AIMS:This secondary analysis aimed to (i) describe psychological resources and distress in women with takotsubo syndrome (TS) and (ii) explore whether such factors affect blood pressure (BP) responses to acute mental stress. METHODS AND RESULTS:Participants were 47 women consecutively enrolled in an ongoing study examining the prognostic significance of stress reactivity in TS. Psychological resources (resilience and adaptive coping) and distress [depression, anxiety, post-traumatic stress disorder (PTSD), and perceived stress] were self-reported using validated questionnaires <12 weeks after TS. Using a standardized protocol, systolic BP (SBP) and diastolic BP (DBP) (mmHg) were measured every 5 min during baseline (10 min), mental stress (10 min), and recovery (20 min). Associations of psychological resources and distress (high vs. low composite scores), respectively, with BP during mental stress and recovery (change from baseline), were examined using one-way analyses of covariance (covariates: age and anti-hypertensive medications). Given the study's exploratory nature, results are shown as effect sizes. On average, women (Mage = 64.3 years) had high perceived stress, anxiety, and PTSD symptoms and low resilience. Women with high (vs. low) psychological distress displayed less complete SBP (d = 0.57) and DBP (d = 0.33) recovery to baseline. Women with low (vs. high) psychological resources demonstrated lower SBP responses during mental stress (d = -0.26) alongside a more complete SBP recovery (d = 0.30). CONCLUSION:Female survivors of TS with high psychological distress exhibited impaired BP recovery following acute mental stress. While the prognostic significance of impaired BP recovery from mental stress remains to be determined in longitudinal studies, this finding could help identify TS survivors at risk for recurrence.

Background Annual lung cancer screening (LCS) with low dose CT reduces lung cancer mortality. LCS is underutilized. Black people who smoke tobacco have high risk of lung cancer but are less likely to be screened than are White people. This study reports provider recommendation and patient completion of LCS and colorectal cancer screening (CRCS) among patients by race to assess for utilization of LCS.Methods 3000 patients (oversampled for Black patients) across two healthcare systems (in Rhode Island and Minnesota) who had a chart documented age of 55 to 80 and a smoking history were invited to participate in a survey about cancer screening. Logistic regression analysis compared the rates of recommended and received cancer screenings.Results 1177 participants responded (42% response rate; 45% White, 39% Black). 24% of respondents were eligible for LCS based on USPSTF2013 criteria. One-third of patients eligible for LCS reported that a doctor had recommended screening, compared to 90% of patients reporting a doctor recommended CRCS. Of those recommended screening, 88% reported completing LCS vs. 83% who reported completion of a sigmoidoscopy/colonoscopy. Black patients were equally likely to receive LCS recommendations but less likely to complete LCS when referred compared to White patients. There was no difference in completion of CRCS between Black and White patients.Conclusions Primary care providers rarely recommend lung cancer screening to patients with a smoking history. Systemic changes are needed to improve provider referral for LCS and to facilitate eligible Black people to complete LCS.

BACKGROUND:Takotsubo syndrome (TS) is preceded by emotional/physical triggers in two-thirds of cases and no trigger in one-third. Information on triggers is typically obtained in the emergency room, and patients rarely have the opportunity to describe in detail the event(s) leading to TS onset. OBJECTIVE:This study aimed to conduct a qualitative exploration of patients' narratives regarding the events preceding their TS episode. METHODS:Semistructured interviews inquiring about the presence, type (physical vs emotional), and timing of contiguous events/circumstances relative to symptoms onset were conducted within 2 to 12 weeks of hospital discharge for a TS episode. Interview recordings were transcribed, coded, and analyzed with applied thematic content analysis. RESULTS:Participants (n = 30; 97% women, 93% White; age, 63 ± 8 years) described equal proportions of acute events (onset < 4 days before admission, 43%) and chronic circumstances (onset > 4 days before admission, 43%) preceding their TS episodes. Acute events included emotional, physical, and mixed (ie, emotional and physical) factors. Chronic circumstances included emotional and mixed factors. Seventy percent of participants perceived these events/circumstances as contributing to their onset of TS. CONCLUSIONS:Patients' narratives of the events contiguous to the TS episode are complex and often include factors that are chronic and/or emotional in nature. Future research should explore the potential importance of emotional aspects and chronic stress in the development of TS.

