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Reis YA, Akay A, Aktan B, Tetik S, Fıratlıgil FB, Kayıkçıoğlu F. The Effect of Clinical Pilates Exercises and Prenatal Education on Maternal and Fetal Health. Z Geburtshilfe Neonatol 2023; 227:354-363. [PMID: 37473767 DOI: 10.1055/a-2096-6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The mental, physical and sexual health of women as well as maternal and fetal health should be considered during the prenatal and postnatal periods. Investigating the effect of clinical Pilates exercises and prenatal education (CPE & PE) on obstetric and neonatal outcomes as well as the mental, physical, and sexual health of women was intended. METHODS In the second trimester, mothers with singleton pregnancies who attended (n=79, study group) or did not attend (n=80, control group) CPE & PR were recruited to this prospective cohort study, and were evaluated in the prenatal and postnatal periods. Depression was assessed with Beck Depression Inventory (BDI), sexual functions with Female Sexual Function Index (FSFI), muscle strength with Gross Muscle Scales (GMS), and labor pain with Visual Analogue Scale (VAS). In addition, the presence of low back pain (LBP) was questioned. RESULTS No significant association of CPE & PE with obstetric outcomes such as cesarean rates, preterm birth, and neonatal outcomes such as birth weight and Apgar scores were identified. Changes in VAS scores, the incidence of perineal trauma, and episiotomy were not associated with CPE & PE. However, CPE & PE was associated with lower BDI scores, a gradual increase in the total scores of FSFI, increased GMS, and reduced LBP. CONCLUSION CPE & PE had no adverse effects on obstetric and neonatal outcomes and was associated with improved mental, physical, sexual health scores during pregnancy and postpartum.
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Affiliation(s)
- Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Arife Akay
- Department of Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Berrin Aktan
- Physiotherapist, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Sinan Tetik
- Psychologist, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Fulya Kayıkçıoğlu
- Department of Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
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Straeten FA, van Zyl S, Maus B, Bauer J, Raum H, Gross CC, Bruchmann S, Landmeyer NC, Faber C, Minnerup J, Schmidt-Pogoda A. EXERTION: a pilot trial on the effect of aerobic, smartwatch-controlled exercise on stroke recovery: effects on motor function, structural repair, cognition, mental well-being, and the immune system. Neurol Res Pract 2023; 5:18. [PMID: 37170385 PMCID: PMC10173484 DOI: 10.1186/s42466-023-00244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Motor impairments are the objectively most striking sequelae after stroke, but non-motor consequences represent a high burden for stroke survivors as well. Depression is reported in one third of patients, the fatigue prevalence ranges from 23 to 75% due to heterogenous definitions and assessments. Cognitive impairment is found in one third of stroke patients 3-12 months after stroke and the risk for dementia is doubled by the event. Aerobic exercise has been shown to reduce depressive symptoms, counteract fatigue, and improve cognitive functions in non-stroke patients. Furthermore, exercise is known to strengthen the immune system. It is unknown, though, if aerobic exercise can counteract poststroke depression, fatigue, poststroke dementia and poststroke immunosuppression. Therefore, we aim to analyse the effect of aerobic exercise on functional recovery, cognition, emotional well-being, and the immune system. Reorganization of topological networks of the brain shall be visualized by diffusion MRI fibre tracking. METHODS Adults with mild to moderate stroke impairment (initial NIHSS or NIHSS determined at the moment of maximal deterioration 1-18) are recruited within two weeks of stroke onset. Study participants must be able to walk independently without risk of falling. All patients are equipped with wearable devices (smartwatches) measuring the heart rate and daily step count. The optimal heart rate zone is determined by lactate ergometry at baseline. Patients are randomized to the control or the intervention group, the latter performing a heart rate-controlled walking training on own initiative 5 times a week for 45 min. All patients receive medical care and stroke rehabilitation to the usual standard of care. The following assessments are conducted at baseline and after 90 days: Fugl Meyer-assessment for the upper and lower extremity, 6 min-walk test, neuropsychological assessment (cognition: MoCA, SDMT; fatigue and depression: FSMC, HADS-D, participation: WHODAS 2.0 12-items), blood testing (i.e. immune profiling to obtain insights into phenotype and functional features of distinct immune-cell subsets) and cranial magnetic resonance imaging (MRI) with grid-sampled diffusion weighted imaging, white matter fibre tracking and MR spectroscopy. PERSPECTIVE This study investigates the effect of smartwatch-controlled aerobic exercise on functional recovery, cognition, emotional well-being, the immune system, and neuronal network reorganization in stroke patients. Trial registration ClinicalTrials.gov NCT Number: NCT05690165. First posted19 January 2023. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05690165.
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Affiliation(s)
- Frederike A Straeten
- Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany
| | - Stephanie van Zyl
- Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany
| | - Bastian Maus
- Translational Research Imaging Center, University of Münster, Münster, Germany
- Clinic of Radiology, University Hospital Münster, University of Münster, Münster, Germany
| | - Jochen Bauer
- Translational Research Imaging Center, University of Münster, Münster, Germany
- Clinic of Radiology, University Hospital Münster, University of Münster, Münster, Germany
| | - Heiner Raum
- Translational Research Imaging Center, University of Münster, Münster, Germany
- Clinic of Radiology, University Hospital Münster, University of Münster, Münster, Germany
| | - Catharina C Gross
- Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany
| | - Sabine Bruchmann
- Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany
| | - Nils C Landmeyer
- Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany
| | - Cornelius Faber
- Translational Research Imaging Center, University of Münster, Münster, Germany
- Clinic of Radiology, University Hospital Münster, University of Münster, Münster, Germany
| | - Jens Minnerup
- Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany
| | - Antje Schmidt-Pogoda
- Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany.
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Thaller L, Frühauf A, Heimbeck A, Voderholzer U, Kopp M. A Comparison of Acute Effects of Climbing Therapy with Nordic Walking for Inpatient Adults with Mental Health Disorder: A Clinical Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116767. [PMID: 35682348 PMCID: PMC9180369 DOI: 10.3390/ijerph19116767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
As climbing therapy is increasingly used for mental health disorders, the present study aimed to compare acute effects of a therapeutic climbing intervention (CT) on affective responses, anxiety, and self-efficacy with those of Nordic walking (NW) and a sedentary control condition (SC) in an inpatient setting with persons with depression, anxiety, or obsessive−compulsive disorders. A total of 21 inpatients (32 ± 12.2 years) participated in a clinical trial in all interventions using an experimental within-subject design. Anxiety and self-efficacy were assessed preintervention (t0) and postintervention (t2) using the State-Trait Anxiety Inventory and the General Self-Efficacy Scale, and affective responses were additionally evaluated during (t1) and 180 min after the intervention (t3) using the Feeling Scale, Felt Arousal Scale, and Positive and Negative Affect Schedule. Statistical evaluation was performed with a 3 × 2 or 3 × 4 repeated measures ANOVA. Significant interaction effects were found for affective responses regarding positive affect, affective valence, and perceived activation (p < 0.015) favoring CT over NW and SC. For anxiety, a significant interaction effect was found (F(2.40) = 6.603; p = 0.003; η2 = 0.248), and also perceived self-efficacy increased significantly (F(2.40) = 6.046; p = 0.005; η2 = 0.232). Single CT sessions may enhance affective responses and self-efficacy and reduce anxiety in inpatients with mental health disorders to a higher extent than NW. CT as part of an inpatient therapy program may help to improve key affective mechanisms and should be further studied in comparison with other exercise interventions with comparable intensity.
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Affiliation(s)
- Lisa Thaller
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
- Correspondence: ; Tel.: +49-151-20702742
| | - Anika Frühauf
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
| | - Alexander Heimbeck
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), 80336 Munich, Germany
| | - Martin Kopp
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
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van Zutphen EM, Kok AAL, Rhebergen D, Huisman M, Beekman ATF. The joint effects of clinically relevant depressive symptoms and cardiovascular risk factors on incident cardiovascular disease among older adults in the community. J Psychosom Res 2021; 149:110572. [PMID: 34332270 DOI: 10.1016/j.jpsychores.2021.110572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine if there is a synergistic effect between clinically relevant depressive symptoms and cardiovascular risk factors that disproportionately increases the risk of cardiovascular disease (CVD) among older adults with depressive symptoms. METHODS Data were obtained from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study. N = 3091 respondents with up to seven years of follow-up were included. Incident CVD was based on self-report, medication use, general practitioners' diagnoses and causes of death. A score of ≥16 points on the Center for Epidemiological Studies Depression Scale indicated clinically relevant depressive symptoms. Risk factors included were sex, education, obesity, smoking, alcohol use, physical inactivity and diabetes mellitus. Data were analysed with Cox regression models. Measures of multiplicative and additive interaction were calculated to determine if the presence of both depressive symptoms and a risk factor amplified the risk of CVD. RESULTS Of all participants, 12.6% had clinically relevant depressive symptoms and, after a median follow-up of six years, 15.7% developed CVD. Only the additive interaction between physical inactivity and depressive symptoms was statistically significant and explained 40.6% of the CVD risk among inactive persons with depressive symptoms. CONCLUSION In the general population, we did not detect synergistic effects for most risk factors. However, older adults with clinically relevant depressive symptoms and a physically inactive lifestyle appeared to be at a particularly high risk to develop CVD and may represent an important target for cardiovascular prevention.
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Affiliation(s)
- Elisabeth M van Zutphen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.
| | - Almar A L Kok
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Didericke Rhebergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Mental Health Care Institute GGZ Centraal, Amersfoort, the Netherlands.
| | - Martijn Huisman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands.
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.
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Sampasa-Kanyinga H, Colman I, Dumuid D, Janssen I, Goldfield GS, Wang JL, Patte KA, Leatherdale ST, Chaput JP. Longitudinal association between movement behaviours and depressive symptoms among adolescents using compositional data analysis. PLoS One 2021; 16:e0256867. [PMID: 34469485 PMCID: PMC8409652 DOI: 10.1371/journal.pone.0256867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/17/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Research examining the associations between movement behaviours and mental health indicators within a compositional framework are sparse and limited by their cross-sectional study design. This study has three objectives. First, to describe the change in movement behaviour composition over time. Second, to explore the association between change in movement behaviour composition and change in depressive symptoms. Third, to explore how reallocations of time between movement behaviours are associated with changes in depressive symptoms. METHODS Longitudinal data of 14,620 students in grades 9-12 (mean age: 14.9 years) attending secondary schools in Canada (Ontario, British Columbia, Alberta, Quebec) were obtained from two waves (2017/18, 2018/19) of the COMPASS study. Moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep duration were self-reported. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (Revised)-10 (CESD-R-10). Compositional data analyses using pivot coordinates and compositional isotemporal substitution for longitudinal data were used to analyse the data. Analyses accounted for school clustering, were stratified by gender and age (< or ≥ 15 years), and were adjusted for race/ethnicity, body mass index z-score, baseline movement behaviour composition, and baseline depressive symptoms. RESULTS There were significant differences in movement behaviour composition over time across all subgroups. For example, the relative contributions of MVPA and sleep duration to the movement behaviour composition decreased over time while screen time increased among younger boys and girls and older girls. Increasing sleep duration relative to the remaining behaviours (i.e. screen time and MVPA) was associated with lower depressive symptoms among all subgroups. Increasing screen time relative to the remaining behaviours (i.e. MVPA and sleep duration) was associated with higher depressive symptoms among all subgroups. Increasing MVPA relative to the remaining behaviours (i.e. screen time and sleep duration) was associated with lower depressive symptoms in older girls only. Isotemporal substitution estimates indicated that decreasing screen time by 60 minutes/day and replacing that time with 60 minutes of additional sleep is associated with the largest change in depressive symptoms across all subgroups. CONCLUSIONS Findings from this prospective analysis suggest that increased sleep duration and reduced screen time are important determinants of lower depressive symptoms among adolescents.
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Affiliation(s)
- Hugues Sampasa-Kanyinga
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Dorothea Dumuid
- Allied Health & Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Gary S. Goldfield
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jian Li Wang
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Karen A. Patte
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, Niagara Region, St. Catharines, Ontario, Canada
| | - Scott T. Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jean-Philippe Chaput
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Krämer LV, Eschrig N, Keinhorst L, Schöchlin L, Stephan L, Stiene M, Bengel J. Effectiveness of a psychological online training to promote physical activity among students: protocol of a randomized-controlled trial. Trials 2021; 22:409. [PMID: 34154637 PMCID: PMC8218437 DOI: 10.1186/s13063-021-05333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background Many students in Germany do not meet recommended amounts of physical activity. In order to promote physical activity in students, web-based interventions are increasingly implemented. Yet, data on effectiveness of web-based interventions in university students is low. Our study aims at investigating a web-based intervention for students. The intervention is based on the Health Action Process Approach (HAPA), which discriminates between processes of intention formation (motivational processes) and processes of intention implementation (volitional processes). Primary outcome is change in physical activity; secondary outcomes are motivational and volitional variables as proposed by the HAPA as well as quality of life and depressive symptoms. Methods A two-armed randomized controlled trial (RCT) of parallel design is conducted. Participants are recruited via the internet platform StudiCare (www.studicare.com). After the baseline assessment (t1), participants are randomized to either intervention group (immediate access to web-based intervention) or control group (access only after follow-up assessment). Four weeks later, post-assessment (t2) is performed in both groups followed by a follow-up assessment (t3) 3 months later. Assessments take place online. Main outcome analyses will follow an intention-to-treat principle by including all randomized participants into the analyses. Outcomes will be analysed using a linear mixed model, assuming data are missing at random. The mixed model will include group, time, and the interaction of group and time as fixed effects and participant and university as random effect. Discussion This study is a high-quality RCT with three assessment points and intention-to-treat analysis meeting the state-of-the-art of effectiveness studies. Recruitment covers almost 20 universities in three countries, leading to high external validity. The results of this study will be of great relevance for student health campaigns, as they reflect the effectiveness of self-help interventions for young adults with regard to behaviour change as well as motivational and volitional determinants. From a lifespan perspective, it is important to help students find their way into regular physical activity. Trial registration The German clinical trials register (DRKS) DRKS00016889. Registered on 28 February 2019
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Affiliation(s)
- Lena Violetta Krämer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.
| | - Nadine Eschrig
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Lena Keinhorst
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Luisa Schöchlin
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Lisa Stephan
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Malin Stiene
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
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Wunram HL, Oberste M, Hamacher S, Neufang S, Grote N, Krischer MK, Bloch W, Schönau E, Bender S, Fricke O. Immunological Effects of an Add-On Physical Exercise Therapy in Depressed Adolescents and Its Interplay with Depression Severity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6527. [PMID: 34204400 PMCID: PMC8296386 DOI: 10.3390/ijerph18126527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pro-inflammatory cytokines (PICs) have gained attention in the pathophysiology and treatment of depressive disorders. At the same time, the therapeutic effect of physical activity seems to work via immunomodulatory pathways. The interventional study "Mood Vibes" analyzed the influence of exercise on depression severity (primary endpoint) in depressive adolescents; the influence of PICs on the clinical outcome was analyzed as a secondary endpoint. METHODS Clinically diagnosed depressed adolescents (N = 64; 28.1% male; mean age = 15.9; mean BMI = 24.6) were included and participated either in Whole Body Vibration (WBV) (n = 21) or bicycle ergometer training (n = 20) in addition to treatment-as-usual (TAU). Patients in the control treatment group received TAU only (n = 23). The PICs (interleukin-6-IL-6 and tumor necrosis factor-α-TNF-α) were analyzed before intervention, after 6 weeks of training (t1), and 8 weeks post-intervention (t2). The effects of the treatment on depression severity were rated by self-rating "Depression Inventory for Children and Adolescents" (DIKJ). RESULTS Basal IL-6 decreased in all groups from t0 to t1, but it increased again in WBV and controls at t2. TNF-α diminished in ergometer and controls from baseline to t1. PIC levels showed no correlation with depression severity at baseline. The influence on DIKJ scores over time was significant for IL-6 in the WBV group (p = 0.008). Sex had an impact on TNF-α (p < 0.001), with higher concentrations in male patients. Higher body mass index was associated with higher IL-6 concentrations over all measurement points (p < 0.001). CONCLUSIONS The positive effects of an intensive add-on exercise therapy on adolescent depression seem to be partly influenced by immunomodulation. A small sample size and non-randomized controls are limitations of this study.
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Affiliation(s)
- Heidrun Lioba Wunram
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, 50937 Cologne, Germany; (M.O.); (S.H.)
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, 50937 Cologne, Germany; (M.O.); (S.H.)
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, 40225 Düsseldorf, Germany;
| | - Nils Grote
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Maya Kristina Krischer
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Wilhelm Bloch
- Institute of Movement and Neuroscience, German Sport University Cologne, 50933 Cologne, Germany;
| | - Eckhard Schönau
- Children’s Hospital, University Hospital of Cologne & UniReha, University Hospital of Cologne, 50933 Cologne, Germany;
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Oliver Fricke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Gemeinschaftskrankenhaus Herdecke & Chair of Child and Adolescent Psychiatry, Witten/Herdecke University, 58313 Witten/Herdecke, Germany;
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Abstract
Most psychiatric care is delivered in primary care settings, where depression is the most common presenting psychiatric symptom. Given the high prevalence of depression worldwide and the well-established consequences of untreated depression, the ability of primary care clinicians to effectively diagnose and treat it is critically important. This article offers up-to-date guidance for the diagnosis and treatment of major depressive disorder, including practical considerations for delivering optimal and efficient care for these patients.
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Affiliation(s)
| | - Bryan Shapiro
- University of California, Irvine, Irvine, California
| | - Jody Rawles
- University of California, Irvine, Irvine, California
| | - John Luo
- University of California, Irvine, Irvine, California
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Zhou S, Zhao K, Shi X, Sun H, Du S, Miao X, Chen J, Yang F, Xing M, Ran W, Lao J, Zhang X, Wang W, Tang W. Serum Lipid Levels and Suicide Attempts Within 2 Weeks in Patients With Major Depressive Disorder: Is There a Relationship? Front Psychiatry 2021; 12:676040. [PMID: 34163387 PMCID: PMC8215165 DOI: 10.3389/fpsyt.2021.676040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
The potential correlation between serum lipid profiles and suicidal tendencies has been previously reported, however, it is unclear whether serum lipid profiles have definite relevance to recently attempted suicides in individuals suffering from major depressive disorder (MDD). In this study, the relationship between blood lipids and suicide attempts in first-episode MDD patients in research were used to examine whether there is a connection. The cross-sectional study recruited 580 patients at the time of their first episode, measuring up to the diagnostic standard of MDD. Baseline demographic, clinical data, and blood lipid level data were collected. Depression severity was measured with the Hamilton Depression Rating Scale (HAMD). Our results revealed that the level of TC may be identified as a promising and effective biomarker for first-episode MDD suicide risk, suggesting that screening of serum lipid profiles in depressive patients is essential for suicide prevention.
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Affiliation(s)
- Siyao Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xiang Shi
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Huankun Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Siyu Du
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xuemeng Miao
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jianjun Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Fan Yang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Minzhi Xing
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wang Ran
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jiaying Lao
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xiangyang Zhang
- Chinese Academy of Science Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wei Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wei Tang
- The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China
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Schmitter M, Spijker J, Smit F, Tendolkar I, Derksen AM, Oostelbos P, Wijnen BFM, van Doesum TJ, Smits JAJ, Vrijsen JN. Exercise enhances: study protocol of a randomized controlled trial on aerobic exercise as depression treatment augmentation. BMC Psychiatry 2020; 20:585. [PMID: 33298013 PMCID: PMC7724825 DOI: 10.1186/s12888-020-02989-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
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).
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Affiliation(s)
- Michèle Schmitter
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands. .,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Jan Spijker
- grid.491369.00000 0004 0466 1666Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Filip Smit
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Biostatistics & Department of Clinical Psychology, Amsterdam Public Health Research Institute, University Medical Centers Amsterdam (location VUmc), Amsterdam, The Netherlands
| | - Indira Tendolkar
- grid.5590.90000000122931605Department of Psychiatry, Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Peter Oostelbos
- grid.491119.5Dutch Depression Association, Amersfoort, The Netherlands and De Hartenboom, Randwijk, The Netherlands
| | - Ben F. M. Wijnen
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tessa J. van Doesum
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Jasper A. J. Smits
- grid.89336.370000 0004 1936 9924Department of Psychology & Institute for Mental Health Research, University of Texas at Austin, Austin, TX USA
| | - Janna N. Vrijsen
- grid.491369.00000 0004 0466 1666Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Department of Psychiatry, Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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M Abd El-Kader S, H Al-Jiffri O. Aerobic exercise affects sleep, psychological wellbeing and immune system parameters among subjects with chronic primary insomnia. Afr Health Sci 2020; 20:1761-1769. [PMID: 34394237 PMCID: PMC8351861 DOI: 10.4314/ahs.v20i4.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic primary insomnia is characterized by long-term difficulties in maintaining and initiating sleep, too early waking up, poor mood, fatigue, impaired concentration and poor quality of life. Exercise training is recommended to prevent and alleviate sleep disorders. OBJECTIVE The aim of the study was to investigate the influence of aerobic exercise training on quality of sleep, psychological wellbeing and immune system among subjects with chronic primary insomnia. MATERIAL AND METHODS Eighty previously sedentary subjects with chronic primary insomnia subjects enrolled in this study, their age ranged from 35-56 years. All participants were randomly assigned to supervised aerobic exercise intervention group (group A, n=40) or control group (group B, n=40). Polysomnographic recordings for sleep quality assessment, Beck Depression Inventory (BDI), Profile of Mood States(POMS), Rosenberg Self-Esteem Scale (RSES), number of CD3+, CD4+, CD8+ T cells count and CD4/CD8 ratio were measured before and at the end of the study after six months. RESULTS There was a significant increase in the total sleep duration, sleep efficiency and sleep onset latency in group(A) after six months of aerobic exercise training, while, wake time after sleep onset and rapid eye movement (REM) latency significantly reduced after six months of aerobic training compared with values obtained prior to aerobic exercise training. Also, the mean values of BDI, POMS, CD3 count, CD4 count and CD8 count decreased significantly and the mean value of RSES significantly increased in group (A) after the aerobic exercise training, while the results of the control group were not significant. Moreover, there were significant differences between both groups at the end of the study. CONCLUSION Exercise training can be considered as a non-pharmacological modalty for modifying sleep quality, psychological wellbeing and immune system among subjects with chronic primary insomnia.
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12
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Naumann J, Kruza I, Denkel L, Kienle G, Huber R. Effects and feasibility of hyperthermic baths in comparison to exercise as add-on treatment to usual care in depression: a randomised, controlled pilot study. BMC Psychiatry 2020; 20:536. [PMID: 33176757 PMCID: PMC7661265 DOI: 10.1186/s12888-020-02941-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Limitations of current therapy of depression highlight the need for an immediately available, easily implementable add-on treatment option with high acceptance from patients. Hyperthermic baths (HTB) are a form of balneotherapy with head-out-of-water-immersion in a hot pool or tub at 40 °C for 15-20 min. A prior study suggests that HTB added to usual depression care can have antidepressant effects. METHOD Single-site, open-label randomised controlled 8-week parallel-group pilot study at a university outpatient clinic. 45 medically stable outpatients with moderate depression as determined by the 17-item Hamilton Depression Rating Scale (HAM-D) score ≥ 18 and a score ≥ 2 on item 1 (Depressed Mood) were recruited. They were randomised to twice weekly HTB (n = 22) or a physical exercise program (PEP) of moderate intensity (n = 23). Primary outcome measure was the change in HAM-D total score from baseline (T0) to the 2-week time point (T1). Linear regression analyses, adjusted for baseline values, were performed to estimate intervention effects on an intention-to-treat (ITT) and per-protocol (PP) principle. RESULTS Forty-five patients (HTB n = 22; PEP n = 23) were analyzed according to ITT (mean age = 48.4 years, SD = 11.3, mean HAM-D score = 21.7, SD = 3.2). Baseline-adjusted mean difference after 2 weeks was 4.3 points in the HAM-D score in favor of HTB (p < 0.001). Compliance with the intervention and follow-up was far better in the HTB group (2 vs 13 dropouts). Per protocol analysis only showed superiority of HTB as a trend (p = 0.068). There were no treatment-related serious adverse events. Main limitation: the number of dropouts in the PEP group (13 of 23) was higher than in other trials investigating exercise in depression. Due to the high number of dropouts the effect in the ITT-analysis may be overestimated. CONCLUSIONS HTB added to usual care may be a fast-acting, safe and easy accessible method leading to clinically relevant improvement in depression severity after 2 weeks; it is also suitable for persons who have problems performing exercise training. TRIAL REGISTRATION German Clinical Trials Register (DRKS) with the registration number DRKS00011013 (registration date 2016-09-19) before onset of the study.
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Affiliation(s)
- Johannes Naumann
- European Institute for Physical Therapy and Balneology, Freiburg, Germany
| | - Iris Kruza
- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Luisa Denkel
- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Gunver Kienle
- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Roman Huber
- University of Freiburg, Faculty of Medicine, Freiburg, Germany.
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13
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Yekrang Safakar M, Hrabok M, Urichuk L, Juhas M, Shalaby R, Parmar D, Chue P, Snaterse M, Mason J, Tchida D, Kelland J, Coulson P, Sosdjan D, Brown J, Hay K, Lesage D, Paulsen L, Delday A, Duiker S, Surood S, Abba-Aji A, Agyapong VIO. Effectiveness of Group Cognitive Behavioral Therapy and Exercise in the Management of Major Depressive Disorder: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e14309. [PMID: 32449684 PMCID: PMC7281203 DOI: 10.2196/14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite evidence in scientific literature indicating the effectiveness of both cognitive behavioral therapy (CBT) and physical exercise in the management of major depressive disorder (MDD), few studies have directly compared them. OBJECTIVE This study aims to evaluate and compare the effectiveness of group CBT, physical exercise, and only wait-listing to receive treatment-as-usual (TAU) in the management of MDD. The investigators hypothesize that participants with MDD assigned to the group CBT or exercise arms of the study will achieve superior outcomes compared with participants wait-listed to receive TAU only. METHODS This prospective rater-blinded randomized controlled trial assesses the benefits of group CBT and exercise for participants with MDD. A total of 120 patients with MDD referred to addiction and mental health clinics in Edmonton, Canada, will be randomly assigned to one of the three equal-sized arms of the study to receive either weekly sessions of group CBT plus TAU, group exercise three times a week plus TAU, or only TAU for 14 weeks. Participants will be assessed at enrollment, 3 and 6 months post enrollment, midtreatment, and upon treatment completion for primary (functional and symptom variables) and secondary outcomes (service variables and health care utilization). In addition, participants in the intervention groups would be evaluated weekly with one functional measure. The data will be analyzed using repeated measures and effect size analyses, and correlational analyses will be completed between measures at each time point. RESULTS The study will be conducted in accordance with the Declaration of Helsinki (Hong Kong amendment) and Good Clinical Practice (Canadian guidelines). Written informed consent will be obtained from each subject. The study received ethical clearance from the Health Ethics Research Board of the University of Alberta on September 7, 2018 (Pro 00080975) and operational approval from the provincial health authority (Alberta Health Services 43638). As of October 13, 2019, we have enrolled 32 participants. The results will be disseminated at several levels, including patients, practitioners, academics, researchers, and health care organizations. CONCLUSIONS The results of the pilot trial may inform the implementation of a multicenter clinical trial and provide useful information for administrators and clinicians who are interested in incorporating group CBT and group exercise interventions into existing care. TRIAL REGISTRATION ClinicalTrials.gov NCT03731728; https://clinicaltrials.gov/ct2/show/NCT03731728. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/14309.
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Affiliation(s)
| | - Marianne Hrabok
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Liana Urichuk
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Michal Juhas
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Devashree Parmar
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Pierre Chue
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Mark Snaterse
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Judith Mason
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Donna Tchida
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Jill Kelland
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Pamela Coulson
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Daniella Sosdjan
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Jason Brown
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Katherine Hay
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Deanna Lesage
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Lacey Paulsen
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Amy Delday
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Sherianna Duiker
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Adam Abba-Aji
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Reduction in physical activity significantly increases depression and anxiety in the perinatal period: a longitudinal study based on a self-report digital assessment tool. Arch Gynecol Obstet 2020; 302:53-64. [PMID: 32372342 DOI: 10.1007/s00404-020-05570-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/25/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Physical activity can reduce pregnancy-related complications and contributes substantially to improving maternal mental health. A reduction in activity encompassing exercise and daily household tasks throughout the course of pregnancy increases the risk of depression and anxiety. The following research examines the longitudinal interaction between exercise, general physical activity, and mental health outcomes in pregnant women. METHODS This prospective longitudinal study was conducted at the maternity departments of two major university hospitals in Germany. Self-reported data of 597 women were digitally assessed every 4 weeks from the second trimester until birth as well as 3 and 6 months postnatally. Depressive and anxiety symptoms were assessed using the EPDS, PRAQ, and STAI and physical activity levels were measured using the PPAQ questionnaire. Cross-sectional and longitudinal analyses using Pearson's correlation coefficient and multiple regression models were conducted. RESULTS We found a significant reduction in general physical activity in the period from the 20th to 32nd gestational week. Women who reported a greater decline during pregnancy showed significantly higher depression and anxiety scores. In stratified analyses, only baseline mental health scores proved to be variables with stronger impact on postnatal depression and anxiety outcomes. CONCLUSION General physical activity and maternal mental health significantly influence each other during and after pregnancy. Both physical activity and the prevention of perinatal mental disorders should be systematically encouraged during perinatal care to prevent adverse maternal and fetal birth outcomes.
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15
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Uebelacker LA, Sillice MA, Epstein-Lubow G, Battle CL, Anderson B, Caviness C, Miller IW, Abrantes AM. Combined intervention approaches for initiating and maintaining physical activity in depressed individuals: design and rationale of the Project MOVE randomized clinical trial. Contemp Clin Trials 2020; 91:105974. [PMID: 32151752 PMCID: PMC8017446 DOI: 10.1016/j.cct.2020.105974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Regular engagement in physical activity decreases risks for many chronic conditions, and may also improve depression symptoms. However, rates of physical activity and adherence to exercise interventions remain low among depressed individuals relative to non-depressed individuals. METHODS This is a study protocol for Project MOVE. This study is a theoretically-driven, 3-arm randomized controlled trial for increasing physical activity with depressed adults. Each successive arm includes an added component that may serve to increase and maintain physical activity. The arms are: 1) Brief advice (BA) to exercise alone (minimal treatment control condition); 2) BA + supervised and home-based exercise (SHE) + health education (HE; serves as contact control for CBEX); and 3) BA + SHE +cognitive-behavioral sessions focused on increasing and maintaining exercise (CBEX). The target sample size is 240. Assessments are conducted at baseline, Month 1.5, end of intervention (month 3), and at 6 and 9 months. The primary outcome is minutes of moderate-to-vigorous physical activity, assessed via an accelerometer. Secondary outcomes include cardiorespiratory fitness, body composition, and depression, and maintenance of moderate-vigorous physical activity through 6 and 9 month follow-ups. Mediators and moderators derived from behavior change theories, including the Health Behavior Model, Self-Determination Theory, and Social Ecological Theory, will be examined. CONCLUSION Project MOVE is designed to test primarily whether both a structured exercise program (SHE) and a cognitive-behavioral group (CBEX) increase physical activity in depressed adults during both a 3-month intervention period, and during the 6-months that follow.
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Affiliation(s)
- Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI, USA
| | - Marie A Sillice
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI, USA; Behavioral Medicine & Addiction Research, Butler Hospital, Providen,ce, RI, USA.
| | - Gary Epstein-Lubow
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA; Department of Health Services, Policy and Practice of Brown University, Providence, RI, USA
| | - Cynthia L Battle
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI, USA; Center for Women's Behavioral Health, Women & Infants' Hospital of Rhode Island, Providence, RI, USA
| | - Bradley Anderson
- Behavioral Medicine & Addiction Research, Butler Hospital, Providen,ce, RI, USA
| | - Celeste Caviness
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine & Addiction Research, Butler Hospital, Providen,ce, RI, USA
| | - Ivan W Miller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine & Addiction Research, Butler Hospital, Providen,ce, RI, USA
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Karg N, Dorscht L, Kornhuber J, Luttenberger K. Bouldering psychotherapy is more effective in the treatment of depression than physical exercise alone: results of a multicentre randomised controlled intervention study. BMC Psychiatry 2020; 20:116. [PMID: 32164679 PMCID: PMC7066840 DOI: 10.1186/s12888-020-02518-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/26/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent scientific studies have suggested that climbing/bouldering is effective in alleviating depression when the comparison group was a waitlist control group, even when physical activity and other therapeutic approaches were controlled for. In the present study, we aimed to investigate the effectiveness of a manualised psychotherapeutic bouldering intervention for depressed individuals, compared with an active control group performing physical exercise alone. METHODS In a multicentre randomised controlled intervention trial, 133 outpatients with depression were assigned to either a bouldering psychotherapy (BPT) group or a home-based supervised exercise programme (EP). Severity of depression as the primary outcome was assessed at baseline and directly after a ten-week intervention period using the Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary outcomes included anxiety, coping skills, self-esteem, body image, and interpersonal sensitivity. We applied t-tests to test for differences within the groups (t0 vs. t1) and between the BPT and the EP and a multiple regression analysis with the post-intervention MADRS score as the dependent variable. The robustness of estimates was investigated with a sensitivity analyses. RESULTS Patients in the BPT group showed a significantly larger decrease in depression scores compared with the EP on the MADRS (drop of 8.4 vs. 3.0 points, p = .002, Cohen's d = 0.55). In the confounder-adjusted regression analyses, group allocation was found to be the only significant predictor of the post-intervention MADRS score (β = - 5.60, p = .001) besides the baseline MADRS score. Further significant differences in change scores between the BPT and the EP were found for anxiety (p = .046, d = 0.35), body image (p = .018, d = 0.42), and global self-esteem (p = .011, d = 0.45). CONCLUSIONS The study provides evidence that the manualised BPT is not only effective in alleviating depressive symptoms but even goes beyond the effect of mere physical exercise. Based on these findings, the BPT should be considered as a complementary therapeutic approach. TRIAL REGISTRATION Trial identification number: ISRCTN12457760: Study KuS (Klettern und Stimmung - Climbing and Mood) combined boulder and psychotherapy against depression, registered retrospectively on July 26th, 2017.
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Affiliation(s)
- Nina Karg
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Lisa Dorscht
- grid.5330.50000 0001 2107 3311Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Kornhuber
- grid.5330.50000 0001 2107 3311Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Katharina Luttenberger
- grid.5330.50000 0001 2107 3311Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
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17
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Lever-van Milligen BA, Verhoeven JE, Schmaal L, van Velzen LS, Révész D, Black CN, Han LKM, Horsfall M, Batelaan NM, van Balkom AJLM, van Schaik DJF, van Oppen P, Penninx BWJH. The impact of depression and anxiety treatment on biological aging and metabolic stress: study protocol of the MOod treatment with antidepressants or running (MOTAR) study. BMC Psychiatry 2019; 19:425. [PMID: 31888565 PMCID: PMC6937704 DOI: 10.1186/s12888-019-2404-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Depressive and anxiety disorders have shown to be associated to premature or advanced biological aging and consequently to adversely impact somatic health. Treatments with antidepressant medication or running therapy are both found to be effective for many but not all patients with mood and anxiety disorders. These interventions may, however, work through different pathophysiological mechanisms and could differ in their impact on biological aging and somatic health. This study protocol describes the design of an unique intervention study that examines whether both treatments are similarly effective in reducing or reversing biological aging (primary outcome), psychiatric status, metabolic stress and neurobiological indicators (secondary outcomes). METHODS The MOod Treatment with Antidepressants or Running (MOTAR) study will recruit a total of 160 patients with a current major depressive and/or anxiety disorder in a mental health care setting. Patients will receive a 16-week treatment with either antidepressant medication or running therapy (3 times/week). Patients will undergo the treatment of their preference and a subsample will be randomized (1:1) to overcome preference bias. An additional no-disease-no-treatment group of 60 healthy controls without lifetime psychopathology, will be included as comparison group for primary and secondary outcomes at baseline. Assessments are done at week 0 for patients and controls, and at week 16 and week 52 for patients only, including written questionnaires, a psychiatric and medical examination, blood, urine and saliva collection and a cycle ergometer test, to gather information about biological aging (telomere length and telomerase activity), mental health (depression and anxiety disorder characteristics), general fitness, metabolic stress-related biomarkers (inflammation, metabolic syndrome, cortisol) and genetic determinants. In addition, neurobiological alterations in brain processes will be assessed using structural and functional Magnetic Resonance Imaging (MRI) in a subsample of at least 25 patients per treatment arm and in all controls. DISCUSSION This intervention study aims to provide a better understanding of the impact of antidepressant medication and running therapy on biological aging, metabolic stress and neurobiological indicators in patients with depressive and anxiety disorders in order to guide a more personalized medicine treatment. TRIAL REGISTRATION Trialregister.nl Number of identification: NTR3460, May 2012.
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Affiliation(s)
- Bianca A. Lever-van Milligen
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Josine E. Verhoeven
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Lianne Schmaal
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Laura S. van Velzen
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Dóra Révész
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Catherine N. Black
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Laura K. M. Han
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Melany Horsfall
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Neeltje M. Batelaan
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Digna J. F. van Schaik
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Brenda W. J. H. Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
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Parker AG, Markulev C, Rickwood DJ, Mackinnon A, Purcell R, Alvarez-Jimenez M, Yung AR, McGorry P, Hetrick SE, Jorm A. Improving Mood with Physical ACTivity (IMPACT) trial: a cluster randomised controlled trial to determine the effectiveness of a brief physical activity behaviour change intervention on depressive symptoms in young people, compared with psychoeducation, in addition to routine clinical care within youth mental health services-a protocol study. BMJ Open 2019; 9:e034002. [PMID: 31662409 PMCID: PMC6830686 DOI: 10.1136/bmjopen-2019-034002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Depression is highly prevalent and the leading contributor to the burden of disease in young people worldwide, making it an ongoing priority for early intervention. As the current evidence-based interventions of medication and psychological therapy are only modestly effective, there is an urgent need for additional treatment strategies. This paper describes the rationale of the Improving Mood with Physical ACTivity (IMPACT) trial. The primary aim of the IMPACT trial is to determine the effectiveness of a physical activity intervention compared with psychoeducation, in addition to routine clinical care, on depressive symptoms in young people. Additional aims are to evaluate the intervention effects on anxiety and functional outcomes and examine whether changes in physical activity mediate improvements in depressive symptoms. METHODS AND ANALYSIS The study is being conducted in six youth mental health services across Australia and is using a parallel-group, two-arm, cluster randomised controlled trial design, with randomisation occurring at the clinician level. Participants aged between 12 years and 25 years with moderate to severe levels of depression are randomised to receive, in addition to routine clinical care, either: (1) a physical activity behaviour change intervention or (2) psychoeducation about physical activity. The primary outcome will be change in the Quick Inventory of Depressive Symptomatology, with assessments occurring at baseline, postintervention (end-point) and 6-month follow-up from end-point. Secondary outcome measures will address additional clinical outcomes, functioning and quality of life. IMPACT is to be conducted between May 2014 and December 2019. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Melbourne Human Research Ethics Committee on 8 June 2014 (HREC 1442228). Trial findings will be published in peer-reviewed journals and presented at conferences. Key messages will also be disseminated by the youth mental health services organisation (headspace National Youth Mental Health Foundation). TRIAL REGISTRATION NUMBER ACTRN12614000772640.
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Affiliation(s)
- Alexandra G Parker
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Connie Markulev
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Debra J Rickwood
- Department of Psychology, University of Canberra, Canberra, Australian Capital Territory, Australia
- headspace, National Youth Mental Health Foundation, Melbourne, Victoria, Australia
| | - Andrew Mackinnon
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- The University of New South Wales, Black Dog Institute, Randwick, New South Wales, Australia
| | - Rosemary Purcell
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Alison R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Patrick McGorry
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony Jorm
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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19
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Gultyaeva VV, Zinchenko MI, Uryumtsev DY, Krivoshchekov SG, Aftanas LI. [Exercise for depression treatment. Exercise modalities and types]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:136-142. [PMID: 31626231 DOI: 10.17116/jnevro2019119091136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The risk of metabolic disorders, including type 2 diabetes and cardiovascular diseases, is increased in depression, there is a decrease in life expectancy by 8-10 years. Pharmacotherapy is the first-line method in the treatment of depression. However, pharmaceutical-related side-effects and resistance to antidepressant pharmacotherapy create serious problems in treatment. Regular exercise not only weakens the symptoms of depression, increases aerobic capacity and muscle strength, but also has a positive effect on comorbid diseases. The purpose of this review is to answer the question, on which parameters of exercise the antidepressant effect depends. The review highlights the results of clinical studies of different types of exercises, intensities and modalities for the treatment of depression over the past 10 years. Because of the contradictory results of the studies, it is impossible to make final conclusions regarding the parameters of exercise. It is possible to say with high probability that in the treatment of depression, moderate and intense aerobic exercises with elements of strength exercises and a variety of coordination exercises more often lead to a positive effect than monotonous exercises with low intensity. It is possible that regular patient adherence to the prescribed exercise regimen is more important than the specific exercise type.
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Affiliation(s)
- V V Gultyaeva
- Federal State Budgetary Scientific Institution 'Scientific Research Institute of Physiology and Basic Medicine', Novosibirsk, Russia
| | - M I Zinchenko
- Federal State Budgetary Scientific Institution 'Scientific Research Institute of Physiology and Basic Medicine', Novosibirsk, Russia
| | - D Yu Uryumtsev
- Federal State Budgetary Scientific Institution 'Scientific Research Institute of Physiology and Basic Medicine', Novosibirsk, Russia
| | - S G Krivoshchekov
- Federal State Budgetary Scientific Institution 'Scientific Research Institute of Physiology and Basic Medicine', Novosibirsk, Russia
| | - L I Aftanas
- Federal State Budgetary Scientific Institution 'Scientific Research Institute of Physiology and Basic Medicine', Novosibirsk, Russia
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20
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Shariat A, Alizadeh R, Moradi V, Afsharnia E, Hakakzadeh A, Ansari NN, Ingle L, Shaw BS, Shaw I. The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: a randomized clinical trial. J Exerc Rehabil 2019; 15:703-708. [PMID: 31723560 PMCID: PMC6834712 DOI: 10.12965/jer.1938490.245] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 02/05/2023] Open
Abstract
This study aimed to evaluate the effectiveness of a modified package of exercise therapy combined with relaxation on pain intensity, range of motion (ROM), anxiety, and quality of life (QoL) in office workers with chronic lower back pain. In this clinical trial, 72 office workers aged 20 to 50 years with chronic low back pain were randomized to one of four groups including; group 1, exercise therapy; group 2, psychotherapy (relaxation therapy); group 3, modified protocol (exercise therapy followed by relaxation therapy); group 4, control group (no intervention). Participants exercised 3 times weekly for 6 weeks for 40-45 min of exercise/relaxation. Pain intensity, ROM, anxiety, and QoL were evaluated at baseline, 6 weeks, and 12 weeks after the end of the intervention. Results showed significant decreases in pain intensity and anxiety in the three experimental groups compared to the control group. The three intervention groups indicated a significant decrease in pain intensity and anxiety after 6 and 12 weeks. ROM significantly improved in the exercise therapy and the modified protocol over time (after 6 and 12 weeks). A significant difference in QoL was found between the groups, with the greatest improvement found in the psychotherapy and modified protocol groups. This therapeutic package (including exercise movements and psychological interventions) was found to have a superior effect on pain intensity, ROM, anxiety, and QoL after 6 and 12 weeks compared to other interventions (only exercise and psychotherapy).
