{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T19:04:45Z","timestamp":1782327885602,"version":"3.54.5"},"reference-count":56,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antioxidants"],"abstract":"<jats:p>Multicomponent cardiac rehabilitation (CR) is a secondary prevention strategy for cardiac patients to tackle stress and psychosocial wellbeing. However, there is a lack of data on its psychoneuroimmunological effects and of biomarkers to determine individual risk and to develop treatment strategies. We conducted a pilot randomized controlled trial (RCT) to investigate the feasibility of deriving psychophysiological stress markers in patients with cardiovascular diseases. Thirty individuals with cardiovascular disease (mean age 58.8 years; 23.3% female) were enrolled and randomized into three treatment groups: standard rehabilitation, yoga, or transcendental meditation (TM). Depression, anxiety, sleep, stress perception, personality functioning, hair cortisol, serum tryptophan, kynurenine and neopterin concentrations were estimated at baseline and after a four-week intervention. Hair cortisol levels decreased significantly after rehabilitation in all groups (F = 15.98, p &lt; 0.001). In addition, personality functioning improved in all patients over time. Participants with impairments in personality functioning showed a positive correlation with baseline neopterin that did not remain significant after Bonferroni correction. Concentrations of serum tryptophan and its metabolite kynurenine did not change significantly. This pilot RCT provides preliminary evidence of multicomponent CR leading to stabilization of hair cortisol levels and improved psychophysiological wellbeing and personality functioning. Impairments in personality functioning were correlated with neopterin levels, which may impact the symptomatology and outcome.<\/jats:p>","DOI":"10.3390\/antiox10091425","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T10:24:25Z","timestamp":1631010265000},"page":"1425","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of Cardiovascular Rehabilitation on Psychophysiological Stress, Personality and Tryptophan Metabolism: A Randomized Pilot Feasibility Study"],"prefix":"10.3390","volume":"10","author":[{"given":"Jolana","family":"Wagner-Skacel","sequence":"first","affiliation":[{"name":"Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5034-6358","authenticated-orcid":false,"given":"Sabrina","family":"M\u00f6rkl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-3674","authenticated-orcid":false,"given":"Nina","family":"Dalkner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7215-3848","authenticated-orcid":false,"given":"Frederike","family":"Fellendorf","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Fitz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7308-5450","authenticated-orcid":false,"given":"Bianca","family":"Brix","sequence":"additional","affiliation":[{"name":"Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruslan","family":"Neshev","sequence":"additional","affiliation":[{"name":"Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Wedenig","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"M\u00e4chler","sequence":"additional","affiliation":[{"name":"Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Dorr","sequence":"additional","affiliation":[{"name":"Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Picha","sequence":"additional","affiliation":[{"name":"Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian E.","family":"Rudlof","sequence":"additional","affiliation":[{"name":"Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till O.","family":"Bartel","sequence":"additional","affiliation":[{"name":"Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef M.","family":"Tatschl","sequence":"additional","affiliation":[{"name":"Health Psychology Unit, Institute of Psychology, Karl-Franzens University of Graz, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1532-5177","authenticated-orcid":false,"given":"Johanna M.","family":"Gostner","sequence":"additional","affiliation":[{"name":"Biochemical Immunotoxicology Group, Institute of Medical Biochemistry, Medical University Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne A.","family":"Bengesser","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Z.","family":"Reininghaus","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4271-918X","authenticated-orcid":false,"given":"Josef","family":"Jenewein","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6704-0723","authenticated-orcid":false,"given":"Nandu","family":"Goswami","sequence":"additional","affiliation":[{"name":"Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: The European Strorganization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)","volume":"39","author":"Aboyans","year":"2018","journal-title":"Eur. 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