Exercise and severe major depression: effect on symptom severity and quality of life at discharge in an inpatient cohort

Effectiveness of Mobile-Based Progressive and Fixed Physical Activity on Depression, Stress, Anxiety, and Quality of Life Outcomes Among Adults in South Korea: Randomized Controlled Trial

BACKGROUND

Depression acts as a significant obstacle to the overall well-being of individuals. Given the significant consequences, timely recognition and proactive steps to manage symptoms of depression become essential. Such actions not only reduce personal distress but also play a crucial role in reducing its far-reaching impact on society as a whole.

OBJECTIVE

In response to this concern, the objective of this study was to explore the use of mobile-based interventions as a possible remedy. More specifically, this study aimed to investigate the effectiveness of 2 types of physical activity (PA), progressive and fixed, within a mobile-based app on depression, perceived stress, anxiety, physical health, and psychological health, aiming to contribute to the optimization of mental health benefits.

METHODS

Participants (N=60; mean age 25.29, SD 6.10 years) were recruited using a combination of web-based and offline methods, and the study lasted for 8 weeks. The baseline and posttest questionnaires were administered to all participants. The participants were randomly assigned to 1 of the 3 groups: progressive group (n=20; performing mobile-based progressive PA), fixed group (n=20; performing mobile-based fixed intensity PA), and control group C (n=20). Data analysis involved comparing scores between the experimental and control groups using a one-way ANOVA, paired sample t tests (2-tailed), and repeated measures ANOVA with a 3 (group)×2 (time) design.

RESULTS

The findings revealed significant improvements in mental health indicators among participants engaged in both fixed and progressive PA groups compared with the control group. However, the fixed PA group demonstrated more significant reductions in symptoms. Specifically, the progressive PA group showed significant reductions in depression (F1,36=6.941; P=.01; ηp2=0.16) and perceived stress (F1,36=5.47; P=.03; ηp2=0.13), while the fixed PA group exhibited significant reductions in depression (F1,37=5.36; P=.03; ηp2=0.12), perceived stress (F1,37=7.81; P=.008; ηp2=0.17), and general anxiety disorder (F1,37=5.45; P=.03; ηp2=0.13) compared with the control group.

CONCLUSIONS

This study underscores the potential of mobile-based PA in improving mental health outcomes. The findings offer significant insights for mental health professionals and researchers aiming to optimize mental well-being through innovative mobile therapies.

TRIAL REGISTRATION

Clinical Research Information Service KCT0009100; https://tinyurl.com/mr33fmur.

[Effects of a Motivational Intervention on the Effectiveness and Sustainability of Sports and Exercise Therapy in Inpatient Psychiatric Care]

OBJECTIVE

Reinforcement and sustainability of sports and exercise therapy in inpatient depression treatment.

METHODS

Randomized controlled study with 3 measurement times: t0 admission to the study, t1 after four weeks, t2 two months after discharge. 96 inpatients with depressive disorders (ICD-10 F32, F33) were randomly assigned to an intervention group (IG) or a control group (KG). In addition to sports and exercise therapy (KG), the IG received an educational and motivational session on the importance of sports and exercise, as well as a motivational final discussion.

RESULTS

Endurance performance and physical fitness improved more significantly in the IG than in the CG over the 3 measurement times. The motivational final discussion was rated as more helpful.

DISCUSSION

The intervention was well accepted by the patients and partially increased the effects of sports and exercise therapy. Not only psychological aspects of depression treatment were influenced, but also measurable physical effects.

CONCLUSION

The practical and time-efficient motivational intervention in inpatient psychiatric care can complement sports and exercise therapy for depressive patients.

Evaluating the effect of exercise-based interventions on functioning in people with transdiagnostic depressive symptoms: A systematic review of randomised controlled trials

BACKGROUND

Depressive symptoms are associated with various conditions and can exacerbate the outcome of somatic diseases. Transdiagnostic symptom-based approaches provide treatment flexibility, and exercise has demonstrated benefits beyond clinical symptoms. This work aimed to synthesise and establish the effects of exercise-based interventions on global functioning and quality of life in adults with transdiagnostic depressive symptoms, as well as their impact on clinical symptoms.

METHODS

A systematic review was conducted following PRISMA guidelines. PubMed, Scopus and PsycINFO databases were searched from inception to April 2023. Eligibility criteria included randomised controlled trials involving adults with transdiagnostic depressive symptoms who received exercise-based interventions and provided details of the interventions. Comparators included treatment as usual or other active control groups. The Cochrane quality assessment tool was used for quality assessment.

RESULTS

Fifteen articles involving 2064 participants were included. Data on study design, sample, intervention characteristics, and outcomes were extracted. Several trials demonstrated the expected positive effects of exercise on functioning (7/15). Most results supported the benefits of adjunctive exercise interventions on illness outcomes.

LIMITATIONS

The studies had methodological limitations, including small sample sizes and an underrepresentation of somatic diseases.

CONCLUSIONS

The functional consequences of exercise-based interventions targeting depressive symptoms are often understudied. Incorporating exercise routinely as an add-on treatment for transdiagnostic depressive symptoms could improve overall functioning, quality of life, and symptom severity. There is a need to expand the focus of exercise-based interventions to incorporate functional outcomes. Future research should address the methodological limitations and include a wider range of participants, including those with somatic diseases.

Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Physical activity and specific symptoms of depression: A pooled analysis of six cohort studies

BACKGROUND

The association between physical activity (PA) and depression is well-established, but the details that explain this association remain elusive. We examined whether PA is differentially associated with specific symptoms of depression (e.g., cognitive vs somatic symptoms), and whether these associations follow a dose-response pattern with respect to intensity or frequency of PA.

METHODS

Cross-sectional analyses were based on 6 samples of the continuous U.S. National Health and Nutrition Examination Surveys (NHANES) carried out between 2007 and 2018 (n = 28,520). Depressive symptoms were assessed with Patient Health Questionnaire 9 (PHQ-9). Information about PA (vigorous, moderate, and daily commuting by foot or bike) and covariates was self-reported.

RESULTS

After adjusting for education, health behaviors, body-mass index, physical functioning, and all the other depressive symptoms, lower PA was specifically associated with four depressive symptoms: loss of interest/pleasure, feeling down/hopeless, fatigue, and changes in appetite (odds ratios from 0.94 to 0.59). A monotonic dose-response pattern on PA amount was observed only for interest/pleasure and fatigue, and these associations were independent of PA intensity.

LIMITATIONS

Cross-sectional data did not allow us to assess temporal ordering. Both depressive symptoms and PA were self-reported, which may induce bias.

CONCLUSION

Low PA may be linked to depressive symptoms particularly through the symptoms of anhedonia and fatigue. Given that their association with PA amount follows a dose-response pattern and is independent of PA intensity, we hypothesize that behavioral activation and exposure to rewarding experiences might help to explain why PA alleviates depression.

Analysis of the Effect of Different Physical Exercise Protocols on Depression in Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Physical exercise (PE) is an effective treatment for depression, alone or as an adjunct.

OBJECTIVE

There is a lack of indicators regarding the frequency, intensity, duration, and type of physical exercise (PE). This study aims to synthesize and analyze the dose-effect of different PE protocols in adult subjects in the treatment of depression, based on the analysis of randomized controlled trials (RCTs).

DATA SOURCES

The search was conducted using Web of Science, PubMed, and Cochrane Library electronic databases.

STUDY SELECTION

Studies with an exercise-based intervention published by December 31, 2021 were identified. RCTs and meta-analyses involving adults with depression were also included; 10 studies were selected, including a total of 956 subjects.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

RESULTS

Effect sizes were summarized using standardized mean differences (95% confidence interval) by effected randomized models. The results reinforce that exercise appears to be beneficial in improving depression among adults aged 18 to 65 years. Interventions lasting above 150 minutes per week of moderate intensity and group interventions seem to have a more significant effect on reducing depression. Studies have revealed that aerobic exercise, compared with resistance or flexibility, has a more positive effect on depression.

