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Cardiovascular DiseasesOPTICARE-RESSTNCT06505109

OPTImizing CArdiac REhabilitation by REfining Sleep and STress

A study testing RESST in people with Cardiovascular Diseases and Cardiac Rehabilitation, run by Erasmus Medical Center at 3 sites in Netherlands.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The primary objective of this project is to investigate the effectiveness and costs of integrating a behavioural program targeting sleep and stress (the RESST intervention) into cardiac rehabilitation (CR). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
RESST
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
3 sitesNetherlands
Study dates
28 Aug 2024to Jan 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Participate in CR at one of the study centres for any cardiac diagnosis or reason as stated in the Dutch guidelines
  • Age at or above 18 years
  • Proficient in the Dutch language
  • Experiencing sleep and/or stress problems as indicated by a high score on the Pittsburgh Sleep Quality Index (PSQI score >5) or Perceived Stress Scale-10 (PSS-10 score >13)
  • Signed informed consent

Who cannot join

  • Severe psychiatric, cognitive or physical comorbidity that would impede CR participation
  • Active treatment for sleep disorders, stress, or other forms of (behavioural) therapy at the start of the study or expected to start within the first 6 months of the study, that could interfere with the RESST intervention. Note: Participants with previously diagnosed sleep disorders are eligible if they still experience sleep or stress problems, unless they fall under the above criteria. Participants who received a prior treatment that is still ongoing but has resulted in a stable sleep and stress condition in the 3 months before the cardiovascular event (e.g., Continuous Positive Airway Pressure (CPAP)) are eligible.

Trial locations and contacts

3 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Nienke ter Hoeve, PhD contact

+31107033190

n.terhoeve@erasmusmc.nl

Netherlands3 sites, 3 recruiting
  • Máxima Medisch Centrum

    Eindhoven, North Brabant, 5631BM

    Esmée Ooms, MSc, +31622366387, e.ooms@erasmusmc.nl

    Inge van Loon, MSc, +31622366387, i.g.vanloon@erasmusmc.nl

    Recruiting
  • Capri Hartrevalidatie

    Rotterdam, South Holland, 3062MA

    Esmée Ooms, MSc, +31622366387, e.ooms@erasmusmc.nl

    Inge van Loon, MSc, +31622366387, i.g.vanloon@erasmusmc.nl

    Recruiting
  • Capri Hartrevalidatie

    The Hague, South Holland, 2597AX

    Esmée Ooms, MSc, +31622366387, e.ooms@erasmusmc.nl

    Inge van Loon, MSc, +31622366387, i.g.vanloon@erasmusmc.nl

    Recruiting

Other trials in Netherlands

About this study

The primary objective of this project is to investigate the effectiveness and costs of integrating a behavioural program targeting sleep and stress (the RESST intervention) into cardiac rehabilitation (CR). In addition, the investigators will also study whether parameters regarding diversity (e.g., sex, ethnicity, socioeconomic position) are associated with intervention effectiveness. Furthermore, the investigators aim to explore the (bidirectional) relation between sleep and stress on the one hand, and other lifestyle components and health outcomes on the other hand.

Read the detailed description

CR focuses on the secondary prevention of cardiovascular disease (CVD) by promoting a healthy lifestyle and is a valuable approach to improve quality of life, mortality and hospital readmissions. However, optimization of CR is necessary. Current CR programs pay insufficient attention to sleep and stress problems, despite more than 50% of CVD patients experiencing sleep problems and high stress levels. Both sleep and stress are associated with adverse cardiovascular health and a decreased quality of life. The hypothesis for this study is that adding a behavioural intervention will improve sleep and perceived stress (primary outcomes), along with positive outcomes on biomarkers of chronic stress, QoL, cardiometabolic risk factors, physical fitness, lifestyle components, and psychosocial well-being.

