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Ross RE, Saladin ME, George MS, Gregory CM. Acute effects of aerobic exercise on corticomotor plasticity in individuals with and without depression. J Psychiatr Res 2024; 176:108-118. [PMID: 38852541 PMCID: PMC11283944 DOI: 10.1016/j.jpsychires.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/24/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Although complex in nature, the pathophysiology of depression involves reduced or impaired neuroplastic capabilities. Restoring or enhancing neuroplasticity may serve as a treatment target for developing therapies for depression. Aerobic exercise (AEx) has antidepressant benefits and may enhance neuroplasticity in depression although the latter has yet to be substantiated. Therefore, we sought to examine the acute effect of AEx on neuroplasticity in depression. METHODS Sixteen individuals with (DEP; 13 female; age = 28.5 ± 7.3; Montgomery-Äsberg Depression Rating Scale [MADRS] = 21.3 ± 5.2) and without depression (HC; 13 female; age 27.2 ± 7.5; MADRS = 0.8 ± 1.2) completed three experimental visits consisting of 15 min of low intensity AEx (LO) at 35% heart rate reserve (HRR), high intensity AEx (HI) at 70% HRR, or sitting (CON). Following AEx, excitatory paired associative stimulation (PAS25ms) was employed to probe neuroplasticity. Motor evoked potentials (MEP) were assessed via transcranial magnetic stimulation before and after PAS25ms to indicate acute changes in neuroplasticity. RESULTS PAS25ms primed with HI AEx led to significant increases in MEP amplitude compared to LO and CON. HI AEx elicited enhanced PAS25ms-induced neuroplasticity for up to 1-h post-PAS. There were no significant between-group differences. CONCLUSION HI AEx enhances PAS measured neuroplasticity in individuals with and without depression. HI AEx may have a potent influence on the brain and serve as an effective primer, or adjunct, to therapies that seek to harness neuroplasticity.
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Affiliation(s)
- Ryan E Ross
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA; Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.
| | - Michael E Saladin
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Chris M Gregory
- Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA; Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
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2
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Alderman BL, Perdue HM, Sarwani AH. Exercise for the Prevention and Treatment of Depression. Curr Top Behav Neurosci 2024. [PMID: 39042248 DOI: 10.1007/7854_2024_496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Depression is among the world's leading causes of disability and accounts for a significant loss of life. Despite large investments in research for antidepressants and psychotherapies, non-response, partial response, and small effects remain significant problems. Exercise and physical activity are two lifestyle behaviors that have been studied for well over half a century for the prevention and treatment of depression. The aim of this chapter is to summarize the current evidence base supporting the efficacy of exercise and physical activity in the prevention and treatment of depression, including evidence supporting exercise as a monotherapy and adjunct to antidepressant medication and psychotherapies. We conclude the chapter by outlining challenges to prescribing exercise for depression and general recommendations for encouraging behavioral adoption for individuals suffering from depression.
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Affiliation(s)
- Brandon L Alderman
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA.
| | - Hannah M Perdue
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
| | - Amber H Sarwani
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
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Zhang B, Deng H, Ren J, Legrand FD, Ahmad Yusof H, Zhang R, Leong Bin Abdullah MFI. Study protocol on the efficacy of exergames-acceptance and commitment therapy program for the treatment of major depressive disorder: comparison with acceptance and commitment therapy alone and treatment-as-usual in a multicentre randomised controlled trial. BMJ Open 2024; 14:e080315. [PMID: 38926142 PMCID: PMC11216053 DOI: 10.1136/bmjopen-2023-080315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The prevalence of major depressive disorder (MDD) is on the rise globally, and the use of antidepressant medications for its treatment does not usually result in full remission. However, the combination of physical exercise and psychotherapy for the treatment of MDD increase the rate of full remission among patients. This three-armed, parallel-group, double-blinded randomised controlled trial (RCT) aims to assess and compare the effects between the combination of exergame and acceptance and commitment therapy (e-ACT) programme, ACT only and treatment-as-usual (TAU) control groups on the severity of depression and anxiety symptoms, the degree of experiential avoidance and quality of life (QoL) and the serum levels of depression biomarkers (such as brain-derived neurotrophic factor, C-reactive protein and vascular endothelial growth factor) among patients with MDD across three time points. METHODS AND ANALYSIS This RCT will recruit 126 patients with MDD who will be randomised using stratified permuted block randomisation into three groups, which are the combined e-ACT programme, ACT-only and TAU control groups in a 1:1:1 allocation ratio. The participants in the e-ACT and ACT-only intervention groups will undergo once a week intervention sessions for 8 weeks. Assessments will be carried out through three time points, such as the pre-intervention assessment (t0), assessment immediately after completion of the intervention at 8 weeks (t1) and assessment at 24 weeks after completion of the intervention (t2). During each assessment, the primary outcome to be assessed includes the severity of depression symptoms, while the secondary outcomes to be assessed are the severity of anxiety symptoms, experiential avoidance, QoL and depression biomarkers. ETHICS AND DISSEMINATION Approval of this study was obtained from the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/PP/23050420). The findings of the study will be published in academic peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05812001 (ClinicalTrials.gov). Registered on 12 April 2023.
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Affiliation(s)
- Bingyu Zhang
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Hongdu Deng
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Jinli Ren
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
| | | | - Hazwani Ahmad Yusof
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Ruiling Zhang
- Department of Psychiatry, Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
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Legrand FD, Chaouloff F, Ginoux C, Ninot G, Polidori G, Beaumont F, Murer S, Jeandet P, Pelissolo A. [Exercise for the promotion of mental health II: Putative mechanisms, recommendations, and scientific challenges]. L'ENCEPHALE 2023; 49:296-303. [PMID: 37105781 DOI: 10.1016/j.encep.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 04/29/2023]
Abstract
The idea of applying various forms of physical activity for the betterment of physical health and the reduction of chronic medical conditions is ubiquitous. Despite evidence of successful applications of physical activity for improvement of mental health dating back to antiquity, it has until recent years remained unconventional to consider exercise as an intervention strategy for various mental health conditions. The past two decades, however, have seen a relative explosion of interest in understanding and applying various programs and forms of exercise to improve mental health. Here, our purpose is to provide a comprehensive and updated overview of the application of exercise as a strategy for improving mental health. In the present paper we first summarize contemporary research regarding short- and long-term impacts of exercise on mental health. Then an overview of the putative mechanisms and neurobiological bases underpinning the beneficial effects of exercise is provided. Finally, we suggest directions for future research as well as a series of concrete recommendations for clinicians who wish to prescribe physical activity as part of patient mental health management.
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Affiliation(s)
- Fabien D Legrand
- Université de Reims Champagne Ardenne, laboratoire cognition santé société (EA 6291), Reims, France.
| | | | - Clément Ginoux
- Université de Grenoble-Alpes, laboratoire sport en environnement social (SENS), Grenoble-Alpes, France
| | - Gregory Ninot
- Université de Montpellier, institut Debrest d'épidémiologie et de santé publique - Inserm, Montpellier, France
| | | | - Fabien Beaumont
- Université de Reims Champagne Ardenne, laboratoire MATIM, Reims, France
| | - Sébastien Murer
- Université de Reims Champagne Ardenne, laboratoire MATIM, Reims, France
| | - Philippe Jeandet
- Université de Reims Champagne Ardenne, laboratoire résistance induite et bio-protection des plantes (USC INRAE 1488), Reims, France
| | - Antoine Pelissolo
- Service de psychiatrie sectorisée, Assistance Publique-Hôpitaux de Paris, GHU Mondor, université Paris Est Créteil, Créteil, France
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Martland R, Korman N, Firth J, Stubbs B. The efficacy of exercise interventions for all types of inpatients across mental health settings: A systematic review and meta-analysis of 47 studies. J Sports Sci 2023; 41:232-271. [PMID: 37132599 DOI: 10.1080/02640414.2023.2207855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
This systematic review and meta-analysis investigated the benefits, safety and adherence of exercise interventions delivered in inpatient mental health settings, quantified the number of exercise trials that provided support to maintain engagement in exercise post-discharge, and reported patient feedback towards exercise interventions. Major databases were searched from inception to 22.06.2022 for intervention studies investigating exercise in mental health inpatient settings. Study quality was assessed using Cochrane and ROBINS-1 checklists. Fifty-six papers were included from 47 trials (including 34 RCTs), bias was high. Exercise improved depression (Standardised mean difference = -0.416; 95% Confidence interval -0.787 to -0.045, N = 15) compared to non-exercise comparators amongst people with a range of mental illnesses, with further (albeit limited) evidence suggesting a role of exercise in cardiorespiratory fitness and various other physical health parameters and ameliorating psychiatric symptoms. No serious exercise-related adverse events were noted, attendance was ≥80% in most trials, and exercise was perceived as enjoyable and useful. Five trials offered patients post-discharge support to continue exercise, with varying success. In conclusion, exercise interventions may have therapeutic benefits in inpatient mental health settings. More high-quality trials are needed to determine optimal parameters, and future research should investigate systems to support patients to maintain exercise engagement once discharged.
