Key result
Additional psychological interventions during exercise-based cardiac rehabilitation showed a trend toward reducing depressive symptoms (SMD -0.13; 95% CI -0.30 to 0.05) compared with rehabilitation alone.
Why the study?
The additional benefit of specific psychological interventions alongside exercise-based cardiac rehabilitation on depression, anxiety, quality of life, cardiac morbidity, and mortality was not well investigated.
Do additional psychological interventions reduce depressive symptoms and cardiac morbidity in patients with cardiovascular disease undergoing exercise-based cardiac rehabilitation?
Meta-Analysis (n=4,450)
Do additional psychological interventions reduce depressive symptoms and cardiac morbidity in patients with cardiovascular disease undergoing exercise-based cardiac rehabilitation?
Standardized Mean Difference: -0.13 (95% CI -0.3–0.05)
Additional psychological interventions during exercise-based cardiac rehabilitation show a non-significant trend toward reducing depressive symptoms and cardiac morbidity, though evidence is limited by study quality and heterogeneity.
No clear benefit yet from added psychological interventions in cardiac rehab; larger trials needed to confirm trends.
BACKGROUND: Exercise-based cardiac rehabilitation (ebCR) often includes various psychological interventions for lifestyle change or distress management. However, the additional benefit of specific psychological interventions on depression, anxiety, quality of life, cardiac morbidity and cardiovascular or total mortality is not well investigated. DESIGN: Systematic review and meta-analysis. METHODS: Randomized controlled trials and controlled cohort trials published between January 1995 and October 2017 comparing ebCR with or without pre-specified psychosocial interventions were selected and evaluated on the basis of predefined inclusion and outcome criteria. RESULTS: Out of 15,373 records, 20 studies were identified, including 4450 patients with coronary artery disease (88.5%) or congestive heart failure (11.5%), respectively. Studies were of low to moderate quality and methodological heterogeneity was high. As compared with ebCR alone, additional psychological interventions for lifestyle change or distress management showed a trend to reduce depressive symptoms (standardized mean difference -0.13, 95% confidence interval (CI) -0.30; 0.05). Furthermore, during a follow-up of five years, distress management was associated with a trend to reduce cardiac morbidity (risk ratio 0.74, 95% CI 0.51; 1.07). There was no evidence for an additional impact of either psychological lifestyle change interventions or distress management on anxiety, quality of life, cardiovascular or total mortality. CONCLUSIONS: Specific psychological interventions offered during ebCR may contribute to a reduction of depressive symptoms and cardiac morbidity, but there remains considerable uncertainty under which conditions these interventions exert their optimal effects. (CRD42015025920).
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Albus et al. (2019) conducted a meta-analysis in Cardiovascular disease (coronary artery disease or congestive heart failure) (n=4,450). Psychological interventions for lifestyle change or distress management vs. Exercise-based cardiac rehabilitation (ebCR) alone was evaluated on Depressive symptoms (SMD -0.13, 95% CI -0.30 to 0.05). Additional psychological interventions during exercise-based cardiac rehabilitation showed a trend toward reducing depressive symptoms (SMD -0.13; 95% CI -0.30 to 0.05) compared with rehabilitation alone.
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