According to a new international study led by Duke University researcher’s find patients who recently suffered chronic heart failure can find relief from symptoms of depression through regular moderate exercise.View slideshow: Exercise
According to the researchers depression is common in patients with in cardiac disease especially in those with heart failure and it is linked to an increased risk for adverse health outcomes. Researchers note there is some evidence that suggests aerobic exercise may reduce symptoms of depression, “but to our knowledge the effects of exercise on depression in patients with heart failure have not been evaluated.”
The researchers set out to determine if exercise training results in greater improvements in symptoms of depression compared to usual care for heart failure patients.
Dr. James A. Blumenthal, PhD, professor of psychiatry and behavioral sciences at Duke and lead author of the study, stated “We do not know what comes first – heart disease or depression – but we do know the two are often related, and if depression gets worse, people have worse outcomes.” "Exercise has been shown to be safe for people with heart disease, and it also improves depression. These data show the combined benefits of exercise for this population include improved mental health and improved cardiovascular health."
Information in the study notes that clinical depression may affect as many as 40% of the 5 million people in the United States with heart failure. Recent studies have linked depression with worse clinical outcomes for patients with myocardial infarction, unstable angina, coronary bypass surgery and heart failure.
This randomized control trial as part of the HF-ACTION trial sponsored by the National Heart, Lung and Blood Institute, involved 2,322 stable patients treated for heart failure at 82 medical centers in the United States, Canada and France. Measurement for depressive symptoms were taken first using the Beck Depression Inventory ll. Scores were randomized between April 2003 and February 2007. Depressive scores ranged from 0 to 59 with a score of 14 or higher considered clinically significant.
Patients were randomized to either receive education and usual guideline-based care (medications and recommended exercise) or the usual care plus a supervised exercise regimen three times a week for 30 minutes. After three months, the exercise group transitioned to exercising at home for another nine months without supervision.
All patients underwent an initial physical stress test and filled out a questionnaire that measured depressive symptoms such as feelings of sadness, irritability, hopelessness and disturbed sleep. The tests were repeated every three months for the first year. Patients were asked to make quarterly follow-up clinic visits for the second year of the study, and then annual visits through year four of the trial.
Patients who participated on in treadmill or stationary bike workouts had greater improvement in their cardiopulmonary function in comparison to patients who received usual care. Even though the improvements seen at three and twelve months were small the authors wrote the improvements were significant.
Depression scores were better than the usual care group with scores dropping on average by 1.75 points for the exercise group in the first three months while the usual care group saw a drop of only one point. In the twelve month assessment results had been similar.
Also revealed in the study exercise had made a small but notable difference in the risk of hospitalizations and death over the study’s follow-up period with an average of 2.52 years. Among those in the exercise group 60% had died or were hospitalized over the follow-up period in comparison to those in the usual care group at 68% of death or hospitalizations.
Dr. Blumenthal stated "This study shows that exercise is associated not only with physical health benefits, but important mental health benefits as well.” It doesn't require intensive training for a marathon to derive benefits. We're talking about three, 30-minute sessions for an accumulated 90 minutes a week. And the results are significant improvements in mental health, reduced hospitalizations and fewer deaths.”
When it comes to exercise depression in heart patients Tai Chi just may be one of those exercises.
In April 2011, Beth Israel Deaconess Medical Center in Boston, found that tai chi not only improves the mood of patients who are living with chronic heart failure, but also encourages them to be more active.
More information on exercise and activity guidelines for patients with heart failure can be viewed at the Cleveland Clinic online.