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Affiliation(s)
- Rebecca Martland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Nicole Korman
- Metro South Addiction and Mental Health Services, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Joseph Firth
- Western Sydney University, Westmead, NSW, NICM Health Research Institute, Australia
- Faculty of Biology, Medicine & Health, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Brendon Stubbs
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Ross RE, VanDerwerker CJ, Saladin ME, Gregory CM. The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes. Mol Psychiatry 2023; 28:298-328. [PMID: 36253441 PMCID: PMC9969795 DOI: 10.1038/s41380-022-01819-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.
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Affiliation(s)
- Ryan E. Ross
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | | | - Michael E. Saladin
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Chris M. Gregory
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
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Yu Q, Wong KK, Lei OK, Nie J, Shi Q, Zou L, Kong Z. Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis. SPORTS MEDICINE - OPEN 2022; 8:135. [PMID: 36308622 PMCID: PMC9617247 DOI: 10.1186/s40798-022-00529-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders. OBJECTIVE The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders. METHODS The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome. RESULTS A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind-body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind-body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms. CONCLUSION Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind-body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence. Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).
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Affiliation(s)
- Qian Yu
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
| | - Ka-Kit Wong
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
| | - On-Kei Lei
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
| | - Jinlei Nie
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Qingde Shi
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Liye Zou
- grid.263488.30000 0001 0472 9649Body-Brain-Mind Laboratory, The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, School of Psychology, Shenzhen University, Shenzhen, 518060 China
| | - Zhaowei Kong
- grid.437123.00000 0004 1794 8068Faculty of Education, University of Macau, Macao, China
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Hassan J, Shannon S, Tully MA, McCartan C, Davidson G, Bunn R, Breslin G. Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings. J Psychiatr Ment Health Nurs 2022; 29:630-646. [PMID: 35426209 PMCID: PMC9544360 DOI: 10.1111/jpm.12832] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Individuals with a severe mental illness (SMI) are less physically active and have a lower life expectancy than the general population due to increased risks of cardiometabolic diseases (obesity, diabetes and respiratory diseases) and other health risks. Physical activity has been used as an adjunct therapy for individuals with SMI yielding improvements in cognitive functioning, quality of life and a reduction in psychiatric symptoms. Individuals with SMI residing within a secure forensic setting have reduced physical activity opportunities, possibly due to a number of factors including low motivation and restricted access to exercise facilities combined with a lack of knowledge and/or confidence in staff members to assist in physical activity programmes. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review demonstrates that little is known around the effects of physical activity for people with SMI who reside in secure forensic settings, with little to no long-term effects reported. Physical activity interventions have shown some positive results through decreasing weight and waist circumference as well as a reduction in negative symptom scores in an exercise group compared with the "no treatment" control group post-intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' reluctance to engage in physical activity may be overcome by improving staff commitment, creating a motivational atmosphere and promoting service user decision making. ABSTRACT INTRODUCTION: Participating in physical activity has many benefits, yet those with severe mental illness (SMI) living in forensic settings are less likely to be active, and more likely to experience ill-health. The aim of this study was to systematically review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings. METHOD A systematic search of six databases was conducted, in addition to a grey literature search. Studies were included if they had participants with SMI; were based in a forensic setting; involved a physical activity programme and reported physical and mental health outcomes. RESULTS A total of 112 participants were included in four studies. One study showed a significant improvement in negative symptom scores in the exercise group compared with a treatment as usual group. Two studies reported improvements in psychiatric symptoms with no significant difference between groups; however, statistically significant changes in weight and waist circumference were evident (p < .001). No adverse effects were reported. CONCLUSION Only a small number of studies were included and of limited design and quality, with no follow-up assessments; therefore, more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting. This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.
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Affiliation(s)
- Jessica Hassan
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK
| | - Stephen Shannon
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Londonderry, UK
| | - Mark A Tully
- School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Claire McCartan
- Centre for Evidence and Social Innovation, School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Gavin Davidson
- Centre for Evidence and Social Innovation, School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Richard Bunn
- Belfast Health & Social Care Trust, Shannon Clinic, Regional Secure Unit, Belfast, UK
| | - Gavin Breslin
- School of Psychology, Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
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Short-term aerobic exercise for depression in acute geriatric psychiatry: study protocol for a randomized controlled trial. Trials 2022; 23:615. [PMID: 35908008 PMCID: PMC9338474 DOI: 10.1186/s13063-022-06567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Major depression is one of the main mental illnesses in old age, with acute exacerbated episodes requiring treatment in geriatric psychiatry. A meta-analysis showed that aerobic exercise in moderate intensity has large effects in older adults with major depression, but there is no evidence of aerobic exercise in geriatric psychiatry. Therefore, this study aims to analyze the feasibility and effects of an ergometer-based aerobic exercise on depressive symptoms. Methods A single-center randomized controlled trial will be conducted in an acute geriatric psychiatric hospital. Inpatients allocated to the intervention group will receive a 2-week aerobic ergometer program. The control group will receive seated flexibility exercise in addition to usual care. The overall effects on the patients’ depressive symptoms will be measured by clinical global impression of change (CGI) as the primary outcome. Changes in depressive symptom domains, physical (in)activity, and aerobic performance as well as the dosage of applied antidepressants will be examined as secondary outcomes. Discussion This short-term aerobic exercise program is expected to decrease depressive symptoms in acute exacerbated periods in older adults. The results may increase the evidence for implementing physical activity interventions in acute hospital settings. The disease-related motivation for exercise in acute exacerbated depressive periods will be the most challenging aspect. The treatment of depression requires new cost-effective approaches, especially in acute geriatric psychiatry with potential benefits for patients, family members, and clinicians. Trial registration German Clinical Trial Register ID: DRKS00026117 Trial status Protocol Version 1.2 dated February 23, 2022. By February 23, 2022, the trial had recruited a total of 15 participants in two wards at the Department of Geriatric Psychiatry at the LVR-Hospital Cologne. Recruitment started on November 12, 2021. The recruitment is expected to continue for at least 12 months.
