Exercise training as treatment of depression in heart failure.

We read with interest the thoughtful review by Downing and Balady (1) describing in detail the pathophysiology of exercise impairment in heart failure (HF) and the beneficial role of exercise training in this population. The authors outline the many pathophysiological effects of exercise but fail to include the salutary effects of exercise on behavioral conditions, including depression and depressive symptoms, which are estimated to occur in 24% to 42% of HF patients (2,3). When present, depression and depressive symptoms are associated with poorer survival and greater use of healthcare services, including hospitalization, emergency room visits, and outpatient services. We and others have demonstrated the beneficial effects of exercise in the treatment of depression in the general population, in patients with coronary disease, and in patients with HF, where depressive symptoms were reduced by 40% (2– 6). The importance of this high-risk and common comorbidity should not be overlooked when outlining the many benefits of exercise training as treatment.