Background Approximately 400,000 people who smoke cigarettes survive Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS. A single, integrated treatment targeting depressed mood and smoking could be effective in reducing post-ACS mortality. Method/design The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 324 smokers with ACS and randomizing them to 12 weeks of an integrated smoking cessation and mood management treatment [Behavioral Activation Treatment for Cardiac Smokers (BAT-CS)] or control (smoking cessation and general health education). Both groups will be offered 8 weeks of the nicotine patch if medically cleared. Counseling in both arms will be provided by tobacco treatment specialists. Follow-up assessments will be conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We will track major adverse cardiac events and all- cause mortality for 36 months post-discharge. Primary outcomes are depressed mood and biochemically validated 7-day point prevalence abstinence from smoking over 12 months. Discussion Results of this study will inform smoking cessation treatments post-ACS and provide unique data on the impact of depressed mood on success of post-ACS health behavior change attempts. Trial registration ClinicalTrials.gov, NCT03413423. Registered 29 January 2018. https://beta.clinicaltrials.gov/study/ NCT03413423.

BACKGROUND:Heart failure (HF) self-care is a robust predictor of prognosis in HF patients. Cognitive impairment is a common comorbidity in HF patients and constitutes a major challenge to HF self-care. Mindfulness training (MT) has been shown to improve cognitive function and interoception, two components essential to promoting effective HF self-care. OBJECTIVES:The aims of the Mind Your Heart-II (MYH-II) study are to investigate the effects of MT on HF self-care via changes in cognitive function and interoception in patients with comorbid HF and cognitive impairment, and to study the process by which MT can improve cognitive function via vagal control. We hypothesize that MT will improve cognitive function, interoception, and vagal control, resulting in enhanced HF self-care, compared to control participants. METHODS:MYH-II is a mechanistic parallel phase II behavioral randomized controlled trial. We will enroll 176 English or Spanish-speaking patients with comorbid chronic HF and mild cognitive impairment. Participants will be randomized to either: (1) 8-week phone-delivered MT + Enhanced Usual Care (EUC), or (2) EUC alone. Participants will complete baseline, end-of-treatment (3 months), and follow-up (9 months) assessments. The primary outcome is cognitive function (NIH Toolbox Fluid Cognition Composite Score). Additional key outcomes include: interoception (heartbeat tracking task, Multidimensional Assessment of Interoceptive Awareness), HF self-care (Self-Care of Heart Failure Index v7.2), and vagal control (high-frequency heart rate variability). IMPLICATIONS:If study hypotheses are confirmed, phone-based MT may be a key tool for improving HF self-care, and possibly clinical outcomes, in HF patients with comorbid cognitive impairment.

PURPOSE:Annual low dose Computed Tomography (CT) scans for lung cancer screening (LCS) among high risk individuals reduce lung cancer mortality.Despite this, LCS is underutilized.Black people who use tobacco have high risk of lung cancer but have been underserved for screening.The current study reports LCS eligibility based on the 2013 and 2021 USPSTF guidelines compared to the PLCO m2012 lung cancer risk calculator and examines lung cancer screening eligibility, referral and uptake among patients by race. METHODS:We invited 3000 patients aged 55-80 with a smoking history (oversampled for Black patients) across two healthcare systems to participate in a survey.The survey assessed lung cancer risk; eligibility, referral and receipt of LCS.RESULTS: 1177 participants completed the survey (45% White, 39% Black; 42% response rate).Of these, 23.6% met USPSTF 2013 criteria and 30.7% met USPSTF 2021 criteria.White patients were more likely than Black patients to be recommended for LCS with USPSTF 2013 but not USPSTF 2021 guidelines.USPSTF 2021 guidelines recommended LCS for more patients including more low risk patients.About a third of patients eligible for LCS reported a doctor recommended screening, compared to 90% of eligible patients receiving a doctor recommendation for colorectal cancer screening.Black patients were less likely to complete lung cancer screening when referred compared to White patients.CONCLUSIONS: New LCS guidelines ameliorated racial disparities (White vs. Black) in eligibility, but screen more low risk individuals.Physician recommendations for LCS but not colorectal cancer screening are far below guidelines.CLINICAL IMPLICATIONS: System changes are needed to improve provider referral for LCS and to assist eligible Black patients in receiving LCS.