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Faltinsen E, Todorovac A, Staxen Bruun L, Hróbjartsson A, Gluud C, Kongerslev MT, Simonsen E, Storebø OJ. Control interventions in randomised trials among people with mental health disorders. Cochrane Database Syst Rev 2022; 4:MR000050. [PMID: 35377466 PMCID: PMC8979177 DOI: 10.1002/14651858.mr000050.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Control interventions in randomised trials provide a frame of reference for the experimental interventions and enable estimations of causality. In the case of randomised trials assessing patients with mental health disorders, many different control interventions are used, and the choice of control intervention may have considerable impact on the estimated effects of the treatments being evaluated. OBJECTIVES To assess the benefits and harms of typical control interventions in randomised trials with patients with mental health disorders. The difference in effects between control interventions translates directly to the impact a control group has on the estimated effect of an experimental intervention. We aimed primarily to assess the difference in effects between (i) wait-list versus no-treatment, (ii) usual care versus wait-list or no-treatment, and (iii) placebo interventions (all placebo interventions combined or psychological, pharmacological, and physical placebos individually) versus wait-list or no-treatment. Wait-list patients are offered the experimental intervention by the researchers after the trial has been finalised if it offers more benefits than harms, while no-treatment participants are not offered the experimental intervention by the researchers. SEARCH METHODS In March 2018, we searched MEDLINE, PsycInfo, Embase, CENTRAL, and seven other databases and six trials registers. SELECTION CRITERIA We included randomised trials assessing patients with a mental health disorder that compared wait-list, usual care, or placebo interventions with wait-list or no-treatment . DATA COLLECTION AND ANALYSIS Titles, abstracts, and full texts were reviewed for eligibility. Review authors independently extracted data and assessed risk of bias using Cochrane's risk of bias tool. GRADE was used to assess the quality of the evidence. We contacted researchers working in the field to ask for data from additional published and unpublished trials. A pre-planned decision hierarchy was used to select one benefit and one harm outcome from each trial. For the assessment of benefits, we summarised continuous data as standardised mean differences (SMDs) and dichotomous data as risk ratios (RRs). We used risk differences (RDs) for the assessment of adverse events. We used random-effects models for all statistical analyses. We used subgroup analysis to explore potential causes for heterogeneity (e.g. type of placebo) and sensitivity analyses to explore the robustness of the primary analyses (e.g. fixed-effect model). MAIN RESULTS We included 96 randomised trials (4200 participants), ranging from 8 to 393 participants in each trial. 83 trials (3614 participants) provided usable data. The trials included 15 different mental health disorders, the most common being anxiety (25 trials), depression (16 trials), and sleep-wake disorders (11 trials). All 96 trials were assessed as high risk of bias partly because of the inability to blind participants and personnel in trials with two control interventions. The quality of evidence was rated low to very low, mostly due to risk of bias, imprecision in estimates, and heterogeneity. Only one trial compared wait-list versus no-treatment directly but the authors were not able to provide us with any usable data on the comparison. Five trials compared usual care versus wait-list or no-treatment and found a SMD -0.33 (95% CI -0.83 to 0.16, I² = 86%, 523 participants) on benefits. The difference between all placebo interventions combined versus wait-list or no-treatment was SMD -0.37 (95% CI -0.49 to -0.25, I² = 41%, 65 trials, 2446 participants) on benefits. There was evidence of some asymmetry in the funnel plot (Egger's test P value of 0.087). Almost all the trials were small. Subgroup analysis found a moderate effect in favour of psychological placebos SMD -0.49 (95% CI -0.64 to -0.30; I² = 53%, 39 trials, 1656 participants). The effect of pharmacological placebos versus wait-list or no-treatment on benefits was SMD -0.14 (95% CI -0.39 to 0.11, 9 trials, 279 participants) and the effect of physical placebos was SMD -0.21 (95% CI -0.35 to -0.08, I² = 0%, 17 trials, 896 participants). We found large variations in effect sizes in the psychological and pharmacological placebo comparisons. For specific mental health disorders, we found significant differences in favour of all placebos for sleep-wake disorders, major depressive disorder, and anxiety disorders, but the analyses were imprecise due to sparse data. We found no significant differences in harms for any of the comparisons but the analyses suffered from sparse data. When using a fixed-effect model in a sensitivity analysis on the comparison for usual care versus wait-list and no-treatment, the results were significant with an SMD of -0.46 (95 % CI -0.64 to -0.28). We reported an alternative risk of bias model where we excluded the blinding domains seeing how issues with blinding may be seen as part of the review investigation itself. However, this did not markedly change the overall risk of bias profile as most of the trials still included one or more unclear bias domains. AUTHORS' CONCLUSIONS We found marked variations in effects between placebo versus no-treatment and wait-list and between subtypes of placebo with the same comparisons. Almost all the trials were small with considerable methodological and clinical variability in factors such as mental health population, contents of the included control interventions, and outcome domains. All trials were assessed as high risk of bias and the evidence quality was low to very low. When researchers decide to use placebos or usual care control interventions in trials with people with mental health disorders it will often lead to lower estimated effects of the experimental intervention than when using wait-list or no-treatment controls. The choice of a control intervention therefore has considerable impact on how effective a mental health treatment appears to be. Methodological guideline development is needed to reach a consensus on future standards for the design and reporting of control interventions in mental health intervention research.
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Affiliation(s)
- Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | | | - Asbjørn Hróbjartsson
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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11
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Jazayeri D, Zanjani Z, Jokar S, Alvani SR, Molaei A. Comparison Study of the Effects of Resistance and Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ramsey CM, Lynch KG, Gehrman PR, Vairavan S, Narayan VA, Li QS, Oslin DW. Daily steps and depressive symptoms: A longitudinal evaluation of patients with major depressive disorder in the precision medicine in mental health care study. J Affect Disord 2022; 300:334-340. [PMID: 34979178 DOI: 10.1016/j.jad.2021.12.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/12/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although the benefits of exercise on Major Depressive Disorder (MDD) are well established, longitudinal studies of objectively measured activity in clinical populations are needed to establish specific guidelines for exercise by persons with moderate-to-severe depression. This study examines the association between objectively assessed daily step count and depressive symptoms over a 24-week follow- up period in outpatients receiving treatment for moderate-to-severe depression. METHODS Participants were US Veterans with MDD enrolled in the Precision Medicine in Mental Health Care study (PRIME Care), a pragmatic, multi-site, randomized, controlled trial that examines the utility of genetic testing in the context of pharmacotherapy for MDD. Participants were a subset (N = 66) enrolled in actigraphy (using GT9X ActiGraph) monitoring component of the trial. Daily steps were examined as a predictor of depressive symptoms over 4-, 8-, 12-, 18-, and 24-weeks. RESULTS On average, participants took 3,460 (±1,768) steps per day. In generalized linear mixed models, an increase in 1,000 steps per day was associated with a 0.6-point decrease in depressive symptom severity at the subsequent follow-up assessment. LIMITATIONS Activity monitoring was observational and causal inferences cannot be made between daily steps and subsequent depressive symptom severity. Results may not generalize to non-treatment-seeking populations. CONCLUSIONS Study findings provide an initial metric for persons with clinically significant MDD, of whom most do not get sufficient daily activity. The findings can inform future trials aimed at determining how much daily activity is needed to improve symptoms in individuals with MDD.
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Affiliation(s)
- Christine M Ramsey
- VISN 4 Mental Illness, Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 5800 Woodland Ave, Philadelphia, PA 19130, United States; Yale School of Medicine, New Haven, CT, United States.
| | - Kevin G Lynch
- VISN 4 Mental Illness, Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 5800 Woodland Ave, Philadelphia, PA 19130, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Philip R Gehrman
- VISN 4 Mental Illness, Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 5800 Woodland Ave, Philadelphia, PA 19130, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Srinivasan Vairavan
- Neuroscience Data Science, Janssen Research & Development, LLC, Titusville, NJ, United States
| | - Vaibhav A Narayan
- Neuroscience Data Science, Janssen Research & Development, LLC, Titusville, NJ, United States; Science for Minds, Janssen Research & Development, LLC, Titusville, NJ, United States
| | - Qingqin S Li
- Neuroscience Data Science, Janssen Research & Development, LLC, Titusville, NJ, United States
| | - David W Oslin
- VISN 4 Mental Illness, Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 5800 Woodland Ave, Philadelphia, PA 19130, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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13
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Efficacy of exercise combined with standard treatment for depression compared to standard treatment alone: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2021; 295:1494-1511. [PMID: 34565591 DOI: 10.1016/j.jad.2021.09.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Exercise is indicated as a monotherapy for depression, as well as an augmentation strategy alongside standard treatments. However, it is not yet clear how exercise and standard treatments interact with regards to patient outcomes. The primary aim of the current systematic review and meta-analysis was to compare the antidepressant effects of exercise combined with standard treatment to standard treatment alone. METHOD A systematic search was conducted for trials comparing the efficacy of standard treatments alone or in combination with exercise for reducing symptoms of depression. Random effects meta-analysis was used to estimate pooled standardized mean difference for standard treatment alone versus standard treatment with exercise. RESULTS Twenty-two studies were included in the meta-analysis. There was a moderate pooled effect in favour of exercise combined with standard treatment compared to standard treatment alone (SMD = -0.62, p < 0.00001, I2 = 70%), with greatest benefits accruing for more severe patients (SMD = -0.99, p < 0.00001; I2 = 0%). Sensitivity analyses remained significant for trials with lower risk of bias (SMD = -0.41, p = 0.0009; I2 = 52%) and patients with a major depressive disorder diagnosis (SMD = -0.70, p < 0.0001; I2 = 72%). LIMITATIONS There was considerable heterogeneity between trials. Uneven covariate distributions within subgroups limited our ability to explore the sources of heterogeneity. CONCLUSIONS Exercise combined with standard treatments leads to significantly greater antidepressant effects over standard treatment alone. Patients and clinicians should consider using exercise alongside standard treatments to enhance therapeutic efficacy for depression.
