Milani R V, Lavie C J, Cassidy M M
Department of Internal Medicine, Ochsner Clinic, Alton Ochsner Medical Foundation, New Orleans, LA, USA.
Am Heart J. 1996 Oct;132(4):726-32. doi: 10.1016/s0002-8703(96)90304-x.
To evaluate the effect of cardiac rehabilitation and exercise training on depression after major cardiac events, we studied 338 consecutive patients in whom a major cardiac event had occurred 4 to 6 weeks previously and who were participating in phase II cardiac rehabilitation consisting of 36 sessions over a 3-month period. Depressive symptoms and other behavioral characteristics and quality-of-life parameters were analyzed by validated questionnaire. Depression was prevalent in patients with coronary heart disease, occurring in 20% of the patients evaluated. At baseline, depressed patients had lower exercise capacity, reduced high-density lipoprotein cholesterol level, and higher triglyceride levels; had lower scores for mental health, energy or fatigue, general health, pain, overall function, well-being, and total quality of life; and had greater scores for somatization, anxiety, and hostility than those of nondepressed patients. After cardiac rehabilitation, depressed patients had marked improvements in depression scores and other behavioral parameters (anxiety, somatization, and hostility) and quality of life. Depressed patients also showed improved exercise capacity, percentage of body fat, and levels of triglycerides and high-density lipoprotein cholesterol. Depressed patients exhibited statistically greater improvements in certain behavioral and quality-of-life parameters than did nondepressed patients. Two thirds of the patients who were initially depressed resolved their symptoms by study completion. In conclusion, depression is reduced in patients with symptomatic coronary heart disease patients enrolled in cardiac rehabilitation. Greater emphasis is needed to ensure that depressed patients are referred to and attend formal cardiac rehabilitation programs after major cardiac events.
为了评估心脏康复和运动训练对重大心脏事件后抑郁症的影响，我们研究了338例连续患者，这些患者在4至6周前发生了重大心脏事件，并且正在参加为期3个月、共36节课程的II期心脏康复项目。通过经过验证的问卷对抑郁症状、其他行为特征和生活质量参数进行分析。抑郁症在冠心病患者中很普遍，在所评估的患者中，有20%的患者患有抑郁症。在基线时，抑郁患者的运动能力较低，高密度脂蛋白胆固醇水平降低，甘油三酯水平较高；心理健康、精力或疲劳、总体健康、疼痛、整体功能、幸福感和生活质量总分较低；与非抑郁患者相比，躯体化、焦虑和敌意得分更高。心脏康复后，抑郁患者的抑郁评分以及其他行为参数（焦虑、躯体化和敌意）和生活质量有显著改善。抑郁患者的运动能力、体脂百分比以及甘油三酯和高密度脂蛋白胆固醇水平也有所改善。与非抑郁患者相比，抑郁患者在某些行为和生活质量参数方面的改善在统计学上更为显著。三分之二最初患有抑郁症的患者在研究结束时症状得到缓解。总之，参加心脏康复的有症状冠心病患者的抑郁症有所减轻。需要更加重视确保抑郁患者在重大心脏事件后被转介并参加正式的心脏康复项目。
