Meeting guideline-recommended exercise targets is associated with a reduced risk of cardiovascular disease (CVD) in everyone, but the benefits may be particularly clear for people with anxiety and depression, a new analysis suggests.

In a study of more than 50,000 adult patients with or without CVD or risk factors who were followed for a median of 1.8 years, the cardioprotective effects associated with exercise were almost twice as large in people with anxiety and depression than in those without these conditions.

Overall, individuals who met the American Heart Association (AHA)/American College of Cardiology (ACC) recommendations for physical activity had a 17% lower risk of having coronary major adverse cardiovascular events (MACE), defined as unstable angina, myocardial infarction (MI), or coronary revascularization.

However, individuals with anxiety or depression had a 22% lower risk of coronary MACE during follow-up, compared to the 10% lower risk in individuals without these stress-related conditions.

Hadil Zureigat, MD, a clinical research fellow at Massachusetts General Hospital and Harvard Medical School, Boston, reported these findings in a press briefing; the study will be presented at the American College of Cardiology 2022 Scientific Session, being held virtually and in person in Washington, DC, starting April 2.

Importantly, the “findings don’t suggest that exercise is only effective in those with anxiety and depression,” Zureigat stressed in an email to | Medscape Cardiology. Rather, they show that “people with these diagnoses derive a relatively greater cardiovascular benefit from exercise — roughly double the risk reduction.”

These findings are “really important,” said Andrew Kates, MD, who was not involved in this research.

“We use multiple medications for secondary prevention in our patients with CVD,” Kates, professor of medicine, Washington University School of Medicine, St. Louis, Missouri, told | Medscape Cardiology in an email. “This gives us additional data to present to patients to encourage lifestyle changes as a way to combat CVD,” or to prevent CVD in other patients.

“Anxiety and depression are common in patients with heart disease and estimated to be present in 15% to 30% of such patients,” Kates noted.

“We should screen for this,” he added, by asking “simple questions about fatigue, stress, self-esteem, etc, with a low threshold for referral to a primary provider for more formal assessment. For many, it is a matter of making sure patients are aware of the association of anxiety and depression with heart disease.”

Building on Prior Imaging Studies

This study builds on two earlier ones using data from this biobank, both of which were presented at recent cardiology meetings, Zureigat noted.

In the first study, imaging data showed that exercise decreases stress-associated neural activity predominantly by upregulating regulatory medial prefrontal cortical activity. In a second study, she said, “we showed that this mechanism (that involves the brain) explains about 7% of the cardiovascular benefit of exercise.

“Given these findings,” Zureigat said, “we asked the next logical question, ‘Shouldn’t people with stress-related conditions such as anxiety and depression, derive more cardiovascular benefit from exercise?’ ”

The current study did indeed show this and provides “further support of the importance of stress-related neural mechanisms in explaining the cardiovascular benefits of exercise.”

Moreover, “any amount of exercise is helpful [to lower CVD risk], particularly for those with depression or anxiety,” Zureigat said in a press release issued by the ACC.

“Not only will physical activity help them feel better, but they will also potentially reduce their risk of cardiovascular disease,” she said. “It can be hard to make the transition, but once achieved, physical activity allows those with these common chronic stress-related psychiatric conditions to hit two birds with one stone.”

Anxiety, Depression Common

The researchers analyzed data from 50,359 adults older than 18 years who were enrolled in the Mass General Brigham Biobank and who replied to questionnaires in which they reported physical activity.

Of these, 16,995 patients (34%) had a diagnosis of anxiety, and 14,015 patients (20%) had a diagnosis of depression, based on ICD codes.

The cohort included patients with a wide age range, with or without previous MI or stroke, and 15% to 48% had cardiovascular risk factors of type 2 diabetes, hypertension, or hyperlipidemia, or current or past smoking.

The patients were classified as either meeting or exceeding, or not meeting AHA/ACC recommendations of at least 150 minutes of moderate physical activity per week, equivalent to 500 metabolic equivalent of task (MET) minutes per week.

Meeting or exceeding these physical activity recommendations was associated with a lower risk of coronary MACE compared to not meeting these targets, after adjusting for cardiovascular risk factors and age and sex, (odds ratio, 0.838, 95% CI, 0.78 – 0.90, P = .015).

Among patients with anxiety or depression, those with ≥500 MET minutes of physical activity per week had a lower risk of coronary MACE than those who did not meet this target.


SOURCE:, Marlene Busko