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Affiliation(s)
- Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Alizadeh
- Department of Anesthesiology, AJA University of Medical Sciences, Tehran, Iran
| | - Vahideh Moradi
- Department of Orthotics and Prosthetics, Iran University of Medical Sciences, Tehran, Iran
| | - Elahe Afsharnia
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Hakakzadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhsotin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, UK
| | - Brandon S. Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, South Africa
| | - Ina Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, South Africa
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Kruisdijk F, Hopman-Rock M, Beekman ATF, Hendriksen I. EFFORT-D: results of a randomised controlled trial testing the EFFect of running therapy on depression. BMC Psychiatry 2019; 19:170. [PMID: 31182060 PMCID: PMC6558800 DOI: 10.1186/s12888-019-2156-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/21/2019] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Frank Kruisdijk
- GGz Centraal Innova, Amersfoort, the Netherlands
- Body@Work, TNO-VU University Amsterdam Medical Center, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marijke Hopman-Rock
- Body@Work, TNO-VU University Amsterdam Medical Center, Amsterdam, the Netherlands
- The Netherlands Organisation for applied scientific research TNO, Leiden, the Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam University Medical Center, location VUmc, Department of Psychiatry, Amsterdam, the Netherlands
| | - Ingrid Hendriksen
- Body@Work, TNO-VU University Amsterdam Medical Center, Amsterdam, the Netherlands
- The Netherlands Organisation for applied scientific research TNO, Leiden, the Netherlands
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22
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Matthews J, Torres SJ, Milte CM, Hopkins I, Kukuljan S, Nowson CA, Daly RM. Effects of a multicomponent exercise program combined with calcium-vitamin D 3-enriched milk on health-related quality of life and depressive symptoms in older men: secondary analysis of a randomized controlled trial. Eur J Nutr 2019; 59:1081-1091. [PMID: 30993400 DOI: 10.1007/s00394-019-01969-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Osteoporosis is associated with both lower health-related quality of life and depression in older people. We examined the independent and combined effects of a multi-component exercise program and calcium-vitamin D3 fortified milk on health-related quality of life (HR-QoL) and depression in older men. METHODS In this 12-month, factorial design randomized controlled trial, 180 healthy community-dwelling men aged 50-79 years with normal to below average bone mineral density were allocated into one of four groups: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of high-intensity resistance training with weight-bearing exercise (3 days per week; 60-75 min per session). Men assigned to fortified milk consumed 400 ml/day of low-fat milk containing 1000 mg/day calcium and 800IU/day vitamin D3. Questionnaires were used to assess HR-QoL (SF-36) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) at baseline, and 6 and 12 months. A linear mixed model analysis was used to test whether there was a synergistic interaction between exercise and calcium-vitamin D3. If no significant interactions were detected, the main effects of exercise and fortified milk were examined. RESULTS Mean adherence to the exercise program and fortified milk was 67% (95% CI 61, 73%) and 90% (95% CI 86, 93%), respectively. There were no exercise-by-fortified milk interactions nor main effects of exercise or calcium-vitamin D for any of the HR-QoL measures or depressive symptoms. CONCLUSION In healthy community-dwelling older men, exercise training and/or calcium-vitamin D fortified milk did not improve HR-QoL or depressive symptoms.
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Affiliation(s)
- Joshua Matthews
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Susan J Torres
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Catherine M Milte
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Indee Hopkins
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Sonja Kukuljan
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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23
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López-Torres Hidalgo J. Effectiveness of physical exercise in the treatment of depression in older adults as an alternative to antidepressant drugs in primary care. BMC Psychiatry 2019; 19:21. [PMID: 30642326 PMCID: PMC6332682 DOI: 10.1186/s12888-018-1982-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although currently available evidence suggests that physical exercise can be beneficial for depressed patients and might be comparable to antidepressant treatment, the best way of implementing this recommendation in clinical practice is not known. This study therefore aims to ascertain the non-inferiority of supervised physical exercise to antidepressant drug treatment, in terms of reducing depressive symptoms among patients presenting with clinical criteria of a depressive episode (ICD-10), across a follow-up period of 6 months. METHODS It will take the form of a randomised clinical trial undertaken in a primary care setting, in which a total of 312 patients over the age of 65 years with clinically significant depression will be randomly assigned to supervised physical exercise programme, or will alternatively receive treatment with antidepressant drugs habitually used in clinical practice. Participants' physical condition will be assessed at baseline, and again at 15 days and 1, 3 and 6 months. The supervised exercise programme will consist of 2 weekly sessions in groups of 10-12 patients across a period of 6 months, in which a sports instructor will train patients to do at least 30 min of regular activity at moderate intensity on an almost daily basis, including aerobic, muscle-strengthening, flexibility, and balance-strengthening exercises. The following will be assessed at regular intervals in both groups: status of depression symptoms; level of physical activity; self-perceived health status; appearance of adverse effects; and adherence to the physical exercise programme or antidepressant treatment. The principal outcome variable will be a reduction in pre-treatment depression-symptom scale scores (Montgomery-Asberg Depression Rating Scale and Geriatric Depression Scale). DISCUSSION In terms of the number of patients and duration of follow-up, this proposed clinical trial is a project which easily surpasses the few studies on this subject that have been previously conducted on the elderly. Its aim is to provide solid scientific evidence on a therapeutic resource -physical exercise- which has undeniable health benefits and can be applied to certain health problems, such as depressive disorders, which are of great magnitude and considerable socio-economic relevance, and have a significant impact on the quality of life of older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT03358433 (retrospectively registered on 11/25/2017).
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Gerber M, Isoard-Gautheur S, Schilling R, Ludyga S, Brand S, Colledge F. When Low Leisure-Time Physical Activity Meets Unsatisfied Psychological Needs: Insights From a Stress-Buffer Perspective. Front Psychol 2018; 9:2097. [PMID: 30450065 PMCID: PMC6224427 DOI: 10.3389/fpsyg.2018.02097] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Few studies have tested whether the stress-buffering effects of leisure-time physical activity (LTPA) depend on other resources, such as the satisfaction of basic psychological needs. Therefore, the present study examines the interaction between perceived stress, LTPA and psychological need satisfaction (PNS) on occupational burnout symptoms in a sample of Swiss workers. Methods: The sample consisted of 306 employees (48% women; Mage = 42.9 years, SD = 14.1). Perceived stress was assessed with the Perceived Stress Scale, LTPA with the International Physical Activity Questionnaire, PNS (autonomy, relatedness, and competence) with the Need Satisfaction Scale, and occupational burnout symptoms with the Shirom-Melamed Burnout Measure. A hierarchical regression analysis and single slopes tests were performed to examine two- and three-way interactions. Results: Stress was positively correlated with burnout, and negatively correlated with LTPA and PNS levels. LTPA was positively associated with PNS, and negatively correlated with burnout. A negative association existed between PNS and burnout. In the hierarchical regression analysis, all main effects, two- and three-way interactions were significant. People who engaged in more LTPA reported fewer burnout symptoms, if they reported high stress. However, the potential of LTPA to buffer stress was particularly evident in participants who reported low PNS. Conclusion: If adult workers are exposed to elevated stress, they are particularly likely to show increased burnout levels if they report low LTPA in combination with low PNS, specifically a lack of autonomy, competence and relatedness.
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Affiliation(s)
- Markus Gerber
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | | | - René Schilling
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Serge Brand
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland.,Center for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland.,Substance Abuse Prevention and Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Flora Colledge
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
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Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci 2018; 12:397. [PMID: 30356789 PMCID: PMC6189422 DOI: 10.3389/fnhum.2018.00397] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/14/2018] [Indexed: 12/25/2022] Open
Abstract
Contemplative practices, such as meditation and yoga, are increasingly popular among the general public and as topics of research. Beneficial effects associated with these practices have been found on physical health, mental health and cognitive performance. However, studies and theories that clarify the underlying mechanisms are lacking or scarce. This theoretical review aims to address and compensate this scarcity. We will show that various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline in turn could parsimoniously explain the physical and mental benefits of contemplative activities through changes in autonomic balance. We propose a neurophysiological model that explains how these specific respiration styles could operate, by phasically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation (rVNS). The vagal nerve, as a proponent of the parasympathetic nervous system (PNS), is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition. We will discuss implications and limitations of our model.
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Affiliation(s)
- Roderik J. S. Gerritsen
- Institute of Psychology, Cognitive Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Guido P. H. Band
- Institute of Psychology, Cognitive Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
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Roberts L, Jones G, Brooks R. Why Do You Ride?: A Characterization of Mountain Bikers, Their Engagement Methods, and Perceived Links to Mental Health and Well-Being. Front Psychol 2018; 9:1642. [PMID: 30283372 PMCID: PMC6156442 DOI: 10.3389/fpsyg.2018.01642] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/16/2018] [Indexed: 12/01/2022] Open
Abstract
Mountain biking is an increasingly popular outdoor activity on the extreme sport continuum. Extreme and high-risk sports have been investigated using a variety of motivational theories with sensation seeking a dominant theme; however, behavioral and motivational homogeneity within these types of populations should not be assumed. Recent studies have highlighted the therapeutic potential of extreme sports and similar outdoor activities. The aim of this study was to describe the characteristics of mountain biking participants, their engagement methods, and perceived benefits to mental health and well-being. This was a cross-sectional survey and participants were recruited via social media. An online questionnaire specific to the domain of mountain biking was developed. Analysis of the full sample (n = 1,484) and of three independent paired sub-samples was conducted using SPSS. The sub-samples compared the results of males and females; younger and older riders; and those who have recently engaged in downhill mountain biking and those who have not. The results have succeeded in identifying some disparities in mountain biker characteristics and engagement methods. The results suggest that some riders found pleasure in higher risk engagement. The study proposes various explanations for the disproportion of women in mountain biking. Irrespective of the confounding factors related to rider characteristics or engagement methods, mountain bikers reported copious benefits to mental health and well-being related to their engagement. There was a high reported usage of mountain biking as a coping strategy. As such, this study provides insights that could inform the development of outdoor activities as interventions for mental health.
