INCREASING the intensity of physical activity over 2 months was associated with improvements in anxiety, depression, and fatigue in heart failure patients with an implantable device like the implantable cardioverter defibrillators (ICD), while reductions in activity were not linked to worsening symptoms.
Understanding how physical activity changes over time can impact heart failure symptoms is essential for optimising patient care. This study analysed data from 96 heart failure patients with ICDs participating in a randomised controlled trial of an exercise intervention. Researchers examined the relationship between changes in physical activity and symptoms of fatigue, pain, depression, and anxiety. Physical activity was measured over five days at baseline and again after two months, assessing both daily step count and the intensity of the most active 30 minutes per day. Symptom burden was evaluated using validated assessment tools, including the SF-36 Vitality and Bodily Pain subscales, the Patient Health Questionnaire-9, and the State-Trait Anxiety Index.
The study population was predominantly male (83%) and Caucasian (79%), with an average age of 55.8 years and a mean BMI of 29.7. Most had heart failure with reduced ejection fraction (HFrEF; 30.9±9.9%). Results showed that an increase in daily step count was significantly associated with reduced anxiety (β: -1.178, p=0.048). More importantly, greater physical activity intensity was linked to significant improvements in depression (β: -0.127, p=0.021), anxiety (β: -0.234, p=0.037), and fatigue (β: 0.528, p=0.022). Notably, reductions in physical activity, whether in total steps or intensity, were not associated with worsening symptoms.
These findings highlight the potential benefits of encouraging heart failure patients with ICDs to gradually increase the intensity of their physical activity. Given the observed improvements in psychological wellbeing and fatigue, clinicians should consider incorporating structured exercise interventions with a focus on intensity progression into routine heart failure care. Future research should explore the long-term sustainability of these benefits and the most effective strategies for promoting safe and sustained physical activity in this patient population.
Katheeja Imani, EMJ
Reference
Auld JP et al. Heart failure symptoms improve with more intense physical activity. Biol Res Nurs. 2025;27(2):236-45.
