Index > Vol. 40/2008 > Iss. 3/March > pp. 213-218 > Abstract
 

Relationship between cardiopulmonary fitness and depressive symptoms in cardiac rehabilitation patients with coronary artery disease

doi: 10.2340/16501977-0151

Abstract:

Objective: To identify independent predictors of depressive symptoms in a cohort of patients with coronary artery disease entering cardiac rehabilitation.
Design: Cross-sectional cohort study.
Patients and methodsConsecutive patients entering a cardiac rehabilitation and secondary prevention programme underwent screening for depressive symptoms using the Center for Epidemiological Studies Depression (CES-D) scale and cardiopulmonary fitness testing to quantify peak oxygen consumption.
Results: Of the 366 patients with coronary artery disease, 22.3% reported at least mild (CES-D ≥ 16) and 10.4% reported significant (CES-D ≥ 23) depressive symptoms. Antidepressant medications were being used by 6.3% of patients. Sociodemographic, cardiopulmonary and cardiac characteristics, and medical co-morbidities previously associated with depression accounted for 14.7% of the variance in a multiple linear regression model (F = 8.713, p < 0.001) predicting CES-D scores. Significant independent predictors of CES-D scores were lower peak oxygen consumption, younger age, female sex, lower maximum diastolic blood pressure, angina pectoris and antidepressant use.
Conclusion: Reduced physical fitness, younger age, female sex and ischaemic symptoms of coronary artery disease predict higher depressive symptoms in patients entering cardiac rehabilitation.

Authors:

Walter Swardfager, Nathan Herrmann, Yekta Dowlati, Paul Oh, Alex Kiss, Krista Lanctôt

Key words:

depression, coronary disease, exercise test, rehabilitation, physical fitness.

