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Exercise and Counseling May Benefit Heart Failure Patients With Depression 

Aerobic exercise and cognitive behavioral therapy may reduce depressive symptoms, improve physical functioning and enhance quality of life in heart failure patients with depression.  Researchers reported these findings at the American Heart Association's Ninth Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke. 

In this recent research, heart failure patients with depression were divided into four groups: one group received a 12 week, home-based program of exercise and psychological counseling; a second group received psychological counseling alone; a third received exercise alone; and a fourth received the usual care. 

Rebecca Gary, Ph.D., assistant professor in the School of Nursing at Emory University in Atlanta, Georgia, and lead author of the study reported, "By combining exercise with psychological counseling, these depressed patients do better in all parameters compared to the other groups."  She also stated "This may be the best method for improving their depression, symptom severity, and quality of life." 

 

This randomized controlled pilot study consisted of participants with an average age of 66.  The majority were Caucasian and 57% were women.  The study participants were all diagnosed with clinical depression as determined by the DSM-IV criteria as well as the Hamilton Rating Scale for Depression. 

All of the participants were either New York Heart Association class II or class III heart failure patients.  Individuals in the class II category had a slight limitation of physical activity.  While being comfortable at rest, ordinary physical activity resulted in fatigue, palpitation, angina and dyspnea.  Individuals in the class III category had significant limitations of physical activity.  Activity that was less than ordinary seemed to cause fatigue, dyspnea, angina and palpitations.  Dr. Gary reported "What makes this study different from other studies of exercise in heart failure patients is that all these patients were clinically depressed." 

All four groups were assessed at four different time intervals including baseline, after the 12-week intervention program, after a follow-up period of three months and a telephone follow-up at six months. 

The exercise aspect of the study included a 12-week progressive program, with low to moderate exercise intensity which included walking outdoors.  They were asked to walk three times per week for a minimum of 30 minutes.  Individuals in the combined program or exercise-only program were given heart rate monitors and were taught how to self- monitor their exertion level, as well as when to stop exercising.  All individuals despite their initial symptoms, and although some were quite debilitated were able to achieve their goals.  A six minute walking test was administered at each of the time intervals.  Dr. Gary said "The cognitive behavioral therapy was geared toward changing the attitude of the patients about their illness." She stated "We wanted them to change their negative thoughts and beliefs and restructure and reformat how they think about their illness and limitations.  For example, we developed a volunteer and activities sign-up sheet in each community that provided transportation for those who wanted to get out of the home or contribute in some way." 

The cognitive therapy component was conducted, one-on-one in participantís homes, once a week, for 12 weeks by Ph.D. students trained in counseling techniques and psychiatric nurse specialists.  Patients in the combined exercise and behavioral therapy group improved significantly better in the six minute walk test than did the other groups.  The combined group was able to lower their depression symptoms by 10 points over the usual care group.  A 50% decrease in scores or more or HAM-D score of less than 8 indicates that depressive symptoms are in remission.  Depressive symptoms were also reduced in the counseling only group although they perceived their quality of life to be worse than the combined group or exercise group.  The combined group of participants lowered depression symptoms by 10 points over the usual care group. 

Information adapted from article (May 8, 2008) at ScienceDaily: 

American Heart Association (2008, May 2). Exercise Plus Psychological Counseling May Benefit Depressed Heart Failure Patients. ScienceDaily. Retrieved May 8, 2008, from http://www.sciencedaily.com≠ /releases/2008/05/080502171622.htm

Additional Information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist)

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