Combination of Exercise and CBT Improves Outcomes in
Depressed Patients with Heart Failure
A recent study appearing in the Journal of Psychosomatic Research aimed to examine the effectiveness of exercise combined with Cognitive Behavioral Therapy (CBT) as a treatment for heart failure. Participants were divided into four groups: 18 patients were assigned to complete a 12-week home-based exercise program in addition to 12 weeks of CBT, 19 patients were assigned to complete 12 weeks of CBT alone, 20 patients were assigned to complete only a 12-week home-based exercise program, and 17 patients were assigned to receive usual care. All of the participants were stable New York Heart Association Class II (mild) to III (moderate) heart failure patients that had been diagnosed with depression. Patients with Class II heart failure experience fatigue, palpitations or dyspnea when undergoing ordinary physical activity. Patients with Class III heart failure experience those same symptoms when undergoing less than ordinary physical activity.
The patients were evaluated before treatment, after 12 weeks of treatment, and 3 months after the end of treatment. To evaluate the participants, the researchers used the Hamilton Rating Scale for Depression (HAM-D) to determine depressive symptom severity, a 6-minute walk test (6MWT) to determine physical function, and the Minnesota Living with Heart Failure Questionnaire to determine health-related quality of life (HRQOL).
The combination group showed the greatest decrease in HAM-D scores (-10.4), while the usual care group showed the least decrease (-6.2), though none of the groups showed a statistically significant decrease. The combination group also showed a large improvement in the 6MWT at the three-month follow-up. Within the cross-section of moderately-to-severely depressed participants across all groups, only those in the combination group sustained lower HAM-D scores, showed significant improvement in the 6MWT, and showed the greatest increase in HRQOL.