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The DEMO Trial: A Randomized, Parallel-Group, Observer-Blinded Clinical Trial of Strength Versus Aerobic Versus Relaxation Training for Patients With Mild to Moderate Depression
Abstract
To assess the benefit and harm of exercise training in adults with clinical depression.
The DEMO trial is a randomized pragmatic trial for patients with unipolar depression conducted from January 2005 through July 2007. Patients were referred from general practitioners or psychiatrists and were eligible if they fulfilled the International Classification of Diseases, Tenth Revision, criteria for unipolar depression and were aged between 18 and 55 years. Patients (N = 165) were allocated to supervised strength, aerobic, or relaxation training during a 4-month period. The primary outcome measure was the 17-item Hamilton Rating Scale for Depression (HAM-D(17)), the secondary outcome measure was the percentage of days absent from work during the last 10 working days, and the tertiary outcome measure was effect on cognitive abilities.
At 4 months, the strength measured by 1 repetition maximum for chest press increased by a mean (95% CI) of 4.0 kg (0.8 to 7.2; p = .014) in the strength training group versus the relaxation group, and maximal oxygen uptake increased by 2.7 mL/kg/min (1.2 to 4.3; p = .001) in the aerobic group versus the relaxation group. At 4 months, the mean change in HAM-D(17) score was -1.3 (-3.7 to 1.2; p = .3) and 0.4 (-2.0 to 2.9; p = .3) for the strength and aerobic groups versus the relaxation group. At 12 months, the mean differences in HAM-D(17) score were -0.2 (-2.7 to 2.3; p = .8) and 0.6 (-1.9 to 3.1; p = .6) for the strength and aerobic groups versus the relaxation group. At 12 months, the mean differences in absence from work were -12.1% (-21.1% to -3.1%; p = .009) and -2.7% (-11.7% to 6.2%; p = .5) for the strength and aerobic groups versus the relaxation group. No statistically significant effect on cognitive abilities was found.
Our findings do not support a biologically mediated effect of exercise on symptom severity in depressed patients, but they do support a beneficial effect of strength training on work capacity.
(ClinicalTrials.gov) Identifier: NCT00103415.
... periods of these studies varied between 8 weeks and 26 months. Training frequency was between two and four times per week, with training intensity varying between 20 and 80% of subjects' 1RM (18,(20)(21)(22)(23)(24)(25). One of the studies provided no specific data on training intensity (22), whereas another study used mean heart rate as a measure of intensity (25). ...
... Moreover, the study by Krogh et al. (2009) found no significant effects for strength training. Having said that, subjects in the strength training group had fewer days of absence from work compared to the control group (relaxation training: mat exercises/selfmassage, light balance exercises, tension and relaxation exercises) (24). ...
... Moreover, the study by Krogh et al. (2009) found no significant effects for strength training. Having said that, subjects in the strength training group had fewer days of absence from work compared to the control group (relaxation training: mat exercises/selfmassage, light balance exercises, tension and relaxation exercises) (24). At 12 months, a mean difference of −12.1% (95% CI: [−21.1%; ...
Background:
More than 320 million people around the world suffer from depression. Physical activity and sports are effective treatment strategies. Endurance training has already been intensively studied, but any potential antidepressant effect of resistance training is unknown at present, nor is it clear whether this could yield any relevant benefit in clinical use.
Methods:
The PubMed database was selectively searched for recent studies and review articles concerning the use, efficacy, and safety of resistance training in persons with depressive symptoms and diagnosed depression.
Results:
Two meta-analyses revealed that resistance training alleviated depressive symptoms with a low to moderate effect size (0.39-0.66). Resistance training in patients with diagnosed depression was studied in seven randomized controlled trials, in which the duration of the intervention ranged from eight weeks to eight months. In six of these trials, the depressive symptoms were reduced. In one trial, a persistent benefit was seen in the resistance-training group at 26 months of follow-up (adherence, 33%). Moreover, resistance training improved strength, quality of life, and quality of sleep. No serious adverse events occurred; this indicates that resistance training in depression is safe.
Conclusion:
Resistance training seems to have an antidepressant effect. Open questions remain concerning its effects in different age groups, as well as the optimal training parameters. Further high-quality trials will be needed to document the effect of resistance training more conclusively and to enable the formulation of treatment recommendations.
... Physical exercise uses specific movement patterns performed in a systematic manner through a program planned to improve fitness or health-related outcomes [31]. Clinical research assessing the effects of chronic exercise on cognition in adults with depression has predominantly used aerobic exercise training programs [32][33][34][35], although it has also considered strength training [36] or multicomponent training (coordination, endurance, and strength training) [30]. The results obtained in these investigations in adults with depression show improvements in short-term memory [34,35], inhibitory control [33], processing speed [35,37], attention, verbal fluency, and cognitive flexibility [37] after the implementation of sustained exercise programs for weeks and months. ...
... The results obtained in these investigations in adults with depression show improvements in short-term memory [34,35], inhibitory control [33], processing speed [35,37], attention, verbal fluency, and cognitive flexibility [37] after the implementation of sustained exercise programs for weeks and months. However, other studies have not shown improvements in cognitive measures when comparing physical exercise with the control condition in this population [36,38]. Hoffmann et al. [38] state that the lack of effect of their intervention program (aerobic exercise versus placebo) on the cognitive functioning of adults with depression could be explained by the absence of baseline cognitive impairment among participants, the characteristics of the diagnosis of depression (nonrecurring, early onset mild-to-moderate depression with good response to treatment), the relatively short duration of treatment (4 months in both studies), and a small percentage of improvement in the aerobic capacity of participants (6%), which could have been insufficient to elicit effects on the cognitive functioning at the end of the intervention. ...
... Hoffmann et al. [38] state that the lack of effect of their intervention program (aerobic exercise versus placebo) on the cognitive functioning of adults with depression could be explained by the absence of baseline cognitive impairment among participants, the characteristics of the diagnosis of depression (nonrecurring, early onset mild-to-moderate depression with good response to treatment), the relatively short duration of treatment (4 months in both studies), and a small percentage of improvement in the aerobic capacity of participants (6%), which could have been insufficient to elicit effects on the cognitive functioning at the end of the intervention. However, Krogh et al. [36] suggest that the absence of significant effects of their four-month training programs (strength training versus relaxation and aerobic training versus relaxation) on the cognitive abilities of adults with depression could be due to a possible antidepressant effect of the control condition, non-blinded treatment allocation for patients and therapists, inclusion of participants who had received previous pharmacological treatment for more than 6 weeks, low attendance at training programs (approximately 50%), low weekly scheduled frequency (twice a week), and the possible absence of baseline cognitive impairment of patients. ...
Executive function is among the most affected cognitive dimensions in depression. Physical ex-ercise may improve executive function (e.g., working memory, inhibition, cognitive flexibility), although without consensus on adults with depression. Through this systematic review, we aim to elucidate the effects of physical exercise programs on executive functions in adults with depression. The literature search was performed in four relevant electronic databases, combining keywords and medical subject headings, from inception until September 2022. Controlled interventions were considered includable, involving adults with depression, and reporting working memory, inhi-bition, and/or cognitive flexibility pre-post-intervention data. Meta-analyses results included effect size (ES, i.e., Hedges’ g) values reported with 95% confidence intervals (95%CIs), with p set at ≤0.05. Seven studies were included, including 202 men and 457 women (age: 21.0–51.2 years; mild–moderate depression). For working memory, a small favoring effect was observed in the ex-perimental groups compared to controls (ES = 0.33, 95%CI = 0.04–0.61; p = 0.026; I2 = 64.9%). For inhibition, physical exercise had a small favoring non-significant effect compared to controls (ES = 0.28, 95%CI = −0.17–0.74; p = 0.222; I2 = 72.4%). Compared to the control group, physical exercise had a trivial effect on cognitive flexibility (ES = 0.09, 95%CI = −0.21–0.39; p = 0.554; I2 = 68.4%). In con-clusion, physical exercise interventions may improve working memory behavioral measures in adults with mild-to-moderate depression when compared to active and passive control conditions. However, the reduced number of available high-quality studies precludes more lucid conclusions.
... Exercise is a physical activity performed systematically according to a planned program to improve fitness and physical or health-related outcomes [31]. Clinical research on the effects of chronic exercise on the cognition of adults with depression has mainly used aerobic exercise training programs [32][33][34][35], but has also included strength training [36] or multicomponent training (coordination, endurance, and strength) [30]. The results of these studies show improvements in short-term memory [34,35], inhibitory control [33], processing speed [35,37], attention, verbal fluency, and cognitive flexibility [37] after implementing chronic exercise programs. ...
... The results of these studies show improvements in short-term memory [34,35], inhibitory control [33], processing speed [35,37], attention, verbal fluency, and cognitive flexibility [37] after implementing chronic exercise programs. However, other studies did not find improvements in cognitive measures when comparing physical exercise with a control condition in this population [36,38]. Hoffman et al. [38] explain that the lack of effect of their intervention program on the cognitive functioning of adults with depression could be explained by the lack of baseline cognitive impairment among participants, the diagnostic characteristics of depression (mild to moderate severity, non-recurring, early onset, and with good response to treatment), the relatively short duration of treatment (4 months in both studies), and a small percentage of improvement in the aerobic capacity of participants (6%). ...
... This may not have been enough to cause effects on cognitive functioning near the end of the intervention. However, Krogh et al. [36] suggest that the lack of significant effects of their 4-month training programs (strength training versus relaxation and aerobic training versus relaxation) on the cognitive abilities of adults with depression could be due to the following factors: possible antidepressant effect of the control condition, lack of patient and therapist blinding when allocating treatment, inclusion of participants who had received prior pharmacological treatment for more than 6 weeks, low participation in training programs (approximately 50%), low scheduled weekly frequency (twice a week), and possible initial absence of cognitive deficit among patients. ...
Physical exercise is a low-cost and easy-to-implement therapeutic option proposed to reduce the negative effect of depression on the executive function cognitive dimension, including working memory, inhibition, and cognitive flexibility. Although a considerable amount of scientific lit-erature on the topic is currently available, the effects of physical exercise interventions on the executive functions in adults with depression remain unclear. The aim of this review protocol is to synthesize the effects of physical exercise interventions on executive functions in adults with depression. Databases including Web of Science, PubMed, Scopus, and EBSCO will be searched for studies by combining keywords and different medical subject headings to identify and evaluate the relevant studies from inception up to September 2022. This study will consider longitudinal studies (duration, ≥3 weeks) with a minimum of one experimental group and pre- and post-intervention measurements involving adults with depression aged 18–65 years. Studies will be included if these reported ≥1 measures of executive functions (i.e., working memory; inhibition; cognitive flexi-bility). The Physiotherapy Evidence Database (PEDro) scale will be used to assess the methodo-logical quality of studies. The DerSimonian and Laird random-effects model will be used for meta-analyses, with effect size (ES, i.e., Hedges’ g) values reported with 95% confidence intervals (95% CIs), and p ≤ 0.05 will indicate statistical significance. The ES values will be calculated for working memory, inhibition, and cognitive flexibility in the experimental and control groups before and after the intervention program. Our results can help professionals and stakeholders in making better evidence-based decisions regarding the implementation of physical exercise pro-grams in adults with depression and providing relevant information to facilitate the functional performance of this population in complex daily tasks where executive functions are essential.
... Our search yielded a cohort of 34 studies in which exercise was employed in a myriad of strategies. For clarity, we subdivided the cohort based on the exercise intervention(s) application: exercise as a monotherapy [20-23, 38, 50, 51] (Table 1), exercise as an adjunct to psychotherapy [52][53][54] (Table 2), exercise as an adjunct to pharmacotherapy [50,[55][56][57][58][59][60][61][62][63][64] (Table 3), and exercise as an adjunct to standard care [65][66][67][68][69][70][71][72][73][74][75][76][77] (Table 4). The publication year of the included studies ranged from 1985 [65] to 2021 [77]. ...
... Although the public health guidelines for PA recommend both AEx and Rex [42][43][44], an overwhelming majority of studies employed AEx as the primary intervention [21, 23, 50-63, 65-67, 69-74, 77]. Two studies employed REx-only (compared to control) [20,22], three studies employed AEx and REx arms [38,64,68], and one study developed a single intervention that included both AEx and Rex [75]. AEx interventions are generally more practical to implement within and outside of a research setting, as less equipment and experience is required for implementation and it allows for greater ease in controlling dosing variables, which may explain the overwhelming use of AEx compared to REx for depression. ...
