Dose-Response Relationships between Exercise Intensity, Mood States, and Quality of Life in Heart Failure Patients

Copyeditor: Patricia Llenado Journal of Cardiovascular Nursing Vol. 00, No. 0, pp 00Y00 x Copyright B 2017 Wolters Kluwer Health, Inc. All rights reserved. Dose-Response Relationship Between Exercise Intensity, Mood States, and Quality of Life in Patients With Heart Failure AQ1 Lorraine S. Evangelista , PhD, RN, FAHA, FAAN; Marysol Cacciata, MSN, RN, CCRN-K; Anna Stromberg, PhD, RN, NFESC, FAAN; Kathleen Dracup, PhD, RN, FNP, FAAN Background: We conducted a secondary analysis to (1) compare changes in mood disorders and quality of life (QOL) among 4 groups of patients with heart failure in a home-based exercise program who had varying degrees of change in their exercise capacity and (2) determine whether there was an association between exercise capacity, mood disorders, and QOL. Methods: Seventy-one patients were divided into 4 groups based on changes in exercise capacity from baseline to 6 months: group 1showed improvements of greater than 10% (n = 19), group 2 showed improvements of 10% or less (n = 16), group 3 showed reductions of 10% or less (n = 9), and group 4 showed reductions of greater than 10% (n = 27). Results: Over time, patients in all 4 groups demonstrated significantly lower levels of depression and hostility (P G .001) and higher levels of physical and overall quality of life (P = .046). Group differences over time were noted in anxiety (P = .009), depression (P = .015), physical quality of life (P G .001), and overall quality of life (P = .002). Greater improvement in exercise capacity was strongly associated with lower depression scores (r = j0.49, P = .01). Conclusions: An improvement in exercise capacity with exercise training was associated with a decrease in depression and anxiety and an increase in QOL in patients with heart failure. KEY WORDS: dose-response, exercise, heart failure, mood states, quality of life H eart failure (HF) is a debilitating chronic con- dition that affects an estimated 5.7 million Americans, and the projections show that the preva- lence will increase 46% from 2012 to 2030, resulting in more than 8 million Americans 18 years or older with heart failure. 1 Most individuals with heart fail- ure experience deficits in physical functioning and fatigue and report decreased quality of life (QOL). 2Y4 A common finding in patients with heart failure is exercise intolerance, which causes progressive func- tional deterioration. 5 In addition to physical impair- Lorraine S. Evangelista, PhD, RN, FAHA, FAAN Professor and Associate Director of the PhD Program, Program in Nursing Science, University of California, Irvine. Marysol Cacciata, MSN, RN, CCRN-K Doctoral Student, Program in Nursing Science, University of California, Irvine. Anna Stromberg, PhD, RN, NFESC, FAAN Professor, Department of Medical and Health Sciences and Department of Cardiology, Linkoping University, Sweden. Kathleen Dracup, PhD, RN, FNP, FAAN Dean Emerita and Professor Emerita School of Nursing, University of California, San Francisco. This research was partially supported by a grant from the American Heart Association Western Division (NCR 133-09; PI, K. Dracup). The authors have no conflicts of interest to disclose. AQ2 Correspondence Marysol Cacciata, MSN, RN, CCRN-K, UCI Program in Nursing Science, University of California, Irvine, CA 92697 (cacciatm@uci.edu). DOI: 10.1097/JCN.0000000000000407 ments, patients with heart failure also exhibit psychological challenges, specifically anxiety and de- pression, and it is associated with increased morbidity and mortality. 6 Recent heart failure guidelines advise regular exercise for patients with heart failure to improve their functional capacity and decrease their symptoms. 2,7 Research supports the importance of pro- moting exercise training to reduce mortality, hospitali- zations, and risk for other chronic diseases in patients with heart failure. 8Y10 Controlled clinical trials have also shown that exercise training programs improve aer- obic capacity, delay onset of anaerobic metabolism, and improve autonomic balance. 11Y13 Furthermore, improve- ments in exercise capacity in this patient population led to increased metabolism, strength, and vitality 14Y17 and significant reductions in depressive symptoms. 18 The HF-ACTION (‘‘Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training’’) trial also showed that greater physiological and clinical benefits seem likely in patients with heart failure who adhere to a higher volume of exercise. 15 Although previous exercise research indicate that regular exercise represents an effective therapy in the management of patients with heart failure due to left ventricular systolic dysfunction, the benefits of exer- cise training on mood disorders and quality of life re- main inconsistent. Likewise, the relationship between