Self-selected intensity exercise in the treatment of major depression: A pragmatic RCT

Abstract

Objective. The purpose of the study was to determine the therapeutic effect of physical exercise for patients with unipolar depression. Participants took part in an 8-week walking/running aerobic exercise program at a local sports club. Methods. Forty-six outpatients aged 18–65 years and diagnosed with mild to severe depression (ICD-10 criteria) were randomly assigned to an intervention group or wait list. Treatment as usual was continued. The Hamilton Rating Scale for Depression (HRSD-17) served as the main outcome measure. Secondary outcome measures were Beck Depression Inventory (BDI-II), Fitness Index (FI), and VO₂ max as estimated by Urho Kaleka Kekkonen or UKK 2-km Walk Test. Results. Out of forty-six participants, 24% dropped out. Participants attended 58% of exercise sessions. All randomized participants were included in intention-to-treat (ITT) analysis. Analysis of covariance or ANCOVA showed a large reduction of depressive symptoms in HRSD-17 scores (Cohen's d: 1.8; mean change 8.2, p < .0001). BDI-II (Cohen's d: 0.50; mean change: 4.7, p = 0.09), FI scores (Cohen's d: 0.27; mean change: 5.3, p = 0.08), and VO₂ max did not change significantly. Conclusions. We observed a large and clinically significant change in HRSD-17 scores. Moderate changes in BDI-II scores without clinical significance and small changes in physical fitness assessments were observed.

Key words::

• Aerobic exercise
• depression
• non-clinical population
• intervention vs. wait list
• pragmatic RCT

Acknowledgements

We are grateful for the Robert Enke Foundation's financial support. We would like to thank all coaches and President Rolf Jaegersberg of the Sports Club VfL Eintracht Hannover for their support of this intervention study, as well as all sports students who helped conduct the UKK Walk Tests. Finally, we wish to thank all participants.

Disclosure of interests

None to declare.

Source of funding

The Robert Enke Foundation (Robert Enke Stiftung) funded this study with a grant of 12400 €.