A recent article about cardiac prevention came from an unexpected source: a journal dedicated to psychiatry.  Not what I typically expect, but the key to this psych connection is all about depression and its effects on the heart.  We know that cardiovascular disease and depression are the most common causes of disability in Western countries. In fact, one in five people with heart disease has depression. So it is worth exploring this connection in more detail.

The article, published in JAMA Psychiatry, not only links the two conditions but also concludes with some important advice about how to live longer.

The new information: Men and woman who remain physically fit in middle age may be able to avoid depression and have a lower chance of dying of a heart problem when they get older.  This study looked at participants in the Cooper Center Longitudinal Study, which is a prospective, ongoing examination of people living in Texas, that began in 1970.  Records from almost 18,000 patients provided this snapshot of aging.  Middle age was defined at 45-50 years; older age at more than 65 years. (This is a definition that I object to, as I think middle age starts at 60!) Fitness was established objectively on baseline stress tests.

Here are my 10 takeaways form the study:

  1. In a group of healthy middle-aged men and women, higher mid-life fitness was associated with less depression after the age of 65.
  2. Depression has been shown in other studies to be clearly linked to a bad outcome after a heart attack and should be considered a risk factor for developing heart disease. Treating depression is as important in prevention as not smoking, having high cholesterol, high blood pressure, or diabetes.
  3. If depression developed later in life, someone who exercised frequently years earlier had a 56 percent decreased chance of dying from a cardiac problem after the age of 65.
  4. If there was no history of depression, a high fitness level in middle age was associated with a 61 percent lower risk of dying from a heart problem compared to a lower level of fitness.
  5. The study looked primarily at a well-educated, white population who had good access to health care. The large homogeneous population and long follow-up were a strength of the study, but it is hard to know if the results would apply to people of color or economic disadvantage.
  6. The magic amount of exercise needed to prevent a problem seemed to be as little as walking or biking for two hours per week. Doing at least this amount decreased the chance of having a heart problem.
  7. Exercise may help depression and heart disease by decreasing inflammation and the stickiness of blood, and by changing hormone levels
  8. A recent review showed no evidence that exercise alone is enough to treat someone who has been diagnosed with depression. If you or someone you care about has depression, see a trained specialist, as medication and/or therapy can make a difference, perhaps with exercise as part of the prescription.
  9. Still another recent study of almost 34,000 adults without depression who were followed for 11 years found that 12 percent of future cases of depression could be prevented by engaging in at least one hour per week of any kind of leisure-time exercise, regardless of intensity.
  10. Other activities besides walking, biking or running can make a difference. Standing is better than sitting. Relaxation techniques like meditation, or trying yoga or tai-chi can also help cardiac health.

The bottom line is that remaining fit in middle age is associated with a lower risk of depression in later life.  Beginning an exercise program now will decrease your risk of having a stroke, heart attack or dying from any heart related reason in the future.  Any amount or kind of exercise will help, and it is never too late to start.

David Becker, M.D., is a frequent Inquirer contributor and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for 25 years.