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Wolf S, Seiffer B, Zeibig JM, Welkerling J, Bauer LL, Frei AK, Studnitz T, Rosenstiel S, Fiedler DV, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Kropp S, Franke S, Peters S, El-Kurd N, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Sudeck G, Ehring T. Efficacy and cost-effectiveness of a Transdiagnostic group-based exercise intervention: study protocol for a pragmatic multi-site randomized controlled trial. BMC Psychiatry 2021; 21:540. [PMID: 34717567 PMCID: PMC8556805 DOI: 10.1186/s12888-021-03541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD). METHODS This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention "ImPuls", among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block-randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios. DISCUSSION Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (ID: DRKS00024152 , 05/02/2021).
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Affiliation(s)
- Sebastian Wolf
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany.
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Leonie Louisa Bauer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - David Victor Fiedler
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Eva Herzog
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Tristan Nakagawa
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Sebastian Franke
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Stefan Peters
- German Association for health-related Fitness and Exercise Therapy (German: DVGS), Hürth-Efferen, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
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Jiang X, Luo Y, Chen Y, Yan J, Xia Y, Yao L, Wang X, He S, Wang F, Wang T, Chen Y. Comparative Efficacy of Multiple Therapies for the Treatment of Patients With Subthreshold Depression: A Systematic Review and Network Meta-Analysis. Front Behav Neurosci 2021; 15:755547. [PMID: 34690713 PMCID: PMC8531252 DOI: 10.3389/fnbeh.2021.755547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Subthreshold depression (SD) is considered to be the precursor stage of major depression, which is correlated with functional impairment and increased suicide rate. Although there are multiple therapies for the treatment of SD, the comparison and efficacy of various methods has yet to be evaluated. This study aimed to evaluate the efficacy of different therapies by performing a Bayesian network meta-analysis. Methods: We searched eight databases on April 3, 2021. Center for Epidemiologic Studies Depression Scale (CES-D), Beck Depression Inventory scale (BDI), the Patient Health Questionnaire-9 (PHQ-9), and the Kessler Screening Scale for Psychological Distress (K-6) were used as efficacy outcomes. This Bayesian network meta-analysis used a fixed-effects model. Findings: Twenty-one randomized controlled trials involving 5,048 participants were included in this study. The results suggested that electroacupuncture (MD −12.00, 95% CrI −15.00, −10.00), conventional acupuncture plus wheat-grain moxibustion (MD −9.70, 95% CrI −14.00, −5.30), and the Chinese traditional peripateticism pill plus group counseling (MD −9.00, 95% CrI −11.00, −6.70) had better efficacy than the control group (CG) in improving CES-D. For BDI outcome, bright light therapy (MD −9.70, 95% CrI −13.00, −6.00), behavioral activation program (MD −5.70, 95% CrI −6.10, −5.40), and dim light therapy (MD −6.30, 95% CrI −10.00, −2.20) were better than the CG. Tai chi (MD −3.00, 95% CrI −4.00, −2.00) was better than CG for PHQ-9 outcomes. Telephone-based cognitive behavioral treatment (MD −2.50 95% CrI −2.70, −2.30) was better than the CG for K-6 scores. Conclusion: Our results suggest that electroacupuncture or bright light therapy appear to be the better choices in the treatment of SD. This study provide new insights into clinical treatment selection and may aid the development of guidelines for the management of SD.
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Affiliation(s)
- Xiumin Jiang
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongxin Luo
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiwen Chen
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinglan Yan
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yucen Xia
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lin Yao
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaotong Wang
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Su He
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Feixue Wang
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Taiyi Wang
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongjun Chen
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.,Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China
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16
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Choudhury A, Asan O. Impact of using wearable devices on psychological Distress: Analysis of the health information national Trends survey. Int J Med Inform 2021; 156:104612. [PMID: 34649113 DOI: 10.1016/j.ijmedinf.2021.104612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 01/11/2023]
Abstract
AIM This study explores the possible impact of wearables on psychological distress and their implications on designs. METHOD The study conceptualizes and tests two exploratory models by analyzing the US-based Health Information National Trends Survey of 2019 and 2020. Six variants from the databases were used in the study as predictors. We used models 4 and 6 of the Hayes PROCESS macros to test our conceptual parallel and sequential mediation models, respectively. RESULTS The finding indicates significant and negative indirect effects of 'Use of wearable device' on 'Psychological distress.' In parallel mediation models, 'self-care' and 'health perception' were noted to be significant mediators. Wearable devices were associated with improved 'Health perception,' 'Self-care,' and longer 'workout duration,', which in turn helped reduce 'psychological distress' (better mental health). The sequential mediation model captured the indirect effect of 'Use of wearable device' on 'Psychological distress' when sequentially mediated by 'workout duration,' 'BMI,' 'self-care,' and 'health perception' in the given order. CONCLUSION As the adoption of digital wearables is increasing due to their growing potential to augment physiological and psychosocial health, it is critical that these technologies are designed to address the needs of users from diverse backgrounds (race, education level, age).
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Affiliation(s)
- Avishek Choudhury
- Stevens Institute of Technology, School of Systems and Enterprises, United States.
| | - Onur Asan
- Stevens Institute of Technology, School of Systems and Enterprises, United States.
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17
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Przybylko G, Morton D, Kent L, Morton J, Hinze J, Beamish P, Renfrew M. The effectiveness of an online interdisciplinary intervention for mental health promotion: a randomized controlled trial. BMC Psychol 2021; 9:77. [PMID: 33975645 PMCID: PMC8111974 DOI: 10.1186/s40359-021-00577-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 04/28/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is an urgent need for efficacious interventions to combat the global mental health crisis, and mental health promotion and primary prevention approaches are paramount. The aim of this study is to examine whether an online interdisciplinary intervention that incorporates evidence-based strategies from the disciplines of Lifestyle Medicine and Positive Psychology improves measures of mental health and emotional wellness. METHODS A randomized controlled trial with a wait-list control (N = 425, aged 46.97 ± 14.5, 69.9% females) was conducted in Australia and New Zealand. The intervention group participated in a 10-week online interdisciplinary intervention. Primary outcome measures of mental health and emotional wellness were taken at baseline (Week 1), post-intervention (Week 12), and 12 weeks post-intervention (Week 24). The wait-list control completed the same assessments. RESULTS General Linear Modelling analyses indicated that the intervention group experienced significantly greater improvements than the wait-list control group over time in all outcome measures: mental health (F(319) = 7.326, p = 0.007) and vitality (F(319) = 9.445, p = 0.002) subscales of the Short Form Survey (SF-36); depression (F(319) = 7.841, p = 0.005), anxiety (F(319) = 4.440, p = 0.36) and stress (F(319) = 12.494, p < 0.001) scales of the Depression, Anxiety and Stress Scale (DASS-21); and life satisfaction (F(319) = 8.731, p = 0.003) as measured by the Satisfaction With Life Scale. Within the intervention group, significant improvements were observed from Week 1 to 12 in all outcome measures: mental health (10%, t(167) = - 6.423), p < 0.001, dz = 0.50), vitality (22%, t(167) = - 7.043, p < 0.001, dz = 0.54), depression (- 41%, t(167) = 6.189, p < 0.001, dz = 0.48), anxiety (- 38%, t(167) = 5.030, p < 0.001, dz = 0.39), stress (- 31%, t(167) = 6.702, p < 0.001, dz = 0.52) and life satisfaction (8%, t(167) = - 6.199, p < 0.001, dz = 0.48). Improvements in the outcome measures remained significant in the intervention group at 12 weeks post-intervention. CONCLUSION The online interdisciplinary intervention improved measures of mental health and emotional wellness suggesting that such interventions may be useful for mental health promotion and prevention. Trial registration The Australian New Zealand Clinical Trials Registry. ACTRN12619000993190. Registered on 12 July 2019 (Retrospectively registered). The ANZCTRN is part of the WHO Primary Registries.
