Rate of Change in Physical Fitness and Quality of Life and Depression Following Exercise Training in Patients With Congestive Heart Failure

Association Between Depressive Symptoms and Exercise Capacity in Patients With Heart Disease: A META-ANALYSIS

PURPOSE

Depression and reduced exercise capacity are risk factors for poor prognosis in patients with heart disease, but the relationship between the 2 is unclear. We assessed the relationship between depressive symptoms and exercise capacity in patients with heart disease.

METHODS

PubMed, Cochrane Library, Google Scholar, and ProQuest databases were browsed for English-language studies published from January 2000 to September 2013. Studies including adult patients with coronary artery disease, heart failure, congenital heart disease, and implantable cardioverter defibrillator, reporting correlation between a depression scale and exercise capacity ((Equation is included in full-text article.)O2peak, peak watts, estimated metabolic equivalents, and incremental shuttle walk test distance), as well as studies from which such a correlation could be calculated and provided by the authors, were included. Correlation coefficients (CCs) were converted to Fischer z values, and the analysis was performed using a random-effects model. Then, summary effects and 95% CIs were converted back to CCs.

RESULTS

Fifty-nine studies (25 733 participants) were included. Depressive symptoms were inversely correlated to exercise capacity (CC = -0.15; 95% CI, -0.17 to -0.12). Heterogeneity was significant (I = 64%; P < .001). There was no evidence of publication bias (Fail-safe N = 4681; Egger test: P = .06; Kendall test: P = .29).

CONCLUSIONS

Patients with heart disease and elevated depressive symptoms may tend to have reduced exercise capacity, and vice versa. This finding has clinical and prognostic implications. It also encourages research on the effects of improving depression on exercise capacity, and vice versa. The effects of potential moderators need to be explored.

Nonpharmacological interventions to improve quality of life in heart failure: an integrative review

Objective:

to identify articles that assessed the effectiveness or efficacy of nonpharmacological interventions to improve quality of life of people with heart failure in the literature.

Method:

an integrative literature review was performed in Lilacs, MedLine and SciELO databases, including randomized or nonrandomized clinical trials and quasi-experimental studies published between 2003 and 2014, in Portuguese, English or Spanish.

Results:

twenty-three studies were included. The categories of nonpharmacological interventions that improved quality of life of people with heart failure were: Remote health monitoring, Instructions on health practices, Physical activity follow-up and Traditional Chinese Medicine practices.

Conclusion:

these results can guide the selection of interventions to be implemented by health professionals that treat people with heart failure. Future systematic reviews with meta-analyses are needed in order to identify the most effective interventions for improving these individuals' quality of life.

One-year trajectories of mental and physical functioning during and after rehabilitation among individuals with disabilities

Purpose

First, to evaluate the trajectories of physical and mental functioning in individuals with chronic disabilities receiving adapted physical activity-based rehabilitation. Second, to determine whether demographic factors, disability group, pain, fatigue and self-efficacy at baseline influenced these trajectories.

Research design

A prospective intervention study.

Methods

The study included 214 subjects with chronic disabilities who were admitted to a four-week adapted physical activity-based rehabilitation stay at Beitostølen Healthsports Centre. The subjects completed written questionnaires eight and four weeks before the rehabilitation, at admission to and discharge from the rehabilitation centre and again four weeks and 12 months after discharge. Multilevel models were performed to examine the trajectories of SF-12 physical and mental functioning with possible predictors.

Results

Time yielded a statistically significant effect on physical and mental functioning (p < 0.001). Low age (p = 0.002), no more than 2 h of personal assistance per week (p = 0.023), non-nervous system disability (p = 0.019), low pain level (p < 0.001) and high chronic disease-efficacy (p = 0.007) were associated with higher physical functioning. There was a greater improvement in physical functioning for subjects with lower chronic disease-efficacy at baseline (p = 0.036) and with a disability not associated with the nervous system (p = 0.040). Low fatigue (p = 0.001) and high chronic disease-efficacy (p = 0.004) predicted higher mental functioning. There was also a greater improvement in mental functioning for subjects with high fatigue (p =0.003) and low chronic disease efficacy at baseline (p = 0.032).

Conclusion

Individuals with chronic disabilities who participated in an adapted physical activity-based intervention showed statistically significant increases in both physical and mental functioning across the 12 months after the intervention. The greatest improvement was among subjects with a high level of fatigue and low chronic disease-efficacy, as well as disabilities not associated with the nervous system, which has implications for the target groups in future rehabilitation.

Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients

Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure.