Non-Pharmacological Interventions in Older People with Heart Failure: Effects of Exercise Training and Relaxation Therapy

Abstract

Background: Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment. Yet, there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure. Objective: To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients. Methods: Subjects undertook relaxation (n = 59), exercise training (n = 32) or received attention placebo (n = 62) for 12 weeks. The relaxation group attended two training sessions, one revision workshop, and continued with twice-daily taped-directed home relaxation practice, with support from the intervener through bi-weekly telephone contact, for 12 weeks. The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise. The control group received regular telephone calls for general ‘greetings’. Results: The relaxation and exercise groups reported a significantly greater improvement in psychological [F(2, 149) = 6.69, p = 0.002] and various disease-specific quality of life outcomes [dyspnea: F(2, 149) = 5.72, p = 0.004; fatigue: F(2, 149) = 3.78, p = 0.25; emotion: F(2, 149) = 6.68, p = 0.001], compared with those who received the attention placebo. While relaxation therapy was more effective to reduce psychological distress, with depression in particular (p < 0.001), exercise therapy worked better to control fatigue symptoms (p = 0.03). Conclusion: Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients. They should be used as an individual treatment modality, or as care components of a disease management program.

Pathophysiological Relationships Between Heart Failure and Depression and Anxiety

“…96 The effects of an exercise program on depression in patients with heart failure were examined in 7 studies. [101][102][103][104][105][106][107] The exercise programs varied by type, intensity, frequency, duration, and patients' adherence. Despite the differences, the strength of the evidence was moderate that exercise is effective at decreasing depressive symptoms in patients with heart failure.…”

A Systematic Review of Recreation Therapy for Depression in Older Adults

“…In addition, other 5 studies are non-controlled one-group interventions [39][40][41][42][43]. Table 1 summarizes the characteristics and design of the included studies.…”

“…Sample size ranged from 9 people to 439 people. All participants from eight studies were all diagnosed patients with depression [18,27,31,32,34,37,42], while older adults in another eight studies did not meet criteria for depression, instead they either suffered from chronic physical illness [35,40], balance-problem [29,38], dementia [36] and cognitive decline [44,45] or were regular attendees [39,43]. The last two studies [28,41] mixed up the depressed and non-depressed participants, in which the depressed elderly accounted for 48.3% and 52% of total participants respectively.…”

“…Physical interventions embraced multiple forms and included gardening [39], biking [18,27], balance training [29,38], Taichi and stretching [30], aerobic and resistance exercise [32,33,43] and Qigong [34,35]. Recreation therapy focusing on the psychological training comprised therapeutic intervention of anticipatory grief [40], support group [31], group reminiscence [36] and behavioral activation [42].…”

“…It may be argued that the differences in sample size, intervention frequency and length could have affected the outcomes. Further evidence from the 3-group pretest post-test study [43] suggested that, in the relaxation training and exercise training intervention programs, participants reported different levels of improvement on the Hospital Anxiety and Depression Scale (HADS) subscales. Although both interventions had improvement in depression, only the relaxation group yielded significance from the HADS depression subscale while exercise group did not.…”