Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial

Carneiro, Lara; Fonseca, António Manuel; Vieira-Coelho, Maria Augusta; Mota, Maria Paula; Vasconcelos-Raposo, José

doi:10.1016/j.jpsychires.2015.09.007

Cited by 56 publications

(70 citation statements)

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“…This position is contrary to the reviews examining exercise vs. other treatments for depression, including antidepressants, which generally recommend exercise as a stand-alone and/or as adjunctive treatment for depression. The evidence is even greater when considering two additional recent well-designed RCTs not included in any of the reviews (possibly because they were published later than the RCTs mentioned in the reviews) which pointed out the effect of exercise as a complement to antidepressant medication (Carneiro et al, 2015; Legrand and Neff, 2016) ( Table 1 ). Furthermore, while the underlying biological mechanisms mediating between exercise and reduced depressive symptoms are not entirely clear, it is apparent that exercise induces both acute and chronic responses, particularly in hormones, neurotrophines, and inflammation biomarkers, and that there is an association between hippocampus neurogenesis as a result of exercise and depressive symptoms’ improvement (Schuch et al, 2016a).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The duration of the exercise period varied from 10 days (Knubben et al, 2007; Legrand and Neff, 2016), to 6 weeks (Kerling et al, 2015), 10 weeks (Mather et al, 2002), 3 months (Mota-Pereira et al, 2011), 4 months (Carneiro et al, 2015), 6 months (Murri et al (2015), 8 months (Pilu et al, 2007), 12 months (Chalder et al, 2012), to throughout a hospitalization period (undefined time period) (Schuch et al, 2011, 2015). Control groups included antidepressants only (Mather et al, 2002; Pilu et al, 2007; Mota-Pereira et al, 2011; Schuch et al, 2011, 2015; Chalder et al, 2012; Carneiro et al, 2015; Kerling et al, 2015), light exercise with both exercise groups receiving antidepressants (Knubben et al, 2007; Legrand and Neff, 2016), and antidepressants only (Murri et al, 2015). The exercise mode included mostly aerobics (Knubben et al, 2007; Mota-Pereira et al, 2011; Schuch et al, 2011, 2015; Kerling et al, 2015; Murri et al, 2015; Legrand and Neff, 2016) or aerobic and strength (Pilu et al, 2007); aerobic, strength, and stretching exercises (Mather et al, 2002 ) ; aerobics and strength exercises, games and dancing (Carneiro et al, 2015), and facilitated physical activity chosen and performed individually by participants (Chalder et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Control groups included antidepressants only (Mather et al, 2002; Pilu et al, 2007; Mota-Pereira et al, 2011; Schuch et al, 2011, 2015; Chalder et al, 2012; Carneiro et al, 2015; Kerling et al, 2015), light exercise with both exercise groups receiving antidepressants (Knubben et al, 2007; Legrand and Neff, 2016), and antidepressants only (Murri et al, 2015). The exercise mode included mostly aerobics (Knubben et al, 2007; Mota-Pereira et al, 2011; Schuch et al, 2011, 2015; Kerling et al, 2015; Murri et al, 2015; Legrand and Neff, 2016) or aerobic and strength (Pilu et al, 2007); aerobic, strength, and stretching exercises (Mather et al, 2002 ) ; aerobics and strength exercises, games and dancing (Carneiro et al, 2015), and facilitated physical activity chosen and performed individually by participants (Chalder et al, 2012). The studies using exercise in a control group used light stretching (Knubben et al, 2007; Legrand and Neff, 2016) and low-intensity aerobics (Murri et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?

Netz

2017

Front. Pharmacol.

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Major depression disorder is most commonly treated with antidepressants. However, due to their side effects clinicians seek non-pharmacologic options, and one of these is exercise. The literature on the benefits of exercise for depression is extensive. Nevertheless, two recent reviews focusing on antidepressants vs. other therapies as a basis for clinical practice guidelines recommended mainly antidepressants, excluding exercise as a viable choice for treatment of depression. The aim of this perspective is to analyze the literature exploring the reasons for this discrepancy. Two categories of publications were examined: randomized controlled trials (RCTs) and meta-analyses or systematic reviews. Based on this reassessment, RCTs comparing exercise to antidepressants reported that exercise and antidepressants were equally effective. RCTs comparing exercise combined with antidepressants to antidepressants only reported a significant improvement in depression following exercise as an adjunctive treatment. Almost all the reviews examining exercise vs. other treatments of depression, including antidepressants, support the use of exercise in the treatment of depression, at least as an adjunctive therapy. The two reviews examining pharmacologic vs. non-pharmacologic therapies as a basis for clinical practice guidelines examined limited evidence on exercise vs. antidepressants. In addition, it is possible that academics and health care practitioners are skeptical of viewing exercise as medicine. Maybe, there is a reluctance to accept that changes in lifestyle as opposed to pharmacological treatment can alter biological mechanisms. Longitudinal studies are needed for assessing the effectiveness of exercise in real clinical settings, as well as studies exploring dose-response relationship between exercise and depression.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?

