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Dose-Response Relationship Between Exercise Intensity, Mood States, and Quality of Life in Patients With Heart Failure

Evangelista, Lorraine S. PhD, RN, FAHA, FAAN; Cacciata, Marysol MSN, RN, CCRN-K; Stromberg, Anna PhD, RN, NFESC, FAAN; Dracup, Kathleen PhD, RN, FNP, FAAN

The Journal of Cardiovascular Nursing: November/December 2017 - Volume 32 - Issue 6 - p 530–537
doi: 10.1097/JCN.0000000000000407
ARTICLES: Prevention

Background: We conducted a secondary analysis to (1) compare changes in mood disorders and quality of life (QOL) among 4 groups of patients with heart failure in a home-based exercise program who had varying degrees of change in their exercise capacity and (2) determine whether there was an association between exercise capacity, mood disorders, and QOL.

Methods: Seventy-one patients were divided into 4 groups based on changes in exercise capacity from baseline to 6 months: group 1showed improvements of greater than 10% (n = 19), group 2 showed improvements of 10% or less (n = 16), group 3 showed reductions of 10% or less (n = 9), and group 4 showed reductions of greater than 10% (n = 27).

Results: Over time, patients in all 4 groups demonstrated significantly lower levels of depression and hostility (P < .001) and higher levels of physical and overall quality of life (P = .046). Group differences over time were noted in anxiety (P = .009), depression (P = .015), physical quality of life (P < .001), and overall quality of life (P = .002). Greater improvement in exercise capacity was strongly associated with lower depression scores (r = −0.49, P = .01).

Conclusions: An improvement in exercise capacity with exercise training was associated with a decrease in depression and anxiety and an increase in QOL in patients with heart failure.

Lorraine S. Evangelista, PhD, RN, FAHA, FAAN Professor and Associate Director of the PhD Program, Program in Nursing Science, University of California, Irvine.

Marysol Cacciata, MSN, RN, CCRN-K Doctoral Student, Program in Nursing Science, University of California, Irvine.

Anna Stromberg, PhD, RN, NFESC, FAAN Professor, Department of Medical and Health Sciences and Department of Cardiology, Linkoping University, Sweden.

Kathleen Dracup, PhD, RN, FNP, FAAN Dean Emerita and Professor Emerita School of Nursing, University of California, San Francisco.

This research was partially supported by a grant from the American Heart Association Western Division (NCR 133-09; PI, K. Dracup).

The authors have no conflicts of interest to disclose.

Correspondence Marysol Cacciata, MSN, RN, CCRN-K, Sue and Bill Gross School of Nursing, University of California, Irvine 299E Berk Hall, Irvine, CA 92697-3959 (

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