Exercise improved depression scores in patients with CHD

Increased physical activity appeared to decrease depressive symptoms in clinically depressed patients with CHD, new data from the UPBEAT study indicate.

Clinical depression is common in patients with CHD, according to researchers for the Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy (UPBEAT) study, with an estimated 15% to 20% of cardiac patients meeting criteria for major depressive disorder.

“There is now good reason to believe that exercise may be a viable alternative to traditional mental health interventions in cardiac patients,” they wrote in the Journal of the American College of Cardiology. “An increasing number of studies have shown that exercise may reduce depressive symptoms in patients with [major depressive disorder] and that exercise may be comparable with established psychological or pharmacological therapies.”

Value of exercise

The researchers randomly assigned 101 participants with CHD and elevated depressive symptoms to 4 months of aerobic exercise performed three times per week, 50 mg to 200 mg of sertraline (Zoloft, Pfizer) daily or placebo.

When compared with the placebo group, participants in the exercise and sertraline groups demonstrated considerable improvement in depressive symptoms after 16 weeks. Whereas the placebo group experienced a mean –4.5 reduction in Hamilton Rating Scale for Depression scores, the exercise and sertraline groups experienced mean reductions of –7.5 and –6.1, respectively. Analysis also indicated that exercise and sertraline were comparable in their effect on decreasing depressive symptoms.

Additionally, exercise may confer other benefits in this patient population. The researchers examined CV biomarkers, including heart rate variability, endothelial function, baroreflex sensitivity, inflammation and platelet function. They found that exercise and medication generally yielded greater decreases in heart rate variability, as compared with placebo, and exercise resulted in greater reductions in heart rate variability when compared with sertraline.

“Although further research in larger samples is warranted, these findings provide preliminary evidence that cardiac patients with elevated depressive symptoms are likely to benefit from the antidepressant effects of exercise in addition to the well-documented cardiopulmonary benefits,” the researchers wrote.

Practical application

In an accompanying editorial, Alan Rozanski, MD, of St. Luke’s and Roosevelt Hospitals in New York, discussed the “bidirectional” relationship between depression and CVD and what the findings from UPBEAT may mean for clinical practice.

“The findings of Blumenthal et al raise a practical question. Overall, current American society is highly sedentary and depressed patients even more so,” he wrote. “Comorbid depression and cardiac disease make exercise instruction and maintenance more complex. Although some depressed patients may simply respond to their physician instructions concerning exercise, many will require more assistance than practicing doctors can provide in constrained medical practice.”

Rozanski said these study results may lead to exercise programs that incorporate self-monitoring, peer-based and professional social support, and home-based or group-based exercise.

“The clinical reasons for developing such exercise programs are already compelling, but by demonstrating the efficacy of exercise vs. antidepressant medication for reducing depressive symptoms, Blumenthal et al have now provided an important additional incentive for developing practical exercise programs for medical patients.”

For more information:

Blumenthal JA. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.04.040.

Rozanski A. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.05.015.

Disclosure: See the study for a full list of disclosures. Dr. Rozanski reports no relevant financial disclosures.