References

  1. Frasure-Smith N, Lesperance F, Juneau M, Talajic M, Bourassa MG. Gender, depression, and one-year prognosis after myocardial infarction. Psychosom Med 1999; 61: 26–37.
  2. Caulin-Glaser T, Maciejewski PK, Snow R, LaLonde M, Mazure C. Depressive symptoms and sex affect completion rates and clinical outcomes in cardiac rehabilitation. Prev Cardiol 2007; 10: 15–21.
  3. Penninx BW, Guralnik JM, Ferrucci L, Simonsick EM, Deeg DJ, Wallace RB. Depressive symptoms and physical decline in community-dwelling older persons. JAMA 1998; 279: 1720–1726. Link to article
  4. Lavoie KL, Fleet RP, Lesperance F, Arsenault A, Laurin C, 
Frasure-Smith N, Bacon SL. Are exercise stress tests appropriate for assessing myocardial ischemia in patients with major depressive disorder? Am Heart J 2004; 148: 621–627.
  5. Cankurtaran M, Halil M, Yavuz BB, Dagli N, Cankurtaran ES, 
Ariogul S. Depression and concomitant diseases in a Turkish geriatric outpatient setting. Arch Gerontol Geriatr 2005; 40: 307–315.
  6. Almeida OP, Flicker L, Norman P, Hankey GJ, Vasikaran S, van Bockxmeer FM, Jamrozik K. Association of cardiovascular risk factors and disease with depression in later life. Am J Geriatr Psychiatry 2007; 15: 506–513
.
  7. Norwood R, Balkissoon R. Current perspectives on management of co-morbid depression in COPD. COPD 2005; 2: 185–193.
  8. Ruo B, Rumsfeld JS, Hlatky MA, Liu H, Browner WS, Whooley MA. Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA 2003; 290: 215–221.
  9. Ried LD, Tueth MJ, Taylor MD, Sauer BC, Lopez LM, Pepine CJ. Depressive symptoms in coronary artery disease patients after hypertension treatment. Ann Pharmacother 2006; 40: 597–604.
  10. Morales K, Wittink M, Datto C, DiFilippo S, Cary M, TenHave T, Katz IR. Simvastatin causes changes in affective processes in elderly volunteers. J Am Geriatr Soc 2006; 54: 70–76.
  11. Radloff L. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385–401. Link to article
  12. Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W. Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med 1997; 27: 231–235. Link to article
  13. Roberts RE, Vernon SW. The Center for Epidemiologic Studies Depression Scale: its use in a community sample. Am J Psychiatry 1983; 140: 41–46.
  14. Hamm LF, Kavanagh T. The Toronto Cardiac Rehabilitation and Secondary Prevention Program: 1968 into the new millennium. J Cardiopulm Rehabil 2000; 20: 16–22.
  15. Milani RV, Lavie CJ, Mehra MR, Ventura HO. Understanding the basics of cardiopulmonary exercise testing. Mayo Clin Proc 2006; 81: 1603–1611.
  16. Hollenberg M, Haight T, Tager IB. Depression decreases cardio­respiratory fitness in older women. J Clin Epidemiol 2003; 56: 1111–1117.
  17. Josephson EA, Casey EC, Waechter D, Rosneck J, Hughes JW. Gender and depression symptoms in cardiac rehabilitation: women initially exhibit higher depression scores but experience more improvement. J Cardiopulm Rehabil 2006; 26: 160–163.
  18. Marchionni N, Fattirolli F, Fumagalli S, Oldridge NB, Del Lungo F, Bonechi F, et al. Determinants of exercise tolerance after acute myocardial infarction in older persons. J Am Geriatr Soc 2000; 48: 146–153.
  19. Weber-Hamann B, Werner M, Hentschel F, Bindeballe N, 
Lederbogen F, Deuschle M, Heuser I. Metabolic changes in elderly patients with major depression: evidence for increased accumulation of visceral fat at follow-up. Psychoneuroendocrinology 2006; 31: 347–354.
  20. Hildrum B, Mykletun A, Stordal E, Bjelland I, Dahl AA, Holmen J. Association of low blood pressure with anxiety and depression: the Nord-Trondelag Health Study. J Epidemiol Community Health 2007; 61: 53–58.
  21. Hofer S, Doering S, Rumpold G, Oldridge N, Benzer W. Determinants of health-related quality of life in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil 2006; 13: 398–406.
  22. Turner SC, Bethell HJ, Evans JA, Goddard JR, Mullee MA. Patient characteristics and outcomes of cardiac rehabilitation. J Cardiopulm Rehabil 2002; 22: 253–260.
  23. Kullo IJ, Khaleghi M, Hensrud D. Markers of inflammation are inversely associated with VO2 max in asymptomatic men. J Appl Physiol 2007;102: 1374–1379 
.
  24. Miller GE, Stetler CA, Carney RM, Freedland KE, Banks WA. Clinical depression and inflammatory risk markers for coronary heart disease. Am J Cardiol 2002; 90: 1279–1283.
  25. Frasure-Smith N, Lesperance F, Irwin MR, Sauve C, Lesperance J, Theroux P. Depression, C-reactive protein and two-year major adverse cardiac events in men after acute coronary syndromes. Biol Psychiatry 2007; 62: 302–308 
.
  26. Hashmi S, Zeng QT. Role of interleukin-17 and interleukin-17-induced cytokines interleukin-6 and interleukin-8 in unstable coronary artery disease. Coron Artery Dis 2006; 17: 699–706.
  27. Appels A, Bar FW, Bar J, Bruggeman C, de Baets M. Inflammation, depressive symptomatology, and coronary artery disease. Psychosom Med 2000; 62: 601–605.
  28. Grace SL, Abbey SE, Shnek ZM, Irvine J, Franche RL, Stewart DE. Cardiac rehabilitation II: referral and participation. Gen Hosp Psychiatry 2002; 24: 127–134.
  29. Dallow CB, Anderson J. Using self-efficacy and a transtheoretical model to develop a physical activity intervention for obese women. Am J Health Promot 2003; 17: 373–381.
  30. Mittag O, China C, Hoberg E, Juers E, Kolenda KD, Richardt G, et al. Outcomes of cardiac rehabilitation with versus without a follow-up intervention rendered by telephone (Luebeck follow-up trial): overall and gender-specific effects. Int J Rehabil Res 2006; 29: 295–302.
  31. Lavie CJ, Milani RV. Adverse psychological and coronary risk profiles in young patients with coronary artery disease and bene­fits of formal cardiac rehabilitation. Arch Intern Med 2006; 166: 1878–1883.
  32. Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006; 144: 884–893.
  33. Giese-Davis J, Wilhelm FH, Conrad A, Abercrombie HC, Sephton S, Yutsis M, et al. Depression and stress reactivity in metastatic breast cancer. Psychosom Med 2006; 68: 675–683.
  34. Grace SL, Abbey SE, Pinto R, Shnek ZM, Irvine J, Stewart DE. Longitudinal course of depressive symptomatology after a cardiac event: effects of gender and cardiac rehabilitation. Psychosom Med 2005; 67: 52–58.
  35. Roose SP, Miyazaki M. Pharmacologic treatment of depression in patients with heart disease. Psychosom Med 2005; 67 Suppl 1: S54–S57.