Features October 2012 Issue

Exercise Helps Heart Failure Patients Deal with Depression

New research shows aerobic activity helps reduce depressive symptoms.

Regular aerobic exercise can be among the biggest challenges facing heart failure (HF) patients, because a weakened heart can make patients tire quickly. Many individuals with HF also face mental challenges, as an estimated 40 percent of people with heart failure suffer from depression.

But a recent study in the Aug. 1 issue of the Journal of the American Medical Association found that exercise training can help relieve moderate depression symptoms, as well as improve the energy level and quality of life of HF patients. Michael Crawford, manager of Cleveland Clinic’s Cardiac Rehabilitation Program, says there may be multiple explanations for exercise’s positive mental outcomes in HF patients.

“One reason is that exercise releases ‘feel good hormones’ such as serotonin,” he explains. “The primary function of serotonin is regulation of our emotions. Low levels of serotonin are thought to cause depression, and according to the American Medical Association, exercise may increase serotonin levels resulting in reduced feelings of depression.”

Other possible explanations include the brighter outlook associated with more socializing, increased self-image due to becoming more fit, increased independence and returning to “normal” life all of which can improve depression symptoms. Because HF can limit daily function and physical activity, it’s common for patients to develop a helpless and hopeless outlook, allowing those and other depressive symptoms to overtake them.

Depression and Activity
Indeed, a vicious circle can develop, in which a lack of exercise fuels depressive symptoms, while feelings of depression can reduce one’s will to get up and get moving. A common early sign of depression, in fact, can be a noticeable decrease and/or disinterest in physical activity.

“Depression can lead to lack of activity due to increase in fatigue, pain and lack of motivation,” Crawford says. He adds that a major key is to find an activity that is enjoyable and is one that you will stick with for a long time. It’s also important that depressed individuals have a realistic expectation about the effects of exercise, and that at first, it may be more important to develop the habit of exercise rather than worry about fitness or weight goals.
“Keep in mind that exercise is good and is a long journey,” Crawford explains. “Start small and progress your program over time so that both your physical health and social life can adapt to the new commitment. Some people find encouragement by having an exercise partner, listening to music or books, trying a variety of exercise, scheduling their exercise time into their daily calendars or even logging their exercise progression can be valuable tools for long term success.”

Exercise needs to provide rewards, whether it’s simply feeling more energetic and optimistic for a day or finding a social connection in an aerobics class or other outlet. Crawford suggests finding activities that get your lungs going as well as your major muscle groups.

“A good exercise program consists of both aerobic exercise (walking, cycling, swimming) and muscle toning or strength training exercise,” he explains. “Sometimes setting small goals such as starting with 10 minutes of exercise three times per week can begin to set up a positive reinforcement scenario that will continue to promote additional exercise.  However, if a person has moderate-to-severe heart failure, high intensity aerobic or strength exercises may have a detrimental effect on the heart.”

Start With Cardiac Rehab
For people with heart failure and depression, it’s a good idea to begin your exercise in a supervised setting such as cardiac rehab, Crawford suggests. “This will ensure the exercise is safe and at a level to optimally improve the cardiovascular system as well as depression,” he says. “A supervised program provides encouragement, monitoring and feedback to both the person and his or her physician. If a supervised facility is not available, start out slowly and discuss with your doctor what is the right amount of exercise.”

Cardiac rehab also provides you the tools to continue with exercise once the program officially ends.