CONCLUSION

PE can be a way to reduce depression and can be used as a possible adjunctive tool for pharmacological and/or alternative treatments. Considering the findings of this study, it is important that health professionals (eg, exercise physiologists, physicians, nurses, psychologists) promote the practice of PE as a complementary alternative and act early to prevent the worsening of depression.

PROSPERO REGISTRATION NUMBER

CRD42020188909.

Causal links between sedentary behavior, physical activity, and psychiatric disorders: a Mendelian randomization study

BACKGROUND

Studies suggest a correlation between excessive sedentary behavior, insufficient physical activity, and an elevated likelihood of experiencing psychiatric disorder. Nonetheless, the precise influence of sedentary behavior and physical activity on psychiatric disorder remains uncertain. Hence, the objective of this research was to investigate the possible causal relationship between sedentary behavior, physical activity, and the susceptibility to psychiatric disorder (depression, schizophrenia and bipolar disorder), utilizing a two-sample Mendelian randomization (MR) approach.

METHODS

Potential genetic instruments related to sedentary leisure behaviors were identified from the UK Biobank database, specifically a summary-level genome-wide association study (GWAS) involving 422,218 individuals of European descent. The UK Biobank database also provided the GWAS data for physical activity. Primary analysis was performed using inverse variance weighting (IVW) to assess the causal relationship between sedentary behavior, physical activity, and the risk of psychiatric disorder (depression, schizophrenia and bipolar disorder). Sensitivity analysis was conducted using Cochran's Q test, the MR-Egger intercept test, the MR-pleiotropy RESidual sum and outlier test, leave-one-out analysis, and funnel plot analysis.

RESULTS

According to the IVW analysis, there was a significant association between genetically predicted leisure television watching and an increased risk of depression (odds ratio [OR] = 1.027, 95% confidence interval [CI]: 1.001-1.053; P = 0.04). The IVW analysis also indicated that there was a decreased risk of depression associated with fraction accelerations of > 425 milligravities, as measured by accelerometers (OR = 0.951, 95%CI: 0.914-0.989; P = 0.013). The other MR methods obtained consistent but non-significant results in the same direction. However, there was no evidence of a causal association between genetic liability for moderate-to-vigorous physical activity, accelerometer-assessed physical activity, computer use, or driving and the risk of depression. Furthermore, IVW analysis has also found that driving has a slight effect in reducing the risk of schizophrenia (OR = 0.092, 95%CI: 0.010-0.827; P = 0.033), while leisure television viewing has a significant protective effect against the onset of bipolar disorder (OR = 0.719, 95%CI: 0.567-0.912; P = 0.006).

CONCLUSION

The study provides compelling evidence of a link between depression, bipolar disorder, and excessive TV watching. Furthermore, it suggests that higher accelerometer-assessed fraction accelerations of > 425 milligravities can serve as a genetic protective factor against depression. To mitigate the risk of developing depression, it is advisable to reduce sedentary activities, particularly television watching, and prioritize engaging in vigorous physical exercise.

Gender Differences in Psychological Outcomes Following Surf versus Hike Therapy among U.S. Service Members

BACKGROUND

Surf and hike therapies have demonstrated effectiveness as adjunct interventions for service members with major depressive disorder (MDD). This study explores gender differences in intervention outcomes following a pragmatic, randomized controlled trial of Surf and Hike Therapy for service members with MDD (N = 96; men, n = 46; women, n = 50).

METHODS

Clinician-administered and self-report measures (depression, anxiety, positive affect, negative affect, resilience, and pain) were completed at preprogram, postprogram, and 3-month follow-up; brief measures (depression/anxiety and positive affect) were completed before and after each session.

RESULTS

Multilevel modeling results showed that anxiety decreased from pre- to postprogram and significantly differed by gender (B = -2.26, p = 0.029), with women reporting greater reductions. The remaining outcomes from pre- to postprogram demonstrated significant improvements that did not differ by gender (ps = 0.218-0.733). There were no gender differences through follow-up (ps = 0.119-0.780). However, within sessions, women reported greater improvements in depression/anxiety (B = -0.93, p = 0.005) and positive affect (B = 3.73, p = 0.001). The change in positive affect scores within sessions was greater for women in Hike Therapy compared to men (p = 0.016).

CONCLUSIONS

Overall, results demonstrate that both genders benefit from adjunctive Surf and Hike Therapies, but women exhibit a better response in terms of longer-term anxiety and immediate psychological outcomes.

Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression

OBJECTIVE

To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias.

DESIGN

Systematic review and meta-analysis with meta-regression.

DATA SOURCES

The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group.

RESULTS

Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)).

CONCLUSION

Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

The Effectiveness of a Mobile Phone-Based Physical Activity Program for Treating Depression, Stress, Psychological Well-Being, and Quality of Life Among Adults: Quantitative Study

BACKGROUND

Depression is a substantial global health problem, affecting >300 million people and resulting in 12.7% of all deaths. Depression causes various physical and cognitive problems, leading to a 5-year to 10-year decrease in life expectancy compared with the general population. Physical activity is known to be an effective, evidence-based treatment for depression. However, people generally have difficulties with participating in physical activity owing to limitations in time and accessibility.

OBJECTIVE

To address this issue, this study aimed to contribute to the development of alternative and innovative intervention methods for depression and stress management in adults. More specifically, we attempted to investigate the effectiveness of a mobile phone-based physical activity program on depression, perceived stress, psychological well-being, and quality of life among adults in South Korea.

METHODS

Participants were recruited and randomly assigned to the mobile phone intervention or waitlist group. Self-report questionnaires were used to assess variables before and after treatment. The treatment group used the program around 3 times per week at home for 4 weeks, with each session lasting about 30 minutes. To evaluate the program's impact, a 2 (condition) × 2 (time) repeated-measures ANOVA was conducted, considering pretreatment and posttreatment measures along with group as independent variables. For a more detailed analysis, paired-samples 2-tailed t tests were used to compare pretreatment and posttreatment measurements within each group. Independent-samples 2-tailed t tests were conducted to assess intergroup differences in pretreatment measurements.

RESULTS

The study included a total of 68 adults aged between 18 and 65 years, who were recruited both through web-based and offline methods. Of these 68 individuals, 41 (60%) were randomly assigned to the treatment group and 27 (40%) to the waitlist group. The attrition rate was 10.2% after 4 weeks. The findings indicated that there is a significant main effect of time (F_1,60=15.63; P=.003; η_p²=0.21) in participants' depression scores, indicating that there were changes in depression level across time. No significant changes were observed in perceived stress (P=.25), psychological well-being (P=.35), or quality of life (P=.07). Furthermore, depression scores significantly decreased in the treatment group (from 7.08 to 4.64; P=.03; Cohen d=0.50) but not in the waitlist group (from 6.72 to 5.08; P=.20; Cohen d=0.36). Perceived stress score of the treatment group also significantly decreased (from 2.95 to 2.72; P=.04; Cohen d=0.46) but not in the waitlist group (from 2.82 to 2.74; P=.55; Cohen d=0.15).

CONCLUSIONS

This study provided experimental evidence that mobile phone-based physical activity program affects depression significantly. By exploring the potential of mobile phone-based physical activity programs as a treatment option, this study sought to improve accessibility and encourage participation in physical activity, ultimately promoting better mental health outcomes for individuals with depression and stress.

