A meta-analysis was conducted to examine the effects of exercise on anxiety. Because previous meta-analyses in the area included studies of varying quality, only randomized, controlled trials were included in the present analysis. Results from 49 studies show an overall effect size of -0.48, indicating larger reductions in anxiety among exercise groups than no-treatment control groups. Exercise groups also showed greater reductions in anxiety compared with groups that received other forms of anxiety-reducing treatment (effect size = -0.19). Because only randomized, controlled trials were examined, these results provide Level 1, Grade A evidence for using exercise in the treatment of anxiety. In addition, exercise dose data were calculated to examine the relationship between dose of exercise and the corresponding magnitude of effect size.

Several meta-analyses examining the effects of exercise on depression have been criticized for including studies of poor methodological integrity. More recent meta-analyses addressed the most common criticism by including only randomized control trials; however, these analyses suffer from incomplete literature searches and lack of moderating variable analyses. Using a more extensive search procedure, the current meta-analysis examines the effects of exercise on depressive symptoms in 58 randomized trials (n = 2982). An overall effect size of -0.80 indicates participants in the exercise treatment had significantly lower depression scores than those receiving the control treatment. This frac34; SD advantage represents level 1, Grade A evidence for the effects of exercise upon depression. Analysis of moderating variables examined the influence of population characteristics, exercise characteristics and methodological characteristics. Examination of clinical significance in 16 trials with clinically depressed patients found 9 of 16 exercise treatment groups were classified as 'recovered' at post-treatment, with another three groups classified as 'improved'. Analysis showed dropout rates for the exercise treatment were similar to those found in psychotherapeutic and drug interventions.

Exercise is an efficacious treatment for Major Depressive Disorder (MDD) and has independently been shown to have anti-inflammatory effects in non depressed subjects. Patients with MDD have elevated inflammatory cytokines but it is not known if exercise affects inflammation in MDD patients and whether these changes are clinically relevant. In the TReatment with Exercise Augmentation for Depression (TREAD) study, participants who were partial responders to a Selective Serotonin Reuptake Inhibitor (SSRI) were randomized to receive one of two doses of exercise: 16 kilocalories per kilogram of body weight (KKW), or 4 KKW for 12 weeks. Blood samples were collected before initiation and again at the end of the 12-week exercise intervention. Serum was analyzed using a multiplexed ELISA for Interferon-γ (IFN-γ), Interleukin 1-β (IL-1β), Interleukin-6 (IL-6), and Tumor Necrosis Factor-α (TNF-α). Higher baseline levels of TNF-α were associated with greater decrease in depression symptoms over the 12 week exercise period (p = 0.0023). In addition, a significant positive correlation between change in IL-1β and change in depression symptom scores was observed (p=0.0441). There were no significant changes in mean level of any cytokine following the 12-week intervention, and no significant relationship between exercise dose and change in mean cytokine level. Results suggest that high TNF-α may differentially predict better outcomes with exercise treatment as opposed to antidepressant medications for which high TNF-α is linked to poor response. Our results also confirm findings from studies of antidepressant medications that tie decreasing IL-1β to positive depression treatment outcomes.

Major depressive disorder (MDD) is a source of great disease burden, due in part to the limited accessibility and effectiveness of current treatments. Although current treatments are efficacious in a segment of the population with MDD, there is a clear need for alternative and augmentation treatment strategies. Exercise is one such alternative treatment option. Research has shown exercise to be efficacious as both a stand-alone and an augmentation therapy. As a result, exercise is now included in the American Psychiatric Association's treatment recommendations. The purpose of this article is to provide clinicians with a knowledge base to prescribe exercise to their patients. The authors describe the evidence supporting the use of exercise in the treatment of MDD, provide evidence-based recommendations for prescribing exercise, and address practical considerations related to prescribing exercise in real-world treatment settings.

