title: Effects of exercise training on depression in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The aim of this review is to assess the effects of exercise training on the symptoms of depression in heart failure (HF) patients.
  
  
  RESULTS
  Randomized controlled trials of exercise training in patients with HF and symptoms of depression were identified. The depression data were pooled using meta-analysis, and 19 studies were identified, with a total of 3447 patients, of which 16 (3226 patients) provided data for the meta-analysis. Exercise training demonstrated significant reductions in the symptoms of depression [standardized mean difference (SMD) -0.38, 95% confidence interval (CI) -0.55 to -0.21], and its antidepressive effect was consistent in a number of HF groups, such as in ages under and over 65 years (SMD -0.14, 95% CI -0.22 to -0.07 vs. SMD -0.44, 95% CI -0.61 to -0.27) and EFs of <50% (SMD -0.38, 95% CI -0.56 to -0.20), as well as in a range of interventional strategies, including the aerobic mode (SMD -0.40, 95% CI -0.61 to -0.19), centre, home, or combined setting (SMD -0.61, 95% CI -0.95 to -0.27 vs. SMD -0.25, 95% CI -0.44 to -0.07 vs. SMD -0.13, 95% CI -0.21 to -0.05), and short or longer training programmes (≤12 weeks, SMD -0.50, 95% CI -0.73 to -0.27; 12-26 weeks, SMD -0.47, 95% CI -0.82 to -0.11; >26 weeks, SMD -0.12, 95% CI -0.20 to -0.04). The beneficial effects were preserved when blind design trials were considered (SMD -0.14, 95% CI -0.22 to -0.07).
  
  
  CONCLUSIONS
  Exercise training significantly decreased the symptoms of depression in patients with HF. This benefit remained unclear in cases of HF with a normal EF and combined aerobic and strength training. Random controlled trials are needed to verify the benefit of exercise in these populations, and in very old, asymptomatic, and severe HF patients.
authors.affiliation: Department of Geriatric Cardiology, First Affiliated Hospital, Guang Xi Medical University, Nanning, China.
authors.forename: Rong-Hui
authors.initials: RH
authors.lastname: Tu
authors.forename: Zhi-Yu
authors.initials: ZY
authors.lastname: Zeng
authors.forename: Guo-Qiang
authors.initials: GQ
authors.lastname: Zhong
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Wu
authors.forename: Yun-Juan
authors.initials: YJ
authors.lastname: Lu
authors.forename: Zhan-Dong
authors.initials: ZD
authors.lastname: Bo
authors.forename: Yan
authors.initials: Y
authors.lastname: He
authors.forename: Wei-Qiang
authors.initials: WQ
authors.lastname: Huang
authors.forename: Li-Mei
authors.initials: LM
authors.lastname: Yao
mesh_terms: D003863:Depression / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D064797:Physical Conditioning, Human / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Exercise training; Heart failure; Meta-analysis; Symptoms of depression