Up to 40% of people with heart failure grapple with depression. The combination often leads to poor health outcomes. One study found seriously depressed people with heart failure were more than twice as likely to die or be hospitalized over the course of a year compared to other people with heart failure who weren't depressed.
"Whenever patients are more depressed, their motivation goes down. Their ability to keep up with their doctors' recommendations goes down. Their ability to get out and do basic physical activities like walking goes down," as does their health, says David A. Friedman, MD, chief of Heart Failure Services at North Shore-LIJ Plainview Hospital in New York. "It's a vicious cycle."
"This [study] ... shows a non-drug way to try to improve patients' mood and motivation. That's the best thing you can do," says Friedman, who was not involved in the research.
Testing Exercise for Depression
For the study, which is published in the Journal of the American Medical Association, researchers assigned more than 2,322 stable heart failure patients to a program of regular aerobic exercise or usual care. Usual care consisted of information on disease management and general advice to exercise.
The exercise group started with a standard exercise prescription for patients in cardiac rehab: three 30-minute sessions on either a treadmill or stationary bike each week. After three months, they moved to unsupervised workouts at home. At home, their goal was to get 120 minutes of activity a week.
Just as happens in the real world, most exercisers fell short of their weekly goals.
Despite the fact that they weren't as active as they were supposed to be, they still had slightly better scores on a 63-point depression test than the group assigned to usual care. There was a little less than a one-point difference between the two groups. But the differences persisted even after a year, leading researchers to think the result wasn't a fluke.
And the exercisers were about 15% less likely to die or be hospitalized for heart failure compared with the group getting usual care.
Researchers think the differences between the two groups were small because most people in the study weren't depressed to begin with. Only 28% had test scores high enough to indicate clinical depression.
But the more depressed a person was, the more they had to gain from regular exercise. After a year, test scores of depressed patients were about 1.5 points better in the exercise group compared to those assigned to usual care.
"We know that exercise is beneficial in terms of improving cardiovascular fitness. Now we know depression is also reduced in these patients," says researcher James A. Blumenthal, PhD, a professor of psychology and neuroscience at Duke University in Durham, N.C.
"For people who were more depressed, they experienced a greater reduction in their depressive symptoms with exercise," he says.