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21-12-2010 | Cardiology | Article

Exercise improves HF survival by reducing depression

Abstract

Free abstract

MedWire News: Structured exercise training (ET) may reduce long-term mortality risk among heart failure (HF) patients by alleviating depressive symptoms, US researchers report.

"Clinically unrecognized depressive symptoms are prevalent in the HF population, particularly in patients after major coronary heart disease (CHD) events, and their presence, regardless of age or gender, confers a marked increase in all-cause mortality risk over time," explain Richard Milani from The University of Queensland School of Medicine in New Orleans, Louisiana, and team.

"ET offers a mechanism of improving survival in patients with HF, primarily by decreasing the adverse consequences of depression," they add.

The researchers recruited 189 patients with a mean age of 65 years and HF (mean left ejection fraction <45%) secondary to CHD. All patients were assessed for the presence of depressive symptoms at baseline and after a mean follow-up period of 4.6 years, using the Kellner Symptom Questionnaire - a 92-question assessment designed to identify symptoms of depression, anxiety, somatization, and hostility.

In all, 151 patients underwent ET over the follow-up period and 33 (22%) of these patients had depressive symptoms at baseline.

As reported in the American Journal of Cardiology, Milani et al observed a decrease in the rate of depressive symptoms from 22% before ET to 13% after (p<0.0001).

In addition, depressed patients with symptoms unaffected by ET had a higher mortality rate than those with depressive symptoms that improved after ET, at 43% and 11%, respectively (p=0.005).

Milani and colleagues also noted a higher mortality rate of 44% among the 38 patients who did not undergo ET despite reporting depressive symptoms at baseline, compared with the mortality rate of 18% among depressed patients who underwent ET, (p<0.05).

Of note, depressed patients who experienced an increase in peak oxygen uptake after ET had a 61% lower mortality rate than those with no improvement in exercise capacity after ET (p=0.006).

This, say the researchers demonstrates that "patients with HF who improve aerobic capacity, even modestly, have a survival benefit over those whose exercise capacity does not improve."

Milani and team conclude: "Our findings in the present investigation mirror the findings observed in the broader CHD population.

"We confirm that depression carries an adverse prognosis in patients with HF and establish that ET is an effective method for decreasing depressive symptoms in these patients."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lauretta Ihonor

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