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Affiliation(s)
- Lisa Roberts
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Gareth Jones
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Rob Brooks
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
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Sullivan KA, Hills AP, Iverson GL. Graded Combined Aerobic Resistance Exercise (CARE) to Prevent or Treat the Persistent Post-concussion Syndrome. Curr Neurol Neurosci Rep 2018; 18:75. [DOI: 10.1007/s11910-018-0884-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Phillips C, Fahimi A. Immune and Neuroprotective Effects of Physical Activity on the Brain in Depression. Front Neurosci 2018; 12:498. [PMID: 30093853 PMCID: PMC6070639 DOI: 10.3389/fnins.2018.00498] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/03/2018] [Indexed: 12/13/2022] Open
Abstract
Physical activity-a lifestyle factor that is associated with immune function, neuroprotection, and energy metabolism-modulates the cellular and molecular processes in the brain that are vital for emotional and cognitive health, collective mechanisms that can go awry in depression. Physical activity optimizes the stress response, neurotransmitter level and function (e.g., serotonergic, noradrenergic, dopaminergic, and glutamatergic), myokine production (e.g., interleukin-6), transcription factor levels and correlates [e.g., peroxisome proliferator-activated receptor C coactivator-1α [PGC-1α], mitochondrial density, nitric oxide pathway activity, Ca2+ signaling, reactive oxygen specie production, and AMP-activated protein kinase [AMPK] activity], kynurenine metabolites, glucose regulation, astrocytic health, and growth factors (e.g., brain-derived neurotrophic factor). Dysregulation of these interrelated processes can effectuate depression, a chronic mental illness that affects millions of individuals worldwide. Although the biogenic amine model has provided some clinical utility in understanding chronic depression, a need remains to better understand the interrelated mechanisms that contribute to immune dysfunction and the means by which various therapeutics mitigate them. Fortunately, convergent evidence suggests that physical activity improves emotional and cognitive function in persons with depression, particularly in those with comorbid inflammation. Accordingly, the aims of this review are to (1) underscore the link between inflammatory correlates and depression, (2) explicate immuno-neuroendocrine foundations, (3) elucidate evidence of neurotransmitter and cytokine crosstalk in depressive pathobiology, (4) determine the immunomodulatory effects of physical activity in depression, (5) examine protocols used to effectuate the positive effects of physical activity in depression, and (6) highlight implications for clinicians and scientists. It is our contention that a deeper understanding of the mechanisms by which inflammation contributes to the pathobiology of depression will translate to novel and more effective treatments, particularly by identifying relevant patient populations that can benefit from immune-based therapies within the context of personalized medicine.
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Affiliation(s)
- Cristy Phillips
- Physical Therapy, Arkansas State University, Jonesboro, AR, United States
- Physical Therapy, University of Tennessee Health Science Center, Memphis, TN, United States
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Magnetic resonance imaging evidence of hippocampal structural changes in patients with primary biliary cholangitis. Clin Transl Gastroenterol 2018; 9:169. [PMID: 29977030 PMCID: PMC6033882 DOI: 10.1038/s41424-018-0038-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/11/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Behavioral symptoms are commonly reported by patients with primary biliary cholangitis (PBC). In other patient populations, symptoms are commonly associated with hippocampal volume reduction linked to neuroinflammation (inferred from regional iron deposition), as demonstrated by magnetic resonance imaging (MRI). We hypothesized that PBC patients would exhibit reduced volume and increased iron deposition of the hippocampus. Methods Seventeen female non-cirrhotic PBC patients and 17 age/gender-matched controls underwent 3-Tesla T1-weighted MRI and quantitative susceptibility mapping (QSM; an indicator of iron deposition). The hippocampus and its subfields were segmented from T1 images using Freesurfer, and susceptibility of the whole hippocampus was calculated from QSM images. Volume and susceptibility were compared between groups, and associations with PBC-40 score and disease indicators (years since diagnosis, Fibroscan value, alkaline phosphatase level, clinical response to ursodeoxycholic acid (UDCA)) were investigated. Results PBC patients exhibited significantly reduced hippocampal volume (p = 0.023) and increased susceptibility (p = 0.048). Subfield volumes were reduced for the subiculum, molecular layer, granule cell layer of the dentate gyrus and CA4 (p < 0.05). Fibroscan value was significantly correlated with PBC-40 (Spearman’s rho = 0.499; p = 0.041) and disease duration (Spearman’s rho = 0.568; p = 0.017). Discussion Our findings suggest hippocampal changes occur early in the disease course of PBC, similar in magnitude to those observed in major depressive disorder and neurodegenerative diseases. Translational impact Clinical management of PBC could include early interventional strategies that promote hippocampal neurogenesis that may beneficially impact behavioral symptoms and improve quality of life.
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Affiliation(s)
- Egil W Martinsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Abstract
OBJECTIVE Depression is associated with an increased risk of mortality in patients with coronary heart disease (CHD). The risk may be reduced in patients who remit with adequate treatment, but few patients achieve complete remission. The purpose of this study was to identify the symptoms that persist despite aggressive treatment for depression in patients with CHD. METHODS One hundred twenty-five patients with stable CHD who met the DSM-IV criteria for a moderate-to-severe major depressive episode completed treatment with cognitive behavior therapy, either alone or combined with an antidepressant, for up to 16 weeks. Depression symptoms were assessed at baseline and after 16 weeks of treatment. RESULTS The M (SD) Beck Depression Inventory scores were 30.0 (8.6) at baseline and 8.3 (7.5) at 16 weeks. Seventy seven (61%) of the participants who completed treatment met remission criteria (Hamilton Rating Scale for Depression ≤7) at 16 weeks. Loss of energy and fatigue were the most common posttreatment symptoms both in remitters (n = 44, 57%; n = 34, 44.2%) and nonremitters (n = 42, 87.5%; n = 35, 72.9%). These symptoms were not predicted by baseline depression severity, anxiety, demographic, or medical variables including inflammatory markers or cardiac functioning or by medical events during depression treatment. CONCLUSIONS Fatigue and loss of energy often persist in patients with CHD even after otherwise successful treatment for major depression. These residual symptoms may increase the risks of relapse and mortality. Development of effective interventions for these persistent symptoms is a priority for future research.
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Exercise reduces depression and inflammation but intensity matters. Biol Psychol 2018; 133:79-84. [PMID: 29408464 DOI: 10.1016/j.biopsycho.2018.01.015] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Exercise may help to mitigate symptoms of depression by reducing inflammation; however, little is known about the influence of exercise intensity on depressed mood. METHODS In the present study, sixty-one university students were assigned to six weeks of high-intensity interval training (HIT), moderate continuous training (MCT), or no exercise (CON) during their academic term. We measured changes in depression, anxiety and perceived stress along with pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and C-reactive protein (CRP). RESULTS Depression increased for CON, demonstrating how quickly mental health can decline for students during their academic term. In contrast, MCT decreased depression and pro-inflammatory cytokine TNF-α levels. Although HIT decreased depressive symptoms, it also increased perceived stress, TNF-α and IL-6 relative to MCT. This may be due to the higher level of physical stress evoked by the more strenuous exercise protocol. CONCLUSIONS Taken together, the results suggest that moderate-intensity exercise may be an optimal intensity of exercise for the promotion of mental health by decreasing TNF-α. This is critical for informing the use of exercise as medicine for mental health.
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Nebiker L, Lichtenstein E, Minghetti A, Zahner L, Gerber M, Faude O, Donath L. Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review. Front Psychiatry 2018; 9:305. [PMID: 30072923 PMCID: PMC6060256 DOI: 10.3389/fpsyt.2018.00305] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Exercise training is a beneficial treatment strategy for depression. Previous meta-analytical reviews mainly examined the effect of aerobic exercise on depressive symptoms neglecting comparisons with neuromuscular training and meta-regression considering relevant exercise training prescriptors such as exercise duration, intensity, number of exercise sessions (volume) and frequency. Methods: A structured literature search was conducted in biomedical and psychological databases and study selection was conducted following the PICOS approach. (Randomized) controlled trials that compared supervised neuromuscular or endurance exercise interventions with an inactive control group (CON) in clinically depressed in- or out-patients over 18 years were included. Eligibility and study quality were evaluated by two independent researchers. Standardized mean differences (SMD) for the reduction of depressive symptoms, measured with different evaluation scales (e.g., BDI, HAM-D, PHQ-9, HRSD, MADRS, GDS) were calculated with the adjusted Hedges'g equation as main outcome for the comparison of endurance and neuromuscular exercise interventions vs. CON. Statistical analyses were conducted using a random effects inverse-variance model. Multivariate meta-regression analysis was performed in order to examine the modulating effects of exercise training prescriptors. Results: Twenty seven trials with 1,452 clinically depressed adults were included. 20 out of 27 included trials reached a PEDro score of at least 6, representing high-quality. Irrespective of the exercise mode and study quality, large effects in favor of exercise compared to the control condition were found. Compared to CON, sensitivity analyses revealed a moderate to large effect in favor of endurance exercise [SMD: -0.79 (90% CI: -1.10, -0.48); p < 0.00001, I2 = 84%] and a large effect size in favor of neuromuscular exercise [SMD: -1.14 (90 CI: -1.50, -0.78); p < 0.00001, I2 = 80%]. These effects decreased to moderate for endurance and remained large for neuromuscular trials when considering studies of high quality, indicating a significant difference (p = 0.04). Multivariate meta- regression revealed that exercise duration in endurance trials and exercise intensity in neuromuscular trials had a significantly moderating effect. Conclusions: Strong neuromuscular exercise interventions can be slightly more effective than endurance exercise interventions. Interestingly, exercise duration and exercise intensity moderated the effect size meaningfully. This result might be used on exercise in depression to increase efficacy.
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Affiliation(s)
- Lukas Nebiker
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Eric Lichtenstein
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Alice Minghetti
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Lukas Zahner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Lars Donath
- Department of Intervention Research in Exercise Training German Sport University Cologne, Köln, Germany
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Lott MA, Jensen CD. Executive Control Mediates the Association Between Aerobic Fitness and Emotion Regulation in Preadolescent Children. J Pediatr Psychol 2017; 42:162-173. [PMID: 27342303 DOI: 10.1093/jpepsy/jsw052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/20/2016] [Indexed: 02/03/2023] Open
Abstract
Objective This study evaluated direct and indirect associations between aerobic fitness, executive control, and emotion regulation among a community sample of preadolescent children. Methods Two-hundred and seventy-eight children aged 8-12 years completed measures of aerobic fitness (Progressive Aerobic Cardiovascular Endurance Run) and executive control (Stroop Test). Parents completed questionnaires assessing child emotion regulation and executive control (Emotion Regulation Checklist; Early Adolescent Temperament Questionnaire). We evaluated associations between these constructs using structural equation modeling. Results Study findings supported a moderate direct association between childhood aerobic fitness and executive control, a strong direct negative association between executive control and emotion regulation, and a moderate indirect association between aerobic fitness and emotion regulation through executive control. Conclusions These findings provide preliminary evidence that executive control functions as a mediator between aerobic fitness and emotion regulation and may help explain the mechanism by which aerobic exercise influences emotional well-being among preadolescent children.
