Cardiac effects of exercise rehabilitation on quality of life, depression and anxiety in patients with heart failure patients

Document Type : Research Paper

Authors

1 Ph.D. student in sport physiology, Faculty of sport sciences, Orumiyeh University, Orumiyeh, Iran

2 Associate professor of sport physiology, Faculty of sport sciences, Isfahan University, Isfahan, Iran

3 M.Sc. in movement-behavioral, Faculty of sport sciences, Isfahan University, Isfahan, Iran

Abstract

Abstract
Introduction: Exercise training has well documented beneficial effects in a variety of cardiac disorders. This study was designed to assess the effects of exercise on an exercise rehabilitation program on the quality of life, depression and anxiety in heart failure patients referred for cardiac rehabilitation.
 Materials and Methods: In this clinical trial,65 patients aged 50-70 years with heart failure among patients who referred to Institute of Heart Rehabilitation of Isfahan were assigned randomly to two groups of experimental (n=33) and control (n=32). Subjects in the experimental group participated in a supervised 8-week aerobic training program of 30-45 min sessions (3 days per week on alternate days), while those in the control group received standard medical care and were not involved in any regular training program during this period. At the beginning and the end of the exercise rehabilitation program, the Beck Anxiety and Depression inventories and short form of quality of life questionnaire were fulfilled for the assessment of depression, anxiety and quality of life.
Results: The scores of quality of life, depression and anxiety  showed a significant improvement in experimental compared to control group after 8 weeks exercise rehabilitation (P=0.001). 
Conclusion: It seems that an appropriate application of exercise rehabilitation program would improve the psychological status and quality of life in long-term maintenance chronic heart failure patients.