... Three studies have directly compared the anti-depressant effect of AEx vs. REx [38,64,68] (Table 5) [64,68]. In Doyne et al.'s monotherapy study, the remission rate (Beck Depression Inventory score <9) was 67% for the AEx group (running at 80% of age-predicted MHR [APMHR]), 80% for the REx group (50-60% of APMHR) and 17% for the waitlist control, with no significant difference, noted between the two exercise groups (Table 1) [38]. ...
Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.
... In patients with MDD randomized to 4 weeks' sprint interval training or continuous aerobic exercise training, improvements in CRF were observed in both groups and were associated with improved depressive symptoms, emotional wellbeing, and sleep [48]. In contrast, another study found no improvements in depression score in the Hamilton Rating Scale for Depression after a 4-month strength and aerobic exercise training in patients with MDD [49]. Using mendelian randomization methods on genomic and phenotypic data from the UK biobank, beneficial effects of exercise were detected in depression but not in SZ [50,51] (Table 1). ...
... [99][100][101][102][103]) ( Table 2). Some studies directly measured maximal oxygen uptake (referred to as VO2max or VO2peak) to test changes in CRF in patients with MDD [45,48,49,92,95,97,98] and SZ [57,63,64,85,90,99,100,[103][104][105][106]. These tests are considered the gold standard, but other tests indirectly assessing CRF have been applied. ...
... Mixed programs consisting of aerobic training combined with resistance training may also have the potential to improve CRF in patients with MDD [49,94] and SZ [85,102]. Although three studies measured CRF directly by cardiopulmonary exercise testing [49,85,94,106], Korman et al. [102] used a submaximal test (they assessed functional exercise capacity, a submaximal proxy measure of CRF, as the distance walked during the 6-min walking test). ...
Major depression, bipolar disorder, and schizophrenia are severe mental illnesses. Despite receiving psychopharmacological and psychosocial treatments, about half of patients develop a chronic course with residual cognitive and negative symptoms and have a high risk for cardiovascular disease and reduced life expectancy. Therefore, add-on innovative treatment approaches are needed to improve outcome. Aerobic exercise interventions have been shown to improve global functioning, cognition, and negative and depressive symptoms in these patients. The basic mechanism of these exercise-related changes has been reported to be improved brain plasticity, e.g., increased volume of disease-related brain regions such as the hippocampus. The optimal type, duration, and frequency of exercise have not yet been determined and need to be addressed in supervised physical exercise studies. Because of the low physical activity levels, lack of drive related to negative and depressive symptoms, and high prevalence of cardiovascular comorbidities in patients with severe mental illness, besides aiming to improve symptoms of mental illness, exercise interventions should also aim to increase cardiorespiratory fitness, which they should comprehensively assess by direct measurements of maximal oxygen uptake. Based on the recommendations for developing cardiorespiratory fitness by the American College of Sports Medicine, 150 min moderate-intensity training per week or vigorous-intensity exercise training for 75 min per week are appropriate. Most studies have had relatively short intervention periods, so future studies should focus on long-term adherence to exercise by implementing motivational strategies supported by telemedicine and by identifying and targeting typical barriers to exercise in this patient population.
... The papers of Ansai and Rebelatto [32], Chin et al. [33], Kekäläinen et al. [34], LeCheminant et al. [35], and Levinger et al. [36] were excluded because there was no diagnostic of depression and the average values of the utilized scales for evaluation of depression or depressive symptoms did not reach the cut-off value indicative of depressive symptoms. The final sample consisted of four articles: Krogh et al. [37], Moraes et al. [38], Sims et al. [39] and Singh et al. [40]. The process is synthesized in Figure 1. ...
... The article by Krogh, Saltin, Gluud and Nordentoft [37] was an RCT with patients diagnosed with unipolar depression according to the ICD 10th revision. The sample of 165 patients (73.9% of which were women) was by far the largest among the included articles, potentially affording greater confidence in terms of the generalizability of the results. ...
... Risk of bias was assessed using Cochrane's RoB 2 (see Table 5). Risk of bias arising from the randomization process was low for the articles by Krogh, Saltin, Gluud and Nordentoft [37] and Singh, Stavrinos, Scarbek, Galambos, Liber and Singh [40], but there were concerns with the other two papers [38,39]. Risk of bias due to deviations from intended interventions (effect of assignment to intervention) was low for all articles. ...
The purpose of this study was to systematically review the effects of supervised resistance training (RT) programs in people diagnosed with depression or depressive symptoms. The following databases were used to search and retrieve the articles: Cochrane Library, EBSCO, PEDro, PubMed, Scopus and Web of Science. The search was conducted in late June 2020. Search protocol required the title to contain the words depression or depressive or dysthymia. Furthermore, the title, abstract or keywords had to contain the words or expressions: “randomized controlled trial”; and “strength training” or “resistance training” or “resisted training” or “weight training”. The screening provided 136 results. After the removal of duplicates, 70 records remained. Further screening of titles and abstracts resulted in the elimination of 57 papers. Therefore, 13 records were eligible for further scrutiny. Of the 13 records, nine were excluded, and the final sample consisted of four articles. Results were highly heterogeneous, with half of the studies showing positive effects of resistance training and half showing no effects. In two of the four combinations, the meta-analysis revealed significant benefits of RT in improving depressive symptoms (p ≤ 0.05). However, considering significant differences with moderate (Effect Size = 0.62) and small (ES = 0.53) effects, the heterogeneity was above 50%, thus suggesting a substantial level. To draw meaningful conclusions, future well-designed randomized controlled trials (RCTs) are needed that focus on understudied RT as a treatment for depression.
... Thus, the current systematic review included 38 studies (Ansai and Rebelatto, 2015;Anshel and Russell, 1994;Arrieta et al., 2020;Baker et al., 2007;Bastone Ade and Jacob Filho, 2004;Brown et al., 2009;Cassilhas et al., 2007;Chau et al., 2022;Choi and Sohng, 2018;Cress et al., 1999;Cunha et al., 2022;Diaz-Benito et al., 2022;Haller et al., 2018;Heissel et al., 2015;Huang et al., 2015;Kekäläinen et al., 2018;Kim et al., 2019;Krogh et al., 2009;Makizako et al., 2019;Martins et al., 2011;McGale et al., 2011;Moraes et al., 2020;Norvell and Belles, 1993;Paw et al., 2004;Pedersen et al., 2017;Ruiz et al., 2015;Sen et al., 2020;Sims et al., 2006;Singh et al., 1997Singh et al., , 2005Sohng et al., 2003;Sola-Serrabou et al., 2019;Sparrow et al., 2011;Tapps et al., 2013;Tekin and Cetisli-Korkmaz, 2022;Tse et al., 2014;Williams and Lord, 1997;Zanuso et al., 2012). ...
... However, some articles did not provide pre or post data as mean and standard deviation (even after we requested them by e-mail from the corresponding author), so, the meta-analyses considered 29 studies (Ansai and Rebelatto, 2015;Arrieta et al., 2020;Baker et al., 2007;Bastone Ade and Jacob Filho, 2004;Brown et al., 2009;Choi and Sohng, 2018;Cunha et al., 2022;Diaz-Benito et al., 2022;Haller et al., 2018;Heissel et al., 2015;Kekäläinen et al., 2018;Kim et al., 2019;Krogh et al., 2009;Makizako et al., 2019;Martins et al., 2011;McGale et al., 2011;Moraes et al., 2020;Norvell and Belles, 1993;Paw et al., 2004;Pedersen et al., 2017;Sen et al., 2020;Sims et al., 2006;Singh et al., 1997Singh et al., , 2005Sohng et al., 2003;Tekin and Cetisli-Korkmaz, 2022;Tse et al., 2014;Williams and Lord, 1997;Zanuso et al., 2012). The study selection is detailed in Fig. 1. ...
Depression and subthreshold depressive symptoms reduce quality of life and function and treatment does not work effectively in one-third of patients. Exercise can reduce depressive symptoms, but more information is required regarding strength training (ST). The objective of the present meta-analysis was to summarize and estimate the efficacy of ST in people with a diagnosis of depression or subthreshold depressive symptoms and no other severe disease. We also aimed to explore the variables that could influence the antidepressant effects. PubMed, Embase, Web of Science, PsyINFO, CINAHL, and SPORTDiscus were searched from inception to August 2022. The overall effect antidepressant of training was moderate (SMD = -0.51, 95 % CI -0.72 to -0.30, p < 0.001). The meta-regression demonstrated preliminary evidence that the variables: duration of the intervention in weeks, weekly frequency of the intervention, number of sets, and number of repetitions can influence the antidepressant effects. However, these variables had a small role in the variation of the effect.
... [64] using the metafor package 3.0-2 [65]. All included studies included two or more effect sizes (ESs), and some studies compared exercise training with two different comparator groups [53,66] or compared two exercise groups with one comparator group [67]. Several studies assessed one of the EF subdomains with multiple outcomes (e.g., reaction time and accuracy) [47,68] and tasks/instruments [66,69], or assessed EF across multiple time points [46,70]. ...
... If the exercise intervention did not last long enough in comparison with the active comparator group (i.e., health education, relaxation, stretching, and occupational therapy), it may be difficult to demonstrate a significant difference between the two groups, as the results shown above indicate that only durations lasting ≥ 13 weeks resulted in a significant ES. It should be noted that only one study [67] compared exercise with an active comparator group (relaxation) with duration ≥ 13 weeks in the included RCTs. More studies are [100], which found that exercise interventions had no significant effects on cognitive function in adults older than 50 years old when compared with active comparator groups. ...
Background
Exercise is a promising nonpharmacological intervention to improve executive function (EF). However, results from randomized trials and meta-analyses examining the effects of exercise on working memory in adults with depression are mixed, and the influence of exercise on EF, as well as the key moderators of the relationship, remain inconclusive.
Objective
The present systematic review with meta-analysis examined the influence of exercise interventions on EF in adults with depression, and the influence of key moderating variables.
Methods
Electronic searches were conducted using Embase, Cochrane Central, Scopus, Ovid MEDLINE, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Weipu Database up to 25 June 2022, and updated on 16 January 2023. Randomized controlled trials (RCTs) examining the effects of exercise training on EF in adults with depression were included. A three-level meta-analysis based on a random-effects model was applied in R. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.
Results
A total of 14 RCTs that evaluated 1201 adults with depression were included. The results indicated that exercise significantly improved global EF [g = 0.180; 95% confidence intervals (CI) = 0.038, 0.323], and the subdomains of working memory (g = 0.182; 95% CI = 0.015, 0.350), cognitive flexibility (g = 0.222; 95% CI = 0.048, 0.395), and reasoning/planning (g = 0.889; 95% CI = 0.571, 1.206). In subgroup analyses, significant improvements in EF were only observed for aerobic exercise (g = 0.203; 95% CI = 0.023, 0.382), moderate-to-vigorous intensity exercise (g = 0.200; 95% CI = 0.022, 0.379), exercise performed three or more times per week (g = 0.207; 95% CI = 0.026, 0.388), in sessions ≤ 60 min (g = 0.173; 95% CI = 0.003, 0.343), and in program durations lasting at least 13 weeks (g = 0. 248; 95% CI = 0.034, 0.462).
Conclusions
This meta-analysis demonstrates the benefits of exercise training for improving EF and the subdomains of working memory, cognitive flexibility, and reasoning/planning in adults with depression. Future randomized clinical trials are warranted to determine the therapeutic effects of exercise training on EF and cognitive symptoms in depressed patients.
... A longitudinal study of 4,257 adolescents in the United States found that a onehour daily increase in light physical activity between the ages of 12 and 16 was associated with an 8%-11% reduction in depression symptom scores [53]. However, some studies have produced inconsistent results and suggested that physical activity may have no clinical benefit on depression symptoms [54,55]. The literature has focused more on the unidirectional relationship between physical activity time and depression symptoms in adolescents [1], but the effect of depression symptoms on physical activity time has received little attention. ...
... Third, we did not find a bidirectional relationship between time spent in physical activity and depression symptoms. This finding is consistent with the two previous randomized control trials, which suggested that physical activity does not have a statistically significant effect on depression symptoms [54,55]. This may be because regular engagement in physical activity alone does not prevent depression symptoms, and only an appropriate increase in physical activity can alleviate depressive symptoms [83,84]. ...