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Affiliation(s)
- Mark A Lott
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chad D Jensen
- Department of Psychology, Brigham Young University, Provo, UT, USA
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Can Gür G, Okanli A. The Effects of Cognitive-Behavioral Model-Based Intervention on Depression, Anxiety, and Self-Efficacy in Alcohol Use Disorder. Clin Nurs Res 2017; 28:52-78. [DOI: 10.1177/1054773817722688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Exercise is constantly gaining attention as adjuvant treatment for alcohol use disorder (AUD), supplementing classical pharmacological and psychotherapeutic approaches. The aim of this study was to determine the effects of cognitive-behavioral model-based (CBM-based) intervention on the depression, anxiety, and self-efficacy levels in AUD. This quasi-experimental study was conducted using pre- and posttests and repeated measurements with a control group; it was completed between February 2015 and August 2015 in Turkey. Participants were 41 individuals with AUD, 20 in the experimental group and 21 in the control group. The individuals in the experimental group performed aerobic exercise 3 days a week as well as attended the psychoeducation provided 1 day a week. The difference between mean scores of the individuals in the experimental and control groups taken in posttest and 4-month follow-up test in the Beck Depression Inventory (BDI) as well as the difference between mean posttest scores in the Beck Anxiety Inventory (BAI) and Self-Efficacy Scale (SES) were found to be statistically significant ( p < .05). In the intragroup comparisons, a significant difference was found between the “BDI,” “BAI,” and “SES” measurement times ( p < .05). It was concluded that CBM-based intervention was effective in reducing depression and anxiety, increasing self-efficacy in individuals with AUD. Appropriate nurse-managed CBM-based intervention for individuals with AUD can promote their health.
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Abstract
More and more people are living into the 90s or becoming centenarians. But, the gift of increased ‘age span’ seldom equates with an improved ‘health-span’. Governments across the world are expressing concern about the epidemic of chronic disease, and have responded by initiating policies that make prevention, reduction and treatment of chronic disease, a public health priority. But understanding, how to age long and well, with the avoidance of chronic disease and later life complex disease morbidity is challenging. While inherited genes have an undoubted role to play in the chance of maintaining good health or conversely a predilection to developing disease and chronic ill health, there is increasing evidence that behavioural and environmental life-style choices may contribute up to 50% of the variability of human lifespan. Physical exercise is readily available to everyone, and is a simple cheap and effective form of life-style intervention. Exercise appears to help maintain good health and to reduce the risk of developing chronic disease and ill health. Evidence suggests that physical activity improves well-being across many health domains through out life, continues to offer important health benefits in older age groups and tracks with a ‘healthy ageing’ profile. Although many of the molecular pathways remain to be fully identified, here we discuss how physical activity and exercise is understood to produce changes in the human epigenome, which have the potential to enhance cognitive and psychological health, improve muscular fitness, and lead to better ageing with improved quality of life in older age.
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Merkt H, Sadeghi Bahmani D, Calabrese P, Naegelin Y, Gerber M, Pühse U, Holsboer-Trachsler E, Brand S. Multiple Sclerosis: Associations Between Physical Disability and Depression Are Not Mediated by Self-Reported Physical Activity. Percept Mot Skills 2017; 124:974-991. [DOI: 10.1177/0031512517711851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the interrelatedness of physical disability, physical activity, and depression among patients with multiple sclerosis (MS). We hypothesized that self-reported physical activity would mediate the effect of disability on depressive symptoms. Twenty-seven patients with MS (mean age: 49 years; 44.5% females) completed self-rating scales covering sociodemographic variables, intake of antidepressants, physical activity, and symptoms of depression; disability was measured by the Expanded Disability Status Scale. We found a higher level of disability to be significantly associated with more symptoms of depression. While higher reported physical activity was descriptively associated with lower depression scores and unrelated to Expanded Disability Status Scale, physical activity levels did not mediate the effect of disability on depressive symptoms.
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Affiliation(s)
- Helene Merkt
- Division of Molecular and Cognitive Neurosciences, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, Basel, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neurosciences, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Department of Neurology, University Hospital, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, Basel, Switzerland
| | - Serge Brand
- Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, Basel, Switzerland
- Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, Faculty of Medicine, University of Basel, Basel, Switzerland
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Netz Y. Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based? Front Pharmacol 2017; 8:257. [PMID: 28555108 PMCID: PMC5430071 DOI: 10.3389/fphar.2017.00257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/25/2017] [Indexed: 12/22/2022] Open
Abstract
Major depression disorder is most commonly treated with antidepressants. However, due to their side effects clinicians seek non-pharmacologic options, and one of these is exercise. The literature on the benefits of exercise for depression is extensive. Nevertheless, two recent reviews focusing on antidepressants vs. other therapies as a basis for clinical practice guidelines recommended mainly antidepressants, excluding exercise as a viable choice for treatment of depression. The aim of this perspective is to analyze the literature exploring the reasons for this discrepancy. Two categories of publications were examined: randomized controlled trials (RCTs) and meta-analyses or systematic reviews. Based on this reassessment, RCTs comparing exercise to antidepressants reported that exercise and antidepressants were equally effective. RCTs comparing exercise combined with antidepressants to antidepressants only reported a significant improvement in depression following exercise as an adjunctive treatment. Almost all the reviews examining exercise vs. other treatments of depression, including antidepressants, support the use of exercise in the treatment of depression, at least as an adjunctive therapy. The two reviews examining pharmacologic vs. non-pharmacologic therapies as a basis for clinical practice guidelines examined limited evidence on exercise vs. antidepressants. In addition, it is possible that academics and health care practitioners are skeptical of viewing exercise as medicine. Maybe, there is a reluctance to accept that changes in lifestyle as opposed to pharmacological treatment can alter biological mechanisms. Longitudinal studies are needed for assessing the effectiveness of exercise in real clinical settings, as well as studies exploring dose-response relationship between exercise and depression.
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Affiliation(s)
- Yael Netz
- Behavioral Studies, Graduate School, The Academic College at WingateWingate, Israel
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Marijnissen RM, Vogelzangs N, Mulder ME, van den Brink RHS, Comijs HC, Oude Voshaar RC. Metabolic dysregulation and late-life depression: a prospective study. Psychol Med 2017; 47:1041-1052. [PMID: 27938429 DOI: 10.1017/s0033291716003196] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression is associated with the metabolic syndrome (MS). We examined whether metabolic dysregulation predicted the 2-year course of clinical depression. METHOD A total of 285 older persons (⩾60 years) suffering from depressive disorder according to DSM-IV-TR criteria was followed up for 2 years. Severity of depression was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals. Metabolic syndrome was defined according the National Cholesterol Education Programme (NCEP-ATP III). We applied logistic regression and linear mixed models adjusted for age, sex, years of education, smoking, alcohol use, physical activity, somatic co-morbidity, cognitive functioning and drug use (antidepressants, anti-inflammatory drugs) and severity of depression at baseline. RESULTS MS predicted non-remission at 2 years (odds ratioper component = 1.26, 95% confidence interval 1.00-1.58), p = 0.047), which was driven by the waist circumference and HDL cholesterol. MS was not associated with IDS sum score. Subsequent analyses on its subscales, however, identified an association with the somatic symptom subscale score over time (interaction time × somatic subscale, p = 0.005), driven by higher waist circumference and elevated fasting glucose level. CONCLUSIONS Metabolic dysregulation predicts a poor course of late-life depression. This finding supports the concept of 'metabolic depression', recently proposed on population-based findings of a protracted course of depressive symptoms in the presence of metabolic dysregulation. Our findings seem to be driven by abdominal obesity (as indicated by the waist circumference) and HDL cholesterol dysregulation.
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Affiliation(s)
- R M Marijnissen
- Department of Old Age Psychiatry,ProPersona,Arnhem/Wolfheze,The Netherlands
| | - N Vogelzangs
- Department of Epidemiology,Cardiovascular Research Institute Maastricht (CARIM) & Maastricht Centre for Systems Biology (MaCSBio),Maastricht University,Maastricht,The Netherlands
| | - M E Mulder
- Department of Old Age Psychiatry,ProPersona,Arnhem/Wolfheze,The Netherlands
| | - R H S van den Brink
- University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands
| | - H C Comijs
- Department Psychiatry,EMGO Institute for Health and Care Research VU University Medical Center/GGZinGeest,Amsterdam,The Netherlands
| | - R C Oude Voshaar
- University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands
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The longitudinal course of depression symptomatology following a palliative rehabilitation program. Qual Life Res 2017; 26:1809-1818. [PMID: 28236265 DOI: 10.1007/s11136-017-1531-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Patients with advanced cancer have increased life expectancy but suffer from ongoing burden. Depressive symptomatology is their most common mental health concern. The Ottawa Palliative Rehabilitation Program (PRP) offers rehabilitation for this population. It offers 8 weeks of individualized interdisciplinary rehabilitation, post cancer treatment. Interventions include medical (physician and nurse), physiotherapy, occupational therapy, dietary, and social work using a general self-efficacy framework. Pilot data suggest benefits in a range of domains, including ratings of feeling "depressed." We examined whether reduced symptomatology was maintained 3 months after PRP completion. METHODS Participants with advanced heterogeneous cancers who completed the PRP were mailed the Hospital Anxiety and Depression Scale (among others) 3-month post-PRP (n = 44). Demographic and medical information were obtained from patient files. RESULTS There was a significant linear trend (mean T1: 6.79 ± 2.29; T2: 5.23 ± 3.06; T3: 4.59 ± 3.34; p = 0.007) with statistically and clinically significant decreases in reported depressive symptomatology between T1 and T2 (p = 0.042) and T1 and T3 (p = 0.007). There was a significant decreases in number of cases reporting symptomatology scores in the clinical range from T1 to T3 (p = 0.038). CONCLUSION Patients who undergo a palliative rehabilitation program may experience relief of mild depressive symptomatology, maintainable 3-month post-PRP. The sample was exhibiting mild symptomatology and these results may not be generalizable to those with higher scores; a lack of specialized psychosocial clinician may have affected the acquired sample. Experimental designs are needed to more thoroughly compare these findings to independent rehabilitation interventions.
