Canadian Journal of Cardiology

Impact of Physical Activity on Depression After Cardiac Surgery



      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.


      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.


      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).


      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.



      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.


      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.


      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).


      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.
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