The project involves a multicenter randomized controlled trial. The intervention group (100 patients) will receive standard CR along with the RESST intervention, consisting of 5-6 on-site group sessions integrating principles from Acceptance and Commitment Therapy and Cognitive Behavioral Therapy and focused on improving sleep and stress. The control group (100 patients) will receive standard multidisciplinary CR only.

The primary outcomes of the study include both objective and subjective measures of sleep, as well as perceived stress. Secondary outcomes encompass quality of life, chronic stress biomarkers, cardiometabolic risk factors, physical fitness, lifestyle components and psychosocial wellbeing. These outcomes will be assessed before and after the intervention, as well as at a 6-month follow-up.

Being tested
RESST
Keywords
Cardiovascular Diseases, Cardiac Rehabilitation, Sleep, Stress
Medical subject headings
Cardiovascular Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RESSTBehavioural

    Subjects randomized to the RESST intervention will receive on top of standard rehabilitation a behavioural group intervention focussing on improving sleep and stress. This intervention will consist of 5 group sessions of 120 minutes each in the local rehabilitation centre. Sessions should be completed within a maximum of 4 months since the start of CR.

Study groups in NCT06505109
Study groupRoleWhat they receive
Intervention groupExperimentalThe intervention group will receive standard CR along with the RESST intervention, consisting of 5 on-site group sessions, focused on sleep and stress, integrating principles from Acceptance and Commitment Therapy and Cognitive Behavioral Therapy.
Receives: Behavioral: RESST
Control groupNo interventionThe control group will receive standard CR only. Standard CR programs consist of 6-12 weeks of twice-weekly supervised, group-based exercise sessions. In addition, educational sessions are provided, covering topics such as medical information, cardiovascular risk factors, adopting a heart-healthy lifestyle, and coping with emotions. Depending on the patient's specific needs, counselling sessions on stress management, smoking cessation, and healthy diet are available, and individual counselling can be provided by a social worker, dietician, or psychologist/psychiatrist.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Objectively assessed sleep duration

    This will be measured with a GENEACTIV accelerometer for 7 days and nights continuously.

    Measured: At baseline, after 3 months, and after 6 months.

  2. Objectively assessed sleep-onset latency

    This will be measured with a GENEACTIV accelerometer for 7 days and nights continuously.

    Measured: At baseline, after 3 months, and after 6 months.

  3. Objectively assessed wake after sleep onset

    This will be measured with a GENEACTIV accelerometer for 7 days and nights continuously.

    Measured: At baseline, after 3 months, and after 6 months.

  4. Objectively assessed sleep efficiency

    This will be measured with a GENEACTIV accelerometer for 7 days and nights continuously.

    Measured: At baseline, after 3 months, and after 6 months.

  5. Self-reported sleep quality

    This will be measured with the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Score between 0-21, higher score indicates worse sleep quality.

    Measured: At baseline, after 3 months, and after 6 months.

  6. Perceived stress level

    This will be measured with the Perceived Stress Scale-10 (PSS-10) questionnaire. Score between 0-40, higher score indicates higher perceived stress.

    Measured: At baseline, after 3 months, and after 6 months.

Secondary outcomes (44)
  1. Cortisol level

    This will be measured by taking a hair sample. The amount of cortisol in the hair will be determined in a lab.

    Measured: At baseline, after 3 months, and after 6 months.

  2. Cortisone level

    This will be measured by taking a hair sample. The amount of cortisone in the hair will be determined in a lab.

    Measured: At baseline, after 3 months, and after 6 months.

  3. Weight

    Weight will be measured with a digital scale in kilograms.

    Measured: At baseline, after 3 months, and after 6 months.

  4. Height

    Height will be measured with a stadiometer in centimeters.

    Measured: At baseline.

  5. Body Mass Index (BMI)

    Weight and height will be combined to report BMI in kg/m^2.

    Measured: At baseline, after 3 months, and after 6 months.

  6. Blood pressure

    Blood pressure will be measured with a blood pressure monitor.

    Measured: At baseline, after 3 months, and after 6 months.