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Affiliation(s)
- Geraldine Przybylko
- Lifestyle Medicine and Health Research Centre, Avondale University College, 582 Freemans Drive, Cooranbong, NSW, 2265, Australia.
| | - Darren Morton
- Lifestyle Medicine and Health Research Centre, Avondale University College, 582 Freemans Drive, Cooranbong, NSW, 2265, Australia
| | - Lillian Kent
- Lifestyle Medicine and Health Research Centre, Avondale University College, 582 Freemans Drive, Cooranbong, NSW, 2265, Australia
| | - Jason Morton
- Faculty of Education, Business and Science, Avondale University College, 582 Freemans Drive, Cooranbong, NSW, 2265, Australia
| | - Jason Hinze
- Faculty of Education, Business and Science, Avondale University College, 582 Freemans Drive, Cooranbong, NSW, 2265, Australia
| | - Peter Beamish
- Faculty of Education, Business and Science, Avondale University College, 582 Freemans Drive, Cooranbong, NSW, 2265, Australia
| | - Mel Renfrew
- Lifestyle Medicine and Health Research Centre, Avondale University College, 582 Freemans Drive, Cooranbong, NSW, 2265, Australia
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18
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Dauwan M, Begemann MJH, Slot MIE, Lee EHM, Scheltens P, Sommer IEC. Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials. J Neurol 2021; 268:1222-1246. [PMID: 31414194 PMCID: PMC7990819 DOI: 10.1007/s00415-019-09493-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/20/2023]
Abstract
We performed a meta-analysis to synthesize evidence on the efficacy and safety of physical exercise as an add-on therapeutic intervention for quality of life (QoL), depressive symptoms and cognition across six chronic brain disorders: Alzheimer's disease, Huntington's disease, multiple sclerosis, Parkinson's disease, schizophrenia and unipolar depression. 122 studies ( = k) (n = 7231) were included. Exercise was superior to treatment as usual in improving QoL (k = 64, n = 4334, ES = 0.40, p < 0.0001), depressive symptoms (k = 60, n = 2909, ES = 0.78, p < 0.0001), the cognitive domains attention and working memory (k = 21, n = 1313, ES = 0.24, p < 0.009), executive functioning (k = 14, n = 977, ES = 0.15, p = 0.013), memory (k = 12, n = 994, ES = 0.12, p = 0.038) and psychomotor speed (k = 16, n = 896, ES = 0.23, p = 0.003). Meta-regression showed a dose-response effect for exercise time (min/week) on depressive symptoms (β = 0.007, p = 0.012). 69% of the studies that reported on safety, found no complications. Exercise is an efficacious and safe add-on therapeutic intervention showing a medium-sized effect on QoL and a large effect on mood in patients with chronic brain disorders, with a positive dose-response correlation. Exercise also improved several cognitive domains with small but significant effects.
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Affiliation(s)
- Meenakshi Dauwan
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, VU University Medical Center Amsterdam, Neuroscience Campus, Postbus 7057, 1007 MB Amsterdam, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Marieke J. H. Begemann
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Margot I. E. Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Edwin H. M. Lee
- Department of Psychiatry, 2/F, New Clinical Building, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Iris E. C. Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Skeletal Muscle Metabolomic Responses to Endurance and Resistance Training in Rats under Chronic Unpredictable Mild Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041645. [PMID: 33572176 PMCID: PMC7914905 DOI: 10.3390/ijerph18041645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/31/2022]
Abstract
The objectives of this study were to compare the antidepressant effects between endurance and resistance exercise for optimizing interventions and examine the metabolomic changes in different types of skeletal muscles in response to the exercise, using a rat model of chronic unpredictable mild stress (CUMS)-induced depression. There were 32 male Sprague-Dawley rats randomly divided into a control group (C) and 3 experimental groups: CUMS control (D), endurance exercise (E), and resistance exercise (R). Group E underwent 30 min treadmill running, and group R performed 8 rounds of ladder climbing, 5 sessions per week for 4 weeks. Body weight, sucrose preference, and open field tests were performed pre and post the intervention period for changes in depressant symptoms, and the gastrocnemius and soleus muscles were sampled after the intervention for metabolomic analysis using the 1H-NMR technique. The results showed that both types of exercise effectively improved the depression-like symptoms, and the endurance exercise appeared to have a better effect. The levels of 10 metabolites from the gastrocnemius and 13 metabolites from the soleus of group D were found to be significantly different from that of group C, and both types of exercise had a callback effect on these metabolites, indicating that a number of metabolic pathways were involved in the depression and responded to the exercise interventions.
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Imboden C, Gerber M, Beck J, Holsboer-Trachsler E, Pühse U, Hatzinger M. Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. J Affect Disord 2020; 276:866-876. [PMID: 32739704 DOI: 10.1016/j.jad.2020.07.052] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/19/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aerobic exercise (AE) has positive effects on symptom severity and cognitive symptoms of depression. Since data on AE as add-on to inpatient treatment in depression is still scarce, we conducted this double-blind randomized controlled study. METHODS Patients aged between 18 and 60 years were recruited into the study if Hamilton Depression Rating Scale 17 (HDRS-17) score was >16. Participants were randomly assigned to either AE or basic stretching activities (control), which took place 3x/week for 6 weeks. Primary outcome was depression severity as assessed with the HDRS-17 and the Beck Depression Inventory (BDI). Further physiological and psychological variables and cognitive performance were assessed as secondary outcomes. RESULTS Forty-two patients were included in the analysis (exercise: n = 22; control: n = 20). Regardless of group allocation, we found a significant short-term time effect for symptom-severity (HDRS17: p<0.001, η²=0.70; BDI: p<0.001, η²=0.51), mental toughness (p<0.001, η²=0.32), physical self-description endurance score (p = 0.013, η²=0.16), cognitive flexibility (p = 0.013, η²=0.14), and body mass index (BMI) (p = 0.006, η²=0.19). Working memory showed a significant time by group interaction in favor of AE (p = 0.043, η²=0.10). Short-term effects on symptom severity, mental toughness and BMI remained stable across the 6-month follow-up period. Finally, self-reported physical activity increased significantly from baseline to follow-up (p = 0.014, η²=0.15). LIMITATIONS The sample-size is rather small. The control intervention might have been too active as to find a time by group interaction for symptom severity. CONCLUSIONS AE was associated with comparably large depression alleviation vs. stretching and with add-on benefits on working memory.
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Affiliation(s)
- Christian Imboden
- Psychiatric Services Solothurn, Solothurn, Switzerland, and University of Basel, Basel, Switzerland; Private Clinic Wyss, Muenchenbuchsee, Switzerland.
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Johannes Beck
- Psychiatric University Hospital, University of Basel, Basel, Switzerland; Private Clinic Sonnenhalde, Riehen, Switzerland
| | | | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services Solothurn, Solothurn, Switzerland, and University of Basel, Basel, Switzerland
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Md Zemberi NFN, Ismail MM, Abdullah MFIL. Exercise Interventions as the Primary Treatment for Depression: Evidence from a Narrative Review. Malays J Med Sci 2020; 27:5-23. [PMID: 33154698 PMCID: PMC7605827 DOI: 10.21315/mjms2020.27.5.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
There is an increasing evidence supporting the efficacy of exercise interventions in the treatment of depression, which is a growing global health concern. However, data on the efficacy of exercise as the primary treatment for depression are scarce. This narrative review explored the efficacy of exercise interventions as the primary treatment for depressive disorders. A comprehensive search for English-language literature published between January 1965 and November 2019 was conducted via PubMed, Google Scholar, Scopus, Web of Science, PsycINFO, EMBASE, Cochrane database and Medline. Thirteen randomised control trials (RCTs) were included in the final analysis. Their results indicated that supervised aerobic exercise and high-intensity progressive resistance training (PRT) were effective in ameliorating depressive symptoms as the primary treatment compared with control groups, but they were not superior to other active treatments, such as antidepressants and cognitive behavioural therapy. Aerobic exercise and high-intensity PRT may be a promising primary treatment for depression as they may induce biopsychosocial effects (effects on neurotrophic factor, pro-inflammatory cytokines, monoamine, the hypothalamic-pituitary-adrenal axis, self-efficacy, mastery experience, adaptive coping and social interaction), which may ameliorate the severity of depressive symptoms. However, future RCTs with more comprehensive and well-designed methodologies are warranted to confirm our findings.
