Effects of a behavioral psychological intervention in addition to an exercise rehabilitation program in chronic heart failure patients

Introduction Patients with chronic heart failure (CHF) have an increased risk of presenting symptoms of stress and depression compared to the general population. For this reason, mental health components have been integrated into exercise rehabilitation programs. The effectiveness of behavioral interventions has not been evaluated in this clinical population. Purpose The aim of this study was to investigate the impact of a behavioral phycological intervention on stress, depression, and life satisfaction in CHF patients. Method Thirty-six consecutive stable CHF patients on optimal medication (age: 56±10 years, EF<50%) were randomly allocated to the intervention group (IG, n=18) or the control group (CG, n=18). All the patients participated in a combined exercise rehabilitation program (aerobic exercise and strength training) of 36 sessions (3×/week, 12 weeks). The IG team was additionally given information and emotional support (12 sessions) through psychoeducation, stress management techniques and positive reinforcement of self-care behaviors. Depression, stress and life satisfaction rate were assessed with self-report scales, and aerobic capacity with cardiopulmonary exercise test before and after the intervention. Values are expressed as mean and standard deviation. Results In the whole cohort, VO2peak was improved after the program (from 19.4±3.9 to 22.0±6.5 ml/kg/min, p=0.04). Depression rate was reduced in the IG (from 3.4±4.0 to 1.6±2.4, p<0.01) but not the CG (from 3.6±3.4 to 4.0±3.7, p=0.32). Stress rate was reduced (p<0.01) in both IG (from 14.3±8.6 to 9.1±7.4) and CG (from 13.2±9.8 to 8.6±5.9). Finally, life satisfaction was increased in the IG (from 23.8±5.2 to 30.8±3.5, p<0.01), while decreased in the CG (from 26.0±6.9 to 20.2±6.5, p<0.01]. Significant between-group differences were observed in the depression rate and life satisfaction (p<0.01). Conclusion Behavioral and emotional support, with psychoeducation, stress management techniques and positive reinforcement, in addition to an exercise rehabilitation program, can have a positive impact in reducing depression symptoms and boosting the mental status of CHF patients. Further research is necessary to explore the effects of different behavioral and psychological techniques.