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01 August 2012

Exercise may ease depression in heart failure

People with heart failure who are also depressed may benefit from regular, moderate exercise.

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People with heart failure who are also depressed may benefit from regular, moderate exercise, a new study suggests.

Patients who exercised an hour and a half to two hours per week had slightly lower depression scores, which in turn were tied to a reduced risk of re-hospitalisations and deaths related to heart problems. Still, the effects of exercise were modest, researchers said.

"We know that in people who have existing heart disease, including heart failure, that if they have depression on top of it, it tends to make matters worse," said Dr Kenneth Freedland, a psychiatrist from Washington University School of Medicine in St. Louis who wasn't involved in the new study.

"Exercise seems to be helpful but by itself, it's probably not a sufficient treatment for clinical depression in somebody with heart failure," he said. Still, Dr Freeland added, "anything that can make a dent in (depression) is a good thing."

Effects of exercise in heart failure patients

The new findings are based on a secondary analysis of data from the HF-ACTION study, which looked at the effects of exercise in patients with heart failure.

In 2003 through 2007, researchers randomly assigned 2 300 people with heart failure to an exercise program or to their usual treatment. Participants in the exercise group had three supervised 30-minute workout sessions per week for three months, then were given a treadmill or stationary bike to continue exercising at home for another nine months.

About 28% of the patients were clinically depressed at the start of the study, based on a questionnaire covering 21 different symptoms.

Depression scores in general - and especially in people with a depression diagnosis - tended to drop with exercise. But the disparity between exercisers and non-exercisers was small, equal to participants scoring similarly on 20 out of 21 symptoms and exercisers getting a "mild" score on one symptom where the usual care group got a "moderate" or "severe" score.

"Most of the patients were not depressed," said lead researcher Dr James Blumenthal, a clinical psychologist at Duke University Medical Centre in Durham. "To go from being not depressed to a little bit more not depressed may not be that clinically meaningful."

Over an average of two and a half years, close to 1 200 study participants were hospitalised and 386 died. Exercise was tied to a lower risk of both hospitalisation and death, according to findings published Tuesday in the Journal of the American Medical Association.

In addition, people who got less depressed during the study were less likely to have heart problems, whereas those who had worsening depression symptoms also did worse heart-wise.

"We don't know if worsening depression is a cause of worsening heart failure or a consequence of worsening heart failure," Dr Blumenthal said.

Both could be true, according to Dr Freedland.

"Depression has a lot of bad effects for people with heart disease and of course having heart disease can cause a lot of stress and distress. It's kind of a vicious circle," he said.

(Reuters Health, August 2012)

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