The relationship between physical activity time, openness and depression symptoms among adolescents is a cutting-edge research direction in the field, yet it remains unclear. This study is based on a sample of 7924 students from a nationally representative China Education Panel Survey database and examines the bidirectional relationships between physical activity time, openness and depression symptoms among Chinese adolescents. Descriptive analysis showed that during the 7th and 8th grades, the average physical activity time decreased to less than one hour per day, accompanied by a decreasing trend in openness and a slight worsening in depression symptoms. Correlation analysis showed a significant negative correlation between physical activity time and depression symptoms, a significant positive correlation between physical activity time and openness, and a significant negative correlation between depression symptoms and openness. The results from cross-lagged models indicated a bidirectional relationship between physical activity time and openness, with physical activity time significantly positively predicting openness in the following year and openness significantly positively predicting physical activity time in the following year. In addition, depression symptoms had a unidirectional negative predictive effect on openness. The conclusions provide empirical evidence for education administration and schools to promote the physical and mental health development of adolescents worldwide.
... The age of participants ranged between 19 and 76 years old. Fifty-six studies (1510 participants) examined the effects of AE[34, 36-38, 57-59, 61, 64, 66, 67, 69-72, 74-78, 85, 86, 88-96, 98, 101, 102, 106, 107, 109, 111, 112, 114, 118, 121, 122, 124, 136-138, 141, 147, 150, 155-158, 160, 164], while 9 studies (161 participants) evaluated RE[57,60,63,70,122,125,134,149,166], 49 studies (1530 participants) evaluated MBE[35, 43, 62, 73, 79-84, 87, 93, 97, 99, 100, 103-105, 110, 115-117, 119, 120, 123, 126-131, 136, 138, 139, 141-144, 146, 148, 151-154, 159, 161-163, 165], 9 studies (212 participants) for stretching[37,66,68,78,92,109,111,155,157], 10 studies (276 participants) evaluated ME[39,65,108,113,132,133,135,140,145,151], 3 studies (71 participants) evaluated other exercise types ...
... 161,162], 5 studies evaluated RE vs. the control[60,63,125,134,149], 9 studies evaluated ME vs. the control[39,65,108,113,132,133,135,140,145], 1 study evaluated stretching vs. the control[68], 3 studies evaluated AE vs. RE[57,70,122], 2 studies evaluated AE vs. MBE[93,141], 7 studies evaluated AE vs. stretching ...
Background
The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders.
Objective
The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders.
Methods
The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome.
Results
A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind–body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind–body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms.
Conclusion
Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind–body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence.
Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).
... Many studies have shown that physical exercise is an effective way to alleviate depression [9][10][11]. However, some studies have also found that the effects of exercise on the relief of depression are "moderate at best" or statistically insignificant [12][13][14]. ...
... Adolescents who regularly participate in physical exercise are more likely to form good interpersonal relationships with others, and also enhance their social adaptability and good psychological regulation. As can be seen, the results of this study show that physical exercise has a positive effect on reducing depression in adolescents, which is different from previous studies showing that the effects of exercise on depression relief are "moderate at best" or statistically insignificant [12][13][14]. A possible explanation is that the effect of exercise on depression in adolescents may be influenced by some moderator variables that are not clearly defined and identified now. ...
Depression in adolescents is a major public health disorder. The relationship between physical activity and risk of depression in adolescents was examined using three waves of data from the China Family Panel Studies in 2020. The risk of depression was significantly higher among adolescents who reported lower frequency and shorter duration of physical exercise than those who reported physical exercise more frequently and for a longer duration. The risk of depression was significantly higher among adolescents who reported intense physical exercise than those who reported little or no intense physical exercise. The amount of time spent on housework by adolescents is inversely associated with depression. These results provide somewhat stronger evidence for an activity–depression link than previous studies and suggest a differential role for different types of physical activity, such as exercise and housework. The overall model predicting depression in adolescents (LR chi-squared = 95.974, p < 0.001, Nagelkerke R-square = 0.183) was statistically significant. To effectively control depression in adolescents, the government, schools and parents need to act together to guide adolescents towards participation in appropriate physical activities. The appropriate level of physical activity is for adolescents to experience breathing, rapid heartbeat, and slight perspiration.
... Standardized mean differences were calculated using Hedges' g instead of Cohen d, as the latter is known to produce biased effect estimates for smaller samples. 20 Three exercise studies [21][22][23] had multiple comparison groups comprised of different exercise interventions measured against controls. We treated each comparison independently for these 3 studies. ...
... The most common exercise type was aerobic exercise (17 groups from 15 studies [21][22][23][24]30,[32][33][34][35][36][38][39][40]44,46 ) including walking, jogging, and aerobic exercise machines such as the treadmill and stationary bike, with strength training used in 3 groups (Table 1). The treatment duration for exercise studies varied between 8 and 32 weeks, with a mean study duration of 15.5 weeks ( Table 1). ...
Objective:
Exercise, yoga, and tai chi are commonly used complementary approaches for health and wellness. This review aims to synthesize the evidence for exercise, yoga, and tai chi in the outpatient treatment of major depressive disorder.
Study selection:
A systematic search of the Ovid MEDLINE, EMBASE, PsycINFO, and Cochrane databases was conducted for randomized controlled trials of exercise, yoga, and tai chi for major depressive disorder.
Data extraction:
Standardized mean differences were calculated and meta-analyzed using a random effects multilevel modeling framework. Heterogeneity and subgroup analysis was conducted.
Results:
Twenty-five studies were included for final analysis (exercise: 15, yoga: 7, tai chi: 3). Overall, meta-analysis showed a moderate significant clinical effect. However, when only studies (6 studies) with the lowest risk of bias were included, the overall effect size was reduced to low to moderate efficacy. Overall quality of evidence was low. Heterogeneity and publication bias were high.
Conclusions:
The current meta-analysis of outpatient exercise, yoga, and tai chi for treatment of major depressive disorder suggests that adjunctive exercise and yoga may have small additive clinical effects in comparison to control for reducing depressive symptoms. The evidence for tai chi is insufficient to draw conclusions. The concerns with quality of studies, high heterogeneity, and evidence of publication bias preclude making firm conclusions.
... Krogh and colleagues (Krogh et al. 2009) found that strength training decreased the absence time from work, while another study (Kull et al. 2012) indicated that both LTPA and occupational PA related to depressive symptoms; occupational PA was associated with higher depressiveness and LTPA was related to lower depressiveness. In both of these studies, the majority (Krogh et al. 2009) or all of the participants (Kull et al. 2012) were female. ...
... Krogh and colleagues (Krogh et al. 2009) found that strength training decreased the absence time from work, while another study (Kull et al. 2012) indicated that both LTPA and occupational PA related to depressive symptoms; occupational PA was associated with higher depressiveness and LTPA was related to lower depressiveness. In both of these studies, the majority (Krogh et al. 2009) or all of the participants (Kull et al. 2012) were female. Since a wide range of factors, including sex (Schuch et al. 2016a), can potentially moderate the response of people with depressive disorders, caution is advised when generalizing these results to men. ...
Purpose
To examine the relationship between leisure-time physical activity (LTPA) and ability to meet different work requirements among adult working men with or without current depressive symptoms.
Methods
We measured LTPA with the long version of the International Physical Activity Questionnaire (IPAQ). The Work Ability Index (WAI) and Beck Depression Inventory (BDI) were used to assess the work ability and depression of 921 Finnish employed male volunteers. Participants were divided into three groups according to the WAI for their work requirements: mental (MENT), physical (PHYS), and an equal amount of mental and physical work (BTH).
Results
When adjusted for age, BMI and employment years, there was a significant difference in weekly LTPA between WAI groups {p = 0.003, [F (2902) = 5.58]}, but not for depression. It appeared that participants with depressive symptoms scored lower WAI in each group regardless of LTPA. In addition, a linear relationship was found between higher LTPA and WAI in nondepressed workers in the PHYS [p = 0.011, β = 0.10 (95% CI 0.03–0.18)] and BTH [p = 0.027, β = 0.19 (95% CI 0.03–0.34)] groups. Among workers with depressive symptoms, similar linearity was found in BTH [p = 0.003, β = 0.20 (95% CI 0.03–0.55)]. In group-wise comparison, work requirements {p = 0.001, [F (2902) = 11.2]} and depressive symptoms {p < 0.001, [F (1902) = 177.0]} related with lower WAI.
Conclusion
Depressive symptoms were associated with lower work ability regardless of the job description. Therefore, higher levels of weekly LTPA was linked with better work ability among nondepressed working men. Workers with depressive symptoms in jobs that require extensive mental or physical work might need more than exercise to improve work ability.
... Various forms of exercise, including aerobic and anaerobic activities, have been shown to alleviate symptoms of depression by modulating neurobiological pathways and improving physical health. Aerobic exercises, in particular, have been associated with enhanced mood and reduced depressive symptoms through the release of endorphins and other neurochemicals that promote feelings of well-being (14). The benefits of exercise are not limited to mood improvement but also include enhanced cognitive function, reduced anxiety, and better overall physical health (6). ...
Objective: The aim of the present study was to investigate the effect of training volume on depression-related behaviors and serum levels of brain-derived neurotrophic factor (BDNF) and testosterone in mice. Male NMRI mice, approximately 80 days old and weighing 20 to 23 grams, were used in this study. Methods and Materials: They were kept under a 12-hour light/12-hour dark cycle at a temperature of 23±1°C, with adequate food and water provided. The male NMRI mice, approximately 80 days old and weighing 20 to 23 grams, were kept under a 12-hour light/12-hour dark cycle at a temperature of 23±1°C, with adequate food and water provided. From 90 days old to 118 days old, the animals underwent swimming exercise for 4 weeks. They were divided into two groups: long-term training volume and short-term training volume. The short-term swimming group included one session of short-term training, while the long-term group included three sessions of long-term training with 10-minute swimming periods and 15-minute rest intervals between each session. The water depth and swimming duration gradually increased from 5 to 15 centimeters (second to fourth week) and from 20 (second to third week) to 30 (fourth week) minutes per day. The non-exercised animals were placed in a round tank without water for a duration similar to that of the exercised animals. Results: The results showed a significant difference in immobility duration between the control group and the two training groups, as well as between the two training groups (P ≤ 0.05). There was also a significant difference in depression levels between the two training groups and between the long-term training group and the control group (P ≤ 0.05). However, there was no significant difference between the short-term training group and the control group (P ≥ 0.05). Post hoc test results indicated a significant difference in BDNF levels between the control group and the long-term training group (P ≤ 0.05). Furthermore, there was a significant difference in testosterone levels between the control group and both the short-term and long-term training groups (P ≤ 0.05), but no difference between the two training groups (P ≥ 0.05). Conclusion: Based on the overall results of the study, different training volumes have varying effects on depression and BDNF levels, with long-term training producing greater effects.
... Aerobic exercise was effective in reducing anxiety symptoms in all eight RCTs that investigated aerobic exercise alone and one RCT that combined aerobic and anaerobic exercises [27][28][29][30][31][32][33][34][35][36]. Nine of the 14 RCTs on the effect of aerobic exercise on depression observed a significant improvement in depression after aerobic exercise [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. Eight of the nine RCTs on insomnia and aerobic exercise reported significant improvements in insomnia symptoms [54][55][56][57][58][59][60][61][62]. ...
Purpose of Review
This review aimed to investigate emerging evidence regarding the effectiveness of exercise for migraines, focusing on the results of recent trials. Additionally, it explored the possibility of exercise as a treatment for migraines.
Recent Findings
Between 2020 and 2023, five, four, one, and two trials were conducted regarding the effect of aerobic exercise, anaerobic exercise, Tai Chi, and yoga, respectively, on migraine; all studies showed significant effects. Two trials on aerobic exercise showed that high-intensity exercise was similar to or slightly more effective than moderate-intensity exercise as a treatment for migraines. Three trials on anaerobic exercise reported its effectiveness in preventing migraines.
Summary
Regarding efficacy, side effects, and health benefits, aerobic exercises and yoga are potentially beneficial strategies for the prevention of migraines. Further studies are needed to develop evidence-based exercise programs for the treatment of migraines.
... While many studies have assessed the use of exercise-based interventions for mental disorders, specific evidence supporting the use of such modalities for improving work-related outcomes is scarce. A Cochrane systematic review of interventions to improve return to work in patients with MDD included two randomized controlled trials (41,174,175). For the outcome of reducing sickness absence, supervised strength exercise was more effective than relaxation, whereas aerobic exercise was not more effective than relaxation or stretching. ...
Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker’s compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.
... The data on resistance trainingdefined as the use of resistance to muscular contraction to build the strength, anaerobic endurance and size of skeletal musclesas a standalone intervention for depression are limited; only two studies have evaluated the efficacy of resistance training in people with depression, showing a positive impact of these interventions on the global level of depressive symptoms and quality of life (Krogh et al., 2009);Kvam et al., 2016). ...
People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardio-metabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions ; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psycho-social interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders. ARTICLE HISTORY
... Walking every day for 10 days, with an 80% maximum heart rate (HRmax), significantly reduced the Bech-Rafaelsen Mania Scale (BRMS) score of patients with major depression [73]. Cycling at 70-80% HRmax for 12 weeks reduced the symptoms of individuals with depressive symptoms, and improved maximum oxygen uptake and visuospatial memory [74]. Aerobic exercises in physical education classes significantly reduced adolescents' impulsivity, anxiety, drug abuse [36,38]. ...
Background:
Depression is widespread among adolescents and seriously endangers their quality of life and academic performance. Developing strategies for adolescent depression has important public health implications. No systematic review on the effectiveness of physical exercise for adolescents aged 12-18 years with depression or depressive symptoms has previously been conducted. This study aims to systematically evaluate the effect of physical exercise on adolescent depression in the hope of developing optimum physical exercise programs.
Methods:
Nine major databases at home and abroad were searched to retrieve randomized controlled trials (RCTs) on exercise interventions among adolescents with depression or depressive symptoms. The retrieval period started from the founding date of each database to May 1, 2021. The methodological quality of the included articles was evaluated using the modified PEDro scale. A meta-analysis, subgroup analysis, sensitivity analysis, and publication bias tests were then conducted.
Results:
Fifteen articles, involving 19 comparisons, with a sample size of 1331, were included. Physical exercise significantly reduced adolescent depression (standardized mean difference [SMD] = - 0.64, 95% CI - 0.89, - 0.39, p < 0.01), with a moderate effect size, in both adolescents with depression (SMD = -0.57, 95% CI - 0.90, - 0.23, p < 0.01) and adolescents with depressive symptoms (SMD = - 0.67, 95% CI - 1.00, - 0.33, p < 0.01). In subgroups of different depression categories (depression or depressive symptoms), aerobic exercise was the main form of exercise for the treatment of adolescents with depression. For adolescents with depression, interventions lasting 6 weeks, 30 min/time, and 4 times/week had optimum results. The effects of aerobic exercise and resistance + aerobic exercise in the subgroup of adolescents with depressive symptoms were significant, while the effect of physical and mental exercise (yoga) was not significant. For adolescents with depressive symptoms, aerobic exercise lasting 8 weeks, 75-120 min/time, and 3 times/week had optimum results. Physical exercise with moderate intensity is a better choice for adolescents with depression and depressive symptoms.
Conclusions:
Physical exercise has a positive effect on the improvement of depression in adolescents. The protocol for this study was registered with INPLASY (202170013). DOI number is 10.37766/inplasy2021.7.0013. Registration Date:2021.7.06.
... B. Cooney et al. 2013) liegen. Beispielsweise wurden aktive Kontrollgruppen, wie Sportinterventionen mit mehreren Gruppen (Kraft-, Ausdauer-, und Entspannungstraining) (Krogh et al. 2009), oder Kontrollgruppen, die Antidepressiva erhielten (Blumenthal et al. 1999), miteinander verglichen. Die tatsächliche Effektgröße von Sporttherapie konnte damit nicht nachgewiesen werden (Ekkekakis 2015). ...
... Despite these positive findings, other studies have failed to find an effect. For example, a four-month study comparing aerobic exercise, strength training, and relaxation training did not find an effect of either exercise intervention on cognitive functioning (Krogh, Saltin, Gluud, & Nordentoft, 2009). A recent meta-analysis in this area (Sun, Lanctot, Herrmann, & Gallagher, 2018) included 9 studies and, consistent with a previous meta-analysis (Brondino et al., 2017), failed to find a significant benefit of exercise for cognition in major depression in the overall analysis. ...
Objective
To lay out the argument that exercise impacts neurobiological targets common to both mood and cognitive functioning, and thus more research should be conducted on its use as an alternative or adjunctive treatment for cognitive impairment in late-life depression (LLD).
Method
This narrative review summarizes the literature on cognitive impairment in LLD, describes the structural and functional brain changes and neurochemical changes that are linked to both cognitive impairment and mood disruption, and explains how exercise targets these same neurobiological changes and can thus provide an alternative or adjunctive treatment for cognitive impairment in LLD.
Results
Cognitive impairment is common in LLD and predicts recurrence of depression, poor response to antidepressant treatment, and overall disability. Traditional depression treatment with medication, psychotherapy, or both, is not effective in fully reversing cognitive impairment for most depressed older adults. Physical exercise is an ideal treatment candidate based on evidence that it 1) is an effective treatment for depression, 2) enhances cognitive functioning in normal aging and in other patient populations, and 3) targets many of the neurobiological mechanisms that underlie mood and cognitive functioning. Results of the limited existing clinical trials of exercise for cognitive impairment in depression are mixed but overall support this contention.
Conclusions
Although limited, existing evidence suggests exercise may be a viable alternative or adjunctive treatment to address cognitive impairment in LLD, and thus more research in this area is warranted. Moving forward, additional research is needed in large, diverse samples to translate the growing research findings into clinical practice.
... Some RCT interventions include supervised individual ( Klein et al., 1984 ) or group exercise ( Martinsen et al., 1985 ), and home-based exercise ( Blumenthal et al., 2007 ), while the control treatments range from 'standard treatment' ( Chalder et al., 2012 ) to supervised stretching ( Krogh et al., 2009 ) and health education sessions ( Singh et al., 1997 ). The RCT literature is heterogeneous, which may explain some of its inconsistencies. ...
Background
: Physical activity is associated with better mental health, but the literature does not distinguish which types of activity (e.g. recreational versus other types) are more strongly associated with better mental health.
Methods
: Data from the 2015–2016 Canadian Community Health Survey (CCHS) (N=110,000) was used for analysis, restricted to respondents aged 18+. Self-reported participation in recreational physical activity and non-recreational physical activity (active transport, chores, manual labour) were categorized. The Patient Health Questionnaire (PHQ-9) using a 10+ dichotomization (indicating moderate-to-severe depression symptoms), self-reported diagnoses of mood and anxiety disorders, and self-perceived mental health were used as outcomes. Logistic regression analysis was used to determine the odds ratio of each mental health outcome, adjusted for covariates.
Results
: Recreational physical activity was most strongly associated with the dichotomous PHQ-9 score and perceived mental health outcomes (OR=1.77 and OR=1.57, respectively, in multivariate models for zero recreational physical activity groups). Non-recreational physical activity was not consistently associated with any measure of mental health. Adjusting for age strengthened associations between recreational activity and mental health, but the addition of other covariates generally did not change the crude associations.
Limitations
The cross-sectional nature of our analysis limits causal conclusions that can be drawn from results.
Conclusions
: The main finding, an association of mental health with only recreational physical activity requires replication by other studies. In particular, replication using longitudinal study designs could help to clarify whether these associations reflect causal effects, and could inform clinical and public health actions, having the potential to improve population health.
... The description of the studies reporting the relationship between muscular strength and depression symptoms is presented in Table 1. The results from two clinical trials [33,34] and one observational study [13] were inconsistent. A relationship between muscular strength and depressive symptoms was not observed. ...
The aim was to systematically review the relationship between muscular strength (MS) and depression symptoms (DS) among adults, and conduct a meta-analysis to determine the pooled odds ratio (OR) for the relationship between MS and DS. The strategies employed in this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies published up to December 2019 were systematically identified by searching in the PubMed, Scopus, and Web of Science electronic databases. Inclusion criteria were: (1) cross-sectional, longitudinal and intervention studies; (2) outcomes included depression or DS; (3) participants were adults and older adults; and (4) the articles were published in English, French, Portuguese, or Spanish. A total of 21 studies were included in the review, totalling 87,508 adults aged ≥18 years, from 26 countries. The systematic review findings suggest that MS has a positive effect on reducing DS. Meta-analysis findings indicate that MS is inversely and significantly related to DS 0.85 (95% CI: 0.80, 0.89). Interventions aiming to improve MS have the potential to promote mental health and prevent depression. Thus, public health professionals could use MS assessment and improvement as a strategy to promote mental health and prevent depression.
... B. Cooney et al. 2013) liegen. Beispielsweise wurden aktive Kontrollgruppen, wie Sportinterventionen mit mehreren Gruppen (Kraft-, Ausdauer-, und Entspannungstraining) (Krogh et al. 2009), oder Kontrollgruppen, die Antidepressiva erhielten (Blumenthal et al. 1999), miteinander verglichen. Die tatsächliche Effektgröße von Sporttherapie konnte damit nicht nachgewiesen werden (Ekkekakis 2015). ...
Background
Bottlenecks in care, waiting times and chronification rates demonstrate the need for action in the treatment of mental illnesses, such as depression.QuestionEvidence shows that exercise can be used successfully in the treatment of mild to moderate depression, the implementation in the ambulant health care system is pending.Objective
This practice-oriented overview article presents the scientifically founded implementation of sports therapy in the outpatient care of depressive patients as a treatment option. To this end, an introduction is first given on the evidence of exercise in order to then present practical aspects of the STEP.De study.Material and methodThe overview of the guidelines and meta-analytical studies on the topic is followed by the presentation of the STEP.De study (Sport/exercise therapy for depression). This is a multicenter cluster-randomized non-inferiority efficacy trial evaluating the effectiveness and cost-efficiency of outpatient sports therapy in comparison to psychotherapy for mild and moderate depression.ResultsGuidelines and meta-analytical studies have confirmed the effectiveness of exercise for mild to moderate depression with medium to large effect sizes. The currently carried out STEP.De study can provide precise guidelines for comprehensive practical implementation taking into account and integrating the existing healthcare structures.Conclusion
The implementation of sports therapy as a treatment option for depression is possible and reasonable. The results of the STEP.De study can provide further instructions for action, e.g. for whom exercise therapy is (not) suitable.
BACKGROUND
Major depressive disorder is a common mental disorder, characterized by a high rate of suicide and recurrence, which is frequently accompanied by cognitive impairments, particularly in executive function, memory, attention, and information processing speed. As such, improving the cognitive function in patients with depression and enhancing their quality of life are urgent issues.
AIM
To perform a systematic review and meta-analysis of the effects of exercise on cognitive function in patients with depression.
METHODS
The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Medical, VIP, and Biomedical Databases for randomized controlled trials (RCTs) databases were searched (from inception to October 19, 2023) for studies investigating improvements in cognitive function in patients with depression through exercise. Tools recommended by the Cochrane Handbook for RCT evaluation, and GRADEpro and Stata17 software, were employed for risk of bias assessment, evidence grading, forest plot construction, subgroup and sensitivity analyses, and assessment of publication bias.
RESULTS
Seventeen RCTs (1173 patients with depression) were included. Exercise had a small but significant positive effect on attention, with an effect size of 0.21, 95%CI: 0.07-0.34, P < 0.01. Specifically, aerobic exercise regimens of 30-60 minute/session, thrice a week, at moderate intensity, and sustained over 3-12 weeks, were associated with the most pronounced benefits (P < 0.05), with effect sizes for executive function, memory, and information processing speed of 0.11, 95%CI: -0.11-0.32, P = 0.34; 0.08, 95%CI: 0.00-0.16, P = 0.05; and 0.14, 95%CI: 0.04-0.25, P = 0.01, respectively. The evidence levels for attention, information processing speed, and memory were rated as 'low,’ whereas that for executive function was rated as 'very low.’
CONCLUSION
Exercise could improve attention and information-processing speed in patients with depression, although improvements in executive function and memory are not significant.
Background
This article aims to systematically evaluate the intervention effect of exercise on working memory in patients with depression.
Methods
Six Chinese and English databases were searched for randomized controlled trials (RCTs) about exercise on working memory in patients with depression. PEDro scale was adopted to evaluate the methodological quality of the included articles, GRADEpro scale was employed to evaluate the level of evidence for outcomes, and the Metafor Package in R 4.4.1 was used to analyze the combined effect size, subgroup analyses and publication bias.
