title: Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study.
abstract: OBJECTIVE
  The aim of this study was to assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease.
  
  
  BACKGROUND
  Although there is good evidence that clinical depression is associated with poor prognosis, optimal therapeutic strategies are currently not well defined.
  
  
  METHODS
  One hundred one outpatients with coronary heart disease and elevated depressive symptoms underwent assessment of depression, including a psychiatric interview and the Hamilton Rating Scale for Depression. Participants were randomized to 4 months of aerobic exercise (3 times/week), sertraline (50-200 mg/day), or placebo. Additional assessments of cardiovascular biomarkers included measures of heart rate variability, endothelial function, baroreflex sensitivity, inflammation, and platelet function.
  
  
  RESULTS
  After 16 weeks, all groups showed improvement on Hamilton Rating Scale for Depression scores. Participants in both the aerobic exercise (mean -7.5; 95% confidence interval: -9.8 to -5.0) and sertraline (mean -6.1; 95% confidence interval: -8.4 to -3.9) groups achieved larger reductions in depressive symptoms compared with those receiving placebo (mean -4.5; 95% confidence interval: -7.6 to -1.5; p = 0.034); exercise and sertraline were equally effective at reducing depressive symptoms (p = 0.607). Exercise and medication tended to result in greater improvements in heart rate variability compared with placebo (p = 0.052); exercise tended to result in greater improvements in heart rate variability compared with sertraline (p = 0.093).
  
  
  CONCLUSIONS
  Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in patients with coronary heart disease. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as on quality of life. (Exercise to Treat Depression in Individuals With Coronary Heart Disease; NCT00302068).
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. blume003@mc.duke.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Andrew
authors.initials: A
authors.lastname: Sherwood
authors.forename: Michael A
authors.initials: MA
authors.lastname: Babyak
authors.forename: Lana L
authors.initials: LL
authors.lastname: Watkins
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Benson M
authors.initials: BM
authors.lastname: Hoffman
authors.forename: C Virginia F
authors.initials: CV
authors.lastname: O'Hayer
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mabe
authors.forename: Julie
authors.initials: J
authors.lastname: Johnson
authors.forename: P Murali
authors.initials: PM
authors.lastname: Doraiswamy
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Schocken
authors.forename: Alan L
authors.initials: AL
authors.lastname: Hinderliter
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D032882:Comprehension; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020280:Sertraline / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline