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Exercise reduces effects of depression on the heart, study shows

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Jennifer Johnson McEwen
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An Emory University study published this week in the Journal of the American College of Cardiology (ACC) finds that while symptoms of mild to minimal depression are associated with early indicators of heart disease, regular exercise seems to reduce the adverse cardiovascular effects of depression.

Arshed A. Quyyumi, MD, professor of medicine (cardiology), Emory University School of Medicine and co-director of the Emory Clinical Cardiovascular Research Institute and colleagues studied 965 people who were free of heart disease and who had no prior diagnosis of an affective, psychotic or anxiety disorder. Thirty-five percent of the participants were men and 39 percent were African Americans.

"This study shows that meeting physical activity guidelines can offset the deterioration in vascular health that accompanies depressive symptoms and provides further evidence that regular physical activity is beneficial to everyone," says Quyyumi, the study’s lead investigator.

"The findings highlight the link between worsening depression and cardiovascular risk and support routinely assessing depression in patients to determine heart disease risk."

Researchers used questionnaires to evaluate patients for depression and levels of physical activity, according to the U.S. Department of Health and Human Services’ 2008 Physical Activity Guidelines for Americans (2.5 or 1.25 hours/week of moderate- or vigorous-intensity physical activity, respectively).

They also looked at several early indicators of heart disease, including the inflammatory marker C-reactive protein. Persistently high CRP levels in the blood may indicate increased risk for heart disease.

"We illustrated that the mere presence of minimal depressive symptoms in a lower risk, ambulatory population is associated with significantly higher CRP levels as well as gradual depletion of glutathione and progressive stiffening of the arteries," says co-investigator Ibhar Al Mheid, MD, an Emory cardiology fellow.

The intracellular antioxidant, glutathione, is a naturally occurring protein that protects cell, tissue, and organs from toxic free radicals and disease.

Researchers found arterial stiffening and inflammation — indicators of early heart disease — that accompany worsening depressive symptoms were more pronounced in people who were inactive. The indicators were less common in subjects engaging in regular physical activity.

Depression has been linked to an increased risk of heart disease and other physical ailments, and depression is commonly associated with worse outcomes for patients with heart disease and other conditions. In addition, as many as 20 percent of people hospitalized with a heart attack report symptoms of depression, while patients with heart disease have three times the risk of developing depression compared to the general population.

"There are many patients with heart disease who also experience depression – we need to study whether encouraging them to exercise will reduce their risk of adverse outcomes," Quyyumi adds.

Other co-investigators at Emory include: Elizabeth Held; Irina Uphoff; Greg S. Martin; Sandra Dunbar; Aurelian Bidulescu; Gary Gibbons; Dean P. Jones and Viola Vaccarino.

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