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A new study has suggested that exercise may be beneficial to people with heart failure who are also depressed.

Researchers found patients who exercised an hour and a half to two hours per week had slightly lower depression scores, which in turn were tied to a reduced risk of re-hospitalizations and deaths related to heart problems. Depression is common in patients with cardiac disease, especially in patients with heart failure, and is associated with increased risk of adverse health outcomes.

But, the researchers also noted that the exercise effect is only modest.

The study is published in the Journal of the American Medical Association. Almost six million people in the U.S. have heart failure, according to the Centers for Disease Control and Prevention and up to 40 percent of people with heart failure struggle with depression.

"I think this shows that for patients who have heart failure, exercise is certainly an excellent treatment," said James A. Blumenthal,  lead author of the study. "It's something that most patients can engage in. It results in improved cardiorespiratory fitness, they have more stamina, and now we see that not only do they derive these physical benefits, but they also derive psychological benefits as well."

Over a four-year period, researchers assigned more than 2,322 stable heart failure patients to a program of regular aerobic exercise or usual care. They questioned the participants about depression symptoms at the start of the study and tracked both those symptoms and hospitalizations and deaths over time.

Participants in the exercise group had three 30-minute workout sessions per week for three months, then were given a treadmill or stationary bike to continue exercising at home for another nine months.

About 28 percent of patients were clinically depressed at the start of the study, based on a questionnaire covering 21 different symptoms.

Depression scores in general - and especially in people with a depression diagnosis - tended to drop with exercise. But the disparity between exercisers and non-exercisers was small, equal to participants scoring similarly on 20 out of 21 symptoms and exercisers getting a "mild" score on one symptom where the usual care group got a "moderate" or "severe" score.

Over an average of two and a half years, close to 1,200 study participants were hospitalized and 386 died. Exercise was tied to a lower risk of both hospitalization and death, according to findings published Tuesday in the Journal of the American Medical Association.

In addition, people who got less depressed during the study were less likely to have heart problems, whereas those who had worsening depression symptoms also did worse heart-wise.