Aerobic exercise training reduced the composite of death or hospitalization compared with usual care (66% vs 68%; HR 0.89; 95% CI 0.81-0.99; P=0.03) and modestly improved depressive symptoms.
RCT (n=2,322)
1:1
Yes
Does aerobic exercise training improve depressive symptoms and reduce death or hospitalization in stable patients with chronic heart failure compared with usual care?
Aerobic exercise training provides a modest but statistically significant reduction in depressive symptoms and a slight reduction in all-cause death or hospitalization in patients with stable heart failure.
Effect estimate: HR 0.89 (95% CI 0.81 to 0.99)
Absolute Event Rate: 66% vs 68%
p-value: p=.03
CONTEXT: Depression is common in patients with cardiac disease, especially in patients with heart failure, and is associated with increased risk of adverse health outcomes. Some evidence suggests that aerobic exercise may reduce depressive symptoms, but to our knowledge the effects of exercise on depression in patients with heart failure have not been evaluated. OBJECTIVE: To determine whether exercise training will result in greater improvements in depressive symptoms compared with usual care among patients with heart failure. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized controlled trial involving 2322 stable patients treated for heart failure at 82 medical clinical centers in the United States, Canada, and France. Patients who had a left ventricular ejection fraction of 35% or lower, had New York Heart Association class I to IV heart failure, and had completed the Beck Depression Inventory II (BDI-II) score were randomized (1:1) between April 2003 and February 2007. Depressive scores ranged from 0 to 59; scores of 14 or higher are considered clinically significant. INTERVENTIONS: Participants were randomized either to supervised aerobic exercise (goal of 90 min/wk for months 1-3 followed by home exercise with a goal of ≥120 min/wk for months 4-12) or to education and usual guideline-based heart failure care. MAIN OUTCOME MEASURES: Composite of death or hospitalization due to any cause and scores on the BDI-II at months 3 and 12. RESULTS: Over a median follow-up period of 30 months, 789 patients (68%) died or were hospitalized in the usual care group compared with 759 (66%) in the aerobic exercise group (hazard ratio HR, 0.89; 95% CI, 0.81 to 0.99; P = .03). The median BDI-II score at study entry was 8, with 28% of the sample having BDI-II scores of 14 or higher. Compared with usual care, aerobic exercise resulted in lower mean BDI-II scores at 3 months (aerobic exercise, 8.95; 95% CI, 8.61 to 9.29 vs usual care, 9.70; 95% CI, 9.34 to 10.06; difference, -0.76; 95% CI,-1.22 to -0.29; P = .002) and at 12 months (aerobic exercise, 8.86; 95% CI, 8.67 to 9.24 vs usual care, 9.54; 95% CI, 9.15 to 9.92; difference, -0.68; 95% CI, -1.20 to -0.16; P = .01). CONCLUSIONS: Compared with guideline-based usual care, exercise training resulted in a modest reduction in depressive symptoms, although the clinical significance of this improvement is unknown. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00047437.
Blumenthal et al. (2012) conducted an RCT in Chronic Heart Failure (n=2,322). Aerobic exercise vs. Education and usual guideline-based heart failure care was evaluated on Composite of death or hospitalization due to any cause (HR 0.89, 95% CI 0.81 to 0.99, p=.03). Aerobic exercise training reduced the composite of death or hospitalization compared with usual care (66% vs 68%; HR 0.89; 95% CI 0.81-0.99; P=0.03) and modestly improved depressive symptoms.