Keywords


1. Berry C, McMurray J. A review of quality-of-life evaluations in patients with congestive heart failure. Pharmacoeconomics 1999; 16: 247-71.
2. Wielenga RP, Erdman RAM, Huisveld IA, Bol E, Dunselman PH, Baselier MR, et al. Effect of exercise training on quality of life in patients with chronic heart failure. J Psychosom Res1997; 45: 459-64.
3. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993; 88: 107-15.
4. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats T G, et al. ACC/AHA 2005 Guideline date for the Diagnosis and Management of Chronic Heart Failure in the Adult A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Circulation 2005; 112: 154-235.
5. Bocalini DS, Santos L, Serra AJ. Physical exercise improves the functional capacity and quality of life inpatient with heart failure.  Clinics 2008; 63(4): 437-42.  
6. Rahnavard Z, Zolfaghari M, Kazemnejad A, Hatamipour Kh. [An investigation of quality of life and factors affecting it in the patients with congestive heart failure]. Hayat: Journal of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences 2006; 1(12): 77-86. (Persian)
7. Kuller LH. Epidemiology of cardiovascular diseases: current perspectives. Am J Epidemiol 1976; 104(4): 425-96.
8. World Health Organization. Cause of death. Center for Global. Int Regional Studies (CGIRS) at the University of California Santa 2006: 120-4.
9. Hawthorne MH, Hixon ME. Functional status, mood disturbance and quality of life in patients with heart failure. Prog Cardiovasc Nurs 1994; 9: 22-32.
10. Bonomi AE, Patrick DL, Bushnell DM, Martin M. Validation of the United States’ version of the World Health Organization Quality of Life (WHOQOL) instrument. J Clin Epidemiol 2000; 53(1): 19-23.
11. Christian O. Incomplete remission in depression: Role of psychiatric and somatic co-morbidity. Dialogues Clin Neurosci 2008; 10: 453-60.
12. Vaccarino V, Kasl S, Abramson J, Krumholz H. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol 2001; 38: 199-205.
13. Doerfler L, Pbert L, DeCosimo D. Self-reported depression in patients with coronary heart disease. J Cardiopulm Rehabil 1997; 17: 163-70.
14. Pescatello LS, Di Pietro L. Physical activity in older adults: An overview of health benefits. Sport Med 1993; 15: 353-64.
15. Dubach P, Sixt S, Meyers J. Exercise training in chronic heart failure: Why, when and how. Swiss Med Wkly 2001; 13: 510-14.
16. Cowie MR, Zaphirou A. Management of chronic heart failure. Br Med J 2002; 325: 422-5.
17. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with chronic heart failure delays ventilatory anaerobic threshold and improves submaximal exercise performance. Circulation 1989; 79: 324-9.
18. Willenheimer R, Erhardt L, Cline C, Rydberg E, Isrelsson B. Exercise training in heart failure improves quality of life and exercise capacity. Eur Heart J 1998; 19: 774-81.
19. Maiorana A, O’Driscoll G, Cheetham C, Collis J, Goodam C, Rankin S, et al. Combined aerobic and resistance exercise training improves functional capacity and strength in CHF. J Appl Physiol 2000; 88(5): 1565-70.
20. Shephard R, Kavanagh T, Mertens D. On the prediction of physiological and psychological responses to aerobic training in patients with stable congestive heart failure. J Cardiopulm Rehabil 1998; 18: 51-54.
21. Coats A. Exercise training in heart failure. Curr Control Trials Cardiovasc Med 2000; 1: 155-60.
22. Giannuzzi P, Meyer K, Perk J, Drexler H, Dubach P, Myers J. Recommendations for exercise training in chronic heart failure patients. Working group report of the European Society of Cardiology. Eur Heart J 2001; 22: 125-35.
23. Gottlieb SS, Fisher ML, Freudenberger R, Robinson S, Zietowski G, Alves L, et al. Effects of exercise training on peak performance and quality of life in congestive heart failure patients. J Card Fail 1999; 5: 188-94.
24. Jetté M, Heller R, Landry F, Blumchen G. Randomized 4-week exercise program in patients with impaired left ventricular function. Circulation 1991; 84: 1561-7.
25. Sales Bocalini D, dos Santos L, Jorge Serra A. Physical exercise improves the functional capacity and quality of life in patients with heart failure. Clin Sci 2008; 63: 437-42.
26. Koukouvou G, Kouidi E, Iacovides A, Konstantinidou E, Kaprinis G, Deligiannis A. Quality of life, psychological and physiological changes following exercise training in patients with chronic heart failure. J Rehabil Med 2004; 36: 36-41.
27. Quittan M, Sturm B, Wiesinger GF, Pacher R, Fialka-Moser V. Quality of life in patients with chronic heart failure: a randomized controlled trial of changes induced by a regular exercise program. Scand J Rehabil Med 1999; 31: 223-8.
28. Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation 1999; 99: 1173-82.
29. Kiebzak GM, Pierson LM, Campbell M, Cook JW. Use of the SF36 general health status survey to document health-related quality of life in patients with coronary artery disease: effect of disease and response to coronary artery bypass graft surgery. Heart Lung 2002; 31(3): 207-13.
30. Asghari-Moghadam M, Faghihi S. [Reliability and validity of Short Form-36 health survey in two Iranian samples]. Daneshvar 2003; 10(1): 1-10. (Persian)
31. Eshaghi SR, Ramezani MA, Shahsanaee A, Pooya A. Validity and reliability of the short form-36 item questionnaire as a measure of quality of life in elderly Iranian population. Am J Appl Sci 2006; 3(3): 1763-6.
32. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care 1992; 30(6): 473-83.
33. Ivo A, Frans V, Richel L, Jan L, Adriaan H. Validity of the Beck depression inventory, hospital anxiety and depression scale, SCL-90, and Hamilton depression rating scale as screening instruments for depression in stroke patients. Psychosomatics 2002; 43: 386-93.
34. Thomas F, Deborah D, Dianne L. C. Reliability and validity of the beck anxiety inventory. J Anxiety Disord 1992; 6(1): 55-61.
35. Azkhosh M. [Use of psychological tests and clinical diagnosis]. 3rd ed. Tehran: Psychology; 1999: 224-6. (Persian)
36.  Hossein K, Ashraf Sadat M. [Psychometric properties of Beck anxiety in sex and age classes of the Iranian population]. Journal of faculty of medicine 1999; 66(2): 136-40. (Persian)
37. Aghamohamadi S. Effectiveness of self-efficacy on training on quality of life in Isfahan runaway girls: A single-subject design research. Dissertation. Isfahan. College of educational sciences and psychology, 2009.
38. Chodzko-Zajko W, Schwingel A, Park CH. Successful ageing: The role of physical activity. Am J Lifestyle Med 2009; 3: 20-8.
39. Tyni-Lenne R, Gordon A, Sylven C. Improved quality of life in chronic heart failure patients following local endurance training with leg muscle. J Cardiac Failure 1996; 2: 111-17.
40. Kavanagh T, Myers MG, Baigrie RS, Mertens DJ, Sawyer P, Shephard RJ. Quality of life and cardiorespiratory function in chronic heart failure: Effects of 12 months’ aerobic training. Heart 1996; 76: 42-9.
41. Schleifer SJ, Macari-Hinson MM, Coyle DA, Later WR, Khn M, Gorlin R, et al. The nature and course of depression following myocardial infarction. Arch Intern Med 1989; 149(8): 1785-9.
42. Jenkins CD, Stanton BA, Savageau JA, Denlinger P, Klein MD. Coronary artery bypass surgery: Physical, psychological, social and economic outcomes 6 month later. JAMA 1983; 250(6): 782-8.
43. Hassan EAH, Amin MA. Pilate’s exercises influence on the serotonin hormone, some physical variables and the depression degree in battered women. World J Sport Sci 2011; 5(2): 89-100.
44. Simon N, Young T. How to increase serotonin in the human brain without  drugs. J Psychiatr Neurosci 2007; 32: 394-9.