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Mental healthFeb 16, 2022

Exercise a 'sound investment' for mood management in people with coronary heart disease, says study

Prescribing exercise for depressed people with a history of coronary heart disease is more cost-effective than offering either psychotherapy or medication, according to a research team based in Ireland, the UK and the USA.

Led by Samira Jabakhanji from the Healthcare Outcomes Research Centre at RCSI in Dublin, the research team conducted a study, the results of which will be published in the April issue of the Journal of Psychosomatic Research.

While coronary heart disease cannot be cured, lifestyle changes, medication and medicine and/or surgery are all common treatments. However, many people with the condition experience moderate or severe acute depression that may also require treatment. 

Dr Jabakhanji and colleagues examined the cost and the effectiveness of four types of treatments for depression in individuals with coronary heart disease: antidepressants, psychotherapy, collaborative or multidisciplinary team care, and supervised group exercise.

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Assumptions included patients having regular supervised treadmill exercise sessions

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Cost analysis

Their study built on earlier research findings that showed that exercise was the most effective treatment for depression in coronary heart disease. In their study, the cost of administering each of the four treatment types was analysed against the rate of reoccurrence of depression eight weeks later. The costs studied included the cost of antidepressants, the frequency of contact between patient and staff members, and the cost of staff time.

At eight weeks, the researchers found that group exercise treatment resulted in a cost of €526 per patient (about £440) who achieved remission from depression (was successfully treated). This cost was followed closely by treatment with antidepressants which amounted to €589 per remission (about £493). Individual psychotherapy costed €3,117 per remission (about £2,610) and collaborative care amounted to €4,964 per remission (about £4,157). Future trials should explore the cost-effectiveness of other group treatments, the authors suggest.


They note that their study ‘indicates that group exercise is the most cost-effective intervention for depression in individuals with CAD [coronary artery disease] that shows within only eight weeks of treatment’.

They continue: ‘Pharmacotherapy also was cost-effective after eight or 26 weeks and may be considered as an alternative, in particular for patients who do not respond to exercise after eight weeks. While individual psychotherapy was more expensive and less cost-effective, we suggest that group psychotherapy should be explored as a potentially cost-effective alternative to other depression treatments; however studies are needed to investigate the feasibility and effectiveness of group psychotherapy in Ireland as no trials on group psychotherapy were available.'

The team adds: ‘Where psychologists and cardiac physiologists are employed, cardiac rehabilitation programmes may offer an opportunity to integrate exercise early in CAD treatment to maximise efficiency.’

Exercise is a 'sound investment'

Studies such as this are valuable to policy-makers as they combine the relative costs and effectiveness of treatments, allowing resources to be better targeted ... exercise is a sound investment for mood management in people with coronary heart disease [Frank Doyle]

Lead author Samira Jabakhanji said: ‘The findings of this research indicate that, within a very short time, group exercise most effectively treats depression in individuals with coronary heart disease, and notably it is the most cost-effective treatment. This is followed closely by antidepressants.'

Dr Jabakhanji added: ‘The study gives us important insight into planning future depression treatment in this patient group in terms of delivering the best outcomes and value for both health service and patients.’

Co-author Frank Doyle, from the Department of Health Psychology and study principal investigator at RCSI, said: ‘Studies such as this are valuable to policy-makers as they combine the relative costs and effectiveness of treatments, allowing resources to be better targeted for patients. This work clearly shows that exercise is a sound investment for mood management in people with coronary heart disease.’ 

To see the full version of the article, titled Depression interventions for individuals with coronary artery disease – Cost-effectiveness calculations from an Irish perspective, visit: https://www.sciencedirect.com/science/article/pii/S0022399922000320

Established in 2016, the Healthcare Outcomes Research Centre is dedicated to the development and dissemination of evidence-based research on healthcare outcomes that informs healthcare policy and improves patient outcomes.

Author: Ian A McMillan
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