OBJECTIVE: The purpose of this study is to compare the effectiveness of a combined 12-week home-based exercise (EX)/cognitive behavioral therapy (CBT) program (n = 18) with CBT alone (n = 19), EX alone (n = 20), and with usual care (UC, n = 17) in stable New York Heart Association Class II to III heart failure (HF) patients diagnosed with depression. METHODS: Depressive symptom severity (Hamilton Rating Scale for Depression (HAM-D)), physical function (6-min walk test (6MWT)), and health-related quality of life (HRQOL) (Minnesota Living with Heart Failure Questionnaire) were evaluated at baseline (T1), after the 12-week intervention/control (T2), and following a 3-month telephone follow-up (T3). A repeated measures analysis of variance was used to determine group differences. Depression severity was dichotomized as minor (HAM-D 11 to 14) and moderate-to-major depression (HAM-D >= 15), and group intervention and control responses were also evaluated on that basis. RESULTS: The greatest reduction in HAM-D scores over time occurred in the EX/CBT group (-10.4) followed by CBT (-9.6), EX (-7.3), and UC (-6.2), but none were statistically significant. The combined group showed a significant increase in 6-min walk distance at 24 weeks (F = 13.5, p < 0.001). Among all groups with moderate-to-major depression, only those in CBT/EX had sustained lower HAM-D scores at 12 and 24 weeks, 6MWT distances were significantly greater at 12 (p = 0.018) and 24 (p = 0.013) weeks, and the greatest improvement in HRQOL also occurred. CONCLUSIONS: Interventions designed to improve both physical and psychological symptoms may provide the best method for optimizing functioning and enhancing HRQOL in patients with HF.
With permission from Excerpta Medica Inc.

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