Advertisement
Canadian Journal of Cardiology

Impact of Physical Activity on Depression After Cardiac Surgery

      Abstract

      Background

      Physical activity is associated with a lower prevalence of depressive symptoms in cardiac patients. However, the benefits of physical activity on depression perioperatively are unknown. We sought to identify independent parameters associated with depression in patients undergoing cardiac surgery.

      Methods

      Patients awaiting nonemergent cardiac surgery (n = 436) completed the Patient Health Questionnaire-9 (PHQ-9) to quantify depression (PHQ-9 score > 9). Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ-short) and accelerometry. Data collection occurred preoperatively (Q1, n = 436), at hospital discharge (Q2, n = 374), at 3 months (Q3, n = 318), and at 6 months (Q4, n = 342) postoperatively. Patients were categorized as “depression naive”, “at risk” or “depressed” preoperatively. Physical inactivity was defined as < 600 metabolic equivalent min/wk. Independent perioperative variables associated with depression were identified with univariate and multivariate logistic regression.

      Results

      Depression prevalence from Q1-Q4 was 23%, 37%, 21%, and 23%, respectively. Independent associations with depression were preoperative left ventricular ejection fraction < 50% (Q1, P < 0.05), physical inactivity (Q1, P < 0.05), baseline “at-risk” (Q2, P < 0.05), and baseline “depressed” groups (Q2-Q4, P < 0.05), hospital stay > 7 days (Q2, P < 0.05), postoperative stressful event (Q3 and Q4, P < 0.05), and cardiopulmonary bypass time > 120 minutes (Q4, P = 0.05). Newly depressed patients 6 months postoperatively reported lower IPAQ-short physical activity than depression-free patients (median change, −40 min/wk (interquartile range [IQR], −495 to +255) vs +213 min/wk (IQR, +150 to +830; P < 0.05).

      Conclusions

      Up to 40% of patients are depressed after cardiac surgery. Preoperative depression and postoperative stressful events were the strongest independent associations postoperatively. Physical inactivity was associated with preoperative depression and new depression 6 months postoperatively.

      Résumé

      Introduction

      L’activité physique est associée à une plus faible prévalence des symptômes de la dépression chez les patients ayant une maladie cardiaque. Cependant, on ne connaît pas les effets positifs de l’activité physique sur la dépression en phase périopératoire. Nous avons a cherché à déterminer les paramètres associés à la dépression chez les patients subissant une chirurgie cardiaque.

      Méthodes

      Les patients qui attendent une chirurgie cardiaque non urgente (n = 436) ont rempli le Patient Health Questionnaire-9 (PHQ-9) pour quantifier la dépression (score au PHQ-9 > 9). L’activité physique a été évaluée à l’aide du questionnaire international d’activité physique (International Physical Activity Questionnaire; IPAQ court) et de l’accélérométrie. La cueillette de données a eu lieu en phase préopératoire (Q1, n = 436), au congé de l’hôpital (Q2, n = 374), à 3 mois (Q3, n = 318) et à 6 mois (Q4, n = 342) en phase postopératoire. Les patients ont été classifiés comme « dépression isolée », « exposés à un risque » ou « dépressifs » en phase préopératoire. L’inactivité physique a été définie comme un équivalent métabolique < 600 min/sem. Les variables indépendantes en phase périopératoire associées à la dépression ont été déterminées par la régression logistique univariée et multivariée.

      Résultats

      La prévalence de la dépression aux Q1-Q4 a été de 23 %, 37 %, 21 % et 23 %, respectivement. Les associations indépendantes à la dépression ont été la fraction d’éjection ventriculaire gauche en phase préopératoire < 50 % (Q1, P < 0,05), l’inactivité physique (Q1, P < 0,05) les groupes « exposés à un risque » au début (Q2, P < 0,05) et « dépressifs » au début (Q2-Q4, P < 0,05), le séjour à l’hôpital > 7 jours (Q2, P < 0,05), l’événement stressant en phase postopératoire (Q3 et Q4, P < 0,05) et le temps de pontage cardiopulmonaire > 120 minutes (Q4, P = 0,05). Les patients nouvellement dépressifs 6 mois après l’opération ont déclaré un plus faible niveau d’activité physique à l’IPAQ court que les patients n’ayant pas de dépression (changement médian, −40 min/sem (intervalle interquartile [IIQ], −495 à +255) vs +213 min/sem (IIQ, +150 à +830; P < 0,05).

