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Randomized Controlled Trial
. 2010 Aug;69(2):119-31.
doi: 10.1016/j.jpsychores.2010.01.013. Epub 2010 Mar 12.

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

Rebecca A Gary  1 , Sandra B Dunbar, Melinda K Higgins, Dominique L Musselman, Andrew L Smith
Affiliations
Randomized Controlled Trial

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

Rebecca A Gary et al. J Psychosom Res. 2010 Aug.

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.

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Figures

Fig. 1
Fig. 1
Consort flowchart.
Fig. 2
Fig. 2
HAM-D responses for minor and moderate-to-major depression by group.
Fig. 3
Fig. 3
HAM-D scores across all groups for minor depression.
Fig. 4
Fig. 4
HAM-D across all groups for moderate-to-major depression levels.
Fig. 5
Fig. 5
6MWT for all groups for minor and moderate-to-major depression.
Fig. 6
Fig. 6
Baseline HRQOL scores at BL, 12 and 24 weeks for HAM >15.
See this image and copyright information in PMC

References

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