Results
A total of 15 studies were included. The meta-analysis indicated that exercise had a statistically significant effect on working memory in patients with depression, with an effect size of 0.16 (95% CI [0.03–0.28], p = 0.02). Exercise type (F(3,34) = 1.99, p = 0.13), intervention content (F(1,36) = 1.60, p = 0.22), and exercise duration (F(1,36) = 0.05, p = 0.83) did not moderate the effect, whereas exercise intensity showed a moderating effect (F(2,35) = 8.83, p < 0.01). There was evidence of publication bias in the study results (t = 2.52, p = 0.02).
Conclusion
Exercise can improve the working memory of patients with depression, and its moderating effect is the best when having low-intensity and moderate-intensity. Research plan was registered in international system evaluation platform PROSPERO (https://www.crd.york.ac.uk/PROSPERO/) (CRD42023475325).
Major depressive disorder (MDD) is currently the most common psychiatric disorder in the world. It characterized by a high incidence of disease with the symptoms like depressed mood, slowed thinking, and reduced cognitive function. Without timely intervention, there is a 20–30% risk of conversion to treatment-resistant depression (TRD) and a high burden for the patient, family and society. Numerous studies have shown that physical activity (PA) is a non-pharmacological treatment that can significantly improve the mental status of patients with MDD and has positive effects on cognitive function, sleep status, and brain plasticity. However, the physiological and psychological effects of different types of PA on individuals vary, and the dosage profile of PA in improving symptoms in patients with MDD has not been elucidated. In most current studies of MDD, PA can be categorized as continuous endurance training (ECT), explosive interval training (EIT), resistance strength training (RST), and mind–body training (MBT), and the effects on patients’ depressive symptoms, cognitive function, and sleep varied. Therefore, the present study was based on a narrative review and included a large number of existing studies to investigate the characteristics and differences in the effects of different PA interventions on MDD. The study also investigated the characteristics and differences of different PA interventions in MDD, and explained the neural mechanisms through the results of multimodal brain function monitoring, including the intracranial environment and brain structure. It aims to provide exercise prescription and theoretical reference for future research in neuroscience and clinical intervention in MDD.
In the face of the challenges posed by the COVID-19 pandemic, the hybrid teaching model has garnered significant attention for its combination of the depth of traditional education with the convenience of distance learning. Focusing on the domain of computer programming language instruction, this study innovatively designs a hybrid teaching strategy aimed at fully exploiting the flexibility of its teaching design and the variety of pedagogical approaches. The strategy integrates face-to-face teaching with online autonomous learning, incorporating project-based teaching methodologies and immediate feedback mechanisms to facilitate active student engagement and deep learning. Through a year-long practice in a C++ programming course, encompassing 68 students, the study empirically validates the effectiveness of the hybrid teaching approach. It not only demonstrates remarkable educational outcomes, enhancing the quality of programming instruction and student satisfaction with their learning experience, but also employs Bayesian analysis to delve into the relationship between learning trajectories and students’ sense of self-efficacy. By focusing on key indicators during the learning process, such as the timeliness and quality of online learning, laboratory work, and project assignments, the study then utilizes Bayesian models to directly assess the impact of these learning behavior metrics on students’ perceived self-efficacy. The findings reveal that students with outstanding academic achievements exhibit higher levels of self-efficacy, confirming that academic performance can reasonably reflect teaching effectiveness and provide a quantifiable basis for assessing individual learning progress. Consequently, this research not only contributes a novel strategy to computer programming education practice but also offers a valuable reference for the application of hybrid teaching models in other disciplines. Furthermore, it promotes in-depth contemplation on post-pandemic innovations in teaching modes and issues of educational equity, laying a solid foundation for constructing a more adaptive and inclusive future education system.
Background: Major Depressive Disorder (MDD) is a highly prevalent psychiatric disorder that impairs the
cognitive function of individuals. Aerobic exercise stands out as a promising non-pharmacological intervention
for enhancing cognitive function and promoting brain health.
While positive impacts of aerobic exercise on executive function in adults with depression have been docu-
mented, a comprehensive understanding of its benefits on overall cognitive function, including memory,
attention, and processing speed, along with key moderating factors in adults with MDD, remains unexplored. The
purpose of the systematic review and meta-analysis was to investigate the effects of aerobic exercise on overall
cognitive function in adults with MDD, and to explore whether cognitive sub-domains, aerobic exercise char-
acteristics, and study and sample variables modify the effects of aerobic exercise on cognition.
Methods: Six English electronic databases (Embase, Cochrane Central, Scopus, APA PsycInfo, PubMed, Web of
Science) were searched from inception to 2 April 2023. Randomized trials, including adults aged 18 years or
above with a diagnosis of clinical depression, of the effects of aerobic exercise on cognitive function in adults
with MDD compared to non-aerobic exercise groups were included. A three-level meta-analysis was conducted
utilizing a random-effects model in R. The quality of the studies was evaluated using the Physiotherapy Evidence
Database (PEDro) scale. The PROSPERO registration number is CRD42022367350.
Results: Twelve randomized trials including 945 adults with MDD were included. Results indicated that aerobic
exercise significantly improved overall cognitive function (g = 0.21; 95 % confidence intervals [CI] = 0.07,
0.34), and the sub-domains of memory (g = 0.25; 95 % CI = 0.06, 0.44) and executive function (g = 0.12; 95 % CI
= 0.04, 0.20). Significant benefits in cognitive function were found from moderate-to-vigorous (mixed) intensity
(g = 0.19; 95 % CI = 0.02, 0.37), aerobic exercise conducted 3 times per week (g = 0.23; 95 % CI = 0.10, 0.38),
in sessions < 45 min (g = 0.59; 95 % CI = 0.28, 0.90), and 45–60 min (g = 0.16; 95 % CI = 0.07, 0.26), in aerobic
exercise intervention ≤ 12 weeks (g = 0. 26; 95 % CI = 0.08, 0.44).
Limitations: This review only included peer-reviewed English-language studies, which may lead to a language
bias. The results of the Egger’s test suggested a potential publication bias.
Conclusions: Aerobic exercise is efficacious in improving overall cognitive function and the sub-domains of
memory and executive function in adults with major depressive disorder.
Major depressive disorder (MDD) is associated with significant cognitive deficits during the acute and remitted stages. The aim of this systematic review and meta-analysis was to examine the course of cognitive function whilst considering demographic, treatment, or clinical features of MDD that could moderate the extent of cognitive change. Databases were searched to identify studies that reported on cognitive function in MDD with a ≥12-week test–retest interval. Relevant studies were pooled using random effects modelling to generate an inverse-variance, weighted, mean effect size estimate (Hedges’ g) of cognitive change for each cognitive variable and for an overall composite cognitive domain. Of 6898 records, 99 eligible studies were identified from which 69 were meta-analysed, consisting of 4639 MDD patients (agemean = 40.25 years, female% = 64.62%) across 44 cognitive variables. In over 95% of cognitive variables, improvements were either of non-significant, negligible, or of a small magnitude, and when compared to matched healthy controls, the possibility of practice effects could not be precluded. Depressive symptom improvement and the number of previous depressive episodes moderated the extent of cognitive change, demonstrating state- and scar-like features for one-quarter of the cognitive domains. Further longitudinal studies are required to elucidate the MDD cognitive trajectory from initial onset. Findings nonetheless suggest that following pharmacological and non-pharmacological treatment, cognitive change in MDD is typically small, but the capacity for change may be less with episode recurrence. Targeting cognition early in the course of illness may facilitate better prognosis and support a more complete functional recovery.
Background:
Although exercise may positively impact those with mental or other medical illnesses, there is a lack of understanding on how it influences suicidal ideation or risk.
Methods:
We conducted a PRISMA 2020-compliant systematic review searching MEDLINE, EMBASE, Cochrane, and PsycINFO from inception to June 21, 2022. Randomized controlled trials (RCTs) investigating exercise and suicidal ideation in subject with mental or physical conditions were included. Random-effects meta-analysis was conducted. The primary outcome was suicidal ideation. We assessed bias of studies with risk of bias tool 2.
Results:
We identified 17 RCTs encompassing 1021 participants. Depression was the most included condition (71 %, k = 12). Mean follow up was 10.0 weeks (SD = 5.2). Post-intervention suicidal ideation (SMD = -1.09, CI -3.08-0.90, p = 0.20, k = 5) was not significantly different between exercise and control groups. Suicide attempts were significantly reduced in participants randomized to exercise interventions as compared to inactive controls (OR = 0.23, CI 0.09-0.67, p = 0.04, k = 2). Fourteen studies (82 %) were at high risk of bias.
Limitations:
This meta-analysis is limited by few, and underpowered and heterogenous studies.
Conclusion:
Overall, our meta-analysis did not find a significant decrease in suicidal ideation or mortality between exercise and control groups. However, exercise did significantly decrease suicide attempts. Results should be considered preliminary, and more and larger studies assessing suicidality in RCTs testing exercise are needed.
Background:
Antidepressant medication and running therapy are both effective treatments for patients with depressive and anxiety disorders. However, they may work through different pathophysiological mechanisms and could differ in their impact on physical health. This study examined effects of antidepressants versus running therapy on both mental and physical health.
Methods:
According to a partially randomized patient preference design, 141 patients with depression and/or anxiety disorder were randomized or offered preferred 16-week treatment: antidepressant medication (escitalopram or sertraline) or group-based running therapy ≥2 per week. Baseline (T0) and post-treatment assessment at week 16 (T16) included mental (diagnosis status and symptom severity) and physical health indicators (metabolic and immune indicators, heart rate (variability), weight, lung function, hand grip strength, fitness).
Results:
Of the 141 participants (mean age 38.2 years; 58.2 % female), 45 participants received antidepressant medication and 96 underwent running therapy. Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881). However, the groups differed significantly on various changes in physical health: weight (d = 0.57; p = .001), waist circumference (d = 0.44; p = .011), systolic (d = 0.45; p = .011) and diastolic (d = 0.53; p = .002) blood pressure, heart rate (d = 0.36; p = .033) and heart rate variability (d = 0.48; p = .006).
Limitations:
A minority of the participants was willing to be randomized; the running therapy was larger due to greater preference for this intervention.
Conclusions:
While the interventions had comparable effects on mental health, running therapy outperformed antidepressants on physical health, due to both larger improvements in the running therapy group as well as larger deterioration in the antidepressant group.
Trial registration:
Trialregister.nl Number of identification: NTR3460.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Major depressive disorder (MDD) is the leading cause of disability globally in both developed and developing nations. The staggering economic costs attributable to MDD are largely a consequence of impairment in role function. Evidence indicates that disturbance in the domain of cognitive function in individuals with MDD is the principal determinant of health outcome. This is the first book to comprehensively explore the domain of cognition in MDD. The literature describing cognitive dysfunction is reviewed with particular focus on clinical determinants, pathophysiology and causative factors. The patient subpopulations most susceptible are defined. A summary of contemporary assessment tools for research and clinical purposes is provided. Multimodality treatments and prevention strategies are described. This book is an invaluable resource for psychiatrists, neuropsychologists and other members of the mental health team, as well as for policy makers, vocation rehabilitation experts, disability providers and other stakeholders interested in improving health outcomes in MDD.
Background
Depression is associated with physical inactivity, low cardiorespiratory fitness (CRF), and poor physical health compared with the general population. Various protocols are employed to determine CRF studies of people experiencing depression, but standardized methods are absent from the literature. Thus, the aim of the present review is to systematically examine the protocols reported to determine CRF in patients with major depressive disorder (MDD).
Methods
Replicating a previously published search strategy, the present review sourced relevant studies from PubMed, PsycInfo, Embase, CINAHL, MEDLINE, Psychology and Behavioural Sciences Collection, and SPORTDiscus from August 2015 to February 2021. Details of CRF testing protocols were extracted into a preprepared form for analysis.
Results
Twenty-three studies met the inclusion criteria, including those from a previous review of CRF in people with MDD. Twelve included studies employed maximal testing protocols, while 11 studies reported using submaximal testing protocols. Cycle ergometry was the most used protocol, followed by treadmill and walk tests. Notably, complete descriptions of the test protocols to facilitate test replication were frequently absent.
Conclusions
Cycle ergometry is commonly used to assess CRF in people with MDD, but protocol details are lacking, making replication difficult. Efforts to standardize protocol descriptions are warranted.
