Exercise and Counseling May
Benefit Heart Failure Patients With Depression
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
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≠
Additional Information and
Psychologist Ph.D. Candidate
(Health and Geriatric Psychologist)
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