BackgroundSuicide and suicidal behavior during adolescence have been steadily increasing over the past two decades. The preponderance of interventions focuses on crisis intervention, underlying psychiatric disorders, regulating negative affect, and reducing cognitive distortions. However, low positive affectivity may be a mechanism that contributes to adolescent suicidal ideation and behaviors independent of other risk factors. Skills to Enhance Positivity (STEP) is an acceptance-based intervention, designed to increase attention to, and awareness of, positive affect and positive experiences. Results from a pilot RCT demonstrated engagement of the target (positive affect) and a decrease in clinical outcomes (suicidal events; i.e., either a suicide attempt or an emergency intervention for an acute suicidal crisis), providing support to test the clinical effectiveness of STEP in a larger clinical trial with clinical staff implementing the intervention.ObjectiveTo test the effectiveness of STEP, compared to Enhanced Treatment as Usual (ETAU), in reducing suicidal events and ideation in adolescents admitted to inpatient psychiatric care due to suicide risk. We hypothesize that those randomized to STEP, compared to ETAU, will have lower rates of suicide events, active suicidal ideation (SI), and depressed mood over the 6-month follow-up period. We hypothesize that those randomized to STEP, compared to ETAU, will demonstrate greater improvement in the hypothesized mechanisms of attention to positive affect stimuli and gratitude and satisfaction with life.MethodsParticipants will be randomized to either STEP or ETAU. STEP consists of four in-person sessions focused on psychoeducation regarding positive and negative affect, mindfulness meditation, gratitude, and savoring. Mood monitoring prompts and skill reminders will be sent via text messaging daily for the first month post-discharge and every other day for the following two months. The ETAU condition will receive text-delivered reminders to use a safety plan provided at discharge from the hospital and healthy habits messages, matched in frequency to the STEP group. This trial was registered on 6 August 2021 (ClinicalTrials.gov NCT04994873).ResultsThe STEP protocol was approved by the National Institute of Mental Health (NIMH) Data and Safety Monitoring Board on March 4, 2022. The RCT is currently in progress.DiscussionThe STEP protocol is an innovative, adjunctive treatment that has the potential to have positive effects on adolescent suicidal ideation and attempts beyond that found for standard treatment alone.

Introduction: Takotsubo syndrome (TS) is an acute, reversible episode of systolic dysfunction, preceded by emotional/physical triggers in 2/3 of cases and no trigger in 1/3 of cases based on retrospective medical record data. Research Question: How do patients with a recent TS episode describe their triggers? Goals: To conduct an in-depth investigation of patient narratives concerning the events that triggered their TS episode. Methods: We conducted semi-structured interviews in patients with a recent (< 1 month) TS episode (Mayo Clinic criteria). We inquired about (1) type of trigger(s), and (2) trigger timing (< or > 48-96 hours before TS episode). Triggers were coded as emotional, psychosocial, and/or behavioral/physical. Recordings were transcribed, coded, summarized, and analyzed by the first and second authors. Results: Over 2/3 of patients (n=30; 97% female, 93% white; age 64 ± 9 yrs old) identified a trigger. Triggers included: a) acute events that occurred <48-96 hours before the TS episode (e.g., death of daughter), b) chronic circumstances that occurred both outside of and within 48-96 hours before the episode (e.g., conflicts with spouse), and c) acute events that occurred >48-96 hours before (e.g., binge drinking). The most prevalent triggers were negative emotions (86%; e.g., stress) and behavioral or physical factors (81%; e.g., atypical exercise/exertion). Nearly all triggers reported (81%) were multi-factorial (e.g., both physical and emotional). Of note, among participants who initially did not identify a trigger, 67% described potential triggering factors during the interview (e.g., increased stress). Conclusions: Consistent with the literature, 2/3 of patients identified a trigger. Yet, in contrast with current evidence, triggers were most often multifactorial (e.g., both emotional and physical) and many were chronic/ongoing. Moreover, for participants who could not identify a trigger, a potential trigger was often identified in the interview. Patients’ narratives around TS triggers are highly complex and likely insufficiently captured in clinical encounters. If these findings are replicated in larger and more diverse samples, they could lead to a re-thinking of the role of triggers in the onset of TS.

