The benefits of physical exercise are well documented. Exercise can help improve sleep, increase cardiovascular endurance, and boost the immune system. In addition, exercise helps to prevent diseases such as heart disease, obesity, type 2 diabetes, high blood pressure, and can even help to lower high cholesterol levels. Regular exercise has even been shown to improve self esteem and help prevent and even treat depression and anxiety. Patients with heart disease and heart failure have higher rates of depression, and this can decrease compliance with medication and treatment recommendations. As a result, depression in heart disease and heart failure patients can worsen prognosis and outcome. We have previously discussed the increased risk of developing post traumatic stress disorder after a heart attack.
Researchers, lead by Dr. James Blumenthal of Duke University Medial Center, have shown that regular physical exercise decreases depression symptoms in patients with chronic heart failure. The results of their study were published online in the Journal of the American Medical Association. The investigators used a randomized controlled multicenter trial to study the effect of exercise training on depressive symptoms in 2,322 chronic stable heart failure patients. Study participants had a left ventricular ejection fraction of 35% or less, and were randomized to receive usual cardiac care or usual cardiac care plus participate in a supervised aerobic exercise program. Depression symptoms were monitored using the Beck Depression Inventory II score at the third and the twelfth month of treatment. Study participants who exercised had a modest but statistically significant reduction in depression symptoms.
The authors wrote, “The results of this HF-ACTION ancillary study confirm and extend previous research by demonstrating that exercise training may be effective in reducing depressive symptoms and by further documenting the prognostic significance of depression in patients with heart failure. Although previous studies have reported that exercise is associated with reduced symptoms of depression in patients with clinical depression, to our knowledge, this is the first randomized trial to show that exercise resulted in a small but statistically significant reduction in depressive symptoms in patients with heart failure”.
Heart disease and heart failure has been known to be associated with depression. Patients with heart failure that develop depressive symptoms have been shown to be less compliant with medication and treatment recommendations. This can have an adverse effect on the long term outcomes and natural course of the disease. This study suggests that an aerobic exercise program can improve depressive symptoms in heart failure patient, which may translate into improved clinical prognosis and alter the end result of treatment. In addition, this study highlights the role that depression plays in the clinical course of heart failure patients. Depression screening should be performed for all heart failure patients, in order to identify those that will need additional treatment. For those heart failure patients in whom exercise is not contraindicated, we should recommend a regular aerobic exercise program to decrease depressive symptoms and improve outcomes.
James A. Blumenthal et al. “Effects of Exercise Training on Depressive Symptoms in Patients With Chronic Heart Failure: The HF-ACTION randomized trial” JAMA. 2012;308(5):465-474. doi:10.1001/jama.2012.8720