Structured physical exercise for bipolar depression: an open-label, proof-of concept study

BACKGROUND

Physical exercise (PE) is a recommended lifestyle intervention for different mental disorders and has shown specific positive therapeutic effects in unipolar depressive disorder. Considering the similar symptomatology of the depressive phase in patients with bipolar disorder (BD) and unipolar depressive disorder, it is reasonable to suggest that PE may also be beneficial for bipolar depression. However, there is an absence of studies evaluating the antidepressant effect of a structured PE intervention in BD.

METHODS

This is an open-label, single-arm study trial. Fifteen patients with a diagnosis of BD Type I or Type II, presenting a depressive episode were included in the study. After physical and functional evaluation, patients participated in supervised training sessions with aerobics followed by strength exercises, three times per week, for 12 weeks (36 training sessions). Depressive and manic symptoms were assessed at baseline and 2, 4, 8, and 12 weeks. Additionally, quality of Life and functioning were assessed at baseline and 4, 8, and 12 weeks). Finally, we tested cardiorespiratory fitness, muscle strength and body composition at baseline and week-12.

RESULTS

The mean (± SD) Montgomery Asberg Depression Rating Scale (MADRS) score at baseline was 23.6 ± 8.3 points and after 12 weeks of PE the mean score was 10.2 ± 4.8 points. Nine patients (82%) presented an antidepressant response defined as a reduction of more than 50% of depressive symptoms at week 12 with five of those patients (45%) presenting criteria for full remission. A large and significant Cohen's D Effect Size (pre-post) was verified for MADRS reduction [1.98 (95% Confidence interval = 0.88 to 3.08)]. We did not detect a significant change in manic symptoms, functioning, and quality of life during the 12-week follow-up. At week-12, all patients increased their muscular strength (one repetition maximal test - 1RM) and reduced the percentage of body fat (spectral bioelectrical impedance analysis).

CONCLUSIONS

This study, using rigorous criteria and a structured intervention, provides valid pilot data, showing the feasibility of a structured PE intervention for the treatment of depressive symptoms in BD, and suggesting a potential adjunctive antidepressant effect. Moreover, PE showed a positive impact on muscle strength and body composition. This should be further verified by randomized controlled studies.

Importance of immunometabolic markers for the classification of patients with major depressive disorder using machine learning

BACKGROUND

Although there is scientific evidence of the presence of immunometabolic alterations in major depression, not all patients present them. Recent studies point to the association between an inflammatory phenotype and certain clinical symptoms in patients with depression. The objective of our study was to classify major depression disorder patients using supervised learning algorithms or machine learning, based on immunometabolic and oxidative stress biomarkers and lifestyle habits.

METHODS

Taking into account a series of inflammatory and oxidative stress biomarkers (C-reactive protein (CRP), tumor necrosis factor (TNF), 4-hydroxynonenal (HNE) and glutathione), metabolic risk markers (blood pressure, waist circumference and glucose, triglyceride and cholesterol levels) and lifestyle habits of the participants (physical activity, smoking and alcohol consumption), a study was carried out using machine learning in a sample of 171 participants, 91 patients with depression (71.42% women, mean age = 50.64) and 80 healthy subjects (67.50% women, mean age = 49.12). The algorithm used was the support vector machine, performing cross validation, by which the subdivision of the sample in training (70%) and test (30%) was carried out in order to estimate the precision of the model. The prediction of belonging to the patient group (MDD patients versus control subjects), melancholic type (melancholic versus non-melancholic patients) or resistant depression group (treatment-resistant versus non-treatment-resistant) was based on the importance of each of the immunometabolic and lifestyle variables.

RESULTS

With the application of the algorithm, controls versus patients, such as patients with melancholic symptoms versus non-melancholic symptoms, and resistant versus non-resistant symptoms in the test phase were optimally classified. The variables that showed greater importance, according to the results of the area under the ROC curve, for the discrimination between healthy subjects and patients with depression were current alcohol consumption (AUC = 0.62), TNF-α levels (AUC = 0.61), glutathione redox status (AUC = 0.60) and the performance of both moderate (AUC = 0.59) and vigorous physical exercise (AUC = 0.58). On the other hand, the most important variables for classifying melancholic patients in relation to lifestyle habits were past (AUC = 0.65) and current (AUC = 0.60) tobacco habit, as well as walking routinely (AUC = 0.59) and in relation to immunometabolic markers were the levels of CRP (AUC = 0.62) and glucose (AUC = 0.58). In the analysis of the importance of the variables for the classification of treatment-resistant patients versus non-resistant patients, the systolic blood pressure (SBP) variable was shown to be the most relevant (AUC = 0.67). Other immunometabolic variables were also among the most important such as TNF-α (AUC = 0.65) and waist circumference (AUC = 0.64). In this case, sex (AUC = 0.59) was also relevant along with alcohol (AUC = 0.58) and tobacco (AUC = 0.56) consumption.

CONCLUSIONS

The results obtained in our study show that it is possible to predict the diagnosis of depression and its clinical typology from immunometabolic markers and lifestyle habits, using machine learning techniques. The use of this type of methodology could facilitate the identification of patients at risk of presenting depression and could be very useful for managing clinical heterogeneity.

The efficacy of exercise interventions for all types of inpatients across mental health settings: A systematic review and meta-analysis of 47 studies

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.

The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes

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.

Effects of Physical Exercise on Executive Function in Adults with Depression: A Systematic Review and Meta-Analysis

Executive function is among the most affected cognitive dimensions in depression. Physical exercise may improve executive function (e.g., working memory, inhibition, cognitive flexibility), although this is without consensus on adults with depression. Through this systematic review, we aim to elucidate the effects of physical exercise programs on executive functions in adults with depression. The literature search was performed in four relevant electronic databases, combining keywords and medical subject headings, from inception until September 2022. Controlled interventions, involving adults with depression, and reporting working memory, inhibition, and/or cognitive flexibility pre-post-intervention data, were considered includable. Results from meta-analyses included effect size (ES, i.e., Hedges' g) values reported with 95% confidence intervals (95%CIs), with p set at ≤0.05. Seven studies were included, including 202 men and 457 women (age: 21.0-51.2 years; mild-moderate depression). For working memory, a small favoring effect was observed in the experimental groups compared with controls (ES = 0.33, 95%CI = 0.04-0.61; p = 0.026; I² = 64.9%). For inhibition, physical exercise had a small favoring non-significant effect compared with controls (ES = 0.28, 95%CI = -0.17-0.74; p = 0.222; I² = 72.4%). Compared with the control group, physical exercise had a trivial effect on cognitive flexibility (ES = 0.09, 95%CI = -0.21-0.39; p = 0.554; I² = 68.4%). In conclusion, physical exercise interventions may improve working memory behavioral measures in adults with mild-to-moderate depression when compared with active and passive control conditions. However, the reduced number of available high-quality studies precludes more lucid conclusions.

Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis

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).

The Relationship between Physical Activity and Health-Related Quality of Life (HINT-Eight) in Middle-Aged Korean Women

The purpose of this study was to provide basic data on health by examining the effect of HINT-eight on the physical activity of middle-aged Korean women using secondary data from the 2019 KNHANES. The subjects were 1,428 middle-aged women aged 45-64. Multiple regression was performed to verify the relationship between physical activity and HINT-eight. Following confirmation of the association between HINT-eight and physical activity, it was found that the subdomains of QOL, such as stair climbing, vitality, work, sleeping, and happiness, were connected to physical activity. Stair climbing positively affected physical activity, education level, and grip strength and negatively affected age. Pain positively affected education level and grip strength and negatively affected age. Vitality positively affected physical activity, monthly household income, and grip strength. Working positively affected education level, monthly household income, and grip strength and negatively affected age. Depression positively affected monthly household income. Memory and sleep positively affected education level and negative effect on age. Happiness positively affected physical activity and monthly household income. In this study, physical activity was found to have an effect on various factors of QOL. Physical activity in middle age is an important influencing factor on the QOL in old age; to improve the QOL in older adult, it is necessary to make efforts to improve physical activity in middle age.

Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings

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.

Physical Health Impairment and Exercise as Medicine in Severe Mental Disorders: A Narrative Review

BACKGROUND

Individuals with severe mental disorders (SMDs; schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder) are not only suffering from their mental conditions; they also have an attenuated physical health, augmenting their overall critical condition.

OBJECTIVES

We review and critically appraise the evidence based on (1) key physiological factors relating to aerobic endurance and skeletal muscle strength; (2) implications for physical function and health; and (3) effects of training interventions with different intensities evaluated in individuals with SMDs.

FINDINGS

Reductions in aerobic endurance factors, peak oxygen uptake (VO_2peak) and walking work efficiency, are paralleled by reductions in maximal skeletal muscle strength and power. In turn, the poor aerobic endurance and muscle strength lead to impaired physical function, increased risk of lifestyle-related diseases, and ultimately early death. Exercise has the potential to counteract the attenuated physical health in people with SMDs. While aerobic endurance training is shown to increase VO_2peak due to plasticity of the oxygen transport system, strength training is documented to improve maximal muscle strength, power, and walking work efficiency as a result of adaptations in neuromuscular force developing factors.

CONCLUSIONS

In conclusion, improvements in these key determinants for physical health appear to be achievable in people with SMDs despite many being challenged by motivational difficulties with attending regular exercise and have beneficial implications for physical function during activities of daily living, lifestyle-related diseases, and early death.

Associations between depression, domain-specific physical activity, and BMI among US adults: NHANES 2011-2014 cross-sectional data

Background

Physical activity is associated with depression. However, benefits of physical activity on depression may differ for specific domains of physical activity (i.e., leisure-time, work, and travel). Moreover, the relationship between physical activity and depression could also differ for people in different Body Mass Index (BMI) categories. This study investigated the relationship between domain-specific physical activity and BMI with depression, and the moderation effects of BMI on the relationship between domain physical activity and depression.

Methods

Complex survey data from the NHANES 2011-2014 was used (N=10,047). Depression was measured using the Patient Health Questionnaire (PHQ-9). Participants reported physical activity minutes in each domain using the Global Physical Activity Questionnaire. Demographic characteristics were self-reported. Weight and height were objectively measured and used for calculating BMI. Survey procedures were used to account for complex survey design. As two survey cycles were used, sampling weights were re-calculated and used for analyses. Taylor series linearisation was chosen as a variance estimation method.

Results

Participants who engaged in ≥150 minutes/week of total moderate-vigorous physical activity (MVPA) (adjusted B = 0.83, 95% CI [0.50, 1.16]) and leisure-time MVPA (adjusted B = 0.84, 95% CI [0.57, 1.11]) experienced lower levels of depression compared to those engaging in <150 MVPA minutes/week. Work and travel-related physical activity were not associated with depression. Overweight (adjusted B = -0.40, 95% CI [-0.76, -0.04]) and underweight/normal weight participants (adjusted B = -0.60, 95%CI [-0.96, -0.25]) experienced less depressive symptoms compared to obese participants. BMI did not moderate the relationship between domain-specific physical activity and depression.

Conclusions

Interventions that focus on leisure-time physical activity appear to be best suited to improve depression, however, this needs to be confirmed in purposefully designed intervention studies. Future studies may also examine ways to improve the effectiveness of work and travel physical activity for reducing depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14037-4.

The Mediating Role of Health-Promoting Behaviors on the Association between Symptom Severity and Quality of Life among Chinese Individuals with Mental Illness: A Cross-Sectional Study

INTRODUCTION

Research has shown that people with mental illnesses (PMI) are found to show poorer lifestyle than the general population. Yet, the effect of their psychiatric symptoms in the association between gender difference, health-promoting behaviors, and quality of life have received little attention. The present study examined the association between symptom severity, health-promoting behaviors, and quality of life among PMI in Hong Kong. Gender difference on the association between these variables was also examined.

METHOD

A cross-sectional survey was conducted among 591 individuals with DSM-IV-TR Axis 1 diagnosis recruited from the community.

RESULTS

Results from MANOVA showed that PMI with more severe psychiatric symptoms engaged in a significantly lower level of health-promoting behaviors and reported a lower level of quality of life. Results from structural equation modeling showed that health-promoting behaviors mediated the association between psychiatric symptoms and quality of life. Multigroup analyses showed that the association between psychiatric symptoms and health-promoting behaviors was stronger among female participants, while the association between health-promoting behaviors and quality of life was stronger among male participants.

DISCUSSION/CONCLUSION

Despite clear evidence suggesting symptom severity to be negatively correlated with quality of life, the underlying mechanism has been less clear. There is a need to promote health-promoting behaviors in order to improve the quality of life of PMI. Gender-specific interventions are warranted.

Exercise and yoga during pregnancy and their impact on depression: a systematic literature review

It is well established that exercise can improve depressive symptoms in the general population; however, it is not clear if these benefits are also seen in pregnancy. This review aimed to synthesize the evidence that examines whether exercise during pregnancy impacts depressive and associated symptoms (e.g. anxiety) during the perinatal period. The review was conducted in accordance with PRISMA guidelines and reporting criteria; literature was searched using PubMed, Scopus and Web of Science database engines. Clinical trials published in English evaluating the effects of a defined exercise protocol during pregnancy on depressive and/or anxiety symptoms during the perinatal period were included. Studies without a control group were excluded. Risk of bias was conducted by Cochrane assessment to appraise the quality of the included studies. Twenty-seven articles, between 1994 and 2019, were included. Of these, only 5 specifically recruited women with depression (n = 334), which all assessed a yoga-based intervention; 4 of these studies showed a statistically significant improvement in depressive and/or anxiety symptoms in the intervention group compared to baseline; however, 2 of these studies also showed an improvement in the control group. The remaining 22 studies used various exercise interventions in pregnant women (n = 4808) with 20 studies reporting that exercise during pregnancy has the ability to improve depressive and/or anxiety measures in the perinatal period compared to either baseline or control. The evidence suggests that exercise of various types in pregnancy can reduce depressive and/or anxiety symptoms in the perinatal period in otherwise healthy women. Specifically in women with antenatal depression, the incorporation of yoga in pregnancy can improve depressive/anxiety symptoms in the perinatal period; however, this is based on a small number of studies, and it is not clear whether this is superior to non-exercise controls. Further studies are needed to determine the potential therapeutic effects of exercise of various types during pregnancy on symptoms of antenatal depression.

A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets

BACKGROUND

Aerobic exercise has demonstrated antidepressant efficacy among adults with major depression. There is a poor understanding of the neural mechanisms associated with these effects. Deficits in reward processing and cognitive control may be two candidate targets and predictors of treatment outcome to exercise in depression.

METHODS

Sixty-six young adults aged 20.23 years (s.d. = 2.39) with major depression were randomized to 8 weeks of moderate-intensity aerobic exercise (n = 35) or light stretching (n = 31). Depressive symptoms were assessed across the intervention to track symptom reduction. Reward processing [reward positivity (RewP)] and cognitive control [error-related negativity (ERN)] were assessed before and after the intervention using event-related brain potentials.

RESULTS

Compared to stretching, aerobic exercise resulted in greater symptom reduction (gs = 0.66). Aerobic exercise had no impact on the RewP (gav = 0.08) or ERN (gav = 0.21). In the aerobic exercise group, individuals with a larger pre-treatment RewP [odds ratio (OR) = 1.45] and increased baseline depressive symptom severity (OR = 1.18) were more likely to respond to an aerobic exercise program. Pre-treatment ERN did not predict response (OR = 0.74).