Introduction: Takotsubo Syndrome (TS) is often triggered by acute stressful events. While excessive stress reactivity is associated with worse cardiovascular (CV) outcomes, its role and that of possible stress response moderators in TS are poorly understood. Goals/Aims: To explore whether adaptive coping and resilience affect CV reactivity in TS patients. Hypothesis: Negative psychological functioning will be associated with greater CV reactivity. Methods: Prospectively enrolled women with TS (per Mayo criteria) completed coping (Brief-COPE) and resilience (Brief Resilience Scale) measures at enrollment (scores categorized as “high” or “low” using a median split) and a standardized stress reactivity protocol 2 weeks later. Systolic blood pressure (SBP) and diastolic BP (DBP) (mmHg) were measured every 5 min during Baseline (10 min), Mental Stress (10 min), and Recovery (20 min) using an automated BP cuff. SBP and DBP change from baseline to peak stress and 5 min into recovery were compared between low vs. high coping and resilience groups, respectively, using t-test statistics; p < 0.05 was considered significant. Results: Patients (n=29; mean age 64.1 ± 8.8 years) with low (vs high) adaptive coping showed a smaller stress response (SBP: 15.9 ± 22.2 vs. 28.3 ± 19.2, p= 0.13; DBP: 8.1 ± 17.8 vs 21.8 ± 23.4, p= 0.11) and slower recovery (SBP -12.0 ± 7.0 vs -23.5 ± 19.3, p = 0.12; DBP -3.4 ± 17.6 vs -18.5 ± 22.1, p=0.07). Similar, non-significant responses were noted for the low (vs high) resilience group at peak stress (SBP: 18.8 ± 22.9 vs 27.9 ± 18.7, p= 0.28; DBP: 13.0 ± 20.9 vs. 16.9 ± 23.6, p=0.67) and recovery (SBP: -13.4 ± 17.4 vs -24.7 ± 19.3, p= 0.15; DBP: -5.3 ± 18.4 vs -18.3 ± 23.8, p= 0.16, Figure 1). Conclusion: Consistent with recent evidence in other populations, negative psychological functioning was associated with blunted CV reactivity in women with TS. Further investigation in fully powered studies is needed to confirm these novel, exploratory findings and their prognostic value.

Background Mindfulness training (MT) may promote medication adherence in outpatients with heart failure. Objective The aims of this study were to determine the feasibility and acceptability of MT (primary outcomes) and explore effects on medication adherence, functional capacity, cognitive function, depression, and mindfulness skills (secondary outcomes). Methods In this pre/post-design study, participants received a 30-minute phone-delivered MT session weekly for 8 weeks. Results We enrolled 33 outpatients (32% women; 69.7 White; mean age, 60.3 years). Retention was 100%, and session attendance was 91%. Overall, participants (97%) rated MT as enjoyable. Objectively assessed (P < .05) adherence decreased post intervention, whereas improvements were noted in functional capacity (P = .05), mindfulness (P < .05), and cognitive function (reaching significance for Flanker scores). Conclusions Phone-delivered MT was feasible and acceptable. Whereas no improvements were noted in medication adherence and depression, cognitive function, functional capacity, and mindfulness levels increased post intervention, suggesting MT may have beneficial effects in outpatients with heart failure.

Background Mindfulness training (MT) may promote medication adherence in outpatients with heart failure. Objective The aims of this study were to determine the feasibility and acceptability of MT (primary outcomes) and explore effects on medication adherence, functional capacity, cognitive function, depression, and mindfulness skills (secondary outcomes). Methods In this pre/post-design study, participants received a 30-minute phone-delivered MT session weekly for 8 weeks. Results We enrolled 33 outpatients (32% women; 69.7 White; mean age, 60.3 years). Retention was 100%, and session attendance was 91%. Overall, participants (97%) rated MT as enjoyable. Objectively assessed (P < .05) adherence decreased post intervention, whereas improvements were noted in functional capacity (P = .05), mindfulness (P < .05), and cognitive function (reaching significance for Flanker scores). Conclusions Phone-delivered MT was feasible and acceptable. Whereas no improvements were noted in medication adherence and depression, cognitive function, functional capacity, and mindfulness levels increased post intervention, suggesting MT may have beneficial effects in outpatients with heart failure.