This paper was aimed to clarify the effect of high-intensity interval training (HIIT) on depression. Animal running platforms were used to establish HIIT exercise models, depression models were prepared by chronic unpredictable mild stress (CUMS), and depression-related behaviors were detected by behavioral experiments. The results showed that HIIT exercise improved depression-related behavior in CUMS model mice. Western blot and ELISA results showed that in the hippocampus, medial prefrontal cortex (mPFC) and amygdala of the CUMS model mice, glucocorticoid receptor (GR) protein expression was down-regulated, and the content of tumor necrosis factor α (TNF-α) was increased, compared with those in the control group, whereas HIIT exercise could effectively reverse these changes in CUMS model mice. These results suggest that HIIT exercise can exert antidepressant effect, which brings new ideas and means for the clinical treatment of depressive diseases.
Background
Exercise interventions are increasingly incorporated in the management of severe mental illness; however, best practice screening and outcome monitoring for this unique population are yet to be established. This review aims to explore assessment measures reported in publications of exercise interventions in severe mental illness.
Methods
A scoping review was implemented with a structured search of Embase, PubMed, Medline, PsychINFO, Scopus, and SportDiscus using terms related to severe mental illness, exercise, and health. Studies were included if they incorporated an exercise intervention for people with severe mental illness and measured physical and/or mental health outcomes. Studies were analysed for population, assessment measures, and methodological quality.
Results
1832 studies were identified and following screening and full text review 38 studies involving 2854 participants were included for analysis, primarily psychotic (n = 13), depressive disorder (n = 9) and mixed severe mental illness populations (n = 13). The most frequently reported health domains and assessment measures used included body composition (weight and body mass index), symptom severity, cardiorespiratory fitness (volume of oxygen consumption), cardiometabolic health (blood pressure and metabolic blood sampling), and quality of life. Methodological quality varied with 13 determined as good, 12 fair, and 13 poor.
Conclusion
The review identified domains and assessment tools frequently reported in the exercise and severe mental illness literature. However, given the heterogeneity and scarcity of the research, along with lack of reporting of sufficient detail, best-practice clinical recommendations are still limited. There remains a need to establish best practice assessment and monitoring procedures within exercise interventions in severe mental illness.
The therapeutic effect of antidepressants has been demonstrated for anhedonia in patients with depression. However, antidepressants may cause side‐effects, such as cardiovascular dysfunction. Although physical activity has minor side‐effects, it may serve as an alternative for improving anhedonia and depression. We sought to investigate whether physical activity reduces the level of anhedonia in individuals with depression. Fifty‐six university students with moderate depressive symptoms (Beck Depression Inventory total score > 16) were divided into three training groups: the Running Group (RG, n = 19), the Stretching Group (SG, n = 19), and the Control Group (n = 18). We employed the Monetary Incentive Delay (MID) task and the Temporal Experience of Pleasure Scale (TEPS) to evaluate hedonic capacity. All participants in the RG and SG received 8 weeks of jogging and stretching training, respectively. The RG experienced an increase in the level of arousal during anticipation of a future reward and recalled less negativity towards the loss condition. The SG exhibited enhanced scores on the Anticipatory and Consummatory Pleasure subscales of the TEPS after training. Moreover, in the RG, greater improvements in anticipatory arousal ratings for pleasure and remembered valence ratings for negative affect were associated with longer training duration, lower maximum heart rate, and higher consumed calories during training. To conclude, physical activity is effective in improving anticipatory anhedonia in individuals with depressive symptoms.
Research regarding the association between depression and exercise has been limited regarding precariously employed individuals. The current study investigated the association between exercise variations and depressive symptoms among precarious employees in South Korea. Data from the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed. In total, 13,080 participants aged ≥ 19 years responded to the survey. The Korean version of the PHQ-9 was utilized in addition to questions assessing regular exercise. Precariously employed men engaging in two or more variations of exercise each week were significantly less likely to report depressive symptoms (adjusted (OR): 0.78; 95% CI 0.62–0.97; p = 0.025), and the likelihood of depression was also lower for women who engaged in one or more forms of exercise (adjusted OR: 0.82; 95% CI 0.71–0.94; p = 0.006). These findings support the association between depression and exercise and suggest that greater variations in regular exercise are associated with a reduction in depression for men whereas any form of exercise reduces the risk of depression in women.
BACKGROUND: There has been extensive literature examining the efficacy of exercise interventions in the treatment of depression over the past few decades. However, there is ongoing debate regarding the optimal dosage and the implications of utilising physiotherapists for the management of clinically depressed adults using exercise has not been examined. OBJECTIVES: This review aimed to examine the effectiveness of exercise as a treatment for depression (without comorbidities) and to determine the most effective dosage/mode to treat this population. This review strived to appraise the literature for a potential role for physiotherapists in depression management. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, a search for randomized controlled trials was conducted on the nine databases. All studies were appraised for quality using the Physiotherapy Evidence Database (PEDro) scale and Cochrane Risk of Bias Tool (RoB). Data was manually extracted, and pre- and post-intervention depression scores and program variables were analysed. RESULTS: Of the 5036 papers retrieved, 7 papers met this review’s inclusion criteria. The results of the meta-analysis reveal that exercise as a sole treatment and as an add-on is significantly effective in reducing depressive symptoms. The findings support the use of moderate intensity aerobic exercise for three sessions per week. CONCLUSIONS: Exercise was shown to significantly improve depressive symptoms in depressed adults. This review adds to the growing body of evidence regarding the important role of physiotherapists in the treatment of psychiatric disorders in the design and implementation of exercise interventions.
Background and Aims: Depression is one of the most common psychological disorders in the world, with the prevalence of 13.6% in Iran among the population with 14-64 years old. The effectiveness of using antidepressants drugs is doubtful as the primary method of treatment and researchers are seeking alternative methods without side effects. In the present study, antidepressant effects of strength, aerobic, and combined exercise among adult men were studied. Materials and Methods: In the present semi-experimental study, 60 men aged 20 to 35, who were moderately or moderately to highly depressed, based on the diagnostic interviews and Beck Depression Inventory (BDI-2), were randomly placed into four groups of 15 individuals, including 1) strength group, 2) aerobic group, 3) combined group of strength-aerobic, and 4) control group, and participated in an eight-week exercise period (24 sessions of 45-60 minutes, 3 sessions per week, intensity of 60 to 75% of one maximum repetition/maximum heart rate). The data resulted from depression levels measurements in pre-test and post-test were analyzed using paired t-test and covariance analysis at 95 percent confidence level. Results: Depression levels decreased significantly in all three experimental groups (strength, aerobic, and combined group). In addition, after controlling the effect of pre-test, the aerobic and combined and strength exercises groups experienced the highest reduction in depression levels, respectively. Conclusion: Based on the existing evidence, it seems that aerobic exercises can produce the most physiological adaptations associated with the regulation of emotions and levels of depression in men; however, other kinds of strength and combined physical exercises and sport activities can be used to reduce the symptoms of depression, as well.
Depression is a serious mental health disorder and would be the major public health problem worldwide by 2030. To this extent, conventional depression treatments are challenged and alternative or add-on antidepressant interventions are essential. In this narrative, we discuss the antidepressant role of exercise. Particularly, we discuss clinical evidence from meta-analytic reviews for the causal link of exercise with depression relief in adults (18–65 years) with major depression diagnosis as a primary disorder. Also, the mean- and individual-based pragmatic evidence for the antidepressant effect of exercise in depressed adults is described. Finally, we discuss the effects of exercise on depression as a comorbid with obesity disorder because obesity contributes to depression development regardless of the weight inducing metabolic side effects.
Background
The COVID-19 pandemic has led to a spike in deleterious mental health. This dual-center retrospective cross-sectional study assessed the prevalence of depression in young adults during this pandemic and explored its association with various physical fitness measures.
Methods
This study enrolled 12,889 (80% female) young adults (mean age 20 ± 1) who performed a National Student Physical Fitness battery from December 1st, 2019, to January 20th, 2020, and completed a questionnaire including Beck’s Depression Inventory in May 2020. Independent associations between prior physical fitness and depression during the pandemic were assessed using multivariable linear and binary logistic regressions accordingly, covariates including age, dwelling location, economic level, smoking, alcohol, living status, weight change, and exercise volume during the pandemic. Sex- and baseline stress-stratified analyses were performed.
Results
Of the study population 13.9% of men and 15.0% of women sampled qualified for a diagnosis of depression. After multivariable adjustment, anaerobic (mean change 95% CI −3.3 [−4.8 to 1.8]) aerobic (−1.5 [−2.64 to −0.5]), explosive (−1.64 [−2.7 to −0.6]) and muscular (−1.7 [−3.0 to −0.5]) fitness were independently and inversely associated with depression for the overall population. These remained consistent after sex- and baseline stress-stratification. In binary logistic regression, the combined participants with moderate, high or excellent fitness also showed a much lower risk compared to those least fit in anaerobic (odd ratio (OR) 95% CI 0.68 [0.55–0.82]), aerobic (0.80 [0.68–0.91]), explosive (0.72 [0.61–0.82]), and muscular (0.66 [0.57–0.75]) fitness.
Conclusions
These findings suggest that prior physical fitness may be inversely associated with depression in young adults during a pandemic.
The goals of this study were to determine the feasibility of engaging youth with major depressive disorder (MDD) in a multimodal exercise intervention (Healthy Body Healthy Mind) plus usual care and to evaluate the magnitude of its effects on psychological, physical fitness, and biomarker outcomes to inform a future randomized controlled trial. Youth (15 to 25 y of age) with MDD diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) were eligible to participate. Feasibility measures included recruitment, retention, and program adherence rates. The exercise program consisted of a single session of motivational interviewing to enhance exercise adherence, then 1-hour, small-group supervised exercise sessions 3 times per week for 12 weeks. Assessments were administered at baseline and at 12 weeks. Depression symptoms were assessed using the Beck Depression Inventory (BDI-II). Physical fitness and blood biomarkers were also measured. Three males and 10 females with MDD, who were 18 to 24 years of age, participated. Retention at 12 weeks was 86%, and attendance at exercise sessions averaged 62%±28%. After 12 weeks, 69% of participants experienced a remission of MDD based on the SCID. Mean BDI-II scores decreased from 31.9±9.1 to 13.1±10.1 [Cohen d effect size (ES)=1.96]. Improvements were observed in upper (ES=0.64) and lower (ES=0.32) body muscular endurance. Exercise session attendance was moderately correlated with changes in BDI-II scores (Pearson r=0.49). It appears feasible to attract and engage some youth with MDD in an exercise intervention. The positive impact on depression symptoms justifies further studies employing exercise interventions as an adjunct to routine care for young people with MDD.
Background:
Work disability such as sickness absence is common in people with depression.
Objectives:
To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.
Search methods:
We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020.
Selection criteria:
We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning.
Data collection and analysis:
Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar. MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up. Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up. Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms.
Authors' conclusions:
A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.
There are several mechanisms that cause memory impairment, including motivated forgetting, active forgetting, natural decay, and memory interference. Interference occurs when one is attempting to recall something specific, but there is conflicting information making it more difficult to recall the target stimuli. In laboratory settings, it is common to measure memory interference with paired associate tasks—usually utilizing the AB-CD, AB-AC, AB-ABr, or AB-DE AC-FG method. Memory impairments are frequent among those with neuropsychiatric disorders such as depression, schizophrenia, and multiple sclerosis. The memory effects of each condition differ, but are all related to alterations in brain physiology and general memory deterioration. Exercise, or physical activity, has been demonstrated to attenuate memory interference in some cases, but the mechanisms are still being determined. Further research is needed on memory interference, in regard to exercise and neuropsychiatric disorders.
In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary recommendation:
To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]
We compared the effectiveness of an aerobic and nonaerobic exercise in the treatment of clinical depression in women. A total of 40 women, screened on the Research Diagnostic Criteria for major or minor depressive disorder, were randomly assigned to an 8-week running (aerobic), weight-lifting (nonaerobic), or wait-list control condition. Subjects were reassessed at mid- and posttreatment, and at 1-, 7-, and 12-month follow-ups. Depression was monitored by the Beck Depression Inventory, Lubin’s Depression Adjective Check List, and the Hamilton Rating Scale for Depression; fitness level was assessed using submaximal treadmill testing. Results were remarkably consistent across measures, with both exercise conditions significantly reducing depression compared with the wait-list control condition, and generally appearing indistinguishable from each other. No significant between-group fitness changes were noted. These findings indicate that both types of exercise conditions significantly reduce depression and that these results are not dependent on achieving an aerobic effect.
Several studies have found that depression is an independent predictor of poor outcome after the onset of clinical coronary artery disease. There are few data concerning depression as a risk factor for the development of coronary artery disease.
To determine if clinical depression is an independent risk factor for incident coronary artery disease.
The Johns Hopkins Precursors Study is a prospective, observational study of 1190 male medical students who were enrolled between 1948 and 1964 and who continued to be followed up. In medical school and through the follow-up period, information was collected on family history, health behaviors, and clinical depression. Cardiovascular disease end points have been assessed with reviews of annual questionnaires, National Death Index searches, medical records, death certificates, and autopsy reports.
The cumulative incidence of clinical depression in the medical students at 40 years of follow-up was 12%. Men who developed clinical depression drank more coffee than those who did not but did not differ in terms of baseline blood pressure, serum cholesterol levels, smoking status, physical activity, obesity, or family history of coronary artery disease. In multivariate analysis, the men who reported clinical depression were at significantly greater risk for subsequent coronary heart disease (relative risk [RR], 2.12; 95% confidence interval [CI], 1.24-3.63) and myocardial infarction (RR, 2.12; 95% CI, 1.11-4.06). The increased risk associated with clinical depression was present even for myocardial infarctions occurring 10 years after the onset of the first depressive episode (RR, 2.1; 95% CI, 1.1-4.0).
Clinical depression appears to be an independent risk factor for incident coronary artery disease for several decades after the onset of the clinical depression.
Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated.
To assess the effectiveness of an aerobic exercise program compared with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial.
One hundred fifty-six men and women with MDD (age, > or = 50 years) were assigned randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride), or combined exercise and medication. Subjects underwent comprehensive evaluations of depression, including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. Secondary outcome measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions.
After 16 weeks of treatment, the groups did not differ statistically on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depression yielded an essentially identical result. Growth curve models revealed that all groups exhibited statistically and clinically significant reductions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combination therapy, those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms.
An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.
Depression predicts morbidity and mortality among individuals who have coronary heart disease (CHD), and there is increasing evidence that depression may also act as an antecedent to CHD. The studies that have reported a relationship between depression and CHD incidence or mortality either were restricted to men only or analyzed women and men together. The present investigation was conducted to evaluate the differential effect depression may have on CHD incidence and mortality in women and men.
We analyzed data from 5007 women and 2886 men enrolled in the first National Health and Nutrition Examination Survey (NHANES I) who were free of CHD at the 1982-1984 interview and who had completed the Center for Epidemiologic Studies Depression Scale (CES-D). Participants were evaluated from the 1982 interview date either until the end of the study (1992 interview date) or until the occurrence of a CHD event. Using CHD incidence and CHD mortality (International Classification of Disease, Ninth Revision, codes 410-414) as the outcome variables, Cox proportional hazards regression models were developed to evaluate the relative risk (RR) of CHD incidence and mortality in the depressed women and men separately, controlling for standard CHD risk factors.
The women experienced 187 nonfatal and 137 fatal events, compared with 187 nonfatal and 129 fatal events among the men. The adjusted RR of CHD incidence among depressed women was 1.73 (95% confidence internal [CI], 1.11-2.68) compared with nondepressed women. Depression had no effect on CHD mortality in the women (RR, 0.74; 95% CI, 0.40-1.48). The adjusted RR of CHD incidence among depressed men was 1.71 (95% CI, 1.14-2.56) compared with nondepressed men. Depressed men also had an increased risk of CHD mortality compared with their nondepressed counterparts, with an adjusted RR of 2.34 (95% CI, 1.54-3.56).
In this sample, while controlling for possible confounding factors, depression was associated with an increased risk of CHD incidence in both men and women, as well as CHD mortality in men. Depression had no effect on CHD mortality in women.
Health planning should be based on data about prevalence, disability and services used.
To determine the prevalence of ICD-10 disorders and associated comorbidity, disability and service utilisation.
We surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures.
The sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment.
The high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.
Major depression is a mood disorder that is often accompanied by the impairment of cognitive functions. Although suggestive, the large range of existing neuropsychological, neuropsychiatric, and, lately, neuroimaging investigations have not yet given a consistent picture of the psychological and biological disturbances involved in this psychiatric disorder. The present study of the cognitive functions in depression was part of an extensive investigation, including neuropsychological testing, psychiatric examination, and neuroimaging. A representative sample of 40 severely depressed hospitalized patients and a group of 49 closely matched control subjects were tested with an extensive neuropsychological test battery. Results, corrected for various confounding factors, confirmed the current notion that depressed patients suffer from wide-spread cognitive impairments. The group analysis did not allow any hypothesis on a possible pattern to the dysfunctions, but heterogeneity in the test performances calls for further analysis of the data in patient subgroups in relation to neuroimaging results.
To determine by meta-analysis whether physical exercises are beneficial for people with dementia and related cognitive impairments.
Published articles and nonpublished manuscripts from 1970 to 2003 were identified by using electronic and manual searches. Key search words included exercise, rehabilitation, activities of daily living, dementia, Alzheimer's disease, aged, and geriatrics.
Reviewed studies were limited to randomized trials evaluating exercise in persons 65 years of age or older with cognitive impairment. Studies included quantitative results (means, standard deviations, t tests, F tests) for physical fitness, physical functioning, cognition, or behavior outcomes.
One reviewer extracted data on study characteristics and findings. Selected articles were evaluated for methodologic quality by 2 raters.
A total of 2020 subjects participated in the 30 trials that met the inclusion criteria. Summary effects were computed using a fixed effects (Hedge's g(i)) model. Significant summary effect sizes (ES) were found for strength (ES=.75; 95% confidence interval [CI], .58-.92), physical fitness (ES=.69; 95% CI, .58-.80), functional performance (ES=.59; 95% CI, .43-.76), cognitive performance (ES=.57; 95% CI, 0.43-1.17), and behavior (ES=.54; 95% CI, .36-.72). The overall mean ES between exercise and nonexercise groups for all outcomes was .62 (95% CI, .55-.70).
Exercise training increases fitness, physical function, cognitive function, and positive behavior in people with dementia and related cognitive impairments.
Although exercise has been shown to relieve depression, little is known about its mechanism or dose-response characteristics. We hypothesized that high intensity progressive resistance training (PRT) would be more effective than either low intensity PRT or standard care by a general practitioner (GP) in depressed elderly persons, and that high intensity PRT would provide superior benefits in quality of life, sleep quality, and self-efficacy.
Sixty community-dwelling adults >60 years with major or minor depression were randomized to supervised high intensity PRT (80% maximum load) or low intensity PRT (20% maximum load) 3 days per week for 8 weeks, or GP care.
A 50% reduction in the Hamilton Rating Scale of Depression score was achieved in 61% of the high intensity, 29% of the low intensity, and 21% of the GP care group (p =.03). Strength gain was directly associated with reduction in depressive symptoms (r = 0.40, p =.004), as was baseline social support network type (F = 3.52, p =.015), whereas personality type, self-efficacy, and locus of control were unrelated to the antidepressant effect. Vitality quality-of-life scale improved more in the high intensity group than in the others (p =.04). Sleep quality improved significantly in all participants (p <.0001), with the greatest relative change in high intensity PRT (p =.05).
High intensity PRT is more effective than is low intensity PRT or GP care for the treatment of older depressed patients.
It has been hypothesized that a decrease in the synthesis of new neurons in the adult hippocampus might be linked to major depressive disorder (MDD). This hypothesis arose after it was discovered that antidepressant medications increased the synthesis of new neurons in the brain, and it was noted that the therapeutic effects of antidepressants occurred over a time span that approximates the time taken for the new neurons to become functional. Like antidepressants, exercise also increases the synthesis of new neurons in the adult brain: a 2-3-fold increase in hippocampal neurogenesis has been observed in rats with regular access to a running wheel when they are compared with control animals. We hypothesized, based on the adult-neurogenesis hypothesis of MDD, that exercise should alleviate the symptoms of MDD and that potential mechanisms should exist to explain this therapeutic effect. Accordingly, we evaluated studies that suggest that exercise is an effective treatment for MDD, and we explored potential mechanisms that could link adult neurogenesis, exercise and MDD. We conclude that there is evidence to support the hypothesis that exercise alleviates MDD and that several mechanisms exist that could mediate this effect through adult neurogenesis.
Background Health planning should be based on data about prevalence, disability and services used.
Aims To determine the prevalence of ICD-10 disorders and associated comorbidity, disability and service utilisation.
Method We surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures.
Results The sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment.
Conclusions The high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.
Background
Depression predicts morbidity and mortality among individuals who have coronary heart disease (CHD), and there is increasing evidence that depression may also act as an antecedent to CHD. The studies that have reported a relationship between depression and CHD incidence or mortality either were restricted to men only or analyzed women and men together. The present investigation was conducted to evaluate the differential effect depression may have on CHD incidence and mortality in women and men.Research Methods
We analyzed data from 5007 women and 2886 men enrolled in the first National Health and Nutrition Examination Survey (NHANES I) who were free of CHD at the 1982-1984 interview and who had completed the Center for Epidemiologic Studies Depression Scale (CES-D). Participants were evaluated from the 1982 interview date either until the end of the study (1992 interview date) or until the occurrence of a CHD event. Using CHD incidence and CHD mortality (International Classification of Disease, Ninth Revision, codes 410-414) as the outcome variables, Cox proportional hazards regression models were developed to evaluate the relative risk (RR) of CHD incidence and mortality in the depressed women and men separately, controlling for standard CHD risk factors.Results
The women experienced 187 nonfatal and 137 fatal events, compared with 187 nonfatal and 129 fatal events among the men. The adjusted RR of CHD incidence among depressed women was 1.73 (95% confidence internal [CI], 1.11-2.68) compared with nondepressed women. Depression had no effect on CHD mortality in the women (RR, 0.74; 95% CI, 0.40-1.48). The adjusted RR of CHD incidence among depressed men was 1.71 (95% CI, 1.14-2.56) compared with nondepressed men. Depressed men also had an increased risk of CHD mortality compared with their nondepressed counterparts, with an adjusted RR of 2.34 (95% CI, 1.54-3.56).Conclusions
In this sample, while controlling for possible confounding factors, depression was associated with an increased risk of CHD incidence in both men and women, as well as CHD mortality in men. Depression had no effect on CHD mortality in women.
Reviews historic developments that have led to the modern conceptualization of major depressive disorder (MDD) as a distinct nosologic entity. The epidemiology of depression is discussed, and data from a study of 3,258 adults is presented. MDD was found to affect women more than men by a ratio of nearly 2 to 1. The lifetime prevalence rate for both sexes combined was 8.6%. The period prevalence rates for both sexes combined were 3.2% and 4.6%, for 6 mo and 1 yr, respectively. The age of onset for MDD showed a wide range, with over 75% of cases having an onset prior to age 30 yrs. The presence of a recurrent MDD was associated with an increased risk of substance abuse, panic disorder, and dysthymia, whereas a single MDD episode was not associated with increased comorbidity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Trail Making Test was administered to brain damaged and hospitalized control subjects. The results indicated that "this short, inexpensive, and easily administered test may be a fairly valid indicator of certain effects of brain damage."
Missing data, and the bias they can cause, are an almost ever-present concern in clinical trials. The last observation carried forward (LOCF) approach has been frequently utilized to handle missing data in clinical trials, and is often specified in conjunction with analysis of variance (LOCF ANOVA) for the primary analysis. Considerable advances in statistical methodology, and in our ability to implement these methods, have been made in recent years. Likelihood-based, mixed-effects model approaches implemented under the missing at random (MAR) framework are now easy to implement, and are commonly used to analyse clinical trial data. Furthermore, such approaches are more robust to the biases from missing data, and provide better control of Type I and Type II errors than LOCF ANOVA. Empirical research and analytic proof have demonstrated that the behaviour of LOCF is uncertain, and in many situations it has not been conservative. Using LOCF as a composite measure of safety, tolerability and efficacy can lead to erroneous conclusions regarding the effectiveness of a drug. This approach also violates the fundamental basis of statistics as it involves testing an outcome that is not a physical parameter of the population, but rather a quantity that can be influenced by investigator behaviour, trial design, etc. Practice should shift away from using LOCF ANOVA as the primary analysis and focus on likelihood-based, mixed-effects model approaches developed under the MAR framework, with missing not at random methods used to assess robustness of the primary analysis. Copyright © 2004 John Wiley & Sons, Ltd.
A group of sixty-six adult subjects was given the task of producing as many words as possible beginning with specified letters of the alphabet. The number of words produced during a period of 60 sec correlated highly both with a frequency count derived from the Thorndike-Lorge norms and with estimates derived from the dictionary of the number of words in the English language beginning with each letter. In a second experiment, eight letters representing three levels of difficulty as found in normal subjects were given to thirty brain-damaged and thirty hospitalized control patients. Results in terms of verbal productivity indicated that, for patients of high intelligence, difficult letters (i.e. J and U) showed the greatest discrimination. On the other hand, for patients of low intelligence, easy letters (i.e. F, S, P and T) were more effective in differentiating the brain-damage and control groups. The findings also indicated that difficult letters may be particularly effective in distinguishing between patients with right and left hemisphere damage. An analysis of order of presentation indicated that practice and fatigue effects were not related to verbal fluency when as many as eight letters were administered. It is suggested that the addition of difficult letters to standard word fluency tests may yield more precise discriminations between brain-damaged and control patients when overall level of intellectual functioning is taken into account.
The purpose of this study was to determine the relative importance of training intensity and frequency in endurance training on the development of maximal aerobic power in young females. 40 females aged 18 to 20 yr were divided into 4 groups as follows: Group I trained at 80% vO2max, 4 days per week; Group II at 80% vO2max, 2 days per week; Group III at 60% vO2max, 4 days per week; Group IV at 60% vO2max 2 days per week. Following 8 weeks of training for 10 minutes per day on a cycle ergometer, significant increases were found in vO2max for all groups. Significant differences among groups in the change of vO2max were found for the factor of intensity. Significant decreases in heart rates at 2 submaximal work loads (300 and 450 kpm/min) were found in all groups, whereby the 2 groups with the higher training frequencies showed a significantly greater decrease in exercise heart rate than the other groups.
Eighty-seven male inmates from a state prison and 70 inmates from a county jail volunteered as subjects. The subjects, age 20 to 35 yrs, were assigned randomly into a control or exercise group. Their Vo2max and treadmill performance values were determined before and after a 20 week jogging program. Training intensity was between 85 and 90 percent of maximum heart rate and involved workouts 3 days/week for 15, 30, or 45-min duration at the state prison and for 30-min 1, 3, or 5 days/week at the country jail. Cardiorespiratory fitness improved in direct proportion to frequency and duration of training. Injury, occurred in 22%, 24% and 54% of the 15, 30, and 45-min duration groups and in 0%, 12%, and 39% of the 1, 3, and 5-day/week groups, respectively. Attrition resulting from injury occurred in 0%, 0%, and 17% and in 0%, 4%, and 6% of the same respective groups. Attrition due to lack of interest was similar for all training groups (25%), but was significantly lower in the control groups (10%). Although the results showed a greater increase in cardiorespiratory fitness for the 45-min duration and 5-day/week groups, these programs are not recommened for beginning joggers because of the significantly greater percent of injuries.
This paper reviews the most frequently used and misused reliability measures appearing in the mental health literature. We illustrate the various types of data sets on which reliability is assessed (i.e., two raters, more than two raters, and varying numbers of raters with dichotomous, polychotomous, and quantitative data). Reliability statistics appropriate for each data format are presented, and their pros and cons illustrated. Inadequancies of some methods are highlighted. The meaning of different levels of reliability obtained with various statistics is discussed. This critique is intended for the reading professional and the investigator who has an occasional need for reliability assessment. Statistical expertise is not required and theoretical material is referenced for the interested reader. Necessary formulas for computations are presented in the appendices. A summary table of some suitable reliability measures is presented.
The purpose of this study was to evaluate the effectiveness of resistance training performed either 2 days/week or 3 days/week. One hundred and seventeen sedentary volunteers were randomly assigned to one of the two training groups or a control group. Twenty-two men (27 +/- 5 years) and 22 women (26 +/- 5 years) trained for 10 weeks. Twenty-five men (26 +/- 5 years) and 22 women (24 +/- 5 years) trained for 18 weeks. Twenty-six subjects served as controls and did not train. Training consisted of a single set of variable resistance bilateral knee extensions performed to volitional fatigue with a weight load that allowed seven to ten repetitions. Prior to and immediately following training, isometric strength was evaluated at 70, 85, 100, 115, 130, 145, 160, and 171 degrees of knee extension with a Nautilus knee extension tensiometer. All groups who trained showed a significant increase in peak isometric strength when compared with controls (P less than 0.01). Groups that trained 3 days/week increased peak isometric strength (10 weeks = 21.2%; 18 weeks = 28.4%) to a greater extent (P less than 0.05) than groups that trained 2 days/week (10 weeks = 13.5%; 18 weeks = 20.9%). We conclude that resistance training 2 days/week significantly improves knee extension isometric strength; however, the magnitude of strength gain is greater when training is performed 3 days/week. These data indicate that the adult exerciser (18 to 38 years) training 2 days/week may derive approximately 80% of the isometric strength benefits achieved by those training 3 days/week.
We compared aerobic with nonaerobic forms of exercise in the treatment of clinical depression. Ninety-nine inpatients, who met the DMS-III-R criteria for major depression, dysthymic disorder, or depressive disorder not otherwise specified (NOS), took part in the study. They were randomly assigned to two different physical training conditions, aerobic and nonaerobic. In both conditions, one hour of training was performed three times a week for a period of 8 weeks. There was a significant increase in maximum oxygen uptake (VO2 max) in the aerobic group; there was no change in the nonaerobic group regarding this variable. Depression scores in both groups were significantly reduced during the study, but there was no significant difference between the groups. The correlation between increase in physical fitness and reduction in depression scores was low. The study indicates that the antidepressive effects associated with exercises are not restricted to aerobic forms of training.
Two simple methods that are clinically useful for analyzing impaired memory and learning are selective reminding, and restricted reminding. These new methods provide simultaneous analysis of storage, retention, and retrieval during verbal learning, because they let the patient show learning by spontaneous retrieval without confounding by continual presentation. Because selective reminding and restricted reminding let the patient show consistent retrieval without any further presentation, they also distinguish list learning from item learning, so that impaired memory and learning can be analyzed further in terms of two stages of learning (item and list).
MANY CURRENT neurological texts continue to recommend the inclusion of the serial sevens test (counting backward from 100 in sevens) in neurologic examinations of the mental function of patients with suspected or confirmed brain lesions. Hayman1 (1942) administered this test to 580 adult psychiatric patients and concluded that it was a quick and reasonably accurate test for assessing intellectual efficiency or deterioration in patients with psychiatric and neurologic disorders. Hayman also compared patterns of errors of the adult psychiatric patients with errors of 433 normal male and female school children between the ages of 8 and 15 years, and he described four identical patterns of errors in the two populations. However, the origins, rationale, and validity of this now conventional neurological test have rarely been reviewed.In 1966, Luria2,3 described serial sevens as an important neurologic diagnostic aid in many cases becauseThis test makes particularly high
Maximal oxygen uptake (VO 2max ) was predicted from maximal power output (MPO) in a progressive cycle ergometer test. The subjects were 232 men and 303 women 15–28 years of age. The relationship between VO 2max and MPO was: V O 2max (1 · min ⁻¹ ) = 0.16 + (0.0117 × MPO) (w). A correlation coefficient of r = 0.88 was found between MPO and VO 2max . Test‐retest reliability was evaluated by two procedures. Standard deviations of test‐retest differences in MPO and VO 2max using the same standardized procedure in 35 subjects, were 10% and 8%, respectively, and Pearson correlations between test and retest values were 0.95 and 0.96, respectively.
When MPO of tests conducted at the schools was compared to a standardized test performed by a physiologist in 267 subjects, test‐retest Pearson correlation was 0.82. A prediction model only including MPO and explaining 80% of the variability in VO 2max , is suggested for use in healthy adolescents and young adults.
In this study, the authors attempted to determine predictors of adherence to antidepressant therapy and to identify specific educational messages, side effects, and features of doctor-patient collaboration that influence adherence. Patients newly prescribed antidepressants for depression at a health maintenance organization were identified by using automated pharmacy data and medical records review. Patients (n = 155) were interviewed 1 and 4 months after starting antidepressant medication. Approximately 28% of patients stopped taking antidepressants during the first month of therapy, and 44% had stopped taking them by the third month of therapy. Patients who received the following five specific educational messages--1) take the medication daily; 2) antidepressants must be taken for 2 to 4 weeks for a noticeable effect; 3) continue to take medicine even if feeling better; 4) do not stop taking antidepressant without checking with the physician; and 5) specific instructions regarding what to do to resolve questions regarding antidepressants--were more likely to comply during the first month of antidepressant therapy. Asking about prior experience with antidepressants and discussions about scheduling pleasant activities also were related to early adherence. Side effects, only at severe levels, were associated with early noncompliance. Neuroticism, depression severity, and other patient characteristics did not predict adherence. Primary care physicians may be able to enhance adherence to antidepressant therapy by simple and specific educational messages easily integrated into primary care visits.
A random sample of 3258 adult household residents of Edmonton, Alberta, Canada, were interviewed by trained lay interviewers, using the Diagnostic Interview Schedule (DIS), which generated DSM-III diagnosis data. This paper reports results for major depressive disorder (MDD). MDD was found to affect women more than men by a ratio of nearly 2 to 1. The lifetime prevalence rate for both sexes combined was 8.6%. The period prevalence rates for both sexes combined were 3.2% and 4.6%, for six month and one year, respectively. The presence of a recurrent Major Depressive Disorder was associated with an increased risk of substance abuse, panic disorder and dysthymia, whereas a single major depressive episode was not associated with increased comorbidity.
This paper reviews data concerning the effects of acute physical exercise (treadmill running) in trained rats. Works from the 1980's have established that acute running increases brain serotonin (5-hydroxytryptamine: 5-HT) synthesis in two ways. Lipolysis-elicited release of free fatty acids in the blood compartment displaces the binding of the essential amino acid tryptophan to albumin, thereby increasing the concentration of the so-called "free tryptophan" portion, and because exercise increases the ratio of circulating free tryptophan to the sum of the concentrations of the amino acids that compete with tryptophan for uptake at the blood-brain barrier level, tryptophan enters markedly in the brain compartment. However, this marked increase in central tryptophan levels increases only to a low extent brain 5-HT synthesis, as assessed by the analysis of 5-hydroxyindoleacetic acid levels, thereby suggesting that exercise promotes feedback regulatory mechanisms. Indirect indices of 5-HT functions open the possibility that acute exercise-induced increases in 5-HT biosynthesis are associated with (or lead to) increases in 5-HT release. Lastly, the hypothesis that training and/or acute exercise triggers changes in 5-HT receptors has been examined in several studies; actually, both positive and negative results have been reached. Taken together, all these data support the need for future studies on the functional effects of exercise on 5-HT, including those related to the hypothesis that the positive mood effects of exercise rely (partly or totally) on central serotonergic systems.
To determine the effectiveness of exercise as an intervention in the management of depression.
Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals.
Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy.
All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6); weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)).
The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up.
Investigations of cognitive disturbances among patients with mood disorders have yielded inconsistent results. Although marked neuropsychologic deficits have been reported in elderly patients and in midlife patients with severe depression, the severity of cognitive impairments in medically healthy younger ambulatory adults with depression has not been well characterized.
A comprehensive battery of standard neuropsychologic tests and experimental computerized measures of cognitive functioning were administered to unmedicated ambulatory younger adults with mild to moderate nonbipolar depression and to a group of age- and gender-equated healthy subjects.
Patients demonstrated a notable absence of widespread cognitive impairment. Deficits in executive functions were observed on the Wisconsin Card Sort Test but not on several other tests. Despite the absence of significant impairment on tests of attention, memory, and motor performance in the total sample, symptom severity and age of illness onset were correlated with poorer performance on some tests of cognitive functioning even after correction for age.
These findings, derived from a large sample of unmedicated depressed outpatients, indicate that major depressive disorder in healthy younger ambulatory adults does not cause appreciable impairments in cognitive functioning in the absence of clinical and course-of-illness features.