  7. Smoking behaviour

    This will be measured with a carbon monoxide breath tester.

    Measured: At baseline, after 3 months, and after 6 months.

  8. Smoking behaviour

    This will be measured with a self-designed questionnaire. The outcome of this questionnaire indicates whether a person smokes/has smoked in the past/does not smoke, what sort of tobacco is being smoked and how much the participant smokes.

    Measured: At baseline, after 3 months, and after 6 months.

  9. Muscle strength

    Handgrip strength will be measured with a hand dynamometer.

    Measured: At baseline, after 3 months, and after 6 months.

  10. Physical activity

    This will be measured with a GENEACTIV accelerometer for 7 days and nights continuously.

    Measured: At baseline, after 3 months, and after 6 months.

  11. Sedentary behaviour

    This will be measured with a GENEACTIV accelerometer for 7 days and nights continuously.

    Measured: At baseline, after 3 months, and after 6 months.

  12. Alcohol use

    This will be measured with the five-shot questionnaire. Score between 0-7, higher score indicates higher chance of alcohol overuse, misuse, and dependency.

    Measured: At baseline, after 3 months, and after 6 months.

  13. Health related quality of life

    This will be measured with the MacNew questionnaire. Score between 1-7, higher score indicates higher health related quality of life.

    Measured: At baseline, after 3 months, and after 6 months.

  14. Health related quality of life

    This will be measured with the EuroQol 5D/EQ5D questionnaire. Score between -0.446 - 1, higher score indicates a better health state. One subscale has a score between 0-100, higher score indicates better perceived health.

    Measured: At baseline, after 3 months, and after 6 months.

  15. Fatigue

    This will be measured with the Fatigue Severity Scale (FSS) questionnaire. Score between 9-63, higher score indicates a greater fatigue severity.

    Measured: At baseline, after 3 months, and after 6 months.

  16. Daytime sleepiness

    This will be measured with the Epworth Sleepiness Scale (ESS) questionnaire. Score between 0-24, higher score indicates a higher level of daytime sleepiness.

    Measured: At baseline, after 3 months, and after 6 months.

  17. Anxiety and depression

    This will be measured with the Hospital Anxiety and Depression Scale (HADS) questionnaire. Score between 0-21 per subscale, higher score indicates severe symptoms of anxiety and depression.

    Measured: At baseline, after 3 months, and after 6 months.

  18. Participation in society

    This will be measured with the USER-Participatie (USER-P) questionnare. Score between 0-100, higher score indicates higher participation in society.

    Measured: At baseline, after 3 months, and after 6 months.

  19. Estimated Cardiorespiratory fitness

    This will be measured with the FitMáx©-Questionnaire. The outcome of this questionnaire is the estimated maximum oxygen uptake expressed in mL/kg/min. Higher score indicates better cardiorespiratory fitness.

    Measured: At baseline, after 3 months, and after 6 months.

  20. Presence of restless leg syndrome

    This will be measured with the RLS rating scale questionnaire. Score between 0-28, higher score indicates more severe symptoms of restless leg syndrome.

    Measured: At baseline.

  21. Presence of insomnia

    This will be measured with the Insomnia Severity Index (ISI) questionnaire. Score between 0-28, higher score indicates more severe insomnia complaints.

    Measured: At baseline.

  22. The risk of the presence of obstructive sleep apnoea

    This will be measured with the STOP-bang questionnaire. Score between 0-8, higher score indicates higher risk of obstructive sleep apnoea.

    Measured: At baseline.

  23. Costs incurred by the patients

    This will be measured with the IMTA Medical Consumption Questionnaire (IMCQ) which aims to determine costs within the health care system.

    Measured: After 3 months and after 6 months.

  24. Productivity costs

    This will be measured with the IMTA Productivity Costs Questionnaire (IPCQ) which aims to determine the cost of productivity losses.

    Measured: After 3 months and after 6 months.

