Cardiac resynchronization therapy (CRT) is one of the most common treatments for patients with moderate to severe heart failure, and uses a device to aid the contraction of the heart's ventricles.
- Both cognitive therapy and exercise training helped reduce symptoms of depression in heart failure patients
- Antidepressants do not provide significant relief when compared to placebo or usual care
- Exercise training has been shown to significantly reduce symptoms of depression in patients with heart failure
Heart failure is difficult to manage on its own, and when patients start to feel depressed, the situation only gets harder. That's why physicians are quick to employ treatments that can work in tandem to improve both conditions, and exercise training could be the answer.
Researchers at Massachusetts General Hospital have discovered that exercise can significantly relieve depression in heart failure patients. And because the heart-related benefits of working out are already widely recognized, this form of treatment is especially promising for these patients.
A Deeper Look at Exercise Therapy
Saumya Das, MD, PhD, co-director of the Resynchronization and Advanced Cardiac Therapeutics Program at Mass General, worked with his colleagues to compare three commonly used treatments for depression in heart failure patients: antidepressant drugs, cognitive-behavioral therapy and exercise training.
Although there are no studies comparing these three interventions to each other, the team was able to analyze data from 21 randomized trials involving more than 4,500 patients to determine how effective each therapy was when compared to placebo or standard care. Some standard care practices include medicine to treat cardiac symptoms and educational programs aimed at helping heart failure patients manage their disease.
These trials took place in the United States and more than a half-dozen other countries, including Australia, Sweden and Italy.
Exercise and Improved Well-Being
The research found that both cognitive therapy and exercise training helped reduce symptoms of depression in heart failure patients as compared to placebo or standard care.
Changes to the patients' quality of life were determined through a series of well-known measures of heart health, such as the six-minute walk test, in which participants are tested on how far they can walk in six minutes at a pace that's comfortable for them. The trials showed that heart failure patients saw noted improvements in muscle strength, balance, mental capacity and state of happiness when exercise was used as a form of treatment.
Determining the best treatment route for patients with heart failure and depression is important, the researchers wrote in their study, which was published in the Journal of Psychiatric Research. That's because depression can contribute to poor outcomes in heart patients, including frequent hospitalizations and even death.
A Better Choice for Older Patients
Interestingly, findings showed that there was no difference in relief from depression between patients treated with antidepressants and those who received a placebo or standard care. Dr. Das and his colleagues noted in the study that these drugs didn't provide any significant therapeutic benefit, but by comparison, the benefits provided by both exercise training and cognitive-behavioral therapy were "significant."
That's valuable insight, especially for physicians treating older patients with heart failure. The prevalence of heart failure in people who are 65 and older is higher than in younger populations, and antidepressants can pose risks to older patients. One problem is that geriatric patients are often taking many other medications, which can cause dangerous interactions with some commonly prescribed antidepressants. What's more, antidepressants can trigger cardiac problems such as arrhythmia.
While this study speaks to the power of exercise, the Mass General team noted that more research will need to be done in order to truly compare its benefits with other treatments for depression in heart patients. That said, each physician will ultimately be the best judge of whether or not this treatment is right for their patients."Given the additional beneficial cardiovascular outcomes from exercise, alone or in combination with cognitive therapy," the research team concluded, "[it] appears to be a reasonable intervention to treat depression."
- Aug | 24 | 2016
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