Depressive symptoms interfere with the improvement in exercise capacity by cardiac rehabilitation after left ventricular assist device implantation

Background Although depressive symptoms are associated with an increased risk of readmission after left ventricular assist device (LVAD) implantation, it is unclear whether they affect the efficacy of exercise‐based cardiac rehabilitation (EBCR). This study aimed to investigate the effect of depressive symptoms on EBCR efficacy. Methods We analyzed 48 patients who participated in EBCR after LVAD implantation (mean age 45 ± 12 years; 60% male). Patients were classified into two groups using the Zung Self‐Rating Depression Scale (SDS): depressive group (SDS ≥40, n = 27) and non‐depressive group (SDS <40, n = 21). We examined changes in peak oxygen uptake (VO2), knee extensor muscular strength (KEMS), and quality of life (QOL) during EBCR using analysis of covariance. Results Although baseline characteristics were similar between the two groups, the non‐depressive group was less likely to receive diuretics (22% vs. 52%, p = 0.030). Peak VO2, KEMS, and QOL significantly increased over time in both groups (all p < 0.05). The depressive group had a significantly lower change in peak VO2 than the non‐depressive group (2.7 vs. 1.6 ml/kg/min; mean difference: −1.1 ml/kg/min, 95% confidence interval [CI]: −0.045 to −2.17; p = 0.041, d = 0.59). There was no between‐group difference regarding the change in KEMS or QOL. Adjusting for the baseline value, a significant difference between groups was observed only in peak VO2 (p = 0.045). Conclusions Although EBCR significantly improved exercise capacity after LVAD implantation, depressive symptoms interfered with this improvement. Further studies are needed to determine whether psychological interventions for depression, in addition to EBCR, would improve the response to EBCR after LVAD implantation.