Preliminary communication
Exercise and severe depression: Preliminary results of an add-on study

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Abstract

Background

Physical exercise has been extensively researched as a therapeutic option for treatment of major depression.

Methods

In a randomized controlled trial, we analyze the effects of aerobic physical exercise as an add-on strategy for treatment of severe depressed inpatients. The exercise has a “Dose” of 16.5 kcal/kg/week, three times a week during all the hospitalization.

Results

Our preliminary results show that there is no significant difference in scores of Hamilton in the second week between groups (Mean[SD] = 8.2[5.96] × 11.18[5.03], p = 0.192). However, there is a significant reduction in Hamilton scores of patients in exercise group at discharge (Mean[SD] = 5.93[4.46] × 9.45[3.56], p = 0.041). Regarding Quality of Life (QoL), no significant difference were found between groups in the second week in physical domain (Mean[SD] = 56.98[8.96] × 54.54[9.18], p = 0.511) and psychological domain (Mean[SD] = 50.88[13.88] × 42.04[12.42], p = 0.106). However, there is a significant difference in psychological domain (Mean[SD] = 55.88[9.92] v 41.66[13.04], p = 0.004) and a trend but no statistical significance in the physical (Mean[SD] = 58.80[9.14] × 52.12[8.70], p = 0.07) at discharge.

Limitations

Many patients receive different treatment strategies, like ECT (1 patient at exercise group × 3 at control group). Other limitation is the small number of participants included until this moment.

Conclusion

Our preliminary results suggest that physical exercise could be a feasible and effective add-on strategy for treatment of severe depressed inpatients, improving their depressive symptoms and QoL.

Introduction

Physical exercise has been extensively researched as a therapeutic option for major depression in the last decades. Some Meta-analyses have showed that physical exercise appears to be an effective intervention for treatment of light-to-moderate depression (Byrne and Byrne, 1993, Lawlor and Hopker, 2001, Mead et al., 2009, Rethorst et al., 2009), however little is known about their effects in severe major depression.

One recent study evaluated the effects of physical exercise on severe depressed inpatients and showed that 10 sessions of walking in a treadmill can reduce the depressive symptoms in these patients (Knubben et al., 2007). However, the sample was not composed exclusively by unipolar major depressed inpatients.

An important point is that depression, has a negative impact over Quality of Life (QoL) (Skevington and Wright, 2001). On the other hand, some studies have showed that physical exercise could have a positive impact over QoL of healthy individuals and in some clinical populations (Gillison et al., 2009). However, there is no study evaluating the effects of physical exercise as complementary strategy for the treatment of severe unipolar depressed inpatients.

In this study we examined the preliminary data of a randomized controlled trial with physical exercise as an add-on strategy for the conventional treatment of severe depressed inpatients and their effects over QoL.

Section snippets

Methods

Before initial assessments, patients were randomized into control or physical exercise group. After randomization, patients in control group receive conventional treatments (pharmacological and/or electroconvulsive therapy [ECT]) while patients in exercise group have to complete 16 kcal/kg/week at 3 sessions/week in association with conventional treatment.

To improve patient's adherence and make the exercise sessions more suitable, patients can choose the exercise (stationary bicycle, a treadmill

Assessments and outcomes

Diagnosis was evaluated through M.I.N.I. according to DSM-IV(American Psychiatry Association, 1994) criteria by a trained psychiatry at baseline. Depressive symptoms were assessed through Hamilton-17(Hamilton, 1967) by a trained psychiatry at baseline, second and at the hospital's exit. The estimate Vo2 max was assessed through Ebbeling sub-maximal test(Ebbeling et al., 1991) at baseline by a trained staff. QoL was assessed through The WHOQOL BREF (The WHOQOL GROUP (1995)) at baseline, second

Inclusion and exclusion criteria

Patients were selected through the following inclusion criteria: (A) Diagnosis of Major Depressive Disorder according to M.I.N.I (DSM-IV) criteria American Psychiatry Association (1994); (B) score of 25 or more on Hamilton-17 (Hamilton, 1967), (C) not being involved in other physical activity programs during the hospitalization, (D) aged between 18 and 60 years; (E) being able to read, understand, and provide written informed consent.

Patients were excluded if they (A) have three or more

Sample size and statistical analysis

To detect a difference of 1 SD between groups with power of 90% and α = 0.05, at least 23 patients are needed in each group according to software PEPI version 4.0.

Differences between groups were evaluated with Student T test for independent samples and changes in the time were analyzed with ANOVA. A value of p < 0.05 was considered significant. Statistical analyses were performed with software SPSS version 16.0.

Characteristics of participants

Twenty-six severe depressed inpatients were included in the study until now.

There were no differences between groups in age, gender, weight and height (Table 1), baseline scores of Hamilton, physical, social relationship and environmental domain of WHOQOL-BREF. A statistical significant difference was found in psychological domain (Table 1).

Dropouts and acceptability

Until now there were no dropouts. However, 14 of 40 invited patients were not interested in participate in the study.

Depression

When compared to baseline scores means,

Discussion

Our preliminary results suggest that adding physical exercise to conventional treatment of severe depressed inpatients could be a feasible and effective strategy to relief depressive symptoms and improve QoL.

Our results corroborate with Knubben et al. (2007) study, which have showed that aerobics exercises could be an effective complementary strategy for the treatment of severe bipolar and unipolar depressed and dysthymic inpatients. However, our study is the first to evaluate exclusively

Conclusion

Based on these preliminary results, physical exercise could be a plausible and safe intervention. Apparently, adding physical exercise in the treatment of severe depressed inpatients brings therapeutic benefits diminishing the depressive symptoms and improving QoL, especially at physical and psychological domain.

Role of funding source

This work was supported by FIPE-HCPA(Fundo de incentivo à pesquisa do Hospital de Clinicas de Porto Alegre).

Conflict of interest

The authors declare no conflict of interest.

Acknowledgements

Thanks to the research group and graduate degree from the University Hospital of Porto Alegre for their financial support (FIPE).

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