Commercially available physical activity monitors provide clinicians an opportunity to obtain oncology patient health measures to an unprecedented degree. These devices can provide objective and quantifiable measures of physical activity, which are not subject to errors or bias of self-reporting or shorter duration of formal testing. Prior work on so-called quantified-self data was based on older-generation, research-grade accelerometers, which laid the foundation for consumer-based physical activity monitoring devices to be validated as a feasible and reliable tool in patients with cancer. Physical activity monitors are being used in chronic conditions including chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, and obesity. Differing demographics, compounded with higher symptom and treatment burdens in patients with cancer, imply that additional work is needed to understand the unique strengths and weaknesses of physical activity monitors in this population. Oncology programs can systematically implement these tools into their workflows in an adaptable and iterative manner. Translating large amounts of data collected from an individual physical activity monitoring device into clinically relevant information requires sophisticated data compilation and reduction. In this article, we summarize the characteristics of older- and newer-generation physical activity monitors, review the validation of physical activity monitors with respect to health-related quality-of-life assessments, and describe the current role of these devices for the practicing oncologist. We also highlight the challenges and next steps needed for physical activity monitors to provide relevant information that can change the current state of oncology practice.

Objective To describe the rates of elevated inflammation, obesity and metabolic syndrome (MetS) within a large cohort of individuals with depression and to examine the inter-relationships of inflammation and metabolic syndrome in depressed individuals. Method Analyses were conducted on study participants from the 2009–2010 National Health and Nutrition Survey (NHANES) with Patient Health Questionnaire (PHQ)-9 depression scores ≥ 10 to: 1) examine the relationship of inflammation (C-reactive protein; CRP) with demographic and clinical characteristics and 2) examine the prevalence of MetS criteria within CRP groups. Results 5579 participants provided PHQ-9 data; of those, 606 had PHQ-9 scores ≥ 10 and were included in further analysis. Of the 606 depressed participants, 585 participants had valid CRP data; 275 participants (47.01%) had CRP levels ≥ 3.0 mg/L, while 170 (29.06%) had CRP levels ≥ 5.0 mg/L. Elevated inflammation was significantly correlated with body weight, waist circumference, BMI, insulin, 2-hour glucose tolerance, and self-report general health (p’s < 0.05). 112 subjects (41.18%) met AHA/NHLBI criteria for metabolic syndrome (MetS). Those with elevated CRP were more likely to meet criteria for MetS (Odds Ratios of 2.81 for those with CRP levels ≥ 3.0 mg/L and 1.94 for those with CRP levels ≥ 5.0 mg/L). Conclusion Over 29% of depressed individuals have elevated levels of CRP and 41% met criteria for MetS. Individuals with elevated inflammation are more likely to be obese and meet criteria for MetS. These results highlight the significant inflammatory and metabolic burden of individuals with depression.

BackgroundThere is a need for novel approaches to the treatment of stimulant abuse and dependence. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight gain, quality of life, and anhedonia, since it has been shown to improve many of these domains in a number of other clinical disorders. Furthermore, neurobiological evidence provides plausible mechanisms by which exercise could positively affect treatment outcomes. The current manuscript presents the rationale, design considerations, and study design of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) CTN-0037 Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study.Methods/DesignSTRIDE is a multisite randomized clinical trial that compares exercise to health education as potential treatments for stimulant abuse or dependence. This study will evaluate individuals diagnosed with stimulant abuse or dependence who are receiving treatment in a residential setting. Three hundred and thirty eligible and interested participants who provide informed consent will be randomized to one of two treatment arms: Vigorous Intensity High Dose Exercise Augmentation (DEI) or Health Education Intervention Augmentation (HEI). Both groups will receive TAU (i.e., usual care). The treatment arms are structured such that the quantity of visits is similar to allow for equivalent contact between groups. In both arms, participants will begin with supervised sessions 3 times per week during the 12-week acute phase of the study. Supervised sessions will be conducted as one-on-one (i.e., individual) sessions, although other participants may be exercising at the same time. Following the 12-week acute phase, participants will begin a 6-month continuation phase during which time they will attend one weekly supervised DEI or HEI session.Clinical Trials RegistryClinicalTrials.gov, NCT01141608http://clinicaltrials.gov/ct2/show/NCT01141608?term=Stimulant+Reduction+Intervention+using+Dosed+Exercise&rank=1

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