Objective-To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls. Methods-BetweenOctober 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50-200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D).Results-After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = . 057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23).Conclusions-The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.
The cognitive correlates of anger arousal were investigated in community-based samples of maritally violent (MV), maritally distressed-nonviolent (DNV), and maritally satisfied-nonviolent (SNV) husbands. Participants performed the Articulated Thoughts in Simulated Situations (ATSS) paradigm while listening to anger-arousing audiotapes. Trained raters coded for irrational beliefs, cognitive biases, hostile attributional biases, and anger control statements. Results indicated that MV men articulated significantly more irrational thoughts and cognitive biases than DNV and SNV men. MV men articulated more hostile attributional biases than DNV and SNV men across all ATSS scenarios. SNV men, however, articulated more anger control statements during ATSS anger arousal than MV or DNV participants. Discriminant function analyses indicated that specific thoughts discriminated between the groups and differentiated mildly from severely violent participants. ATSS cognitive distortions (a) were not correlated with questionnaire measures of cognitive distortion, and (b) were superior to questionnaire measures in discriminating between the groups. The findings are interpreted in light of recent advances in understanding the relationship between information processing, anger, and marital aggression.
This article reviews evidence supporting exercise as a treatment for psychiatric disorders. Although data from randomized trials are limited, results of studies included in this review generally support use of exercise as an alternative or adjunctive treatment. Discussion of practical issues regarding exercise, potential mechanisms for the beneficial effects of exercise, and recommendations for future research are provided.
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