title: Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure.
abstract: 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, 11-14) 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<.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=.018) and 24 (P=.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.
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA. ragary@emory.edu
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Gary
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.forename: Melinda K
authors.initials: MK
authors.lastname: Higgins
authors.forename: Dominique L
authors.initials: DL
authors.lastname: Musselman
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
mesh_terms: D000368:Aged; D000465:Algorithms; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D005081:Exercise Therapy; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology* / Q000534:rehabilitation*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome