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Cai Y, Guo H, Han T, Wang H. Lactate: a prospective target for therapeutic intervention in psychiatric disease. Neural Regen Res 2024; 19:1473-1479. [PMID: 38051889 PMCID: PMC10883489 DOI: 10.4103/1673-5374.387969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT Although antipsychotics that act via monoaminergic neurotransmitter modulation have considerable therapeutic effect, they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorders. This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs. Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitters. Among these candidate neurotransmitters, lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years. Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses; animal experiments have also shown that the supply of exogenous lactate exerts an antidepressant effect. In this review, we have described how medications targeting newer neurotransmitters offer promise in psychiatric diseases; we have also summarized the advances in the use of lactate (and its corresponding signaling pathways) as a signaling molecule. In addition, we have described the alterations in brain lactate levels in depression, anxiety, bipolar disorder, and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.
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Affiliation(s)
- Yanhui Cai
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Haiyun Guo
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Tianle Han
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Kreppke JN, Cody R, Beck J, Brand S, Donath L, Eckert A, Imboden C, Hatzinger M, Holsboer-Trachsler E, Lang UE, Mans S, Mikoteit T, Oswald A, Rogausch A, Schweinfurth-Keck N, Zahner L, Gerber M, Faude O. Cardiorespiratory fitness, perceived fitness and autonomic function in in-patients with different depression severity compared with healthy controls. J Psychiatr Res 2024; 175:437-445. [PMID: 38797040 DOI: 10.1016/j.jpsychires.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 03/26/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Over 300 million individuals worldwide suffer from major depressive disorder (MDD). Individuals with MDD are less physically active than healthy people which results in lower cardiorespiratory fitness (CRF) and less favorable perceived fitness compared with healthy controls. Additionally, individuals with MDD may show autonomic system dysfunction. The purpose of the present study was to evaluate the CRF, perceived fitness and autonomic function in in-patients with MDD of different severity compared with healthy controls. We used data from 212 in-patients (age: 40.7 ± 12.6 y, 53% female) with MDD and from 141 healthy controls (age: 36.7 ± 12.7 y, 58% female). We assessed CRF with the Åstrand-Rhyming test, self-reported perceived fitness and autonomic function by heart rate variability (HRV). In specific, we used resting heart rate, time- and frequency-based parameters for HRV. In-patients completed the Beck Depression Inventory-II (BDI-II) to self-assess the subjectively rated severity of depression. Based on these scores, participants were grouped into mild, moderate and severe MDD. The main finding was an inverse association between depression severity and CRF as well as perceived fitness compared with healthy controls. Resting heart rate was elevated with increasing depression severity. The time-based but not the frequency-based autonomic function parameters showed an inverse association with depression severity. The pattern of results suggests that among in-patients with major depressive disorder, those with particularly high self-assessed severity scores show a lower CRF, less favorable perceived fitness and partial autonomic dysfunction compared to healthy controls. To counteract these conditions, physical activity interventions may be effective.
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Affiliation(s)
- Jan-Niklas Kreppke
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Robyn Cody
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Serge Brand
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland; Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland; Substance Use Prevention Research Center and Sleep Disorder Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6715847141, Iran; School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
| | - Lars Donath
- German Sport University Cologne, Department of Intervention Research in Exercise Training, Cologne, Germany
| | - Anne Eckert
- Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
| | - Christian Imboden
- Private Clinic Wyss, Münchenbuchsee, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Martin Hatzinger
- Psychiatric Services, Solothurn, and Medical Faculty, University of Basel, Switzerland
| | | | - Undine E Lang
- Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, Münchenbuchsee, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services, Solothurn, and Medical Faculty, University of Basel, Switzerland
| | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, Riehen, Switzerland
| | | | | | - Lukas Zahner
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Oliver Faude
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Ströhle A. Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders. Eur Arch Psychiatry Clin Neurosci 2019; 269:485-498. [PMID: 29564546 DOI: 10.1007/s00406-018-0891-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/19/2018] [Indexed: 12/11/2022]
Abstract
Sports psychiatry has developed for the past 3 decades as an emerging field within psychiatry and sports medicine. An International society has been established in 1994 and also national interest groups were implemented, mostly within the national organizations for psychiatry, some also containing the topic of exercise treatment of mental disorders. Where are we now 30 years later? We systematically but also selectively review the medical literature on exercise, sport, psychiatry, mental health and mental disorders and related topics. The number of publications in the field has increased exponentially. Most topics keep remaining on the agenda, e.g., head trauma and concussion, drug abuse and doping, performance enhancement, overtraining, ADHD or eating disorders. Supported by the growing literature, evidence-based recommendations have become available now in many clinical areas. A relatively new phenomenon is muscle dysmorphia, observed in weightlifters, bodybuilders but also in college students and gym users. Further, sports therapy of mental disorders has been studied by more and more high-quality randomized controlled clinical trials. Mostly as a complementary treatment, however, for some disorders already with a 1a evidence level, e.g., depression, dementia or MCI but also post-traumatic stress disorder. Being grown up and accepted nowadays, sports psychiatry still represents a fast-developing field. The reverse side of the coin, sport therapy of mental disorders has received a scientific basis now. Who else than sports psychiatry could advance sport therapy of mental disorders? We need this enthusiasm for sports and psychiatry for our patients with mental disorders and it is time now for a broadening of the scope. Optimized psychiatric prevention and treatment of athletes and ideal sport-related support for individuals with mental disorders should be our main purpose and goal.
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Affiliation(s)
- Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Gerber M, Beck J, Brand S, Cody R, Donath L, Eckert A, Faude O, Fischer X, Hatzinger M, Holsboer-Trachsler E, Imboden C, Lang U, Mans S, Mikoteit T, Oswald A, Pühse U, Rey S, Schreiner AK, Schweinfurth N, Spitzer U, Zahner L. The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial. Trials 2019; 20:367. [PMID: 31221205 PMCID: PMC6585067 DOI: 10.1186/s13063-019-3468-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls. METHODS The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2-3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up. DISCUSSION Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD. TRIAL REGISTRATION ISRCTN, ISRCTN10469580 . Registered on 3 September 2018.
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Affiliation(s)
| | | | - Serge Brand
- University of Basel, Basel, Switzerland
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
- Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | | | - Lars Donath
- German Sport University Cologne, Cologne, Germany
| | - Anne Eckert
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | | | | | | | | | | | - Undine Lang
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, Münchenbuchsee, Switzerland
| | | | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, Riehen, Switzerland
| | - Uwe Pühse
- University of Basel, Basel, Switzerland
| | - Sofia Rey
- University of Basel, Basel, Switzerland
| | | | - Nina Schweinfurth
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | - Ursula Spitzer
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
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Gerber M, Minghetti A, Beck J, Zahner L, Donath L. Is improved fitness following a 12-week exercise program associated with decreased symptom severity, better wellbeing, and fewer sleep complaints in patients with major depressive disorders? A secondary analysis of a randomized controlled trial. J Psychiatr Res 2019; 113:58-64. [PMID: 30903972 DOI: 10.1016/j.jpsychires.2019.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/05/2019] [Accepted: 03/08/2019] [Indexed: 01/15/2023]
Abstract
Major depressive disorder (MDD) is one of the most burdensome disorders worldwide. While exercise training in patients with MDD contributes to clinically relevant improvements in cardiorespiratory fitness, whether and to what degree changes in cardiorespiratory fitness impact depressive symptom severity has not yet been addressed systematically in prior research. The purpose of our study was threefold. Firstly, to examine whether baseline levels and improvements in objectively assessed VO2max and subjectively perceived fitness predicted endpoint levels and change in depressive symptoms, wellbeing and sleep. Secondly, to determine whether exercise modality (sprint interval training [SIT]) versus continuous aerobic exercise training [CAT]) predicted depressive symptoms, wellbeing and sleep. Thirdly, whether the affective responses during and following exercise predicted depressive symptoms, wellbeing and sleep. All measurements were taken in a sample of inpatients diagnosed with MDD. The sample consisted of 53 participants (41 women and 12 men, Mage = 36.3 years, SD = 11.3) with unipolar depression who were randomly assigned to SIT and CAT. Data were assessed at baseline and after four weeks of exercise training (including three weekly 35 min sessions). Multiple linear regression analyses showed that improvements in VO2max were associated with fewer depressive symptoms, better mental wellbeing, and better sleep after completion of the intervention. Additionally, improvements in perceived fitness were associated with fewer dysfunctional sleep-related cognitions and higher mental toughness post-intervention. Improvements in VO2max and perceived fitness were also associated with favorable changes in depressive symptoms, mental wellbeing, and sleep. More research is needed to find out which fitness tests are most time- and cost-efficient in a clinical setting and most acceptable for psychiatric patients.
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Affiliation(s)
- Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Alice Minghetti
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | | | - Lukas Zahner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Lars Donath
- Institute of Exercise Training and Sport Informatics, German Sport University Cologne, Cologne, Germany.
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Herbsleb M, Schumann A, Lehmann L, Gabriel HHW, Bär KJ. Cardio-Respiratory Fitness and Autonomic Function in Patients with Major Depressive Disorder. Front Psychiatry 2019; 10:980. [PMID: 32116813 PMCID: PMC7011194 DOI: 10.3389/fpsyt.2019.00980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022] Open
Abstract
Patients with major depressive disorder (MDD) have an augmented risk of cardiovascular morbidity and mortality. Although a link between depression and autonomic dysfunction as well as reduced cardio-respiratory fitness (CRF) is well documented, the underlying cause is a matter of debate. Therefore, we studied the interplay between autonomic function, body composition and severity of the disease to disentangle possible physiological factors influencing the assumed lack of CRF in MDD patients. We investigated seventeen patients suffering from MDD and seventeen control subjects matched with respect to age, sex, body-mass-index, and smoking habits. A resting baseline assessment and a cardiopulmonary exercise test including a prolonged recovery period were performed to study autonomic function (i.e., heart rate responses and heart rate variability) during rest, exercise and recovery as well as CRF. Most investigated autonomic indices were significantly different at rest, during exercise as well as during recovery indicating altered autonomic modulation. Nevertheless, none of our participants was classified as chronotropically incompetent. As expected, a reduced CRF (i.e., peak oxygen uptake and peak power output, p < 0.01) was observed in patients compared to controls. In addition, a correlation of baseline heart rate and of heart rate during recovery with the ventilatory threshold 1 (p < 0.05) was found in patients only, indicating a relation to the lack of CRF. Furthermore, we observed a positive correlation of the severity of the disease with the weekly sitting time (p < 0.01) as well as a negative correlation with the activity time in the intensity domain walking (p < 0.001) and with the total score of the International Physical Activity Questionnaire (p < 0.01) for patients. This study shows that patients with MDD have altered autonomic function not only during resting conditions but also during exercise as well as recovery from exercise. Intervention studies are needed to evaluate how the described autonomic alterations can be influenced by increasing CRF due to appropriate exercise training programs.
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Affiliation(s)
- Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany.,Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Luisa Lehmann
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
| | - Holger H W Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University, Jena, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychosomatic Medicine, University Hospital, Jena, Germany
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7
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Leone M, Lalande D, Thériault L, Kalinova É, Fortin A. Effects of an exercise program on the physiological, biological and psychological profiles in patients with mood disorders: a pilot study. Int J Psychiatry Clin Pract 2018; 22:268-273. [PMID: 29334283 DOI: 10.1080/13651501.2018.1425458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: The objective of this study is to assess the impact of an 8-week physical training program on physiological, biological and psychological profiles in individual with mood disorders. Methods: Seven patients participated in the study. Patients were trained twice weekly (75 min/session) for 8 weeks. The training program aimed to improve muscular and cardiorespiratory reserves as well as functional capacity. Bioassays were also measured (lipid profile, blood glucose and cortisol). Depression, sleep quality and body image dissatisfaction were assessed. All measures were administrated at pre/post-intervention. Results: At post-intervention, 13 of the 15 physiological fitness, muscular strength and functional capacity variables improved significantly (p < .05). In addition, change in cortisol levels represented a medium to large effect size (Cohen's d = -0.67) which indicates a clinical reduction of stress-related symptoms. Depression was significantly improved (Cohen's d = -0.47; p = .027). Sleep and body image showed a trend-level improvement. Conclusions: An 8-week periodised training program improved physiological, biological and psychological profiles in patients with mood disorders.
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Affiliation(s)
- Mario Leone
- a Division of Kinesiology, Department of Health Sciences , Université du Québec à Chicoutimi , Saguenay , Canada Québec
| | - Daniel Lalande
- a Division of Kinesiology, Department of Health Sciences , Université du Québec à Chicoutimi , Saguenay , Canada Québec
| | - Linda Thériault
- a Division of Kinesiology, Department of Health Sciences , Université du Québec à Chicoutimi , Saguenay , Canada Québec
| | - Émilia Kalinova
- b Department of Physical Activity Sciences , Université du Québec à Montréal , Québec, Canada
| | - Audrey Fortin
- c Centre Hospitalier Universitaire de Chicoutimi , Saguenay, Québec , Canada
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Kerling A, von Bohlen A, Kück M, Tegtbur U, Grams L, Haufe S, Gützlaff E, Kahl KG. Exercise therapy improves aerobic capacity of inpatients with major depressive disorder. Brain Behav 2016; 6:e00469. [PMID: 27134769 PMCID: PMC4842901 DOI: 10.1002/brb3.469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/15/2016] [Accepted: 03/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Unipolar depression is one of the most common diseases worldwide and is associated with a higher cardiovascular risk partly due to reduced aerobic capacity. OBJECTIVES Therefore, the aim of our study was to examine whether a structured aerobic training program can improve aerobic capacity in inpatients with MDD (major depressive disorder). METHODS Overall, 25 patients (13 women, 12 men) diagnosed with MDD were included in the study. Parameters of aerobic capacity, such as maximum performance, maximum oxygen consumption, and VAT (ventilatory anaerobic threshold), were assessed on a bicycle ergometer before and 6 weeks after a training period (three times per week for 45 min on two endurance machines). In addition, a constant load test was carried out at 50% of the maximum performance prior to and after the training period. The performance data were compared with 25 healthy controls matched for sex, age, and body mass index before and after the training period. RESULTS Compared to controls, patients with MDD had significantly lower aerobic capacity. After training, there was a significant improvement in their performance data. A significant difference remained only for VAT between patients with MDD and healthy controls. CONCLUSION With regard to the coincidence of MDD with cardiovascular and cardiometabolic disorders, a structured supervised exercise program carried out during hospitalization is a useful supplement for patients with MDD.
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Affiliation(s)
- Arno Kerling
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Anne von Bohlen
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Momme Kück
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Uwe Tegtbur
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Lena Grams
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Sven Haufe
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 HannoverGermany; Institute of Clinical Pharmacology Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Elke Gützlaff
- Institute of Sports Medicine Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Carl-Neuberg-Str. 1 30625 Hannover Germany
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Stubbs B, Rosenbaum S, Vancampfort D, Ward PB, Schuch FB. Exercise improves cardiorespiratory fitness in people with depression: A meta-analysis of randomized control trials. J Affect Disord 2016; 190:249-253. [PMID: 26523669 DOI: 10.1016/j.jad.2015.10.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/28/2015] [Accepted: 10/10/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular disease and all-cause mortality. CRF improves in response to exercise interventions, yet the effectiveness of such interventions to improve CRF among people with depression is unclear. We conducted a systematic review and meta-analysis to evaluate whether CRF improves in people with depression in exercise randomized control trials (RCTs). METHOD Three authors identified RCTs from a recent Cochrane review and conducted updated searches of major electronic databases. We included RCTs of exercise interventions in people with depression (including major depressive disorder (MDD) and above-threshold depressive symptoms) that reported CRF (defined as predicted maximal oxygen uptake (VO2max predicted) or peak oxygen uptake (VO2peak)) versus a control condition. A random effects meta-analysis was conducted. RESULTS Seven unique RCTs including 8 aerobic exercise interventions for depression were eligible, including 293 people allocated to exercise (mean age=40.3 years, range=27.2-64.7 years and 35-100% female) and 205 allocated to control conditions. Across all studies exercise results in a significant increase in CRF (g=0.64, 95%CI=0.32-0.96, p<0.001) equating to a mean increase of 3.05 ml/kg/min. Results remained significant when restricted to MDD only (N=5, g=0.41, 95%CI=0.18-0.64, p<0.001) and in high quality studies (N=5, g=0.60, 95%CI=0.19-1.00, p=0.004). CONCLUSIONS People with depression can achieve clinically relevant improvements in CRF in response to exercise interventions. Targeting 'fitness' rather than 'fatness' may be another feasible intervention strategy in this population.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8 AF, United Kingdom.
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Davy Vancampfort
- KU Leuven University of Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven-University of Leuven, Z.org Leuven, Campus Kortenberg, Kortenberg, Belgium
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Felipe B Schuch
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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10
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Brand S, Colledge F, Beeler N, Pühse U, Kalak N, Sadeghi Bahmani D, Mikoteit T, Holsboer-Trachsler E, Gerber M. The current state of physical activity and exercise programs in German-speaking, Swiss psychiatric hospitals: results from a brief online survey. Neuropsychiatr Dis Treat 2016; 12:1309-17. [PMID: 27350748 PMCID: PMC4902243 DOI: 10.2147/ndt.s107313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Physical activity and exercise programs (PAEPs) are an important factor in increasing and maintaining physical and mental health. This holds particularly true for patients with psychiatric disorders undergoing treatment in a psychiatric hospital. To understand whether the benefits reported in the literature are mirrored in current treatment modalities, the aim of the present study was to assess the current state of PAEPs in psychiatric hospitals in the German-speaking part of Switzerland. METHODS All psychiatric hospitals (N=55) in the German-speaking part of Switzerland were contacted in spring 2014. Staff responsible for PAEPs were asked to complete an online questionnaire covering questions related to PAEPs such as type, frequency, staff training, treatment rationale, importance of PAEPs within the treatment strategy, and possible avenues to increase PAEPs. RESULTS Staff members of 48 different psychiatric hospitals completed the survey. Hospitals provided the following therapeutic treatments: relaxation techniques (100%), sports therapy (97%), activity-related psychotherapeutic interventions (95%), physiotherapy (85%), body therapies (59%), far-east techniques (57%), and hippotherapy (22%). Frequencies ranged from once/week to five times/week. Approximately 25% of patients participated in the PAEPs. Interventions were offered irrespective of psychiatric disorders. PAEP providers wanted and needed more vocational training. CONCLUSION All participating psychiatric hospitals offer a broad variety of PAEPs in their treatment curricula. However, the majority of inpatients do not participate in PAEPs. Furthermore, those who do participate cannot continue to do so following discharge. PAEP providers need specific extended vocational trainings and believe that the potential of PA should be improved.
