The effect of cardiac rehabilitation on quality of life , anxiety and depression in patients with congestive heart failure ; a randomized controlled trial , short-term results Europa Medicophysica Best

AIM One of the major treatment goals in congestive heart failure (CHF) is to preserve the functional level of the patient and to improve psychosocial factors. For these purposes, exercise training is recommended for the management of CHF. With this background, the aim of this study is to investigate the effects of aerobic exercise on quality of life, depression and anxiety levels in a Turkish patient population with CHF. METHODS Sixty patients with CHF in stage II-III according to NYHA were included. Patients were randomly assigned either to a cardiac rehabilitation group or to a control group. Twenty-seven patients were allocated to a weekly aerobic walking program on treadmill, thrice a week for 8 weeks, and 26 patients did not receive any exercise training. Both groups were assessed by an ergospirometric exercise test, Hacettepe Quality of Life Questionnaire (HQoL), Beck Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI) at baseline and at the end. RESULTS Forty-four patients (treatment group: 23) completed the study. In the treatment group, significant increases in peak oxygen consumption, exercise time and metabolic equivalents (MET) levels were attained (P=0.001, P=0.001, P=0.003, respectively). Significant decreases in BDI (P=0.004) and STAI subgroups (P=0.049, P=0.023, respectively) were observed, whereas there was no change in HQoL scores. In the control group, there was no difference between baseline and 8th week evaluation in all parameters. CONCLUSIONS Patients with CHF tolerated aerobic exercise programs well. This resulted with improvement in both physical and psychologic wellbeing, but not in quality of life in the short term.

[1]  R. Shephard Exercise for Patients with Congestive Heart Failure , 1997, Sports medicine.

[2]  R. Belardinelli,et al.  Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy , 2006, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[3]  M. Kovács Cognitive therapy in depression. , 1980, The Journal of the American Academy of Psychoanalysis.

[4]  B. Resnick Encouraging exercise in older adults with congestive heart failure. , 2004, Geriatric nursing.

[5]  J. Wilson,et al.  Dissociation between exertional symptoms and circulatory function in patients with heart failure. , 1995, Circulation.

[6]  E. Antman,et al.  ACC/AHA PRACTICE GUIDELINES ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary , 2002 .

[7]  Kenneth E. Freedland,et al.  Depression in elderly patients with congestive heart failure , 1991 .

[8]  Meili Yang,et al.  The Influence of Exercise Tolerance on Quality of Life Among Patients with Heart Failure , 2004, Quality of Life Research.

[9]  R. Shephard,et al.  Quality of life and cardiorespiratory function in chronic heart failure: effects of 12 months' aerobic training. , 1996, Heart.

[10]  K. Swedberg,et al.  Comprehensive guidelines for the diagnosis and treatment of chronic heart failure Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology , 2002, European journal of heart failure.

[11]  L. Levin,et al.  Cardiac rehabilitation — a cost analysis , 1991, Journal of internal medicine.

[12]  D. Moser Psychosocial Factors and Their Association with Clinical Outcomes in Patients with Heart Failure: Why Clinicians Do not Seem to Care , 2002, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[13]  R. Carels The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients , 2004, Quality of Life Research.

[14]  Hans Bussmann,et al.  Does aerobic training lead to a more active lifestyle and improved quality of life in patients with chronic heart failure? , 2004, European journal of heart failure.

[15]  G. Lip,et al.  Psychological Factors in Heart Failure , 2002 .

[16]  G. Huster,et al.  Psychosocial variables and hospitalization in persons with chronic heart failure. , 1997, Progress in cardiovascular nursing.

[17]  W. Kraus,et al.  Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. , 2007, American heart journal.

[18]  L. Tavazzi,et al.  Relationship between psychological profile and cardiological variables in chronic heart failure. The role of patient subjectivity. , 1999, European heart journal.

[19]  P Kligfield,et al.  A modified treadmill exercise protocol for computer-assisted analysis of the ST segment/heart rate slope: methods and reproducibility. , 1986, Journal of electrocardiology.

[20]  G. Kwakkel,et al.  Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: A meta‐analysis , 2006, European journal of heart failure.

[21]  I. Keber,et al.  Patient's View of Heart Failure: From the Understanding to the Quality of Life , 2003, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[22]  Catherine Mondoa The implications of physical activity in patients with chronic heart failure. , 2004, Nursing in critical care.

[23]  Joseph S Alpert,et al.  ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). , 2002, Journal of the American College of Cardiology.

[24]  I. Piña,et al.  Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. , 2003, Circulation.

[25]  R. Belardinelli,et al.  Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. , 1999, Circulation.

[26]  K. Kawecka-Jaszcz,et al.  Effect of physical training on quality of life and oxygen consumption in patients with congestive heart failure. , 2005, International journal of cardiology.

[27]  E. Kouidi,et al.  Quality of life, psychological and physiological changes following exercise training in patients with chronic heart failure. , 2004, Journal of rehabilitation medicine.

[28]  M. Piepoli Exercise training in heart failure , 2006, Current heart failure reports.

[29]  R J Shephard,et al.  On the prediction of physiological and psychological responses to aerobic training in patients with stable congestive heart failure. , 1998, Journal of cardiopulmonary rehabilitation.

[30]  A. Radzewitz,et al.  Exercise and muscle strength training and their effect on quality of life in patients with chronic heart failure , 2002, European journal of heart failure.

[31]  A. Cohen-Solal,et al.  Executive summary of the Position Paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology (ESC): core components of cardiac rehabilitation in chronic heart failure , 2005, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[32]  Recommendations for exercise training in chronic heart failure patients. , 2001, European heart journal.

[33]  M. Clark,et al.  Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation. , 1999, The American journal of cardiology.

[34]  Alan C. Wilson,et al.  Nonpharmacologic therapy improves functional and emotional status in congestive heart failure. , 1994, Chest.

[35]  C. Spielberger Development of the Spanish edition of the State-Trait Anxiety Inventory. , 1971 .

[36]  H. Müderrisoğlu,et al.  Quality of Life in Patients with Rate Responsive Pacemakers: A Randomized, Cross‐Over Study , 1991, Pacing and clinical electrophysiology : PACE.

[37]  P. Armstrong,et al.  A systematic review of randomized trials of disease management programs in heart failure. , 2001, The American journal of medicine.

[38]  Gregory Y H Lip,et al.  Psychological factors in heart failure: a review of the literature. , 2002, Archives of internal medicine.

[39]  M. H. Phillips,et al.  Changes in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status following a 12 month cardiac exercise rehabilitation programme , 1999 .