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Exercise Reduces Death Rate by Half for Depressed or
Unsupported Heart Attack Patients
Beneficial for patients who are older, minority or
women
May 4, 2004 – A new study says heart attack
patients who are depressed or without social support are more than twice
as likely to die of a second heart attack if they do not exercise. It is
just one more medical report in a mounting mountain of evidence proving
the benefits of exercise.
The study was a large-scale national trial led by
Duke University Medical Center researchers. They study of 2,078
patients, is one of the largest to examine the potential role of
exercise in forestalling future heart attacks in this high-risk group of
patients, the researchers said. In contrast to past studies that
concentrated on Caucasian males, the researchers said the current trial
was more representative of the population as a whole, with 33.6 percent
being minority, 43.5 percent being women, and 38.8 percent over the age
of 65.
The researchers found that after an average
two-year follow-up, 5.7 percent of those who reported regular exercised
had died, compared to 12 percent of those reported not exercising.
Additionally, 6.5 percent of exercisers experienced a non-fatal heart
attack, compared to 10.5 percent for non-exercisers.
"Our findings demonstrate the value of exercise for
those heart attack patients who are at higher risk of future cardiac
events because of their depression or social isolation," said lead
researcher James Blumenthal, Ph.D., Duke behavioral psychologist. The
results of the study were published May 4, 2004, in the
Medicine & Science
in Sports & Exercise, a journal of the American College of
Sports Medicine.
"Exercise was associated with lower baseline levels
of depression, greater reductions in the symptoms of depression, as well
as increased survival," Blumenthal continued. "We believe that exercise
can be valuable in treating the physical and mental health of these
high-risk heart attack patients."
While the medical community is increasingly
recognizing the important role of exercise in preventing initial as well
as subsequent heart attacks, no study to date has looked specifically at
the impact of exercise on heart attack patients considered at a high
psychosocial risk for another heart attack, said the researchers.
Most previous studies on the effect of exercise on
heart disease enrolled predominantly Caucasian men and patients under at
age of 65, and most of those studies did not include a non-exercising
group of patients as a control, said the researchers.
In 1996, the National Institutes of Health awarded
a $29.6 million grant to an eight-center consortium to investigate the
promise of behavior therapy interventions in a "real-world" group of
patients with heart disease who were either depressed or socially
isolated. The trial was dubbed ENRICHD (Enhancing Recovery in Coronary
Heart Disease Patients).
Last year, The ENRICHD investigators reported in
the
Journal of American
Medical Association (June 18, 2003), that counseling and
group therapy reduced levels of depression and social isolation in these
patients, but did not lower mortality or morbidity rates of study
participants. For the current study, the researchers went a step further
to compare the outcomes of patients enrolled in ENRICHD who exercised
and those who did not.
"Our latest findings suggest exercise can be just
as beneficial for patients who are older, minority or women," Blumenthal
said. "This finding is important because previous studies show that men
and Caucasians are more likely to exercise than women and minorities."
Blumenthal said that being sedentary should be
considered as a cardiac risk factor just like other risk factors such as
smoking, improper diet or uncontrolled high blood pressure.
"While our study cannot determine whether patients
in the trial were sedentary because they were depressed, or whether they
became depressed because they weren't physically active, we can say that
patients who are depressed and sedentary are at a much higher risk of
another cardiac event," Blumenthal said. "Moreover, those patients who
reported that they had exercised during the six months after their heart
had almost a 50 percent reduction in risk of dying or suffering further
heart complications compared to the non-exercisers."
Cardiovascular disease is the leading cause of
death in the United States. An estimated 13 million Americans suffer
from coronary artery disease. Each year, up to one-third of the 1.5
million Americans who suffer heart attacks will die. Not only could
psychological treatment result in fewer hospitalizations and lives
saved, it may help reduce the cost of treating heart patients with
high-tech therapies, now estimated at $100 billion a year, Blumenthal
said.
"We hope that the results of this study will
heighten physicians' awareness that exercise can play an important role
in the treatment of their heart attack patients," Blumenthal said. "As
they write their prescriptions for statins or beta blockers, we'd also
like to see them recommend an exercise program."
Blumenthal is currently leading a trial to
determine whether exercise can be an effective treatment for depression
in middle-aged and older adults. An earlier Duke trial demonstrated that
supervised exercise was just as effective as the most commonly used
anti-depression medication in improving the symptoms of depression.
The trial, called SMILE (Standard Medical
Intervention and Long-term Exercise) is building upon the earlier trial
by randomizing patients to supervised exercise, exercise at home,
standard anti-depressant medication or placebo.
Other participating medical centers in the ENRCHD
trial were the University of Alabama at Birmingham, University of Miami,
Yale University/Harvard University, Washington University in St. Louis,
University of Washington in Seattle, Stanford University, and
Rush-Presbyterian-St. Luke's Medical Center in Chicago. The University
of North Carolina at Chapel Hill served as the Coordinating Center.
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