CONCLUSIONS

Aerobic exercise is effective in alleviating depressive symptoms in adults with major depression, particularly for those with increased depressive symptom severity and a larger RewP at baseline. Although aerobic exercise did not modify the RewP or ERN, there is preliminary support for the utility of the RewP in predicting who is most likely to respond to exercise as a treatment for depression.

Effectiveness and Benefits of Exercise on Older People Living With Mental Illness’ Physical and Psychological Outcomes in Regional Australia: A Mixed-Methods Study

Regular exercise is reported to improve depressive symptoms and quality of life for people experiencing mental illness. For older adults, including strength and balance can also decrease falls. Mental health services seldom include funding for Accredited Exercise Physiologist programs. A 9-week Accredited Exercise Physiologist-led program for older adults receiving mental health treatment with a community Older People’s Mental Health Service was trialed in regional Australia. This clinician-conceived small-scale feasibility study utilized a two-phase concurrent triangulation mixed-method design to evaluate physical and psychological program outcomes and identify factors related to engaging in physical activity. This tailored exercise program led to improvements in measures of psychological distress and physical and psychological function. These changes corresponded with participants identifying benefits of exercising as a group of adults living with mental illness. Such findings suggest a supervised, individualized program for older mental health consumers confers physical and psychological benefits; however, further research evaluating exercise interventions with this population is required.

Efficacy of exercise combined with standard treatment for depression compared to standard treatment alone: A systematic review and meta-analysis of randomized controlled trials

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.

Major depressive disorder: Validated treatments and future challenges

Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning. Treatment during the acute phase of a major depressive episode aims to help the patient reach a remission state and eventually return to their baseline level of functioning. Pharmacotherapy, especially selective serotonin reuptake inhibitors antidepressants, remains the most frequent option for treating depression during the acute phase, while other promising pharmacological options are still competing for the attention of practitioners. Depression-focused psychotherapy is the second most common option for helping patients overcome the acute phase, maintain remission, and prevent relapses. Electroconvulsive therapy is the most effective somatic therapy for depression in some specific situations; meanwhile, other methods have limits, and their specific indications are still being studied. Combining medications, psychotherapy, and somatic therapies remains the most effective way to manage resistant forms of depression.

Sustainability of a Motor Control Exercise Intervention: Analysis of Long-Term Effects in a Low Back Pain Study

Development of chronic pain after a low back pain episode is associated with increased pain sensitivity, altered pain processing mechanisms and the influence of psychosocial factors. Although there is some evidence that multimodal therapy (such as behavioral or motor control therapy) may be an important therapeutic strategy, its long-term effect on pain reduction and psychosocial load is still unclear. Prospective longitudinal designs providing information about the extent of such possible long-term effects are missing. This study aims to investigate the long-term effects of a homebased uni- and multidisciplinary motor control exercise program on low back pain intensity, disability and psychosocial variables. 14 months after completion of a multicenter study comparing uni- and multidisciplinary exercise interventions, a sample of one study center (n = 154) was assessed once more. Participants filled in questionnaires regarding their low back pain symptoms (characteristic pain intensity and related disability), stress and vital exhaustion (short version of the Maastricht Vital Exhaustion Questionnaire), anxiety and depression experiences (the Hospital and Anxiety Depression Scale), and pain-related cognitions (the Fear Avoidance Beliefs Questionnaire). Repeated measures mixed ANCOVAs were calculated to determine the long-term effects of the interventions on characteristic pain intensity and disability as well as on the psychosocial variables. Fifty four percent of the sub-sample responded to the questionnaires (n = 84). Longitudinal analyses revealed a significant long-term effect of the exercise intervention on pain disability. The multidisciplinary group missed statistical significance yet showed a medium sized long-term effect. The groups did not differ in their changes of the psychosocial variables of interest. There was evidence of long-term effects of the interventions on pain-related disability, but there was no effect on the other variables of interest. This may be partially explained by participant's low comorbidities at baseline. Results are important regarding costless homebased alternatives for back pain patients and prevention tasks. Furthermore, this study closes the gap of missing long-term effect analysis in this field.

Exploring the Relationship Between Mental Well-Being, Exercise Routines, and the Intake of Image and Performance Enhancing Drugs During the Coronavirus Disease 2019 Pandemic: A Comparison Across Sport Disciplines

Introduction: Physical distancing under the coronavirus disease 2019 (COVID-19) pandemic had a significant impact on lifestyles, including exercise routines. In this study, we examined the relationship between mental health and addictive behaviors, such as excessive exercise and the use of image and performance enhancing drugs (IPEDs) across 12 sport disciplines. Materials and methods: A large cross-sectional sample of the adult population (N = 2,295) was surveyed. The mean age was 33.09 (SD = 11.40). The number of male participants was 668 (30.0%). The use of IPEDs was assessed in conjunction with psychometric measures such as the Exercise Addiction Inventory (EAI) and the Appearance Anxiety Inventory (AAI). The participants were grouped into activity group (AG) and non-activity group (NAG) according to the presence or absence of their exercise habits. The results were compared between these groups, as well as across sport disciplines, while taking into account the relationship between different psychological measures and IPEDs consumption. Results: The frequency of IPEDs use was higher among AG (34.6%) than NAG (14.6%), although AG participants reported less history of addictions (7.1%) than NAG (11.8%). The logistic regression analysis revealed that scores equal to or above cutoff points, in both the EAI and AAI, predicted the IPEDs use. Regarding the differences across the various sport disciplines, those who were involved in practicing Weight Lifting and Cross Fit were found to be more at risk of excessive exercising and more inclined to use a wide range of IPEDs. Conclusions: Although exercise could help to increase well-being and prevent addictions during the COVID-19 pandemic, our results show that those in the AG are particularly vulnerable to excessive IPEDs use. Sport disciplines associated with higher EAI and AAI scores have also shown a higher tendency to excessive IPEDs use. Furthermore, the factor of having above the cutoff scores in EAI or AAI in each sport could indicate larger IPEDs consumption regardless of the discipline. In light of the current findings, it is necessary to better define the "non-excessive" levels of exercise in various sport disciplines and an adequate intake of IPEDs to ensure the safety and well-being of people during a pandemic.

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

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.

Step Away from Depression-Study protocol for a multicenter randomized clinical trial for a pedometer intervention during and after in-patient treatment of depression

OBJECTIVES

Increasing the number of daily steps by using a pedometer and a diary leads to an activity increase and improved health outcomes in a variety of somatic disorders. Hence, for the inpatient treatment of depression, supervised exercise interventions are more widespread. We aim to examine if a self-managed pedometer intervention (PI) with the option of being proceeded after discharge leads to reduction of depression and to a physical activity (PA) increase.

METHODS

The Step Away from Depression (SAD) study is a multicenter randomized controlled trial targeting 400 patients with major depressive disorder. Treatment as usual (TAU) is compared to TAU plus PI after 4 weeks, at discharge, and 6 months after hospital admission. Primary outcomes are clinically rated depression severity and accelerometer-measured step counts. Secondary outcomes include self-reported depression symptoms and PA level, psychiatric symptoms, health-related quality of life, self-efficacy, and components of the Motivation Volition Process Model.

RESULTS

We report the design of the SAD study considering several methodological aspects for exercise studies, in general.

CONCLUSIONS

Results of our study will provide information about efficacy of PI for inpatient treatment and about interrelating processes of change concerning depression, PA, and aspects of motivation and volition.

