August 1, 2012
Heart Failure Patients’ Mental And Physical Health Improve With Exercise
Lawrence LeBlond for redOrbit.com - Your Universe Online
Exercise in patients who have recently suffered chronic heart failure has been shown to reduce symptoms of depression, as well as a significant reduction in deaths and hospitalizations, according to an international study published in the August 1st issue of the Journal of the American Medical Association (JAMA).
The study, led by researchers at Duke University Medical Center, adds insight to the complex relationship between mental and physical health, and the role exercise plays in improving both.
James A. Blumenthal, PhD, professor of psychiatry and behavioral sciences at Duke and lead author of the study, said it is unknown which 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 cardio-vascular health,” he noted.
Background information included in the study states that as many as 40 percent of the 5 million people suffering from heart failure may also be affected by clinical depression. Recent studies have linked depression with worse clinical outcomes for patients with myocardial infarction, unstable angina, coronary bypass and heart failure.
“Some evidence suggests that aerobic exercise may reduce depressive symptoms, but to our knowledge the effects of exercise on depression in patients with heart failure have not been evaluated,” the authors wrote.
To investigate, Blumenthal and colleagues set out to determine whether exercise would reduce depressive symptoms and improve the clinical outcomes of patients with heart failure.
Funded by 13 grants from the National Heart, Lung and Blood Institute, the researchers enrolled 2,322 patients at 82 medical centers across the US, Canada and France. The researchers first measured depressive symptoms of the participants via the Beck Depression Inventory II (BDI-II) questionnaire. Depressive scores ranged from 0 to 59. The median score at study entry was 8; 28 percent of the sample had scores of 14 or higher, which were considered clinically significant.
Patients were then randomly assigned to receive usual care (necessary medications and a recommendation to exercise) or 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.
Patients who participated in treadmill or stationary bike workouts showed greater improvement of their cardio-pulmonary function than patients who received usual care. Though the improvements accrued at three and 12 months out were small, they were significant, the authors wrote.
Depression scores were also better for the exercise group compared to the standard care group. Cardiac patients in the exercise group saw their average depression scores drop by 1.75 points in the first three months, while patients in the usual care group dropped about 1 point. Similar results were found in the 12-month assessment.
The researchers also found that exercise made a small but significant difference in the risk of hospitalizations and death over the follow-up period of the study (about 2.5 years). Sixty-six percent of those in the exercise group died or were hospitalized during the follow-up period, compared to 68 percent in the usual care group.
“This study shows that exercise is associated not only with physical health benefits, but important mental health benefits as well,” Blumenthal said.
Besides the Duke team, researchers in the study also hailed from Henry Ford Hospital in Detroit; Hackensack University Medical Center in Hackensack, New Jersey; Queen Elizabeth II Health Sciences Center in Halifax, Canada; University of Maryland, Baltimore; Cleveland Clinic Foundation, Cleveland, Ohio; and University of Louisville, Louisville, Kentucky.