COMMENTARY

Exercise and Depression in Cardiac Patients

Bernard J Gersh, MB, ChB, DPhil; Randal J Thomas, MD

Disclosures

January 16, 2014

Editorial Collaboration

Medscape &

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In This Article

Exercise as Antidepressant

Bernard J Gersh MB ChB DPhil: I'm Bernard Gersh from the Mayo Clinic, and with me today is Dr Randy Thomas, who is director of our Cardiovascular Health Clinic and preventive cardiology at Mayo Clinic. We are going to talk about a very interesting topic and one that we haven't discussed before—the role of exercise in depression, particularly in cardiac patients.

As someone who exercises a lot and enjoys it—it makes me feel good, and I don't think I am depressed—it doesn't come as a surprise that exercise is good medicine for depression.

Randal J Thomas MD: That's exactly right. It has long been known that exercise helps us feel better. There is the concept of the "runner's high." In fact, all the way back to Hippocrates, depression was treated with exercise. It has been known for many years that when we exercise more, it elevates our mood.

Dr Gersh: I would love to go back to the Hippocrates part, but we don't have the time. However, depression is very common in patients with coronary disease, and very common post–myocardial infarction (MI). What are the objective data that exercise benefits these patients? From there, you can go on to heart failure.

Dr Thomas: From 15% to 20% of people who have had a severe MI have severe depression; and another 15%-20% have some depressive symptoms.[1,2,3] Studies have been somewhat mixed on the best way to treat these patients. Medication therapy may be helpful in alleviating symptoms but probably doesn't improve outcomes very much.

Dr Gersh: The randomized-trial data on medications for depression in post-MI patients were not very impressive, were they? There was no difference in outcomes, just some difference in symptoms.

Dr Thomas: A modest improvement in symptoms was seen.[4] In patients with heart failure, it doesn't seem that medication improves their depression at all.[5] What has been thought to help is exercise, and until now there has not been a very well-done randomized study comparing exercise, placebo, and medication therapy, but recently a study was conducted to look at this.

Dr Gersh: Was the study done in post-MI patients?

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