Lang U. How a Depressive Medical Doctor Profited in the Long-Term from a New and Short Psychological Group-Treatment against Major Depressive Disorder

Background: Individuals suffering from major depressive disorder (MDD) often describe workplace-related stress as one of the main causes of their disorder. Here, we present the story of a 33 year old “Bob” (a pseudonym) who suffered from a moderate (Hamilton-21 = 18) major depressive episode. Workplace-related stress seemed to be the main stressor for Bob at the time. We were interested in long-lasting effects of a newly established group called “work-related interpersonal Psychotherapy, W-IPT”. W-IPT consists of eight weekly 90 min sessions. The follow-ups were 12 weeks after the group-treatment and 18 months later. Bob was chosen because he agreed in advance to participate in a follow-up. We were interested if the group-treatment of W-IPT also has a persistent positive effect. Case presentation: We present the case of a 33-year-old man “Bob”. He was included in our previous published pilot-study 2020 with diagnosed moderate MDD, and he attended the group treatment. This case report focuses on a follow-up period of 18 months. A structured clinical interview for DSM-IV was carried out in order to be included in the study, and no comorbid diagnoses were detected. Conclusions: However, the psychotherapeutic effects in this case seem enduring and prolonged. Of course, additional research to study the long-term effects of W-IPT is needed, and more patients need to be included.

Physical Activity Reduces Clinical Symptoms and Restores Neuroplasticity in Major Depression

Major depressive disorder (MDD) is the most common mental disorder and deficits in neuroplasticity are discussed as one pathophysiological mechanism. Physical activity (PA) enhances neuroplasticity in healthy subjects and improves clinical symptoms of MDD. However, it is unclear whether this clinical effect of PA is due to restoring deficient neuroplasticity in MDD. We investigated the effect of a 3-week PA program applied on clinical symptoms, motor excitability and plasticity, and on cognition in patients with MDD (N = 23), in comparison to a control intervention (CI; N = 18). Before and after the interventions, the clinical symptom severity was tested using self- (BDI-II) and investigator- (HAMD-17) rated scales, transcranial magnetic stimulation (TMS) protocols were used to test motor excitability and paired-associative stimulation (PAS) to test long-term-potentiation (LTP)-like plasticity. Additionally, cognitive functions such as attention, working memory and executive functions were tested. After the interventions, the BDI-II and HAMD-17 decreased significantly in both groups, but the decrease in HAMD-17 was significantly stronger in the PA group. Cognition did not change notably in either group. Motor excitability did not differ between the groups and remained unchanged by either intervention. Baseline levels of LTP-like plasticity in the motor cortex were low in both groups (PA: 113.40 ± 2.55%; CI: 116.83 ± 3.70%) and increased significantly after PA (155.06 ± 10.48%) but not after CI (122.01 ± 4.1%). Higher baseline BDI-II scores were correlated with lower levels of neuroplasticity. Importantly, the more the BDI-II score decreased during the interventions, the stronger did neuroplasticity increase. The latter effect was particularly strong after PA (r = -0.835; p < 0.001). The level of neuroplasticity related specifically to the psychological/affective items, which are tested predominantly in the BDI-II. However, the significant clinical difference in the intervention effects was shown in the HAMD-17 which focuses more on somatic/neurovegetative items known to improve earlier in the course of MDD. In summary, PA improved symptoms of MDD and restored the deficient neuroplasticity. Importantly, both changes were strongly related on the individual patients' level, highlighting the key role of neuroplasticity in the pathophysiology and the clinical relevance of neuroplasticity-enhancing interventions for the treatment of MDD.

The Effects and Mechanisms of Exercise on the Treatment of Depression

Background: It is necessary to seek alternative therapies for depression, because side effects of medications lead to poor adherence and some patients do not achieve a clinical treatment effect. Recently the role of exercise as a low-cost and easy-to-use treatment for depression has gained attention with a number of studies showing that exercise is effective at reducing depressive symptoms and improving body functions such as cardiorespiratory system and cognitive function. Because of the heterogeneity of exercise therapy programs, there is no standardized and unified program. Few studies have summarized the specific properties of exercise programs (type, intensity, duration, and frequency) and clinical prescriptions for exercise are not mentioned in most articles. Aims: This study aimed to investigate the feasibility and efficacy of exercise therapy for patients with depression, in order to appraise the evidence and outline accepted guidelines to direct individualized treatment plans for patients with depression based on their individual situations. Methods: A systematic review of English language literature including papers published from 2010 to present in PubMed was performed. Given the feasibility of prescribing exercise therapy for patients with depression, nearly 3 years of clinical studies on the treatments of depressive symptoms with exercise were first reviewed, comparing the exercise programs utilized. Conclusions: Exercise has therapeutic effects on depression in all age groups (mostly 18-65 years old), as a single therapy, an adjuvant therapy, or a combination therapy, and the benefits of exercise therapy are comparable to traditional treatments for depression. Moderate intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions. Recommendations: Aerobic exercise/mind-body exercise (3-5 sessions per week with moderate intensity lasting for 4-16 weeks) is recommended. Individualized protocols in the form of group exercise with supervision are effective at increasing adherence to treatment.

Exercise enhances: study protocol of a randomized controlled trial on aerobic exercise as depression treatment augmentation

BACKGROUND

Major depressive disorder (MDD) is a considerable public health concern. In spite of evidence-based treatments for MDD, many patients do not improve and relapse is common. Therefore, improving treatment outcomes is much needed and adjunct exercise treatment may have great potential. Exercise was shown to be effective as monotherapy for depression and as augmentation strategy, with evidence for increasing neuroplasticity. Data on the cost-effectiveness and the long-term effects of adjunct exercise treatment are missing. Similarly, the cognitive pathways toward remission are not well understood.

METHODS

The present study is designed as a multicenter randomized superiority trial in two parallel groups with follow-up assessments up to 15 months. Currently depressed outpatients (N = 120) are randomized to guideline concordant Standard Care (gcSC) alone or gcSC with adjunct exercise treatment for 12 weeks. Randomization is stratified by gender and setting, using a four, six, and eight block design. Exercise treatment is offered in accordance with the NICE guidelines and empirical evidence, consisting of one supervised and two at-home exercise sessions per week at moderate intensity. We expect that gcSC with adjunct exercise treatment is more (cost-)effective in decreasing depressive symptoms compared to gcSC alone. Moreover, we will investigate the effect of adjunct exercise treatment on other health-related outcomes (i.e. functioning, fitness, physical activity, health-related quality of life, and motivation and energy). In addition, the mechanisms of change will be studied by exploring any change in rumination, self-esteem, and memory bias as possible mediators between exercise treatment and depression outcomes.

DISCUSSION

The present trial aims to inform the scientific and clinical community about the (cost-)effectiveness and psychosocial mechanisms of change of adjunct exercise treatment when implemented in the mental health service setting. Results of the present study may improve treatment outcomes in MDD and facilitate implementation of prescriptive exercise treatment in outpatient settings.

TRIAL REGISTRATION

This trial is registered within the Netherlands Trial Register (code: NL8432 , date: 6th March, 2020).

Is Strength Training as Effective as Aerobic Training for Depression in Older Adults? A Randomized Controlled Trial

BACKGROUND

This study aimed to compare the effects of aerobic training (AT), strength training (ST) and low-intensity exercise in a control group (CG) as adjunct treatments to pharmacotherapy for major depressive disorder (MDD) in older persons.

METHODS

Older persons clinically diagnosed with MDD (n = 27) and treated with antidepressants were blindly randomized into three groups: AT, ST and a CG. All patients were evaluated prior to and 12 weeks after the intervention.

RESULTS

Compared with the CG, the AT and ST groups showed significant reductions in depressive symptoms (treatment -response = 50% decrease in the pre- to postintervention assessment) through the Hamilton Depression Rating Scale (AT group: χ2, p = 0.044) and Beck Depression Inventory (ST group: χ2, p = 0.044).

CONCLUSION

Adding AT or ST with moderate intensity to the usual treatment promoted a greater reduction of MDD symptoms.

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

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.

