Key result
Aerobic exercise and sertraline reduce depressive symptoms more than placebo in CHD patients.
Why the study?
Clinical depression is associated with poor prognosis in patients with CHD, but optimal therapeutic strategies remain not well-defined.
Does aerobic exercise or sertraline reduce depressive symptoms in outpatients with coronary heart disease?
RCT (n=101)
randomized
Does aerobic exercise or sertraline reduce depressive symptoms in outpatients with coronary heart disease?
Absolute Event Rate: -7.5% vs -4.5%
p-value: p=0.034
In patients with coronary heart disease and elevated depressive symptoms, both aerobic exercise and sertraline significantly reduced depressive symptoms compared to placebo.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These results are the first from a randomized clinical trial to show that exercise reduces depressive symptoms in stable CHD, which is particularly important in light of the growing evidence that depression is associated with increased risk for fatal and nonfatal events in a wide range of CHD populations.”
“Our study indicates that exercise is likely to be the best treatment for depression following coronary artery disease. Our findings further highlight the clinical importance of exercise as a treatment as we see that it improves not only depression, but also other important aspects of heart disease, such as lowering blood pressure and cholesterol, in these patients.”
May support exercise or sertraline for depression in CHD patients; leaves open optimal strategies and cardiovascular outcomes.
OBJECTIVE To assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease (CHD). BACKGROUND Although there is good evidence that clinical depression is associated with poor prognosis, optimal therapeutic strategies are currently not well-defined. METHODS 101 outpatients with CHD and elevated depressive symptoms underwent assessment of depression including a psychiatric interview and the Hamilton Rating Scale for Depression (HAM-D). Participants were randomized to 4 months of aerobic exercise (3 times/week), sertraline (50-200 mg/day), or placebo. Additional assessments of cardiovascular biomarkers included measures of heart rate variability (HRV), endothelial function, baroreflex sensitivity, inflammation, and platelet function. RESULTS After 16 weeks, all groups showed improvement on HAM-D scores. Participants in both aerobic exercise (M= −7.5 [95% CI = −9.8, −5.0]) and sertraline (M= −6.1 [95% CI = −8.4, −3.9] achieved larger reductions in depressive symptoms compared to placebo (M= −4.5 [95% CI = −7.6, −1.5]; p = .034); exercise and sertraline were equally effective in reducing depressive symptoms (p = .607). Exercise and medication tended to result in greater improvements in HRV compared to placebo (p = .052); exercise tended to result in greater improvements in HRV compared to sertraline (p =.093) CONCLUSIONS Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in CHD patients. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as quality of life.
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Blumenthal et al. (2012) conducted an RCT in Coronary heart disease with elevated depressive symptoms (n=101). Aerobic exercise or sertraline vs. Placebo was evaluated on Change in Hamilton Rating Scale for Depression (HAM-D) score (p=0.034). Aerobic exercise (mean change -7.5) and sertraline (-6.1) achieved larger reductions in depressive symptoms compared to placebo (-4.5; p=0.034) in patients with coronary heart disease.
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