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Affiliation(s)
- Nur Fatin Nabilah Md Zemberi
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Muhammad Mokhzani Ismail
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
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Chen Z, Lan W, Yang G, Li Y, Ji X, Chen L, Zhou Y, Li S. Exercise Intervention in Treatment of Neuropsychological Diseases: A Review. Front Psychol 2020; 11:569206. [PMID: 33192853 PMCID: PMC7642996 DOI: 10.3389/fpsyg.2020.569206] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/14/2020] [Indexed: 01/14/2023] Open
Abstract
Faced with a constant inundation of information and increasing pressures brought by the continuous development of modern civilization, people are increasingly faced with mental health challenges that are only now being actively researched. Mental illness is caused by brain dysfunction due to internal and external pathogenic factors that destroy the integrity of the human brain and alter its function. Regular participation in physical exercise can stimulate the cerebral cortex and simultaneously increase the supply of oxygen and nutrients, helping to preserve or restore normal functioning of the nervous system. In conjunction with other systems of the body, the nervous system constitutes the neuro-humoral regulation system responsible for maintaining the stable state of the human body. This paper is a systematic review of studies investigating the effects of exercise intervention on several common neuropsychological diseases, including depression, anxiety disorder, autism, and attention-deficit/hyperactivity disorder. Furthermore, we discuss possible physiological mechanisms underlying exercise-induced benefits and study limitations that must be addressed by future research. In many cases, drug therapy is ineffective and brings unwanted side effects. Based on the literature, we conclude that exercise intervention plays a positive role and that certain standards must be established in the field to make physical activity consistently effective.
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Affiliation(s)
- Zichao Chen
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Wencen Lan
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Guifen Yang
- College of Applied Technology, Sichuan Normal University, Chengdu, China
| | - Yan Li
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Xiang Ji
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Lan Chen
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Yan Zhou
- Institute of Sport Science, Sichuan University, Chengdu, China
| | - Shanshan Li
- Institute of Sport Science, Sichuan University, Chengdu, China
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Pope BS, Wood SK. Advances in understanding mechanisms and therapeutic targets to treat comorbid depression and cardiovascular disease. Neurosci Biobehav Rev 2020; 116:337-349. [PMID: 32598982 DOI: 10.1016/j.neubiorev.2020.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
Chronic or repeated social stress exposure often precipitates the onset of depression and cardiovascular disease (CVD). Despite a clear clinical association between CVD and depression, the pathophysiology underlying these comorbid conditions is unclear. Chronic exposure to social stress can lead to immune system dysregulation, mitochondrial dysfunction, and vagal withdrawal. Further, regular physical exercise is well-known to exert cardioprotective effects, and accumulating evidence demonstrates the antidepressant effect of exercise. This review explores the contribution of inflammation, mitochondrial dysfunction, and vagal withdrawal to stress-induced depression and CVD. Evidence for therapeutic benefits of exercise, anti-inflammatory therapies, and vagus nerve stimulation are also reviewed. Benefits of targeted therapeutics of mitochondrial agents, anti-inflammatory therapies, and vagus nerve stimulation are discussed. Importantly, the ability of exercise to impact each of these factors is also reviewed. The current findings described here implicate a new direction for research, targeting the shared mechanisms underlying comorbid depression-CVD. This will guide the development of novel therapeutic strategies for the prevention and treatment of these stress-related pathologies, particularly within treatment-resistant populations.
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Affiliation(s)
- Brittany S Pope
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia, SC, 20208, United States
| | - Susan K Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, 29209, United States; William Jennings Bryan Dorn Veterans Administration Medical Center, Columbia, SC, 29209, United States.
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Nasstasia Y, Baker AL, Lewin TJ, Halpin SA, Hides L, Kelly BJ, Callister R. Differential treatment effects of an integrated motivational interviewing and exercise intervention on depressive symptom profiles and associated factors: A randomised controlled cross-over trial among youth with major depression. J Affect Disord 2019; 259:413-423. [PMID: 31610998 DOI: 10.1016/j.jad.2019.08.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/23/2019] [Accepted: 08/17/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Exercise is increasingly recognised as an efficacious intervention for major depressive disorder (MDD) but to our knowledge differential treatment effects on depressive symptom profiles (cognitive, somatic and affective) and associated changes in psychological, physiological and behavioural factors have not been examined among youth with MDD. METHODS Sixty-eight participants (mean age 20.8) meeting DSM-IV diagnostic criteria for MDD were randomised to an Immediate intervention or Control/delayed condition (n = 34 per group). The integrated intervention comprised an initial session of motivational interviewing (MI) followed by a 12-week, multi-modal exercise program. Changes in depressive symptom profiles were assessed with the Beck Depression Inventory-II (BDI-II) total score and factorial symptom subscales. RESULTS There were significant differential improvements in BDI-II total scores post-treatment among intervention participants, which were also observed across the cognitive and affective subscales. Individual BDI-II items from the cognitive subscale showing significant differential improvement related to negative self-concept, while those from the affective subscale related to interest/activation; the energy item within the somatic subscale also revealed significant differential improvement. Significant differential improvements were also observed in exercise participation, negative automatic thoughts, behavioural activation and bench press repetitions among intervention participants, which correlated significantly with depression improvements. LIMITATIONS The exercise intervention was delivered in a supervised, group format and potential social meditators of change cannot be excluded. CONCLUSIONS Exercise differentially effects depressive symptom profiles with similar antidepressant effects as would be expected from psychological therapies improving negative cognition and emotional health.
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Affiliation(s)
- Yasmina Nasstasia
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Terry J Lewin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Sean A Halpin
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Leanne Hides
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
| | - Brian J Kelly
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
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25
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It is time to investigate integrative approaches to enhance treatment outcomes for depression? Med Hypotheses 2019; 126:82-94. [DOI: 10.1016/j.mehy.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/11/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
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Morres ID, Hatzigeorgiadis A, Stathi A, Comoutos N, Arpin-Cribbie C, Krommidas C, Theodorakis Y. Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depress Anxiety 2019; 36:39-53. [PMID: 30334597 DOI: 10.1002/da.22842] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/14/2018] [Accepted: 08/18/2018] [Indexed: 01/22/2023] Open
Abstract
Although exercise is associated with depression relief, the effects of aerobic exercise (AE) interventions on clinically depressed adult patients have not been clearly supported. The purpose of this meta-analysis was to examine the antidepressant effects of AE versus nonexercise comparators exclusively for depressed adults (18-65 years) recruited through mental health services with a referral or clinical diagnosis of major depression. Eleven e-databases and bibliographies of 19 systematic reviews were searched for relevant randomized controlled clinical trials. A random effects meta-analysis (Hedges' g criterion) was employed for pooling postintervention scores of depression. Heterogeneity and publication bias were examined. Studies were coded considering characteristics of participants and interventions, outcomes and comparisons made, and study design; accordingly, sensitivity and subgroup analyses were calculated. Across 11 eligible trials (13 comparisons) involving 455 patients, AE was delivered on average for 45 min, at moderate intensity, three times/week, for 9.2 weeks and showed a significantly large overall antidepressant effect (g = -0.79, 95% confidence interval = -1.01, -0.57, P < 0.00) with low and nonstatistically significant heterogeneity (I2 = 21%). No publication bias was found. Sensitivity analyses revealed large or moderate to large antidepressant effects for AE (I2 ≤ 30%) among trials with lower risk of bias, trials with short-term interventions (up to 4 weeks), and trials involving individual preferences for exercise. Subgroup analyses revealed comparable effects for AE across various settings and delivery formats, and in both outpatients and inpatients regardless symptom severity. Notwithstanding the small number of trials reviewed, AE emerged as an effective antidepressant intervention.
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Affiliation(s)
- Ioannis D Morres
- School of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | | | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nikos Comoutos
- School of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | | | - Charalampos Krommidas
- School of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Yannis Theodorakis
- School of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
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27
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Imboden C, Gerber M, Beck J, Eckert A, Pühse U, Holsboer-Trachsler E, Hatzinger M. Effects of Aerobic Exercise as Add-On Treatment for Inpatients With Moderate to Severe Depression on Depression Severity, Sleep, Cognition, Psychological Well-Being, and Biomarkers: Study Protocol, Description of Study Population, and Manipulation Check. Front Psychiatry 2019; 10:262. [PMID: 31073292 PMCID: PMC6497035 DOI: 10.3389/fpsyt.2019.00262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/08/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Aerobic exercise (AE) may be a non-pharmacological strategy to improve depression treatment and lessen the burden of somatic comorbidity of depression. Only few studies have examined the effect of AE as an add-on treatment for moderate to severe depression in an inpatient setting, and most studies have focused on depression severity and cardiovascular parameters. The purpose of the present article is to present the study protocol, to provide information about the assessed study population, and to perform a manipulation check in order to examine whether the intervention program was properly implemented. Methods: We conducted a randomized controlled trial in two centers comparing 6 weeks of AE to a placebo control intervention (stretching) as an add-on to standardized inpatient treatment of moderate to severe depression. Besides depression severity, several other psychological and biological variables were measured such as salivary cortisol, brain-derived neurotropic factor, cognitive tests, and polysomnography. To evaluate long-term effects of the intervention, we also scheduled a follow-up 6 months after completion of the study intervention. Results: Forty-five patients were randomized to either AE (n = 23) or the placebo intervention (n = 22); 36 patients completed the 6-week intervention. In the AE group, 65% completed all 18 training sessions. Patients who were less physically active prior to admission were less likely to complete the study. With regard to energy expenditure, mean kcal/kg/week was 16.4 kcal/kg/week (range: 13.8-17.7), coming close to the targeted dose of 17.5 kcal/kg/week. Conclusions: Overall, patients showed good adherence to the intervention protocol despite at least moderate depression severity. However, the dropout rate suggests that depressed inpatients may need special support to adhere to a structured exercise intervention program. This study will add evidence on the effects of AE as an add-on to inpatient treatment of moderate to severe depression. Besides antidepressant effects, potentially beneficial effects of AE on a broad array of further variables associated with depression will be evaluated. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02679053.
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Affiliation(s)
- Christian Imboden
- Psychiatric Services Solothurn, Solothurn, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland.,Private Clinic Wyss, Münchenbuchsee, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Johannes Beck
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Private Clinic Sonnenhalde, Riehen, Switzerland
| | - Anne Eckert
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Martin Hatzinger
- Psychiatric Services Solothurn, Solothurn, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
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28
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Physical exercise for late-life depression: Effects on symptom dimensions and time course. J Affect Disord 2018; 230:65-70. [PMID: 29407540 DOI: 10.1016/j.jad.2018.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/12/2017] [Accepted: 01/22/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Physical exercise is increasingly recognized as a treatment for major depression, even among older patients. However, it is still unknown which depressive symptoms exercise affects most, (e.g. somatic vs. affective) and the timing of its effects. Thus, the aim of this study was to examine the changes of depressive symptoms after treatment with exercise. METHODS We analyzed data from the SEEDS study, a trial comparing the antidepressant effectiveness of sertraline (S) and sertraline plus exercise (S+EX). Exercise was delivered thrice weekly in small groups and monitored by heart rate meters. Patients with late life depression (n=121) were assessed at baseline, 4, 8, 12 and 24 weeks with the Hamilton Depression Scale. Scores of affective, vegetative, anxiety and agitation/insight factors were analyzed using Multilevel Growth Curve Models and sensitivity analyses (multiple imputation). RESULTS Compared with the S group, patients in the S+EX group displayed significantly greater improvements of the affective symptom dimension (total effect size = 0.79) with largest changes in the first 4 weeks and last 12 weeks. Improvements were mainly driven by depressed mood and psychomotor retardation. LIMITATIONS Sample size; lack of an exercise only treatment arm CONCLUSIONS: Adding exercise to antidepressant drug treatment may offer significant advantages over affective symptoms of depression, rather than somatic symptoms or other dimensions of depression. Compared with standard antidepressant treatment, clinical advantages should be expected both at an early (first 4 weeks) and later stage (after 12 weeks).
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Belvederi Murri M, Ekkekakis P, Magagnoli M, Zampogna D, Cattedra S, Capobianco L, Serafini G, Calcagno P, Zanetidou S, Amore M. Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes. Front Psychiatry 2018; 9:762. [PMID: 30687141 PMCID: PMC6335323 DOI: 10.3389/fpsyt.2018.00762] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Major depression shortens life while the effectiveness of frontline treatments remains modest. Exercise has been shown to be effective both in reducing mortality and in treating symptoms of major depression, but it is still underutilized in clinical practice, possibly due to prevalent misperceptions. For instance, a common misperception is that exercise is beneficial for depression mostly because of its positive effects on the body ("from the neck down"), whereas its effectiveness in treating core features of depression ("from the neck up") is underappreciated. Other long-held misperceptions are that patients suffering from depression will not engage in exercise even if physicians prescribe it, and that only vigorous exercise is effective. Lastly, a false assumption is that exercise may be more harmful than beneficial in old age, and therefore should only be recommended to younger patients. This narrative review summarizes relevant literature to address the aforementioned misperceptions and to provide practical recommendations for prescribing exercise to individuals with major depression.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Psychological Medicine, King's College London, London, United Kingdom
| | | | - Marco Magagnoli
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Domenico Zampogna
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Simone Cattedra
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Laura Capobianco
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Stamatula Zanetidou
- Department of Mental Health, Consultation Liaison Psychiatry Service, Bologna, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Nebiker L, Lichtenstein E, Minghetti A, Zahner L, Gerber M, Faude O, Donath L. Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review. Front Psychiatry 2018; 9:305. [PMID: 30072923 PMCID: PMC6060256 DOI: 10.3389/fpsyt.2018.00305] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Exercise training is a beneficial treatment strategy for depression. Previous meta-analytical reviews mainly examined the effect of aerobic exercise on depressive symptoms neglecting comparisons with neuromuscular training and meta-regression considering relevant exercise training prescriptors such as exercise duration, intensity, number of exercise sessions (volume) and frequency. Methods: A structured literature search was conducted in biomedical and psychological databases and study selection was conducted following the PICOS approach. (Randomized) controlled trials that compared supervised neuromuscular or endurance exercise interventions with an inactive control group (CON) in clinically depressed in- or out-patients over 18 years were included. Eligibility and study quality were evaluated by two independent researchers. Standardized mean differences (SMD) for the reduction of depressive symptoms, measured with different evaluation scales (e.g., BDI, HAM-D, PHQ-9, HRSD, MADRS, GDS) were calculated with the adjusted Hedges'g equation as main outcome for the comparison of endurance and neuromuscular exercise interventions vs. CON. Statistical analyses were conducted using a random effects inverse-variance model. Multivariate meta-regression analysis was performed in order to examine the modulating effects of exercise training prescriptors. Results: Twenty seven trials with 1,452 clinically depressed adults were included. 20 out of 27 included trials reached a PEDro score of at least 6, representing high-quality. Irrespective of the exercise mode and study quality, large effects in favor of exercise compared to the control condition were found. Compared to CON, sensitivity analyses revealed a moderate to large effect in favor of endurance exercise [SMD: -0.79 (90% CI: -1.10, -0.48); p < 0.00001, I2 = 84%] and a large effect size in favor of neuromuscular exercise [SMD: -1.14 (90 CI: -1.50, -0.78); p < 0.00001, I2 = 80%]. These effects decreased to moderate for endurance and remained large for neuromuscular trials when considering studies of high quality, indicating a significant difference (p = 0.04). Multivariate meta- regression revealed that exercise duration in endurance trials and exercise intensity in neuromuscular trials had a significantly moderating effect. Conclusions: Strong neuromuscular exercise interventions can be slightly more effective than endurance exercise interventions. Interestingly, exercise duration and exercise intensity moderated the effect size meaningfully. This result might be used on exercise in depression to increase efficacy.
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Affiliation(s)
- Lukas Nebiker
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Eric Lichtenstein
- 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
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Lars Donath
- Department of Intervention Research in Exercise Training German Sport University Cologne, Köln, Germany
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Chum J, Kim MS, Zielinski L, Bhatt M, Chung D, Yeung S, Litke K, McCabe K, Whattam J, Garrick L, O’Neill L, Goyert S, Merrifield C, Patel Y, Samaan Z. Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study. EVIDENCE-BASED MENTAL HEALTH 2017; 20:128-133. [PMID: 29056608 PMCID: PMC5750411 DOI: 10.1136/eb-2017-102763] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Major depressive disorder is characterised by low mood and poor motivation. Literature suggests that increased physical activity has positive effects on alleviating depression. Fitness-tracking devices may complement behavioural activation (BA) therapy to improve physical activity and mental health in patients with depression. OBJECTIVES To understand patients' perceived benefit from the Fitbit and explore themes associated with patient experiences. To compare perceived benefit, patient factors, Fitbit usage and Beck's Depression Inventory (BDI) scores. METHODS Semistructured interviews were conducted with patients (n=36) who completed a 28-week BA group programme in a mood disorders outpatient clinic. All patients were asked to carry a Fitbit One device. We conducted thematic analyses on the interviews and exploratory quantitative analyses on patient characteristics, Fitbit usage, steps recorded, perceived benefit and BDI scores. FINDINGS Twenty-three patients found the Fitbit helpful for their physical activity. Themes of positive experiences included self-awareness, peer motivation and goal-setting opportunities. Negative themes included inconvenience, inaccuracies and disinterest. Age, baseline and change in BDI scores, prior physical activity goals and familiarity with technology were not associated with perceived benefit from the Fitbit or usage. Perceived benefit was significantly (p<0.01) associated with usage. CONCLUSIONS Overall, the Fitbit is an acceptable tool to complement BA therapy for patients with depression. Many positive themes were concordant with current literature; however, patients also reported negative aspects that may affect use. CLINICAL IMPLICATIONS Clinicians and researchers should consider both strengths and limitations of activity trackers when implementing them to motivate patients with depression. TRIAL REGISTRATION NUMBER NCT02045771; Pre-results.
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Affiliation(s)
- Jenny Chum
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Min Suk Kim
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Zielinski
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Meha Bhatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Chung
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Yeung
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn Litke
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Kathleen McCabe
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeff Whattam
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Laura Garrick
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Laura O’Neill
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Stefanie Goyert
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Colleen Merrifield
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Yogita Patel
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Research Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioral Neurosciences, Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Populations Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
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Combining aerobic exercise and repetitive transcranial magnetic stimulation to improve brain function in health and disease. Neurosci Biobehav Rev 2017; 83:11-20. [PMID: 28951250 DOI: 10.1016/j.neubiorev.2017.09.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/02/2017] [Accepted: 09/21/2017] [Indexed: 12/22/2022]
Abstract
The aetiology of various psychiatric and neurological disorders may be partially attributable to impairments in neuroplasticity. Developing novel methods of stimulating neuroplasticity is a promising treatment approach to counterbalance these maladaptive influences and alleviate symptomologies. Two non-pharmacological approaches with significant and direct impacts on neuroplasticity are aerobic exercise and repetitive transcranial magnetic stimulation. Aerobic exercise is associated with the promotion of numerous neurotrophic mechanisms at a molecular and cellular level, which have a broad influence on neuroplasticity. Transcranial magnetic stimulation is a form of non-invasive brain stimulation with the capacity to modulate the synaptic efficacy and connectivity of particular brain networks. This review synthesises extant literature to explore the complementary physiological mechanisms targeted by aerobic exercise and repetitive transcranial magnetic stimulation, and to substantiate the hypothesis that the use of these techniques in tandem may result in synergistic impact on neural mechanisms to achieve a more efficacious therapeutic approach for mental disorders.
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Krogh J, Hjorthøj C, Speyer H, Gluud C, Nordentoft M. Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis. BMJ Open 2017; 7:e014820. [PMID: 28928174 PMCID: PMC5623558 DOI: 10.1136/bmjopen-2016-014820] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To assess the benefits and harms of exercise in patients with depression. DESIGN Systematic review DATA SOURCES: Bibliographical databases were searched until 20 June 2017. ELIGIBILITY CRITERIA AND OUTCOMES Eligible trials were randomised clinical trials assessing the effect of exercise in participants diagnosed with depression. Primary outcomes were depression severity, lack of remission and serious adverse events (eg, suicide) assessed at the end of the intervention. Secondary outcomes were quality of life and adverse events such as injuries, as well as assessment of depression severity and lack of remission during follow-up after the intervention. RESULTS Thirty-five trials enrolling 2498 participants were included. The effect of exercise versus control on depression severity was -0.66 standardised mean difference (SMD) (95% CI -0.86 to -0.46; p<0.001; grading of recommendations assessment, development and evaluation (GRADE): very low quality). Restricting this analysis to the four trials that seemed less affected of bias, the effect vanished into -0.11 SMD (-0.41 to 0.18; p=0.45; GRADE: low quality). Exercise decreased the relative risk of no remission to 0.78 (0.68 to 0.90; p<0.001; GRADE: very low quality). Restricting this analysis to the two trials that seemed less affected of bias, the effect vanished into 0.95 (0.74 to 1.23; p=0.78). Trial sequential analysis excluded random error when all trials were analysed, but not if focusing on trials less affected of bias. Subgroup analyses found that trial size and intervention duration were inversely associated with effect size for both depression severity and lack of remission. There was no significant effect of exercise on secondary outcomes. CONCLUSIONS Trials with less risk of bias suggested no antidepressant effects of exercise and there were no significant effects of exercise on quality of life, depression severity or lack of remission during follow-up. Data for serious adverse events and adverse events were scarce not allowing conclusions for these outcomes. SYSTEMATIC REVIEW REGISTRATION The protocol was published in the journal Systematic Reviews: 2015; 4:40.
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Affiliation(s)
- Jesper Krogh
- Faculty of Health Sciences, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Faculty of Health Sciences, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Helene Speyer
- Faculty of Health Sciences, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Faculty of Health Sciences, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Netz Y. Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based? Front Pharmacol 2017; 8:257. [PMID: 28555108 PMCID: PMC5430071 DOI: 10.3389/fphar.2017.00257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/25/2017] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Yael Netz
- Behavioral Studies, Graduate School, The Academic College at WingateWingate, Israel
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Kandola A, Hendrikse J, Lucassen PJ, Yücel M. Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment. Front Hum Neurosci 2016; 10:373. [PMID: 27524962 PMCID: PMC4965462 DOI: 10.3389/fnhum.2016.00373] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/11/2016] [Indexed: 12/24/2022] Open
Abstract
Aerobic exercise (AE) has been widely praised for its potential benefits to cognition and overall brain and mental health. In particular, AE has a potent impact on promoting the function of the hippocampus and stimulating neuroplasticity. As the evidence-base rapidly builds, and given most of the supporting work can be readily translated from animal models to humans, the potential for AE to be applied as a therapeutic or adjunctive intervention for a range of human conditions appears ever more promising. Notably, many psychiatric and neurological disorders have been associated with hippocampal dysfunction, which may underlie the expression of certain symptoms common to these disorders, including (aspects of) cognitive dysfunction. Augmenting existing treatment approaches using AE based interventions may promote hippocampal function and alleviate cognitive deficits in various psychiatric disorders that currently remain untreated. Incorporating non-pharmacological interventions into clinical treatment may also have a number of other benefits to patient well being, such as limiting the risk of adverse side effects. This review incorporates both animal and human literature to comprehensively detail how AE is associated with cognitive enhancements and stimulates a cascade of neuroplastic mechanisms that support improvements in hippocampal functioning. Using the examples of schizophrenia and major depressive disorder, the utility and implementation of an AE intervention to the clinical domain will be proposed, aimed to reduce cognitive deficits in these, and related disorders.
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Affiliation(s)
- Aaron Kandola
- Brain and Mental Health Lab, School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, MelbourneVIC, Australia; Amsterdam Brain and Cognition, University of AmsterdamAmsterdam, Netherlands
| | - Joshua Hendrikse
- Brain and Mental Health Lab, School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne VIC, Australia
| | - Paul J Lucassen
- Centre for Neuroscience, Swammerdam Institute of Life Sciences, University of Amsterdam Amsterdam, Netherlands
| | - Murat Yücel
- Brain and Mental Health Lab, School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne VIC, Australia
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