The Catch-22 of exercise and depression

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Doctor often advise people with heart disease to exercise. But cardiac patients are known to be at higher risk for depression, and some people with depression can’t motivate themselves to get up and move.

That Catch-22 may be a major reason why so many cardiac patients do not follow the routine advice to become more physically active after being treated for a heart attack or other cardiac event, according to a study published in the journal General Hospital Psychiatry.

Researchers analyzed 11 studies with a total of 20,000 patients. Eight of the studies found that the development of depression after a heart attack was a significant factor for adopting a sedentary lifestyle or poor adherence to an exercise program. One study found that among heart attack survivors who said they had depression or anxiety, 59% had a significant decrease in exercise after three months compared with 31% of patients who were not depressed.

Why does depression lead to a decline in activity among people who need it the most? It may be because depressed people adopt habits that make it harder to exercise, such as smoking or over-eating. Depression also decreases energy level, exercise tolerance and pain threshold.

‘The sad part about this is that physical activity is not only important for preventing and managing many chronic conditions, it can be very helpful for improving mood and other symptoms of depression,’ Evette Joy Ludman, of the Group Health Cooperative in Seattle, said of the study.

Cardiologists and other health professionals who work in cardiac rehabilitation might do their patients a big favor by making depression assessment and treatment a central part of patient care. The effects of exercise on depression were described in a story this week in The Times Health section’s special issue on depression.

-- Shari Roan