Anxiety, depression symptoms linked to poorer exercise in CTEPH
Study found worse ventilatory efficiency with higher symptom scores
Written by |
People newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) who have lower exercise capacity and poorer breathing efficiency during exercise tend to also report more severe anxiety and depressive symptoms, according to a new study in China.
“The present findings … support greater attention to psychological symptoms during the initial clinical assessment of CTEPH, particularly in patients with marked functional limitation,” the researchers wrote.
The study, “Cross-sectional independent associations of anxiety and depressive symptoms with cardiopulmonary exercise performance in treatment-naïve chronic thromboembolic pulmonary hypertension,” was published in the Journal of Psychosomatic Research.
Study examines mental health and exercise in untreated CTEPH
In CTEPH, abnormal blood clots block or narrow the blood vessels that carry blood through the lungs, raising pressure in those vessels and reducing the amount of oxygen carried through the body. This can lead to symptoms like shortness of breath and fatigue.
Previous studies have shown that anxiety and depressive symptoms are common among people with CTEPH. However, the relationship between the severity of these symptoms and detailed measures of exercise performance in untreated CTEPH has not been well characterized.
“In CTEPH, available evidence has mainly characterized the prevalence of psychological disorders and patient-reported outcomes, whereas the relationship between psychological symptom burden and comprehensive [cardiopulmonary exercise testing] profiles remains insufficiently characterized,” the researchers wrote.
Seeking to address this gap, this study enrolled 236 participants with newly diagnosed, untreated CTEPH. The participants underwent cardiopulmonary exercise testing, a six-minute walk test, and right heart catheterization, and they also completed standardized questionnaires evaluating the severity of anxiety and depressive symptoms. With all these data in hand, the scientists conducted statistical analyses to look for significant associations.
“This study aimed to explore the independent associations between anxiety and depressive symptoms and [measures from cardiopulmonary exercise testing] in treatment-naïve CTEPH patients. … By focusing on the pre-treatment baseline state, we sought to characterize the relationship between psychological symptom burden and cardiopulmonary exercise performance in CTEPH,” the researchers wrote.
Results showed that both anxiety and depressive symptoms were significantly correlated with measures of exercise capacity and ventilatory efficiency. In other words, anxiety and depressive symptoms were generally more severe in people with greater physical limitations who needed to breathe more to clear a given amount of carbon dioxide during exercise.
After accounting for other factors that could affect the results, depressive symptoms showed a broader pattern of associations with exercise measures than anxiety symptoms. Higher depressive symptom scores were independently linked to lower peak oxygen uptake (VOâ‚‚peak), the highest amount of oxygen used during exercise, and a shorter six-minute walking distance.
Mental health and physical limitations may affect each other
The scientists noted that the relationship between mental health and physical limitations in CTEPH may go both ways. Shortness of breath and physical limitations may worsen anxiety or depressive symptoms, while anxiety or depressive symptoms may also be linked to poorer exercise performance through changes in behavior and how the body responds during exercise.
“Greater dyspnea [shortness of breath] and functional limitation may increase psychological symptom burden, while psychological distress may accompany lower exercise performance through behavioral and physiological pathways,” the researchers wrote.
The team added that these findings “support greater attention to psychological symptoms during initial clinical assessment and provide a basis for prospective studies examining the bidirectional [two-way] links between psychological health and functional recovery.”
The scientists noted that this study assessed Chinese patients at a single point in time, so it could not determine which changes came first. They called for longer-term studies to track how mental health symptoms and exercise performance change during and after treatment and rehabilitation.
“Longitudinal studies tracking both [mental health symptoms and exercise performance] during treatment and rehabilitation will help clarify how changes in one relate to changes in the other,” the researchers wrote.
Leave a comment
Fill in the required fields to post. Your email address will not be published.