fourth-year doctoral student on Farris’s team stood nearby, observing her progress and offering encouragement.

“For me, the critical thing was learning how to redirect my thoughts and push past those feelings of ‘I have to get out of here,’” Haynie said, “I am using the tools Mindy gave me to focus on my goals.”

And those goals are not limited to the exercise bike. Valerie Haynie

“I set a goal for myself of 2,700 steps daily,” she said. “And there are days where I take as many as 8,000 steps.”

“That is wonderful,” Kibbey says. “Congratulations!"

Haynie is one of an eventual 146 cardiac patients who will participate in the five-year randomized clinical trial funded through a $2.75 million grant from the National Institute on Aging. If the results show that patients receiving the Be-Fit intervention achieve higher levels of exercise than a control group, the treatment could become standard care for patients entering cardiac rehab.  And that could help boost the numbers of patients choosing cardiac rehab, which despite evidence of the benefits, has historically low rates of participation.

The project reflects Farris’s longtime research interest in anxiety. As director of the Rutgers Emotion, Health and Behavior Laboratory, she studies the connection between anxiety and various health problems, including physical inactivity, cigarette smoking, and alcohol abuse.

“What we’re doing with Be-Fit is using interventions that target anxiety to promote healthy behavior,” Farris said. “We want to increase patients’ tolerance and willingness to experience a sensation, which can often be tied to an emotion, with the goal of helping them stay in cardiac rehab longer, and to help them continue engaging in physical activity and staying healthy after recovery.”
Lynette Kirkland

The study is now in its second year, with trials carried out at Robert Wood Johnson Cardiac Rehab in East Brunswick. Participants receive one-on-one counseling and education sessions, supervised exercise, and monitoring. They also wear a Fitbit activity monitor for up six months that track physical activity and provide the team with extensive data.

“Ultimately, the amount of exercise is a very important outcome,” Kibbey said. “We should see more minutes per day of moderate to vigorous, exercise, more walking around, and less sitting.

“To see increases in physical activity, we think that we need to address exercise anxiety.”

On a recent day at the clinical trial site, Kibbey worked with patients in the exercise area, while team member Lilly Derby met with a patient in an adjacent office, discussing how to move from anxiety to action. Across six sessions, Derby and others help patients develop an exercise plan, work through difficult emotions, and learn that sensations such as breathlessness, dizziness, or accelerated heart beats are normal responses to exertion.

“We teach them how to acknowledge the sensations, and to continue to lean into them a little bit so they are able to build tolerance,” said Derby, a second-year doctoral student in psychology. “We want them to be able to realize: ‘Okay,I am not actually in danger here; this is my body responding to what is going on around me.’”

Mindy KibbeyThat approach resonated with Lynette Kirkland, a 1988 graduate of Douglass College who started cardiac rehab last spring after suffering a decline in health due to chronic high blood pressure.

“My heart was only pumping at 10 to 15 percent,” Kirkland said. “It was just difficult walking in my apartment from my bedroom to the kitchen.”

A change in medication improved her condition, but Kirkland still had much trepidation about exercise.

“I had a lot of fear about doing too much,” she said. The Be-Fit team “helped me through that fear and to understand that what I was feeling was normal.”

She now walks the three flights of stairs to her apartment without resting and has joined a gym.

“It helped so much just talking to someone, having them listen and respond to my fears,” Kirkland said. “This was totally motivating.”