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ARTICLE CONTRIBUTORS

Journal of the American College of Cardiology

Clinical Articles, Lead Article

Exercise equal to medication for depressed CHD patients

Aerobic exercise equals antidepressant medication in reducing depressive symptoms compared to placebo in patients with coronary heart disease (CHD), according to a study published recently in the Journal of the American College of Cardiology.1

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, the authors say.

Researchers assessed 101 outpatients with CHD and elevated depressive symptoms, the assessment including a psychiatric interview and the Hamilton Rating Scale for Depression. Participants were randomised to four months of aerobic exercise (three 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.

After 16 weeks, all groups showed improvement on Hamilton Rating Scale for Depression scores. Participants in both the aerobic exercise (mean –7.5) and sertraline (mean –6.1) groups achieved larger reductions in depressive symptoms compared with those receiving placebo (mean –4.5); exercise and sertraline were equally effective at reducing depressive symptoms. Exercise and medication tended to result in greater reductions in heart rate variability compared with placebo; exercise tended to result in greater reductions in heart rate variability compared with sertraline.

In an accompanying editorial,2 Dr Alan Rozanski (Columbia University College of Physicians and Surgeons, New York) says that the study’s chief limitation is a lack of generalisability: “The study population consisted of volunteers, who may thus not be typical of depressed patients in general. The nearly complete compliance with exercise and prescribed medication in this study is certainly atypical and suggests that these volunteers were particularly motivated and less severely depressed than many clinic patients”.

Dr Rozanski continues: “The study population was also skewed toward those of higher socioeconomic status and was ethnically narrow. In addition, the 3 randomized trials that have now been conducted by Blumenthal et al. represent the experience garnered at only 1 medical center. Thus, there is a need to perform further multicenter studies that would enroll broader spectra of patients. It is also notable that the present study was not an assessment of exercise per se but rather, supervised group exercise.”

The study’s findings, he says, are “based on a very small sample size and, given the volunteer status of this population, would need to be reproduced in more real-life settings to assess the applicability of this finding”.

References

1. James A. Blumenthal, PHD,* Andrew Sherwood, PHD,* Michael A. Babyak, et al. Exercise and Pharmacological Treatment of Depressive Symptoms in Patients With Coronary Heart Disease.  JACC 2012. http://dx.doi.org/10.1016/j.jacc.2012.04.040

2. Rozanski A. Exercise as medical treatment for depression. JACC 2012. http://dx.doi.org/10.1016/j.jacc.2012.05.015

Published on: August 24, 2012

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