The Effect of Exercise

What about exercise? The HF-ACTION trial is an ideal opportunity to look at exercise in depressed patients with heart failure. Jim Blumenthal from Duke University was in charge of the health status section of HF-Action and published this in JAMA.[2] The patients who were depressed had worse exercise function objectively measured by cardiopulmonary testing, and yes, there was a difference in survival. The patients who were depressed had worse outcomes than the patients who were not depressed; however, exercise improved depression status as measured by the repeated BDI-II. Furthermore, the more adherent that the patients were to the exercise, the better they did.

We have some choices in our depressed patients, but before we can apply therapy, we need to identify these patients. We are not doing a great job of identifying patients with depression and trying to tease out the symptoms of depression from the symptoms of heart failure, because, in fact, they are quite similar: fatigue, listlessness, lack of interest in activities, and avoidance of activity because of real or perceived fears.

So, let's do a better job of looking for depression in these heart failure patients. The BDI-II is easy. You can administer it in the office, and it requires no extra work for you other than the grading of it. If the score is > 10, I strongly recommend that the patient be referred to a clinical psychologist or psychiatrist for some better assessment and treatment, and let's not forget exercise in heart failure patients, which we know is safe. Thank you for joining me today. This is Ileana Piña from ESC in Amsterdam.

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