Exercise to Treat Depression in Individuals With Coronary Heart Disease

CHD is caused by a narrowing of the small blood vessels that supply blood and oxygen to the
heart. It is the leading cause of death in the United States. Recent evidence has suggested
that depression is a significant risk factor for individuals with CHD and may place
additional strain on the heart. Selective serotonin reuptake inhibitors (SSRIs), a type of
antidepressant medication, have been shown to be especially effective at reducing depression
symptoms, particularly for individuals with CHD. However, many people fail to benefit from
medication alone or they experience negative side effects. Therefore, a need exists to
identify alternative approaches for treating depression in individuals with CHD. Preliminary
research has shown that exercise may be an effective way to improve mood and treat
depression. More research, however, is needed to confirm the benefits of exercise in
individuals with CHD. The purpose of this study is to compare the effectiveness of a
supervised exercise program, antidepressant treatment, and placebo in reducing depression
and improving heart function in individuals with CHD.

This 16-week study will enroll adults with a history of CHD and depression. Participants
will be randomly assigned to an aerobic exercise program, antidepressant medication, or
placebo. At study entry, standardized psychological questionnaires will be completed and
depression levels and exercise tolerance will be assessed. Participants' heart function will
be evaluated through measures of flow-mediated vasodilatation, inflammation, platelet
function, baroreflex, and heart rate variability. Participants assigned to the exercise
program will be required to engage in structured aerobic exercise. Participants assigned to
antidepressant medication will receive sertraline, an SSRI. At Week 16, participants will
return to the clinic for repeat assessments of baseline measures. A follow-up evaluation
will occur six months following the end of treatment, and participants' depression levels
and clinical status will be assessed.