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Cited by 216Cardiac Health and Mental HealthHeart Failure Treatment and ManagementCardiovascular and exercise physiology

Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure

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Gary, Rebecca A., Dunbar, Sandra B., Higgins, Melinda K., Musselman, Dominique L., Smith, Andrew L.·2010·Journal of Psychosomatic Research
DOI 10.1016/j.jpsychores.2010.01.013PMC PMC4143390
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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.

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  • Non-pharmacological interventions such as psychotherapy, such as cognitive behaviour therapy and exercise, have also shown to be successful methods of managing depression in CHF but have limited availability.

    “Non‐pharmacological interventions such as psychotherapy, such as cognitive behaviour therapy and exercise, have also shown to be successful methods of managing depression in CHF but have limited availability. 107 , 108”

    From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [107]

    The Results (Depression outcome; page not provided) report sustained reductions in depressive symptoms with combined CBT and exercise among patients with moderate-to-major heart failure depression. They do not show the same sustained benefit for exercise alone, and no passage establishes that these interventions have limited availability. The claim therefore overstates the evidence for the methods individually and adds an unsupported availability claim. (LLM, conf=0.88)

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2 of the 87 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [35]Beck AT Rush AJ Shaw BF Emery G Cognitive therapy of depression New York Guilford Press 1979
  2. [65]American Psychiatric Association Practice guidelines for the treatment of patients with major depressive disorder (revision) Am J Psychiatr 2000 157 Suppl 4 1 45 10767867
  3. [75]Goldenberg DL Multidisciplinary modalities in the treatment of fibromyalgia J Clin Psychiatry 2008 69 Suppl 2 30 4 18537461

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Authors
Gary, R. A., Dunbar, S. B., Higgins, M. K., Musselman, D. L., & Smith, A. L.
Affiliations
Emory University (US)
Corresponding author
Gary, Rebecca A.
ORCID
Venue
Journal of Psychosomatic Research
Publisher
Elsevier BV
Published
2010-08
Volume
69
Issue
2
Pages
119-131
ISSN
0022-3999 (ISSN-L)
DOI
10.1016/j.jpsychores.2010.01.013
PMC
PMC4143390
OpenAlex
W1963723818
Cited by
216
References
87
Citations by year
2026: 5 · 2025: 8 · 2024: 15 · 2023: 12 · 2022: 14 · 2021: 14 · 2020: 20 · 2019: 17 · 2018: 18 · 2017: 13 · 2016: 19 · 2015: 11 · 2014: 10 · 2013: 15 · 2012: 14
FWCI
8.56
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Psychosomatic Research (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • PubMed Central (acceptedVersion)
Funders
  • American Heart Association
  • National Institutes of Health (UL1TR000454, TL1TR000456)
  • National Center for Research Resources (TL1RR025010)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
heart failure, depression, cognitive behavioral therapy, home-based exercise, physical function, health-related quality of life, depression severity, 6-minute walk test, telephone follow-up
MeSH terms
Aged, Algorithms, Combined Modality Therapy, Major Depressive Disorder, Depressive Disorder, Exercise Therapy, Female, Heart Failure, Humans, Male, Middle Aged, Myocardial Infarction, Personality Inventory, Psychometrics, Quality of Life, Cognitive Behavioral Therapy, Treatment Outcome

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