Moderate exercise improves depression parameters in patients with non-remitted major depressive disorder

Abstract

IntroductionIn recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.AimsTo assess the effect of a moderate intensity 12 week exercise program on depression and functional parameters in a population sample of patients with non-remitted Major Depressive Disorder (MDD).MethodsStudy design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Assessed parameters HAMD17, Beck Depression Inventory (BDI), Global Assessment of Functioning (GAF), Clinical Global Impression Scale - Severity (CGI-S).ResultsParticipants in the exercise group showed better depression and functional parameters at the end of the study, both compared to the beginning of the study and compared to the control group (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05).ConclusionsResults suggest that exercise could be an effective adjuvant therapy for non-remitted MDD patients.

Walking for depression or depressive symptoms: A systematic review and meta-analysis

“…In the two trials with no significant positive impact on fitness on the participants in the walking arm, one (Bonnet, 2005) had no significant effect on depressive symptoms and one (Knubben et al, 2007) did. Mota-Pereira et al (2011) found a significant reduction in depression scores in the walking arm compared to the control, but no difference in fitness between the two groups. Table 1 provides details of quality indicators (allocation concealment, intention to treat analysis, sample size calculations and blinding of assessors) reported in the trial papers.…”

“…From these, seven separate trials fully met the inclusion criteria (Armstrong & Edwards, 2003;Armstrong & Edwards, 2004;Bonnet, 2005;Knubben et al, 2007;McNeil, LeBlanc & Joyner, 1991;Mota-Pereira et al, 2011;Nguyen, 2008). We decided to include one further trial (Gusi, Reyes, Gonzalez-Guerrero, Herrera & Garcia, 2008), which recruited participants with a high body mass index in addition to patients who were depressed.…”

“…Further research would be needed to discover if recruitment methods or other factors were important influences on these trials" negative findings. The participants in three of the six trials with positive effects (Knubben et al, 2007;Mota-Pereira, 2011;Nguyen, 2008) (NICE, 2010;Ostler et al, 2001) further research is warranted to build on the results of this study.While randomised, controlled trials offer the highest level of evidence for the effectiveness of treatments on specific diseases (Barton, 2000) they can be expensive and difficult to undertake in a methodologically rigorous manner (Hotopf, Lewis, & Normand, 1997).This would certainly be true for the topic addressed in this paper as walking interventions can take diverse forms (as this review highlighted) and depression can vary from person to person and over time (Thornicroft & Sartorius, 1993). In addition, it is not possible to blind trial participants and eradicate all forms of bias such as demand bias (when the participant acts to please the researcher rather than in their usual way) (Orne, 1962) This review did not provide evidence that health professionals advising patients with depression to walk would have a positive effect on their depression, only that walking can be an effective treatment in research trial settings (Blumenthal & Ong, 2009).…”

“…Further research would be needed to discover if recruitment methods or other factors were important influences on these trials" negative findings. The participants in three of the six trials with positive effects (Knubben et al, 2007;Mota-Pereira, 2011;Nguyen, 2008) (NICE, 2010;Ostler et al, 2001) further research is warranted to build on the results of this study.…”

“…Three trials involved outdoor walking (Armstrong & Edwards, 2003;Armstrong & Edwards, 2004;Gusi et al 2008), three indoor walking (Bonnet, 2005;Knubben et al, 2007;Nguyen, 2008) (with two using treadmills (Bonnet, 2005;Knubben et al, 2007)) and two involved both indoor and outdoor walking (McNeil et al, 1991;Mota-Pereira et al, 2011). In six trials (Armstrong & Edwards, 2003;Armstrong & Edwards, 2004;Bonnet, 2005;Gusi et al 2008;Knubben et al, 2007;Nguyen, 2008) the walking was led or supervised all the time; in one trial (McNeil et al, 1991) two of the three weekly walks were led, and in the final trial (MotaPereira et al, 2011) one of the five weekly walks was supervised.…”