Exercise may reduce heart failure risk for people with depression or anxiety

Physical activity may reduce the risk of heart failure among people with depression or anxiety more so than in people without the mental health conditions, according to new research.

Previous studies have shown that depression and anxiety are associated with unhealthy behaviors that can lead to heart disease, and that physical activity may help reduce heart failure—when the heart can't pump blood properly—by lessening stress-related activity in the nervous system.

For the new study, researchers wanted to learn more about the impact of exercise on heart failure risk in people with depression, anxiety or both. They started with self-reported physical activity data from 48,673 participants in the Mass General Brigham Biobank, with a median age of 60. Then they looked at who developed heart failure over a 10-year period, and compared participants who had depression or anxiety with those who did not have either condition.

"We found that while physical activity very nicely reduces heart failure risk across the entire population, it had a substantially greater impact on heart failure risk among individuals with depression and anxiety, and this differential impact was relatively large," said the study's lead researcher, Dr. Abdulaziz Al-Hamam, a cardiovascular research fellow at Massachusetts General Hospital in Boston. Unpublished data shows the effect ranged from about 33% to 50% greater risk reduction, he said, "which was somewhat surprising."

The findings were presented earlier this week at the American Heart Association's Scientific Sessions 2023 in Philadelphia. They are considered preliminary until full results are published in a peer-reviewed journal.

Al-Hamam said the results underscore the link between physical and mental health and serve as a reminder that cardiologists should work more closely with mental health professionals. Health care systems should establish interdisciplinary clinics, he said. Medical professionals also should be more proactive and speak with their patients about the importance of exercise, and support efforts to stay physically active.

"Patients should prioritize regular physical activity, even if it's simply walking, since the sum of one's physical activity adds up to support heart and brain health," Al-Hamam said. "They need to keep an open line of communication with health care providers about their mental and heart health. Regular checkups and effective stress management play vital roles in maintaining overall well-being and preventing heart failure, particularly for patients with depression and anxiety."

Al-Haman said the research was limited by its reliance on self-reported data and its observational nature, which can't prove cause and effect. Future studies, he said, should look at the ideal type, length and intensity of exercise as well as other lifestyle factors, like sleep and diet, to reduce heart failure risk among people with depression or anxiety.

Dr. Georges Chahoud, a cardiologist with St. Louis Cardiology Consultants and regional director of the Heart Failure Clinical Program at SSM Health in Missouri, called the new research "significant" because it highlights that more physical activity would help people with depression and anxiety who are at higher risk of heart failure.

"Medical professionals should implement counseling about the importance of physical activity, especially in this group of patients who are more vulnerable," said Chahoud, who was not involved with the research.

Chahoud also said more research is needed, including studies to see if similar benefits are observed in people with atherosclerosis, a buildup of plaque in artery walls that can lead to a heart attack or stroke.