Rebecca Gary, Ph.D., R.N.
Exercise plus Psychological Counseling Benefits Depressed Heart Failure PatientsSupported by an American Heart Association Beginning Grant-in-Aid award from the Southeast Affiliate, Rebecca Gary, Ph.D., R.N., has found that aerobic exercise combined with cognitive behavioral therapy may improve physical function, reduce depressive symptoms and enhance quality of life in depressed heart failure patients.
Dr. Gary is the lead author of the study and assistant professor in the School of Nursing at Emory University in Atlanta, Ga.
In this study, 74 heart failure patients with depression were divided into four groups: one group received a 12-week, home-based program of exercise and psychological counseling; a second received psychological counseling alone; a third received exercise alone; and a fourth received usual care.
The exercise component was a 12-week, progressive program, with low-to-moderate intensity exercise, involving walking outdoors. Patients were encouraged to walk three times per week for at least 30 minutes. Patients in the combined program or exercise-only group received heart rate monitors and were taught how to self-monitor their exertion level, and when to stop exercising. All patients, despite initial symptoms and some being quite debilitated, achieved these goals.
"The cognitive behavioral therapy was geared toward changing the attitude of the patients about their illness, Gary said". "We wanted them to change their negative thoughts and beliefs and restructure and reformat how they think about their illness and limitations. For example, we developed a volunteer and activities sign-up sheet in each community that provided transportation for those who wanted to get out of the home or contribute in some way." Cognitive therapy sessions were conducted, one-on-one in the home, once a week, for 12 weeks by psychiatric nurse specialists and Ph.D. students trained in counseling techniques.
The four groups were assessed at four time intervals: baseline, after the 12-week intervention program, following the three-month telephone follow-up and at six months.
The combined group lowered depression symptoms by 10 points over the usual care group. (A decrease in scores of 50 percent or more or a HAM-D score of less than 8 indicates remission of depression symptoms). Interestingly, although depressive symptoms were also reduced in the counseling-only group, they perceived their quality of life to be worse than the combined group or exercise group. The combined group lowered depression symptoms by 10 points over the usual care group.
"What makes this study different from other studies of exercise in heart failure patients is that all these patients were clinically depressed, Gary said". "This may be the best method for improving their depression, symptom severity and quality of life."