The Effects of Exercise on Depression in Patients Diagnosed with Heart Failure with Preserved Ejection Fraction

Background

Millions of Americans are living with heart failure in the United States, and about 50% of those individuals have a preserved ejection fraction (HFpEF). Many patients living with heart failure may deal with managing depression. Depression, combined with HFpEF, puts individuals at risk for increased mortality rates and hospital admissions—making the management of these diseases of the utmost importance. Exercise is recommended for individuals with HFpEF. However, exercise to manage depressive symptoms in individuals with HFpEF has yet to be fully explored.

Aim

This systematic literature review aimed to examine the effects of exercise therapy on depression reported by individuals diagnosed with HFpEF.

Methods

A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology in five electronic databases: SPORTDiscus, PubMed, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, and the Joanna Briggs Institute Evidence-Based Practice Database, using specific terms for research studies published between 2010 and 2024. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of the included studies. Inclusion criteria consisted of original human subjects’ peer-reviewed research, studies that enrolled adults diagnosed with HFpEF, studies using exercise as a form of treatment, studies published in the English language, and studies that used depression as an outcome measure. Exclusion criteria consisted of nonhuman subjects research, studies with participants younger than 18 years of age, studies that did not include patients with HFpHF, studies that did not use exercise as a treatment, studies that used no valid measure of depression, or incomplete studies.

Results

Sixty-seven studies were identified, but only five (totaling 306 participants) met the inclusion criteria. Exercise therapy consisted of strength, endurance training, and Tai Chi. Depression was measured using various validated instruments: the Patient Health Questionnaire (PHQ-9), Geriatric Depression Scale-15, Profile of Mood States, and the Hare-Davis Cardiac Depression Scale. All five studies showed improved depression scores following exercise therapy, with four studies reporting statistically significant improvements. Depression scores improved significantly in four of the five included studies. Specifically, depression was reduced by 0.8 points (measured with the Geriatric Depression Scale-15), 2 points (measured with the PHQ-9 tool), 1.7 points (measured with the subscale of Depression in Profile of Mood State), and 3.95 points (measured with the PHQ-9) in these 4 studies. The fifth study demonstrated a 7-point improvement in depression (measured with the Hare-Davis Cardiac Depression Scale), though this change was not statistically significant.

Conclusions

The data from this systematic review suggests that exercise can be a practical approach to improving reported depressive symptoms among individuals with HFpEF. However, additional, more robust research is warranted to confirm these findings and determine the appropriate type and duration of exercise for maximum benefits.