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Affiliation(s)
- Serge Brand
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland; Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Flora Colledge
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Nadja Beeler
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Nadeem Kalak
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
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Kerling A, Tegtbur U, Gützlaff E, Kück M, Borchert L, Ates Z, von Bohlen A, Frieling H, Hüper K, Hartung D, Schweiger U, Kahl KG. Effects of adjunctive exercise on physiological and psychological parameters in depression: a randomized pilot trial. J Affect Disord 2015; 177:1-6. [PMID: 25743367 DOI: 10.1016/j.jad.2015.01.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) is associated with decreased physical activity and increased rates of the metabolic syndrome (MetS), a risk factor for the development of type 2 diabetes and cardiovascular disorders. Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors. Therefore, our study aimed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors. METHOD Fourty-two inpatients with moderate to severe depression were included. Twenty-two patients were randomized to additional 3x weekly exercise training (EXERCISE) and compared to treatment as usual (TAU). Exercise capacity was assessed as peak oxygen uptake (VO2peak), ventilatory anaerobic threshold (VAT) and workload expressed as Watts (W). Metabolic syndrome was defined according to NCEP ATPIII panel criteria. RESULTS After 6 weeks of treatment, cardiorespiratory fitness (VO2peak, VAT, Watt), waist circumference and HDL cholesterol were significantly improved in EXERCISE participants. Treatment response expressed as ≥50% MADRS reduction was more frequent in the EXERCISE group. CONCLUSIONS Adjunctive exercise training in depressed inpatients improves physical fitness, MetS factors, and psychological outcome. Given the association of depression with cardiometablic disorders, exercise training is recommended as an adjunct to standard antidepressant treatment.
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Affiliation(s)
- Arno Kerling
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Uwe Tegtbur
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Elke Gützlaff
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Momme Kück
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Luise Borchert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Zeynep Ates
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Anne von Bohlen
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Katja Hüper
- Institute for Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Dagmar Hartung
- Institute for Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Tennant GA. Relationships Between Body Areas Satisfaction, Exercise, and Mood in Obese African American Women. JOURNAL OF BLACK PSYCHOLOGY 2015. [DOI: 10.1177/0095798414560438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite a rate of morbid obesity that is 2.5 times that of European American women, African American women have higher body areas satisfaction than any other ethnicities. Previous research suggested differences in African American women’s attitudes toward body image may contribute to a lack of motivation to engage in weight management behaviors, such as physical activity. In addition, factors such as self-efficacy, self-regulation, and mood have been shown to affect healthy behavior participation but have not been studied among obese African American women. This study investigated if changes from baseline to posttreatment in self-efficacy and self-regulation for exercise and mood mediatedthe association between changes in body areas satisfaction and physical activity. The study used archival data consisting of 109 obese African American women who participated in a 6-month weight management intervention. The relationship between changes in body areas satisfaction and physical activity was mediated by changes in self-regulation for exercise and mood but not by change in self-efficacy for exercise. These findings may help in devising treatments targeted at this population. Implications are discussed.
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García-Toro M, Ibarra O, Gili M, Serrano MJ, Oliván B, Vicens E, Roca M. Four hygienic-dietary recommendations as add-on treatment in depression: a randomized-controlled trial. J Affect Disord 2012; 140:200-3. [PMID: 22516309 DOI: 10.1016/j.jad.2012.03.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/21/2012] [Accepted: 03/21/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Modifying diet, exercise, sunlight exposure and sleep patterns may be useful in the treatment of depression. METHOD Eighty nonseasonal depressive outpatients on anti-depressant treatment were randomly assigned either to the active or control group. Four hygienic-dietary recommendations were prescribed together. Outcome measures were blinded assessed before and after the six month intervention period. RESULTS A better evolution of depressive symptoms, a higher rate of responder and remitters and a lesser psychopharmacological prescription was found in the active group. LIMITATIONS Small sample size. Lacked homogeneity concerning affective disorders (major depression, dysthimia, bipolar depression). CONCLUSIONS This study suggests lifestyle recommendations can be used as an effective antidepressant complementary strategy in daily practice.
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Affiliation(s)
- Mauro García-Toro
- Servicio de Psiquiatría, Hospital Son Llatzer, C/ Carretera de Manacor Km. 4, Palma de Mallorca, Spain.
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