      Conclusions

      Jusqu′à 40 % des patients sont dépressifs aprés une chirurgie cardiaque. Les événements stressants de la dépression en phases préopératoire et postopératoire ont été les associations indépendantes les plus importantes en phase postopératoire. L’inactivité physique a été associée à la dépression en phase préopératoire et à la nouvelle dépression 6 mois après la chirurgie.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rugulies R.
        Depression as a predictor for coronary heart disease. A review and meta-analysis.
        Am J Prev Med. 2002; 23: 51-61
        • Brown J.M.
        • Stewart J.C.
        • Stump T.E.
        • Callahan C.M.
        Risk of coronary heart disease events over 15 years among older adults with depressive symptoms.
        Am J Geriatr Psychiatry. 2011; 19: 721-729
        • Connerney I.
        • Shapiro P.A.
        • McLaughlin J.S.
        • Bagiella E.
        • Sloan R.P.
        Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study.
        Lancet. 2001; 358: 1766-1771
        • Wang X.S.
        • Mei Y.Q.
        • Li A.P.
        • et al.
        Depression before and after operation in patients undergoing coronary artery bypass grafting and the effect thereof on quality of life.
        Zhonghua Yi Xue Za Zhi. 2008; 88: 3283-3286
        • Andrade L.
        • Caraveo-Anduaga J.J.
        • Berglund P.
        • et al.
        The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) surveys.
        Int J Methods Psychiatr Res. 2003; 12: 3-21
        • McKhann G.M.
        • Borowicz L.M.
        • Goldsborough M.A.
        • Enger C.
        • Selnes O.A.
        Depression and cognitive decline after coronary artery bypass grafting.
        Lancet. 1997; 349: 1282-1284
        • Blumenthal J.A.
        • Lett H.S.
        • Babyak M.A.
        • NORG Investigators
        Depression as a risk factor for mortality after coronary artery bypass surgery.
        Lancet. 2003; 362: 604-609
        • Rafanelli C.
        • Roncuzzi R.
        • Milaneschi Y.
        Minor depression as a cardiac risk factor after coronary artery bypass surgery.
        Psychosomatics. 2006; 47: 289-295
        • van Melle J.P.
        • de Jonge P.
        • Honig A.
        • et al.
        Effects of antidepressant treatment following myocardial infarction.
        Br J Psychiatry. 2007; 190: 460-466
        • Glassman A.H.
        • O'Connor C.M.
        • Califf R.M.
        • et al.
        Sertraline treatment of major depression in patients with acute MI or unstable angina.
        JAMA. 2002; 288: 701-709
        • Blumenthal J.A.
        • Babyak M.A.
        • O'Connor C.
        • et al.
        Effects of exercise training on depressive symptoms in patients with chronic heart failure: The HF-ACTION randomized trial.
        JAMA. 2012; 308: 465-474
        • Horne D.
        • Kehler S.
        • Kaoukis G.
        • et al.
        Depression before and after cardiac surgery: do all patients respond the same?.
        J Thorac Cardiovasc Surg. 2013; 145: 1400-1406
      1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text rev. ed. Washington, DC: 2000.