Introduction. Takotsubo Syndrome (TS) has been associated with acute stress exposure and excessive activation of the adrenergic nervous system. Less is known about the role of chronic stress and of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of TS. Hair cortisol concentration (HCC) is a novel biomarker of chronic stress and HPA axis activation. Plasma cortisol is incorporated in growing hair (average growth rate = 1 cm/month), reflecting HPA axis activity over the preceding months. In this study we measured HCC in TS patients and explored associations between HCC, trigger status, and psychological characteristics at enrollment. Methods. HCC was measured in a group of patients admitted with a new TS diagnosis based on Mayo Clinic criteria (n=18). Demographics, perceived stress, depression, anxiety, PTSD symptoms, coping skills, and resilience (self-report questionnaires); trigger history (standardized in-person interview); and HCC were collected at the baseline visit. Hair strands were cut near the scalp from a posterior vertex position. HCC was measured in the first 3 cm of hair, which reflects plasma cortisol levels during the previous 3 months. Samples were washed, ground, extracted in HPLC-grade methanol, and quantified (pg/mg) using a high-sensitivity enzyme immunoassay (EIA) kit. Descriptive statistics were used to characterize the sample, and Spearman rho to examine associations. A p value (2-sided) < .05 was considered significant. Results. Participants were 65.6 (SD 9.4) years old, 100% female, 100% white, 10% Hispanic. 52% married/living as married. Median HCC was 6.35 pg/mg (IQR 3.6, 15.2). HCC was significantly higher in patients reporting no triggers vs. those reporting a trigger prior to the TS episode (14.9 vs. 6.8 pg/ml, p=0.03). No associations were found between psychological measures and HCC, except for a non-significant inverse association between HCC and PTSD symptoms (rho=-0.35; p=0.14). Conclusions. This first exploration of HCC levels in patients with a recent TS episode suggests that chronic HPA axis activation likely does not play a role in the pathophysiology of TS. Findings need to be confirmed in a controlled study with a larger and more diverse sample.

Introduction: Cognitive impairment affects up to 2/3 of patients with heart failure (HF) and is an important barrier to HF self-care. Adequate interoceptive awareness (the ability to sense and interpret signals from within the body) is also relevant in this context, in that it allows patients to recognize the worsening of symptoms, receive treatment sooner, and prevent hospital re-admissions. As a secondary analysis from a single arm pilot RCT (NCT03571581), we explored effects of phone-delivered Mindfulness Training (MT) on cognitive function and interoceptive awareness in outpatients with NYHA class I-III HF. Methods: Participants received a weekly, 30-minute phone-delivered MT session for 8 weeks integrated with daily guided individual practice. Assessments of memory, attention, and executive function (NIH Toolbox); interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness/MAIA), and exercise capacity (6-min walk test/6MWT), were conducted at baseline and end of treatment (EOT). Results: We enrolled 33 patients (32% women; 32% minorities; mean age 62 years). Baseline cognitive function was normal. At EOT, we observed improvements in all the cognitive domains considered (Table 1A; p <.05 for the Flanker test) and in MAIA scores (p < .05 - Table 1B). 6MWT distance increased from 349.9 (92.6) to 377.7 (97) meters, p <.05). Conclusions: MT was associated with improvements in cognitive function, interoceptive awareness, and functional status. If confirmed in a large RCT, these findings could pave the way to the integration of MT into rehabilitation programs to improve clinical outcomes in this vulnerable population.

Objectives: This study sought to explore feasibility, acceptability, and preliminary effects of aerobic training (AT), mindfulness training (MT), or both (MT + AT) on cognitive function in older individuals at risk of dementia. Method: Participants were randomized to AT, MT, both, or usual care (UC). Z-scores of attention, verbal fluency, and episodic memory for non-demented adults (ZAVEN) were computed at baseline, end of treatment (EOT), and 6 months since baseline. Results: Of the 36 enrolled participants (12 M, 24 F, mean age = 70.1 years), 97% were retained in the study at 6 months. At EOT, MT had higher ZAVEN scores than UC (b = .43, P =.03) and AT (b = .26, P = .10), while no differences were seen with MT + AT. A similar pattern was observed at a 6 month follow-up (all P values = .10). Discussion: MT may improve cognitive function in older individuals at risk of dementia. These preliminary findings need to be confirmed in a fully powered RCT.

