Exercise of Limited Benefit for Anxiety in Patients With Heart Disease

— Emotional Well-being, Mental Health, Psychiatrists, Psychologists

Although physical exercise does have quite a few wellness rewards, its effect on anxiousness in patients with heart illness is inconsistent. Escitalopram, having said that, has been shown to be protected and successful for symptoms of anxiousness in these patients, according to the final results of a study published in JAMA Psychiatry.

As anxiousness issues are typical amongst persons with heart illness, the researchers wanted to examine the effects of escitalopram and aerobic physical exercise compared with placebo on coronary heart illness (CHD) biomarkers of threat. They performed the UNWIND study (ClinicalTrials.gov Identifier:  NCT02516332), a single-internet site, parallel-group, randomized clinical trial that utilised adjust in scores on the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) as the major outcome.

Enrollment took location in between January 2016 and February 2020. Men and females aged 40 and more than with documented CHD and an anxiousness symptom severity score of 8 or greater on the HADS-A and/or diagnosis of an anxiousness disorder as per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) participated in the study.

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A total of 128 participants exercised for 50 minutes 3 occasions per week at a cardiac rehabilitation facility. Treatment was initiated with escitalopram 5 mg/d or placebo and improved to 10 mg/d at week 2 and 15 mg/d at week 3 if there was no adjust or only minimal improvement in anxiousness symptoms, with a maximum dosage of 20 mg/d at week 4 if no adjust, only minimal improvement, and no side effects. Participants had been randomly assigned to physical exercise, escitalopram, or placebo in a 2:2:1 ratio. The groups shared related demographic and clinical traits.

All groups had been discovered to knowledge lowered anxiousness levels with imply reductions of -4. (95% CI, -4.7 to -3.2) in the physical exercise group, -5.7 (95% CI, -6.4 to -5.) in the escitalopram group, and -3.5 (95% CI, -4.5 to -2.4) in the placebo group. HADS-A scores had been lowest in the escitalopram group. At 12 weeks, each the escitalopram group and the physical exercise group had comparable levels of state anxiousness. The escitalopram group seasoned more speedy improvements early in the study even though the physical exercise group showed improvements in the latter 6 weeks.

Overall, “the effects of exercise in reducing trait anxiety were no better than placebo controls and also provided no advantage compared with placebo in reducing symptoms of depression,” the researchers concluded. However, the study was restricted to a single internet site with a quick therapy duration and smaller sample size. The 12-week therapy period may well have been insufficient to measure heart illness biomarkers. The researchers also did not aspect diagnoses of key depressive disorder. As the physical exercise group participated in a system common in cardiac rehabilitation, adjusting intensity or duration of physical exercise could have impacted the final results.


Blumenthal JA, Smith PJ, Jiang W, et al. Effect of exercise, escitalopram, or placebo on anxiety in patients with coronary heart disease: the understanding the benefits of exercise and escitalopram in anxious patients with coronary heart disease (UNWIND) randomized clinical trial. JAMA Psychiatry. 202178(11):1270-1278. doi:10.1001/jamapsychiatry.2021.2236

Originally published in www.psychiatryadvisor.com