Exercise Intervention in Treatment of Neuropsychological Diseases: A Review

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.

Recovery of patients with severe depression in inpatient rural psychiatry: a descriptive clinical study

Objectives: The aim of this study was to investigate the level of and the relationship between symptoms and health-related quality of life (HRQoL) at admittance and recovery at discharge in patients with severe depression, in a rural inpatient psychiatric setting. Furthermore, whether the anxiety level at admission and/or, if the extent of patients' perception of family support from professionals were related to recovery.Method: Patients admitted with depression were consecutively invited to participate during a 12-month period. Depression, anxiety and stress were measured with DASS (The Depression Anxiety Stress Scale) and HRQoL with The Icelandic Quality of Life scale at admission and discharge. Family support was measured with Icelandic Family Perceived Support Questionnaire at discharge.Results: Majority of the participants had severe depression and anxiety scores (93.8% and 76.9%, respectively) at admission and HRQoL was impaired, especially in men. At discharge, almost three quarters of the participants had recovered into the outpatient or functional symptoms level and HRQoL had increased significantly. Morbid anxiety delayed recovery significantly, but perceived cognitive family support was positively related to depression recovery.Conclusion: Hospitalisation is an effective intervention for severe depression in rural Iceland. Positive benefits in both depression and HRQoL occur, where most of the participants reach outpatient or normal level of depression.

Aquatic exercising may improve sexual function in females with multiple sclerosis - an exploratory study

BACKGROUND

Persons with multiple sclerosis (PwMS) report impaired sexual function, and this is particularly prevalent and burdensome for females with MS. The present study included a randomized controlled trial (RCT) design and examined the effect of aquatic exercise training on sexual function among females with MS.

METHODS

The sample consisted of 60 married female PwMS (mean age: 37.68 years; median EDSS: 1.75) who were randomly assigned into one of the following conditions: aquatic exercise twice a week (2x/w); aquatic exercise three times a week (3x/w); active control condition (ACC). Participants completed questionnaires regarding sexual function (desire, arousal, lubrication, orgasm, satisfaction, pain), symptoms of depression, sleep complaints, fatigue, and couple satisfaction before and after the 8-week study period.

RESULTS

The interventions had significant and positive effects on the overall score of sexual function (p < .001, η_ρ² = .35), all subscales (desire (p = .002, 2 = .20), arousal (p = .01, 2 =.15), lubrication (p = .011, 2 = .15), orgasm (p = .007, 2 = .16), satisfaction (p = .023, 2 = .13), pain (p = .02, 2 = .13)) and depression (p =.002, 2 = .20).The interventions had no significant and positive effects on fatigue (p = .31, 2 = .04) sleep complaints (p = .079, 2= .087), and couple satisfaction (p = .69, 2 = .01) compared with the active control condition.

CONCLUSIONS

Aquatic exercise training may improve sexual function among female PwMS, but this requires further examination using a large sample pre-screened for sexual dysfunction. If confirmed, the present findings are of clinical and practical importance for females with MS.

Workplace-Related Interpersonal Group Psychotherapy to Improve Life at Work in Individuals With Major Depressive Disorders: A Randomized Interventional Pilot Study

OBJECTIVES

Individuals suffering from major depressive disorder (MDD) often report workplace-related stress as the major cause of their disorder. Accordingly, workplace-related stress was established as a fifth psychosocial problem area of Interpersonal Psychotherapy (workplace-related Interpersonal Psychotherapy, W-IPT). The aim of the study was to investigate the influence of W-IPT on depressive symptoms and on workplace-related issues in individuals with MDD compared to a treatment-as-usual (TAU) condition.

METHODS

A total of 27 individuals with MDD (mean age = 43 years, 48% males) were randomly assigned either to eight weekly group sessions of W-IPT or to the TAU condition. At baseline, 8 weeks later at the end of the intervention, and 20 weeks later at follow-up, the Hamilton Rating Scale for Depression was conducted. In addition, the participants completed the Beck Depression Inventory, the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), and the Insomnia Severity Index (ISI).

RESULTS

Symptoms of depression in experts' ratings as well as in self-rated ratings decreased over time, but more so in the W-IPT condition compared to the TAU condition [experts rating: large effect size (d = 1.25) and self-assessment: large effect sizes (d = 0.94)]. The subjective ability to work (WAI) [medium effect size (d = 0.68)], self-efficacy to returning to work RTW-SE [medium effect size (d = 0.57)], and subjective symptoms of insomnia (ISI) [large effect size (d = 1.15)] increased over time, but again more so in the W-IPT condition compared to the TAU condition. The effects of the intervention remained stable from the end of the intervention to follow-up.

CONCLUSIONS

The pattern of results of this pilot study suggests that a newly established fifth IPT focus on workplace-related stress appeared to be particularly efficient in individuals with MDD due to work-related stress in reducing depressive symptoms and reducing sleep complaints as well as in improving occupational outcomes.

Crocus Sativus L. (saffron) versus sertraline on symptoms of depression among older people with major depressive disorders-a double-blind, randomized intervention study

BACKGROUND

While there is sufficient evidence that Crocus Sativus L. (saffron) improves symptoms of depression in young and middle-aged adults, research on older people are missing. The purpose of the double-blind, randomized intervention study was to compare the effect of saffron and sertraline on MDD among a sample of older people.

METHODS

A total of 50 older out-patients with MDD (mean age = =65 years; 70% males) were randomly assigned either to the saffron condition (60 mg/d) or to the sertraline condition (100 mg/day) for six consecutive weeks. Experts employed the Hamilton Depression Rating Scale (HDRS) to rate participants' degree of depression. Timepoints were baseline, week 2, week 4 and week 6, the end of the study.

RESULTS

Symptoms of depression decreased over time, with no advantages or disadvantages for the saffron or sertraline condition.

CONCLUSION

The pattern of results suggests that both saffron and sertraline have the potential to significantly decrease symptoms of depression. The results are clinically relevant, because major depressive disorders in older people is a health concern. The results are further relevant, because saffron appears to be a powerful antidepressant for older people, who might be more reluctant to the use of synthetic drugs.

Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy. Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training, the effects and underlying mechanisms of exercise remain unclear. Thus, the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol. This review summarizes the latest exercise prescription treatments for 26 different diseases: musculoskeletal system diseases (low back pain, tendon injury, osteoporosis, osteoarthritis, and hip fracture), metabolic system diseases (obesity, type 2 diabetes, type 1 diabetes, and nonalcoholic fatty liver disease), cardio-cerebral vascular system diseases (coronary artery disease, stroke, and chronic heart failure), nervous system diseases (Parkinson's disease, Huntington's disease, Alzheimer's disease, depression, and anxiety disorders), respiratory system diseases (chronic obstructive pulmonary disease, interstitial lung disease, and after lung transplantation), urinary system diseases (chronic kidney disease and after kidney transplantation), and cancers (breast cancer, colon cancer, prostate cancer, and lung cancer). Each exercise prescription is displayed in a corresponding table. The recommended type, intensity, and frequency of exercise prescriptions are summarized, and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.

The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls.

METHODS

The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2-3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up.

DISCUSSION

Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD.

TRIAL REGISTRATION

ISRCTN, ISRCTN10469580 . Registered on 3 September 2018.

EFFORT-D: results of a randomised controlled trial testing the EFFect of running therapy on depression

Results of a randomised controlled trial testing the EFFect Of Running Therapy on Depression.

BACKGROUND

This randomised controlled trial explored the anti-depressive and health effects of add-on exercise (running therapy or Nordic walking) in patients with Major Depressive Disorder (MDD).

