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Depression, heart rate variability, and exercise training in dialysis patients.
Eur J Cardiovasc Prev Rehabil 2010; 17(2):160-7EJ

Abstract

BACKGROUND

Functional limitations, altered cardiac autonomic activity, and psychological distress are known disorders in chronic hemodialysis (HD) patients, relating to increased morbidity and mortality. The aim of this study was to examine the influence of an exercise training program on emotional parameters and heart rate variability (HRV) indices, as well as to determine whether emotional stress contributes to autonomic dysfunction in these patients.

METHODS

Forty-four HD patients were randomly assigned into group A (24 patients, aged 46.3+/-11.2 years), who participated in a 1-year intradialytic exercise training program and group B (20 patients, aged 45.8+/-10.8 years), who were used as controls. At baseline and a year after, measures of HRV were obtained for the estimation of standard deviation of RR intervals, the mean square successive differences, percentage of RR intervals differing by more than 50 ms from the preceding RR interval (pNN50), and low to high frequency components. Emotional parameters (Beck Depression Inventory - BDI and Hospital Anxiety and Depression Scale - HADS) were also assessed by validated questionnaires. Moreover, all patients performed a spiroergometric study for the estimation of VO2peak.

RESULTS

At baseline, all measurements were similar in the two groups and remained almost unchanged after a year in group B. After a year of training, VO2peak increased from 16.79+/-5.24 to 22.33+/-4.90 ml/kg per min (P<0.001) in group A. Trained patients also showed an increase in standard deviation of RR intervals by 58.8% (P<0.001), the mean square successive differences by 68.1% (P<0.001), pNN50 by 23.5% (P<0.001), and a low to high frequency ratio by 17.3% (P<0.001). Finally, at the end of the study, group A showed a decrease in BDI score by 34.5% (P<0.001) and HADS by 23.9% (P<0.001). Canonical correlation revealed significant inverse correlation among depression (in BDI and HADS) and HRV indices before and after exercise training.

CONCLUSION

Cardiac autonomic modulation seemed to be sensitive to the experience of persistent depression in HD patients. Significantly, exercise training reduced emotional distress and concomitantly improved HRV.

Authors+Show Affiliations

Sports Medicine Laboratory, TEFAA, Aristotle University of Thessaloniki, Thessaloniki, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19745744

Citation

Kouidi, Evangelia, et al. "Depression, Heart Rate Variability, and Exercise Training in Dialysis Patients." European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups On Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, vol. 17, no. 2, 2010, pp. 160-7.
Kouidi E, Karagiannis V, Grekas D, et al. Depression, heart rate variability, and exercise training in dialysis patients. Eur J Cardiovasc Prev Rehabil. 2010;17(2):160-7.
Kouidi, E., Karagiannis, V., Grekas, D., Iakovides, A., Kaprinis, G., Tourkantonis, A., & Deligiannis, A. (2010). Depression, heart rate variability, and exercise training in dialysis patients. European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups On Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 17(2), pp. 160-7. doi:10.1097/HJR.0b013e32833188c4.
Kouidi E, et al. Depression, Heart Rate Variability, and Exercise Training in Dialysis Patients. Eur J Cardiovasc Prev Rehabil. 2010;17(2):160-7. PubMed PMID: 19745744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Depression, heart rate variability, and exercise training in dialysis patients. AU - Kouidi,Evangelia, AU - Karagiannis,Vassilis, AU - Grekas,Dimitrios, AU - Iakovides,Apostolos, AU - Kaprinis,George, AU - Tourkantonis,Achilleas, AU - Deligiannis,Asterios, PY - 2009/9/12/entrez PY - 2009/9/12/pubmed PY - 2010/7/10/medline SP - 160 EP - 7 JF - European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology JO - Eur J Cardiovasc Prev Rehabil VL - 17 IS - 2 N2 - BACKGROUND: Functional limitations, altered cardiac autonomic activity, and psychological distress are known disorders in chronic hemodialysis (HD) patients, relating to increased morbidity and mortality. The aim of this study was to examine the influence of an exercise training program on emotional parameters and heart rate variability (HRV) indices, as well as to determine whether emotional stress contributes to autonomic dysfunction in these patients. METHODS: Forty-four HD patients were randomly assigned into group A (24 patients, aged 46.3+/-11.2 years), who participated in a 1-year intradialytic exercise training program and group B (20 patients, aged 45.8+/-10.8 years), who were used as controls. At baseline and a year after, measures of HRV were obtained for the estimation of standard deviation of RR intervals, the mean square successive differences, percentage of RR intervals differing by more than 50 ms from the preceding RR interval (pNN50), and low to high frequency components. Emotional parameters (Beck Depression Inventory - BDI and Hospital Anxiety and Depression Scale - HADS) were also assessed by validated questionnaires. Moreover, all patients performed a spiroergometric study for the estimation of VO2peak. RESULTS: At baseline, all measurements were similar in the two groups and remained almost unchanged after a year in group B. After a year of training, VO2peak increased from 16.79+/-5.24 to 22.33+/-4.90 ml/kg per min (P<0.001) in group A. Trained patients also showed an increase in standard deviation of RR intervals by 58.8% (P<0.001), the mean square successive differences by 68.1% (P<0.001), pNN50 by 23.5% (P<0.001), and a low to high frequency ratio by 17.3% (P<0.001). Finally, at the end of the study, group A showed a decrease in BDI score by 34.5% (P<0.001) and HADS by 23.9% (P<0.001). Canonical correlation revealed significant inverse correlation among depression (in BDI and HADS) and HRV indices before and after exercise training. CONCLUSION: Cardiac autonomic modulation seemed to be sensitive to the experience of persistent depression in HD patients. Significantly, exercise training reduced emotional distress and concomitantly improved HRV. SN - 1741-8275 UR - https://www.unboundmedicine.com/medline/citation/19745744/Depression_heart_rate_variability_and_exercise_training_in_dialysis_patients_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=19745744.ui DB - PRIME DP - Unbound Medicine ER -