  25. Perceived sleep

    This will be measured with the Sleep Consensus Diary for 7 days. The Sleep Consensus Diary consists of questions about the experience of sleep, what time the participant went to sleep, and how often the participant woke up.

    Measured: At baseline, after 3 months, and after 6 months.

  26. Diet

    This will be measured with an electronic diary. Intake of caffeine and alcohol and timing of the main meal will be measured.

    Measured: At baseline, after 3 months, and after 6 months.

  27. Momentary fatigue

    This will be measured with an electronic diary.

    Measured: At baseline, after 3 months, and after 6 months.

  28. Momentary stress

    This will be measured with an electronic diary.

    Measured: At baseline, after 3 months, and after 6 months.

  29. Adherence to the CR treatment and RESST intervention

    This will be measured by recording the number of rehabilitation components attended, such as courses on nutrition or personal counseling.

    Measured: After 3 months.

  30. Treatment Satisfaction

    This will be measured with a self-designed questionnaire and consists of questions about the applicability, clarity and logistics of the intervention.

    Measured: After 3 months.

  31. Sex

    Female / male / other

    Measured: At baseline.

  32. Age

    Age in years.

    Measured: At baseline.

  33. Cardiac diagnosis

    Cardiac diagnosis as defined by ICD-10 that has resulted in referral to cardiac rehabilitation.

    Measured: At baseline.

  34. Educational level

    Single-item question (high, middle, or low educated).

    Measured: At baseline.

  35. Relational status

    Single-item question.

    Measured: At baseline.

  36. Cardiac risk factors

    Presence of cardiac risk factors (family history, diabetes mellitus, hypertension, dyslipidemia, smoking prior to event).

    Measured: At baseline.

  37. Cardiac history

    History of cardiovascular events and diseases.

    Measured: At baseline.

  38. Medication usage

    Number of participants using a certain type of prescribed and/or over-the-counter medication.

    Measured: At baseline, after 3 months, and after 6 months.

  39. Comorbidity

    Presence of other diseases.

    Measured: At baseline.

  40. Socioeconomic status

    Socioeconomic status indicated by postal code.

    Measured: At baseline.

  41. Origin

    Determined by birth country and parents' birth country.

    Measured: At baseline.

  42. Employment

    Determined by employment status, and type of job.

    Measured: At baseline.

  43. Drug use

    Drug use (yes/no) and drug classification.

    Measured: At baseline.

  44. Current/previous sleep disorder treatment

    Description of current and previous treatment for sleeping disorders.

    Measured: At baseline.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Jul 2024
  2. Study start28 Aug 2024
  3. Primary completionJan 2027 (estimated)
  4. Study completionJan 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients are randomized to treatment or control.
Masking
None (open label)
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06505109
Sponsor's protocol ID
NL86677.078.24
Other IDs
10930012310027
Acronym
OPTICARE-RESST
Status last verified
Mar 2026
First submitted
1 Jul 2024
Last updated
13 Mar 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes

Publications

  • van Loon I, Ooms E, Luik A, Sunamura M, Wally T, Boersma E, Vromen T, Tenbult-van Limpt N, Bussmann H, Boon M, Louter M, Redekop K, Ista E, van den Berg-Emons R, Ter Hoeve N; other OPTICARE-RESST Consortium members. Optimising sleep and managing stress by integrating a behavioural intervention during cardiac rehabilitation: rationale and design of the OPTICARE-RESST multicentre randomised controlled trial. BMJ Open. 2026 Apr 16;16(4):e117963. doi: 10.1136/bmjopen-2026-117963.

    PubMed 41991268

Questions about this trial

What is this clinical trial studying?

A study testing RESST in people with Cardiovascular Diseases and Cardiac Rehabilitation, run by Erasmus Medical Center at 3 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 13 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Nienke ter Hoeve, PhD (+31107033190, n.terhoeve@erasmusmc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Objectively assessed sleep duration (time frame: At baseline, after 3 months, and after 6 months.). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06505109, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Mar 2026.

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