        • Lichtman J.H.
        • Bigger Jr., J.T.
        • Blumenthal J.A.
        • et al.
        Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from The American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association.
        Circulation. 2008; 118: 1768-1775
        • Craig C.L.
        • Marshall A.L.
        • Sjostrom M.
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • Colley R.C.
        • Garriguet D.
        • Janssen I.
        • et al.
        Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey.
        Health Rep. 2011; 22: 7-14
        • Trost S.G.
        • McIver K.L.
        • Pate R.R.
        Conducting accelerometer-based activity assessments in field-based research.
        Med Sci Sports Exerc. 2005; 37: S531-S543
        • Pirraglia P.A.
        • Peterson J.C.
        • Williams-Russo P.
        • Gorkin L.
        • Charlson M.E.
        Depressive symptomatology in coronary artery bypass graft surgery patients.
        Int J Geriatr Psychiatry. 1999; 14: 668-680
        • Timberlake N.
        • Klinger L.
        • Smith P.
        • et al.
        Incidence and patterns of depression following coronary artery bypass graft surgery.
        J Psychosom Res. 1997; 43: 197-207
        • McKenzie L.H.
        • Simpson J.
        • Stewart M.
        A systematic review of pre-operative predictors of post-operative depression and anxiety in individuals who have undergone coronary artery bypass graft surgery.
        Psychol Health Med. 2010; 15: 74-93
        • Murphy B.M.
        • Elliott P.C.
        • Higgins R.O.
        • et al.
        Anxiety and depression after coronary artery bypass graft surgery: most get better, some get worse.
        Eur J Cardiovasc Prev Rehabil. 2008; 15: 434-440
        • Sansone R.A.
        • Sansone L.A.
        Rumination: relationships with physical health.
        Innov Clin Neurosci. 2012; 9: 29-34
        • Linden W.
        • Phillips M.J.
        • Leclerc J.
        Psychological treatment of cardiac patients: a meta-analysis.
        Eur Heart J. 2007; 28: 2972-2984
        • Peterson J.C.
        • Charlson M.E.
        • Williams-Russo P.
        • et al.
        New postoperative depressive symptoms and long-term cardiac outcomes after coronary artery bypass surgery.
        Am J Geriatr Psychiatry. 2002; 10: 192-198
        • Connerney I.
        • Sloan R.P.
        • Shapiro P.A.
        • Bagiella E.
        • Seckman C.
        Depression is associated with increased mortality 10 years after coronary artery bypass surgery.
        Psychosom Med. 2010; 72: 874-881
        • Furze G.
        • Dumville J.C.
        • Miles J.N.
        • et al.
        “Prehabilitation” before CABG surgery improves physical functioning and depression.
        Int J Cardiol. 2009; 132: 51-58
        • Dao T.K.
        • Youssef N.A.
        • Armsworth M.
        • et al.
        Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery.
        J Thorac Cardiovasc Surg. 2011; 142: e109-e115
        • Dunkel A.
        • Kendel F.
        • Lehmkuhl E.
        • et al.
        Predictors of preoperative depressive risk in patients undergoing coronary artery bypass graft surgery.
        Clin Res Cardiol. 2009; 98: 643-650
        • de Jaegere P.P.
        • Suyker W.J.
        Off-pump coronary artery bypass surgery.
        Heart. 2002; 88: 313-318
        • Marasco S.F.
        • Sharwood L.N.
        • Abramson M.J.
        No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis.
        Eur J Cardiothorac Surg. 2008; 33: 961-970
      2. Winnipeg Regional Health Authority. 2009/2010 Winnipeg Region Annual Report. 2010. Available at: http://www.wrha.mb.ca/healthinfo/reports/annual.php. Accessed October 5, 2013.

        • Rutledge T.
        • Redwine L.S.
        • Linke S.E.
        • Mills P.J.
        A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease.
        Psychosom Med. 2013; 75: 335-349
        • Lee P.H.
        • Macfarlane D.J.
        • Lam T.H.
        • Stewart S.M.
        Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review.
        Int J Behav Nutr Phys Act. 2011; 8: 115
        • van Poppel M.N.
        • Chinapaw M.J.
        • Mokkink L.B.
        • van Mechelen W.
        • Terwee C.B.
        Physical activity questionnaires for adults: a systematic review of measurement properties.
        Sports Med. 2010; 40: 565-600
        • Rimer J.
        • Dwan K.
        • Lawlor D.A.
        • et al.
        Exercise for depression.
        Cochrane Database Syst Rev. 2012; 7: CD004366
        • Herring M.P.
        • Puetz T.W.
        • O'Connor P.J.
        • Dishman R.K.
        Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials.
        Arch Intern Med. 2012; 172: 101-111
        • Win S.
        • Parakh K.
        • Eze-Nliam C.M.
        • Gottdiener J.S.
        • Kop W.J.
        • Ziegelstein R.C.
        Depressive symptoms, physical inactivity and risk of cardiovascular mortality in older adults: the Cardiovascular Health Study.
        Heart. 2011; 97: 500-505
        • Berlin A.A.
        • Kop W.J.
        • Deuster P.A.
        Depressive mood symptoms and fatigue after exercise withdrawal: the potential role of decreased fitness.
        Psychosom Med. 2006; 68: 224-230
        • Roshanaei-Moghaddam B.
        • Katon W.J.
        • Russo J.
        The longitudinal effects of depression on physical activity.
        Gen Hosp Psychiatry. 2009; 31: 306-315
        • Chalder M.
        • Wiles N.J.
        • Campbell J.
        • et al.
        Facilitated physical activity as a treatment for depressed adults: randomised controlled trial.
        BMJ. 2012; 344: e2758
        • Maclullich A.M.
        • Ferguson K.J.
        • Miller T.
        • de Rooij S.E.
        • Cunningham C.
        Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses.
        J Psychosom Res. 2008; 65: 229-238
        • Arenson B.G.
        • Macdonald L.A.
        • Grocott H.P.
        • Hiebert B.M.
        • Arora R.C.
        Effect of intensive care unit environment on in-hospital delirium after cardiac surgery.
        J Thorac Cardiovasc Surg. 2013; 146: 172-178