METHODS

Patients were recruited at three specialised mental health care institutions. In the intervention group exercise was planned two times a week during 6 months, the control group received care as usual. Observer-blinded measurements included Hamilton-17 depression scores and several health and fitness parameters. Submaximal bicycle-tests were performed at inclusion, 3, 6 and 12 months. The effects of exercise were assessed by effect size, intention-to-treat and analysis per protocol using General Linear Models (GLM) with time x group interactions.

RESULTS

In total, 183 patients were assessed for eligibility and 135 were excluded (40% of the potential participants declined to participate mainly due to a lack of time and motivation). Together with a drop-out of 55% at 6 months, this reduced the power of the study severely. As a result, statistical analysis was performed only on the first 3 months of the study. Data were ultimately analysed from 46 patients, of which 24 were in the intervention group. Significantly more women were in the intervention group, and depression and fitness were higher in the control group. Participants showed 2-3 points less depression on average after 3 months. However, the GLM showed no effect on depression (Cohen's d < 0.2, F = .13, p = .73) in both the intention-to-treat and per protocol analyses. However, large effect sizes (Cohen's d > 0.8) were found for aerobic capacity (VO2max∙.kg- 1, F = 7.1, p = .02*), maximal external output (Wmax∙.kg- 1, F = 6.1, p = .03*), and Body Mass Index (F = 5, p = .04*), in favour of the intervention group.

CONCLUSIONS

In this selective and relative small clinical population with MDD, an anti-depressive effect of the exercise intervention could not be measured and is also unlikely due to the very low effect size. An integrated lifestyle intervention will probably be more effective than a single add-on exercise intervention. However, significantly increased fitness levels may contribute to the alleviation of current cardio-metabolic risk factors or prevention of these in the future.

TRIAL REGISTRATION

Netherlands Trial Register (NTR): NTR1894 on July 2nd 2009.

Physical activity as prognostic factor for bipolar disorder: An 18-month prospective study

INTRODUCTION

Exercise is an adjuvant therapy indicated for various psychiatric disorders. However, prospective studies in patients with bipolar disorder (BD) are scarce and with uncertain conclusions. This study aims to evaluate physical activity as a prognostic factor for BD, analyzing relationship with levels of anxiety, functionality, sleep, mood episodes and hospitalizations.

METHODS

Three psychiatrists interviewed 80 BD outpatients in euthymia, referred from four different institutions in Brazil. In this moment, they evaluated the intensity of physical activities using the International Physical Activity Questionnaire (IPAQ) - short form. They reevaluated patients and reviewed medical records monthly for 18 months to identify mood episodes and psychiatric hospitalizations.

RESULTS

Thirty-eight patients (47.5%) were physically inactive (or sedentary) and 42 (52.5%) active. Physically active patients had lower Body Mass Index (p = 0.006), waist circumference (p = 0.002), lower levels of anxiety (p = 0.032) and less insomnia (p = 0.001). Sedentary individuals revealed poorer global functioning (p < 0.001) and in all domains: autonomy (p < 0.001), occupational functioning (p = 0.008), cognitive functioning (p = 0.013), capacity of managing the finances (p = 0.012), interpersonal relationships (p = 0.011) and leisure time (p = 0.001). Less activity was associated with more mood episodes (p = 0.042) and psychiatric hospitalizations (p = 0.043) over 18 months.

CONCLUSION

This study suggested physical activity as a good prognostic factor for BD during euthymia. This reinforces the need to encourage this practice in clinical settings. Future prospective surveys with longer duration using objective instruments are proposed.

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

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.

Prediction of Depression Scores From Aerobic Fitness, Body Fatness, Physical Activity, and Vagal Indices in Non-exercising, Female Workers

Background: Depression is associated with a decreased cardiorespiratory fitness, and physical activity [PA] levels, higher rates of obesity, and dysfunction in autonomic control of heart rate [HR]. However, these parameters were mostly recorded with indirect methods. Thus, the aim of the current study was to investigate the relationships between depression scores and objective measures of body fatness, autonomic indices (i.e. HRV and HRR), cardiorespiratory fitness and PA levels; and subsequently to present the best predictive models of depression scores for this population, based on these variables. Methods: Thirty-five non-exercising women (26-43 years; maximal oxygen consumption [VO₂max] ~ 17.4-38.3 mL/kg/min) volunteered for participation in this study. All participants responded to the Beck Depression Inventory [DBI] and were evaluated for body mass index [BMI], percentage of body fat, sum of skinfolds, and VO₂max. Subsequently, over four consecutive days, an orthostatic test and a submaximal exercise on a cycle ergometer were performed to record HRV and HRR, respectively. In addition, incidental PA was recorded during 5 consecutive days using accelerometers. Results: depression scores were related to VO₂max (r = -0.446, p = 0.007) and the sum of skinfolds (r = 0.434, p = 0.009). Several stepwise multiple linear regression models were performed and only VO₂max was revealed as an independent predictor of the Beck scores (ß = -0.446, R ² = 0.199, p = 0.007). Conclusion: The present study revealed that VO₂max and the sum of skinfolds were moderately related to depression scores, while VO₂max was the only independent predictor of depression scores in female workers.

Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety

PURPOSE OF REVIEW

The purpose of this paper was to provide a comprehensive narrative review of the relationship between physical activity (PA) and anxiety and the rationale for including it as a treatment option for anxiety disorders. Several gaps in the literature are highlighted alongside recommendations for future research.

RECENT FINDINGS

PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing. Recent epidemiological data further suggests that people who are more active may be less likely to have anxiety disorders. In addition, evidence from systematic reviews of randomised control trials suggests that exercise training, a subset of PA, can reduce symptoms in anxiety and stress-related disorders, such as post-traumatic stress disorder, agoraphobia and panic disorder. Anxiety disorders are common, burdensome and costly to individuals and wider society. In addition to the profound negative impact on individuals' wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality. Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease. Given the combined anxiolytic and physical health benefits of increased activity, PA presents a promising additional treatment option for people with anxiety disorders. However, there remain key gaps in the literature regarding the mechanisms underlying the effects of PA, optimal PA protocols, methods of improving adherence and the importance of physical fitness. These must be addressed for PA to be successfully implemented in mental health services.

Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis

BACKGROUND

Cardiorespiratory fitness (CRF) among people with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, and major depressive disorder) is a critical clinical risk factor given its relationship to cardiovascular disease and premature mortality.

OBJECTIVES

This study aimed to: (1) investigate the mean CRF in people with SMI versus healthy controls; (2) explore moderators of CRF; and (3) investigate whether CRF improved with exercise interventions and establish if fitness improves more than body mass index following exercise interventions.

METHODS

Major electronic databases were searched systematically. A meta-analysis calculating Hedges' g statistic was undertaken.

RESULTS

Across 23 eligible studies, pooled mean CRF was 28.7 mL/kg/min [95 % confidence interval (CI) 27.3 to 30.0 mL/kg/min, p < 0.001, n = 980]. People with SMI had significantly lower CRF compared with controls (n = 310) (Hedges' g = -1.01, 95 % CI -1.18 to -0.85, p < 0.001). There were no differences between diagnostic subgroups. In a multivariate regression, first-episode (β = 6.6, 95 % CI 0.6-12.6) and inpatient (β = 5.3, 95 % CI 1.6-9.0) status were significant predictors of higher CRF. Exercise improved CRF (Hedges' g = 0.33, 95 % CI = 0.21-0.45, p = 0.001), but did not reduce body mass index. Higher CRF improvements were observed following interventions at high intensity, with higher frequency (at least three times per week) and supervised by qualified personnel (i.e., physiotherapists and exercise physiologists).

CONCLUSION

The multidisciplinary treatment of people with SMI should include a focus on improving fitness to reduce all-cause mortality. Qualified healthcare professionals supporting people with SMI in maintaining an active lifestyle should be included as part of multidisciplinary teams in mental health treatment.