The impact of exercise-only-based

rehabilitation on depression and anxiety

in patients after myocardial infarction

Iwona Korzeniowska-Kubacka1, Maria Bilińska2, Dorota

Piotrowska1, Monika Stepnowska1 and Ryszard Piotrowicz1

Presenter :
Dr. Yusuf Arifin
Supervisor :
Dr. Saifur Rohman, Sp. JP (K ), Ph.D**
*Resident of Cardiology Department , Brawijaya University School of Medicine/Dr.Saiful Anwar Hospital Malang
**Supervisor of Cardiology, Brawijaya University School of Medicine/
Dr.Saiful Anwar Hospital Malang

1
 BACKGROUND

• Anxiety and depression are commonly observed risk

factors in patients after myocardial infarction (MI) and
are also strong predictors of mortality.
• Approximately 65% of patients with acute MI report
symptoms of depression.
• Cardiac Rehab reduce the rates of all-cause and cardiac
mortality, the incidenc of acute cardiac events, hospital
readmission, and mitigated cardiovascular disease
progression
2
 BACKGROUND
• The aim of the study was to assess the
effectiveness of exercise training on
depression, anxiety, physical capacity and
sympatho-vagal balance in patients after MI
and compare differences between men and
women.
 SAMPLE
Between January and December 2014, 225 consecutive
patients (158 men and 67 women) 3 month after MI
patients

Inclusion criteria: sinus rhythm, preserved left

ventricular function (ejection fraction >50%), clinical
stability for at least two weeks prior to entry to the study
plus optimal and stable medical treatment

Exclusion criteria: unstable angina, congestive heart

failure, uncontrolled hypertension, valvular heart disease,
impaired renal or hepatic function.
 METHODS
Before the TP (TRAINING PROGRAM) each patient
filled out the state–trait anxiety inventory (STAI)
including assessment of state-anxiety (A-state) and
trait-anxiety (A-trait) and the Beck depression
inventory (BDI).

Depression was diagnosed with

BDI > 10 score
Anxiety was diagnosed with 44
points for the A-state subscale
and 46 for the A-trait subscale
 Cont… METHODS
Exercised Stress Test: Cycloergometer with the
workload increased every 3 minutes by 50 Watts using
a computerised system Case 8000. following parameters
were analysed: maximal workload (W), duration
(minutes), double product (DP, mmHg/min), Heart rate
(HR, bpm) at rest and at peak effort and HR recovery in
the first (HRR1) and second minute (HRR2) of the
recovery period

Patients were qualified for the TP on the basis of

their EST results. The limit of training HR was
calculated as the sum of resting HR and 60–80% of
HR reserve
 STATISTICAL ANALYSIS
• Student’s t-test for matched pairs or the analysis of
variance were used to compare the parameters of a
continuous type in the groups studied.
• For non parametric variable test, the chi-square test
was used when the number was high enough or
Fisher’s exact test when it was not significant
• Multivariate regression analysis with stepwise method
selection of variables was done to assess the
association between exercise-induced changes in
anxiety and depress sion and such variables as: age,
sex, hypertension, time to CR after MI and physical
capacity
• The following clinical data were abstracted from hospital
records: demographic information, the use of βblocker
/ ACE - inhibitor at admission, medical history, prior
myocardial infarction, prior HF hospitalization, lab.
findings (Hb, Na, Cr,n, NT-proBNP & albumin), HR, BP,
LVEF & hospital mortality.
• Serum albumin levels were analyzed using a bromocresol
purple dye-binding method. The in-house reference range
for this albumin assay is 38 to 49 g/L, with total imprecision
<2.5%.
Table 1. Clinical characteristics of the study group.
Figure 2. Depression manifestations in all studied groups and separately in men and
women before and after the training programme. See Table 1 for numbers in each
group. All values are mean±SD. *P<0.05, **P<0.01 vs. baseline.
Figure 3. Anxiety as state in all studied groups and separately in men and wome before
and after the training programme. See Table 1 for numbers in each group.
All values are mean±SD. *P<0.05, **P<0.01 vs. baseline.
Figure 4. Changes in the results of exercise stress tests in all studied groups
and separately in men and women before and after the training programme.
Percentage changes from the results of the baseline EST are plotted. See
Table 1 for numbers in each group. All values are mean±SD. *P<0.05,
**P<0.01, #P<0.001 vs baseline
DISCUSSION
 DISCUSSION
• Beyond the beneficial impact of regular exercise
training on physical capacity a shift of the
sympatho-vagal balance toward parasympathetic
dominance has been observed.
• Such parasympathetic parameters as HR, HRR
and HR variability have been shown to improve in
people undergoing exercise training. On the other
hand, increased sympathetic activity is associate
with an increased risk of cardiac events and death
 CONCLUSION
• Participating in an exercise TP
beneficially contributed to a decrease in
depression and anxiety manifestations
in post-MI women. Neither depression
nor anxiety changed significantly in
EXERCISE STRESS TEST men. The impact of exercise training on
CAN RELIEVED physical capacity and autonomic
DEPRESSION AND balance was beneficial and comparable
ANXIETY IN post MI between men and women.
ESPECIALLY in WOMEN
THANK YOU..