Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure

• Type of Material: Article
• Authors: Rebecca A Gary, Emory University; Sandra B Dunbar, Emory University; Melinda K Higgins, Emory University; Dominique L. Musselman, Emory University; Andrew L Smith, Emory University
• Language: English
• Date: 2010-08-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Crown copyright © 2010 Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpsychores.2010.01.013
• Title of Journal or Parent Work: Journal of Psychosomatic Research
• ISSN: 0022-3999
• Volume: 69
• Issue: 2
• Start Page: 119
• End Page: 131
• Grant/Funding Information: Funding for the study was provided by the Southeast Affiliate of the American Heart Association Beginning Grant-in-Aid, Atlanta Clinical and Translational Science Institute at Emory University School of Medicine.
• Keywords: SYMPTOMS; Heart failure; MORTALITY; 6-MINUTE WALK; Cognitive behavioral therapy; Depression; Home-based exercise; HEALTH-STATUS; Psychiatry; CHRONIC MEDICAL ILLNESS; Life Sciences & Biomedicine; FUNCTIONAL STATUS; NEUROPSYCHIATRIC INTERVIEW MINI; Science & Technology; DISEASE; QUALITY-OF-LIFE; MAJOR DEPRESSIVE DISORDER
• Research Categories: Health Sciences, Public Health; Health Sciences, Rehabilitation and Therapy

Abstract

Objective: The purpose of this study is to compare the effectiveness of a combined 12-week home-based exercise (EX)/cognitive behavioral therapy (CBT) program (n=18) with CBT alone (n=19), EX alone (n=20), and with usual care (UC, n=17) in stable New York Heart Association Class II to III heart failure (HF) patients diagnosed with depression. Methods: Depressive symptom severity [Hamilton Rating Scale for Depression (HAM-D)] , physical function [6-min walk test (6MWT)], and health-related quality of life (HRQOL) (Minnesota Living with Heart Failure Questionnaire) were evaluated at baseline (T1), after the 12-week intervention/control (T2), and following a 3-month telephone follow-up (T3). A repeated measures analysis of variance was used to determine group differences. Depression severity was dichotomized as minor (HAM-D, 11-14) and moderate-to-major depression (HAM-D, ≥15), and group intervention and control responses were also evaluated on that basis. Results: The greatest reduction in HAM-D scores over time occurred in the EX/CBT group (-10.4) followed by CBT (-9.6), EX (-7.3), and UC (-6.2), but none were statistically significant. The combined group showed a significant increase in 6-min walk distance at 24 weeks (F=13.5, P < 001). Among all groups with moderate-to-major depression, only those in CBT/EX had sustained lower HAM-D scores at 12 and 24 weeks, 6MWT distances were significantly greater at 12 (P=018) and 24 (P=013) weeks, and the greatest improvement in HRQOL also occurred. Conclusions: Interventions designed to improve both physical and psychological symptoms may provide the best method for optimizing functioning and enhancing HRQOL in patients with HF.