Introduction: Despite increasing evidence that aerobic exercise and cognitive training improve cognitive function among patients with cognitive impairment and dementia, few studies have focused on the effect of a combination of these approaches. This study will explore whether combining aerobic training (AT) with mindfulness training (MT), an intervention promoting the moment-to-moment awareness of physical sensations, affective states, and thoughts, improves cognitive function in individuals at risk of dementia. The primary objective is to determine the feasibility and acceptability of the intervention(s). The secondary objective is to obtain estimates of effect sizes on cognitive function and on possible mediators. Methods and analysis: Forty participants with at least 2 risk factors for dementia will be randomized (2 × 2 factorial design) to either AT (3 sessions/week for 12 weeks), MT (1 session/week for 8 weeks), both, or usual care. Assessments of cognitive function (attention, executive function, episodic, and working memory); physical activity (accelerometry), aerobic capacity (6-minute walk test), waist-to-hip ratio, blood pressure, social support (Multidimensional Scale of Perceived Social Support), depression (Hospital Anxiety and Depression Scale), and mindfulness (Five Facets of Mindfulness) will be conducted at baseline, end of treatment, and 6-months postbaseline. Rates of retention, attendance, and program satisfaction will be calculated for each of the 4 groups to determine the feasibility and acceptability of each intervention. Ethics and dissemination: This study has full ethical approval by The Miriam Hospital Institutional Review Board and adheres to the Standard Protocol Items: Recommendations for Interventional Trials reporting recommendations. If results from this exploratory, proof-of-concept study support our hypotheses, we will conduct a large randomized controlled trial (RCT) to determine the efficacy of combined MT and AT in improving cognitive function in individuals at risk of dementia. Results from the study will be disseminated through peer-reviewed journals and conference presentations. Registration details: http://www.clinicalstrials.gov identifier NCT03289546.

Purpose: The impact of cognitive-behavioral strategies and clinical factors on diet change during cardiac rehabilitation (CR) is not well studied. The purpose of this study was to examine the effects of collaborative goal-setting and clinical predictors on diet scores and weight loss in a case management model of CR. Methods: We retrospectively examined the effects of clinical factors and goal-setting facilitated by case managers on diet scores and weight loss in 629 consecutive patients with atherosclerotic cardiovascular disease enrolled in our CR program between 2014 and 2016. The Rate Your Plate (RYP) diet score was used to measure diet quality at baseline and discharge. Logistic regression modeling was used to identify predictors of diet score change in a subsample with goal-setting data (n = 615). Analysis of variance was conducted in the subset with complete weight data (n = 584) to compare weight loss between those who improved their RYP scores versus those who did not. Results: Participants were 27.9% female, with a mean age of 63.4 ± 11.5 y. The average body mass index at baseline was 30.3 ± 6.8, and 51.7% reported diet change and/or weight loss as a goal. After an average of 33 CR sessions, 27.3% improved their RYP scores by at least 1 risk category (mean score, 54.0 ± 9.0 vs 58.2 ± 7.3, P < .001) and the average weight loss was 1.5 ± 2.9 kg (P < .001). After logistic regression modeling, dietary goal-setting was significantly associated with improvement in diet scores and with greater weight loss (2.2 ± 3.1 kg vs 0.84 ± 2.6 kg, P < .001). Conclusions: A case management model that incorporates dietary goal-setting is associated with improved measures of diet quality and weight loss during CR.

BackgroundMore than 60% of patients decline participation in cardiac rehabilitation after a myocardial infarction. Options to improve physical activity (PA) and other risk factors in these high‐risk individuals are limited. We conducted a phase 2 randomized controlled trial to determine feasibility, safety, acceptability, and estimates of effect of tai chi on PA, fitness, weight, and quality of life. Methods and ResultsPatients with coronary heart disease declining cardiac rehabilitation enrollment were randomized to a “LITE” (2 sessions/week for 12 weeks) or to a “PLUS” (3 sessions/week for 12 weeks, then maintenance classes for 12 additional weeks) condition. PA (accelerometry), weight, and quality of life (Health Survey Short Form) were measured at baseline and 3, 6, and 9 months after baseline; aerobic fitness (stress test) was measured at 3 months. Twenty‐nine participants (13 PLUS and 16 LITE) were enrolled. Retention at 9 months was 90% (LITE) and 88% (PLUS). No serious tai chi–related adverse events occurred. Significant mean between group differences in favor of the PLUS group were observed at 3 and 6 months for moderate‐to‐vigorous PA (100.33 min/week [95% confidence interval, 15.70–184.95 min/week] and 111.62 min/week; [95% confidence interval, 26.17–197.07 min/week], respectively, with a trend toward significance at 9 months), percentage change in weight, and quality of life. No changes in aerobic fitness were observed within and between groups. ConclusionsIn this community sample of patients with coronary heart disease declining enrollment in cardiac rehabilitation, a 6‐month tai chi program was safe and improved PA, weight, and quality of life compared with a 3‐month intervention. Tai chi could be an effective option to improve PA in this high‐risk population. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02165254.