title: Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial.
abstract: BACKGROUND
  Depression is common in patients with cardiac disease, especially in patients with heart failure, and is associated with increased risk of adverse health outcomes. Some evidence suggests that aerobic exercise may reduce depressive symptoms, but to our knowledge the effects of exercise on depression in patients with heart failure have not been evaluated.
  
  
  OBJECTIVE
  To determine whether exercise training will result in greater improvements in depressive symptoms compared with usual care among patients with heart failure.
  
  
  METHODS
  Multicenter, randomized controlled trial involving 2322 stable patients treated for heart failure at 82 medical clinical centers in the United States, Canada, and France. Patients who had a left ventricular ejection fraction of 35% or lower, had New York Heart Association class I to IV heart failure, and had completed the Beck Depression Inventory II (BDI-II) score were randomized (1:1) between April 2003 and February 2007. Depressive scores ranged from 0 to 59; scores of 14 or higher are considered clinically significant.
  
  
  METHODS
  Participants were randomized either to supervised aerobic exercise (goal of 90 min/wk for months 1-3 followed by home exercise with a goal of ≥120 min/wk for months 4-12) or to education and usual guideline-based heart failure care.
  
  
  METHODS
  Composite of death or hospitalization due to any cause and scores on the BDI-II at months 3 and 12.
  
  
  RESULTS
  Over a median follow-up period of 30 months, 789 patients (68%) died or were hospitalized in the usual care group compared with 759 (66%) in the aerobic exercise group (hazard ratio [HR], 0.89; 95% CI, 0.81 to 0.99; P = .03). The median BDI-II score at study entry was 8, with 28% of the sample having BDI-II scores of 14 or higher. Compared with usual care, aerobic exercise resulted in lower mean BDI-II scores at 3 months (aerobic exercise, 8.95; 95% CI, 8.61 to 9.29 vs usual care, 9.70; 95% CI, 9.34 to 10.06; difference, -0.76; 95% CI,-1.22 to -0.29; P = .002) and at 12 months (aerobic exercise, 8.86; 95% CI, 8.67 to 9.24 vs usual care, 9.54; 95% CI, 9.15 to 9.92; difference, -0.68; 95% CI, -1.20 to -0.16; P = .01).
  
  
  CONCLUSIONS
  Compared with guideline-based usual care, exercise training resulted in a modest reduction in depressive symptoms, although the clinical significance of this improvement is unknown.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00047437.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, PO Box 3119, Durham, NC 27710, USA. blume003@mc.duke.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Michael A
authors.initials: MA
authors.lastname: Babyak
authors.forename: Christopher
authors.initials: C
authors.lastname: O'Connor
authors.forename: Steven
authors.initials: S
authors.lastname: Keteyian
authors.forename: Joel
authors.initials: J
authors.lastname: Landzberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: Howlett
authors.forename: William
authors.initials: W
authors.lastname: Kraus
authors.forename: Stephen
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Gordon
authors.initials: G
authors.lastname: Blackburn
authors.forename: Ann
authors.initials: A
authors.lastname: Swank
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
mesh_terms: D000368:Aged; D003863:Depression / Q000150:complications* / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome