EFFECTS OF CARDIAC REHABILITATION AND EXERCISE TRAINING-PROGRAMS ON DEPRESSION IN PATIENTS AFTER MAJOR CORONARY EVENTS

To evaluate the effect of cardiac rehabilitation and exercise training on depression after major cardiac events, we studied 338 consecutive patients in whom a major cardiac event had occurred 4 to 6 weeks previ ously and who were participating in phase II cardiac rehabilitation co nsisting of 36 sessions over a 3-month period. Depressive symptoms and other behavioral characteristics and quality-of-life parameters were analyzed by validated questionnaire. Depression was prevalent in patie nts with coronary heart disease, occurring in 20% of the patients eval uated. At baseline, depressed patients had lower exercise capacity, re duced high-density lipoprotein cholesterol level, and higher triglycer ide levels; had lower scores for mental health, energy or fatigue, gen eral health, pain, overall function, well-being, and total quality of life; and had greater scores for somatization, anxiety, and hostility than those of nondepressed patients. After cardiac rehabilitation, dep ressed patients had marked improvements in depression scores and other behavioral parameters (anxiety, somatization, and hostility) and qual ity of life. Depressed patients also showed improved exercise capacity , percentage of body fat, and levels of triglycerides and high-density lipoprotein cholesterol. Depressed patients exhibited statistically g reater improvements in certain behavioral and quality-of-life paramete rs than did nondepressed patients. Two thirds of the patients who were initially depressed resolved their symptoms by study completion. In c onclusion, depression is reduced in patients with symptomatic coronary heart disease patients enrolled in cardiac rehabilitation. Greater em phasis is needed to ensure that depressed patients are referred to and attend formal cardiac rehabilitation programs after major cardiac eve nts.