By Andrew Czyzewski
Structured exercise achieves modest reductions in depressive symptoms relative to usual care among patients with heart failure, the results of a randomized-controlled trial show.
Although the clinical significance of this small benefit is not known, the researchers point out that it was consistent over a year and unlikely to be due to daily fluctuations.
"Clinical depression is a common comorbidity, affecting as many as 40% of patients with heart failure, and is associated with worse clinical outcomes in a variety of cardiac patient populations," James Blumenthal (Duke University Medical Center, Durham, North Carolina) and colleagues comment in JAMA.
Noting that selective serotonin reuptake inhibitors (SSRIs) have not shown any benefit in heart disease patients with depression, the team set out to investigate the potential role of aerobic exercise.
The HF-ACTION trial included 2322 stable patients who were treated for heart failure at 82 medical centers in the USA, Canada, and France.
Patients were randomized on a 1:1 basis to either supervised aerobic exercise with a goal of 90 min/week for months 1-3, followed by home exercise with a goal of 120 min/wk or more for months 4-12, or to education and usual guideline-based heart failure care.
Depression was assessed at the start of the study and at 3 and 12 months' follow-up using the Beck Depression Inventory (BDI)-II, where scores ranged from 0 to 59 and 14 or higher was taken as clinically significant.
Blumenthal et al found that the median BDI-II score at study entry was 8 and 28% of the sample had BDI-II scores of 14 or higher.
After 3 months, patients in the aerobic-exercise group achieved a mean BDI-II score of 8.95, significantly lower than their peers in the usual-care group at 9.70. A similar pattern was found at 12 months, with respective scores of 8.86 versus 9.54.
In a subset of patients with clinically significant depressive symptoms, BDI-II scores at 3 months were 16.66 versus 17.98 in the aerobic-exercise versus the usual-care group, and at 12 months were 15.85 and 17.34, respectively.
The number of self-reported minutes of exercise per week at month 3 was inversely related to depressive symptoms.
Blumenthal et al say that, although small, "the difference is robust and does not simply reflect daily fluctuations in symptoms but is likely to be associated with better social functioning and higher quality of life."
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