Netz

2017

Front. Pharmacol.

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“…17 Exercise is a pleiotropic therapy shown to improve a broad array of psychological symptoms in patients without cancer. [28][29][30][31][32] In the pediatric oncology setting, a limited number of studies demonstrate that exercise can benefit fatigue and overall quality of life. 26,27 Randomized trials demonstrate that structured Cancer September 1, 2019 exercise training lessens anxiety and depressive symptoms and improves short-term mood, cognition, and overall HRQOL in persons with or at risk for these problems.…”

Section: Introductionmentioning

confidence: 99%

Impact of exercise on psychological burden in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Tonorezos

Ford

Wang

et al. 2019

Cancer

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BACKGROUND: Childhood cancer survivors are at risk for adverse psychological outcomes. Whether exercise can attenuate this risk is unknown. METHODS: In total, 6199 participants in the Childhood Cancer Survivor Study (median age, 34.3 years [range, 22.0-54.0 years]; median age at diagnosis, 10.0 years [range, 0-21.0 years]) completed a questionnaire assessing vigorous exercise and medical/psychological conditions. Outcomes were evaluated a median of 7.8 years (range, 0.1-10.0 years) later and were defined as: symptom level above the 90th percentile of population norms for depression, anxiety, or somatization on the Brief Symptom Inventory-18; cancer-related pain; cognitive impairment using a validated self-report neurocognitive questionnaire; or poor healthrelated quality of life. Log-binomial regression estimated associations between exercise (metabolic equivalent [MET]-hours per week −1 ) and outcomes adjusting for cancer diagnosis, treatment, demographics, and baseline conditions. RESULTS: The prevalence of depression at follow-up was 11.4% (95% CI, 10.6%-12.3%), anxiety 7.4% (95% CI, 6.7%-8.2%) and somatization 13.9% (95% CI, 13.0%-14.9%). Vigorous exercise was associated with lower prevalence of depression and somatization. The adjusted prevalence ratio for depression was 0.87 (95% CI, 0.72-1.05) for 3 to 6 MET hours per week −1 , 0.76 (95% CI, 0.62-0.94) for 9 to 12 MET-hours per week −1 , and 0.74 (95% CI, 0.58-0.95) for 15 to 21 MET-hours per week −1 . Compared with 0 MET hours per week −1 , 15 to 21 MET-hours per week −1 were associated with an adjusted prevalence ratio of 0.79 (95% CI, 0.62-1.00) for somatization. Vigorous exercise also was associated with less impairment in the physical functioning, general health and vitality (P trend < .001), emotional role limitations (P trend = .02), and mental health (P trend = .02) domains as well as higher cognitive function in the domains of task completion, organization, and working memory (P < .05 for all), but not in the domain of cancer pain. CONCLUSIONS: Vigorous exercise is associated with less psychological burden and cognitive impairment in childhood cancer survivors. Cancer 2019;125:3059-3067.

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Factors that influence participation in physical activity for anxiety or depression: a synthesis of qualitative evidence

McCartan

Yap²,

Firth

et al. 2020

Cochrane Database of Systematic Reviews

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This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows: Main objective: To identify the factors that create barriers or facilitate physical activity for people with a diagnosis of anxiety or depression from the perspectives of service users, carers, service providers and practitioners to help inform the design and implementation of interventions that promote physical activity. The overall aim of this review is to identify, appraise, and synthesise qualitative research evidence on the barriers and facilitators to engaging in physical activity in general lifestyle settings or as part of an intervention designed to increase physical activity for people with anxiety and depression. This will allow us to identify factors that create barriers and facilitators of physical activity in this population to inform the development, design, and implementation of future interventions. We will also integrate the findings from the QES with the two associated e ectiveness reviews (Cooney 2014; Larun 2006). We will communicate our findings to public health commissioners and other stakeholders.

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Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial

Cited by 56 publications

References 43 publications

Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?

Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?

Impact of exercise on psychological burden in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Factors that influence participation in physical activity for anxiety or depression: a synthesis of qualitative evidence

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