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Abd El-Kader SM, Al-Jiffri OH. Exercise alleviates depression related systemic inflammation in chronic obstructive pulmonary disease patients. Afr Health Sci 2016; 16:1078-1088. [PMID: 28479901 PMCID: PMC5398455 DOI: 10.4314/ahs.v16i4.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent co-morbidity in Chronic Obstructive Pulmonary Disease (COPD) which was shown to be associated with a worse course of disease, including reduced quality of life and increased symptoms burden, healthcare use, and even mortality. It has been speculated that systemic inflammation may play a role in the presence of depression. Currently, physical activity is an important lifestyle factor that has the potential to modify inflammatory cytokines and depression, however our understanding of how to use exercise effectively in COPD patients to alleviate depression related systemic inflammation is incomplete and has prompted our interest to identify the type and intensities of effective exercise. OBJECTIVE The aim of this study was to measure the changes in depression related systemic inflammation of aerobic exercise training in COPD patients in Jeddah area. MATERIAL AND METHODS Eighty patients with moderate severity of COPD participated in this study and were divided into two groups; the first group received aerobic exercise, whereas the second group received no exercise training for 12 weeks. RESULTS The mean values of tumor necrosis factor-alpha (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6), C-reactive protein (CRP) and Beck Depression Inventory (BDI) scores were significantly decreased in in group (A) after treatments, but the changes in group (B) were not significant .Also, there were significant differences between mean levels of the investigated parameters in group (A) and group (B) at the end of the study. CONCLUSION Aerobic exercise is an effective treatment policy to improve depression related to systemic inflammation in patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Shehab M Abd El-Kader
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University
| | - Osama H Al-Jiffri
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King AbdulazizUniversity
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Bracht T, Jones DK, Bells S, Walther S, Drakesmith M, Linden D. Myelination of the right parahippocampal cingulum is associated with physical activity in young healthy adults. Brain Struct Funct 2016; 221:4537-4548. [PMID: 26786737 PMCID: PMC5102942 DOI: 10.1007/s00429-016-1183-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 01/05/2016] [Indexed: 11/21/2022]
Abstract
Recent evidence suggests that individual differences in physical activity (PA) may be associated with individual differences in white matter microstructure and with grey matter volume of the hippocampus. Therefore, this study investigated the association between PA and white matter microstructure of pathways connecting to the hippocampus. A total of 33 young, healthy adults underwent magnetic resonance imaging (MRI). High angular resolution diffusion-weighted imaging and multi-component relaxometry MRI scans (multi-component driven equilibrium pulse observation of T1 and T2) were acquired for each participant. Activity levels (AL) of participants were calculated from 72-h actigraphy recordings. Tractography using the damped Richardson Lucy algorithm was used to reconstruct the fornix and bilateral parahippocampal cinguli (PHC). The mean fractional anisotropy (FA) and the myelin water fraction (MWF), a putative marker of myelination, were determined for each pathway. A positive correlation between both AL and FA and between AL and MWF were hypothesized for the three pathways. There was a selective positive correlation between AL and MWF in the right PHC (r = 0.482, p = 0.007). Thus, our results provide initial in vivo evidence for an association between myelination of the right PHC and PA in young healthy adults. Our results suggest that MWF may not only be more specific, but also more sensitive than FA to detect white matter microstructural alterations. If PA was to induce structural plasticity of the right PHC this may contribute to reverse structural alterations of the right PHC in neuropsychiatric disorder with hippocampal pathologies.
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Affiliation(s)
- Tobias Bracht
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK.
- Neuroscience and Mental Health Research Institute (NMHRI), Cardiff University, Cardiff, UK.
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000, Bern, Switzerland.
| | - Derek K Jones
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Research Institute (NMHRI), Cardiff University, Cardiff, UK
| | - Sonya Bells
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Research Institute (NMHRI), Cardiff University, Cardiff, UK
| | - Sebastian Walther
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000, Bern, Switzerland
| | - Mark Drakesmith
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Research Institute (NMHRI), Cardiff University, Cardiff, UK
| | - David Linden
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Neuroscience and Mental Health Research Institute (NMHRI), Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatry Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
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Bredemeier K, Warren SL, Berenbaum H, Miller GA, Heller W. Executive function deficits associated with current and past major depressive symptoms. J Affect Disord 2016; 204:226-33. [PMID: 27379618 PMCID: PMC5064806 DOI: 10.1016/j.jad.2016.03.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/17/2016] [Accepted: 03/12/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although there has been extensive research showing that depression is associated with executive function (EF) deficits, the nature of these deficits is not clearly delineated. Specifically, previous reviews on this topic have yielded different conclusions about the particular domains of EF that are disrupted in depressed individuals. Further, research on whether these deficits persist after depressed mood has remitted is less prevalent and not consistent. METHODS In two independent samples of college students, we examined associations between clinical ratings of current and past symptoms of a Major Depressive Episode (MDE) and difficulties in two domains of EF: inhibition and shifting. In Study 1 (n=162), EF was measured using behavioral tasks shown to index these two domains. In Study 2 (n=95), EF was measured using a self-report questionnaire believed to capture EF difficulties experienced in daily life. RESULTS In both studies, past MDE symptoms were associated with worse shifting. In contrast, current MDE symptoms were associated with worse inhibition, though only on the behavioral measure (in Study 1). LIMITATIONS Both studies used college samples and retrospective assessments of past symptoms. Further, only two domains of EF were examined, and the EF measures employed in each study have their own unique methodological limitations. CONCLUSIONS Findings suggest that inhibition deficits vary as a function of current symptoms and thus may be a by-product of distress rather than a causal contributor. In contrast, shifting deficits associated with depression appear to be more enduring, suggesting that they could contribute to risk for depression.
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Affiliation(s)
- Keith Bredemeier
- University of Illinois at Urbana-Champaign, United States; University of Pennsylvania, United States.
| | - Stacie L Warren
- University of Illinois at Urbana-Champaign, United States; Palo Alto University, United States
| | | | - Gregory A Miller
- University of Illinois at Urbana-Champaign, United States; University of California, Los Angeles, United States
| | - Wendy Heller
- University of Illinois at Urbana-Champaign, United States
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Helgadóttir B, Hallgren M, Ekblom Ö, Forsell Y. Training fast or slow? Exercise for depression: A randomized controlled trial. Prev Med 2016; 91:123-131. [PMID: 27514246 DOI: 10.1016/j.ypmed.2016.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/03/2016] [Accepted: 08/06/2016] [Indexed: 11/17/2022]
Abstract
Exercise can be used to treat depression but there is a lack of evidence regarding the optimal intensity and mode. Our aim was to compare the effects of different exercise intensities on post-treatment depression severity. People aged 18-67years with mild to moderate depression (Patient Health Questionnaire-9 score of ≥10) participated in a single-blind, parallel randomized control trial lasting 12-weeks (Sweden 2011-2013). Four treatment arms were included: treatment as usual (TAU) (n=310), light exercise (yoga or similar n=106), moderate exercise (aerobic conditioning, n=105) and vigorous exercise (aerobic conditioning, n=99). Depression severity was measured at baseline and post-treatment using the Montgomery-Åsberg Depression Rating Scale (MADRS). Differences between the groups in depression severity at post-treatment were analysed using linear regression. Differences in exercise intensity were confirmed by heart rate monitoring. At post-treatment, the light (-4.05 Confidence Interval (CI)=-5.94, -2.17), moderate (-2.08 CI=-3.98, -0.18) and vigorous exercise groups (-3.13 CI=-5.07, -1.19) had reduced their MADRS scores significantly more than TAU. No significant differences were found between the exercise groups, and no significant interaction effect was observed between group and gender. In conclusion, exercise, whether performed at a low (yoga or similar), moderate or vigorous intensity (aerobic training) is effective in treating mild to moderate depression and is at least as effective as treatment as usual by a physician.
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Affiliation(s)
- Björg Helgadóttir
- Department of Public Health, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
| | - Mats Hallgren
- Department of Public Health, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden
| | - Örjan Ekblom
- Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Public Health, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden
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de Manincor M, Bensoussan A, Smith CA, Barr K, Schweickle M, Donoghoe LL, Bourchier S, Fahey P. INDIVIDUALIZED YOGA FOR REDUCING DEPRESSION AND ANXIETY, AND IMPROVING WELL-BEING: A RANDOMIZED CONTROLLED TRIAL. Depress Anxiety 2016; 33:816-28. [PMID: 27030303 DOI: 10.1002/da.22502] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 03/10/2016] [Accepted: 03/12/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Depression and anxiety are leading causes of disability worldwide. Current treatments are primarily pharmaceutical and psychological. Questions remain about effectiveness and suitability for different people. Previous research suggests potential benefits of yoga for reducing depression and anxiety. The aim of this study is to investigate the effects of an individualized yoga intervention. METHODS A sample of 101 people with symptoms of depression and/or anxiety participated in a randomized controlled trial comparing a 6-week yoga intervention with waitlist control. Yoga was additional to usual treatment. The control group was offered the yoga following the waitlist period. Measures included Depression Anxiety Stress Scale (DASS-21), Kessler Psychological Distress Scale (K10), Short-Form Health Survey (SF12), Scale of Positive and Negative Experience (SPANE), Flourishing Scale (FS), and Connor-Davidson Resilience Scale (CD-RISC2). RESULTS There were statistically significant differences between yoga and control groups on reduction of depression scores (-4.30; 95% CI: -7.70, -0.01; P = .01; ES -.44). Differences in reduced anxiety scores were not statistically significant (-1.91; 95% CI: -4.58, 0.76; P = .16). Statistically significant differences in favor of yoga were also found on total DASS (P = .03), K10, SF12 mental health, SPANE, FS, and resilience scores (P < .01 for each). Differences in stress and SF12 physical health scores were not statistically significant. Benefits were maintained at 6-week follow-up. CONCLUSION Yoga plus regular care was effective in reducing symptoms of depression compared with regular care alone. Further investigation is warranted regarding potential benefits in anxiety. Individualized yoga may be particularly beneficial in mental health care in the broader community.
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Affiliation(s)
- Michael de Manincor
- National Institute of Complementary Medicine (NICM), Western Sydney University (WSU), Australia.
| | - Alan Bensoussan
- National Institute of Complementary Medicine (NICM), Western Sydney University (WSU), Australia
| | - Caroline A Smith
- National Institute of Complementary Medicine (NICM), Western Sydney University (WSU), Australia
| | - Kylie Barr
- National Institute of Complementary Medicine (NICM), Western Sydney University (WSU), Australia
| | | | | | - Suzannah Bourchier
- National Institute of Complementary Medicine (NICM), Western Sydney University (WSU), Australia
| | - Paul Fahey
- School of Science and Health, Western Sydney University (WSU), Australia
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Young B, Bagley H. Including patients in core outcome set development: issues to consider based on three workshops with around 100 international delegates. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:25. [PMID: 29507761 PMCID: PMC5831887 DOI: 10.1186/s40900-016-0039-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/09/2016] [Indexed: 06/01/2023]
Abstract
PLAIN ENGLISH SUMMARY This commentary article describes three interactive workshops that explored how patients can contribute to decisions about what outcomes are measured in clinical trials across the world. Outcomes like quality of life, side-effects and pain are used in trials to measure whether a treatment is effective. Here, we outline how research groups are increasingly coming together to develop 'core outcomes sets' for particular conditions. Core outcome sets are lists of agreed outcomes. Their use will help in identifying which treatments are effective by enabling people to compare the findings of different clinical trials in the same condition. Currently, it is often very difficult to make these comparisons because different studies often measure different outcomes. Delegates attending the workshops included patients, clinicians and researchers. They discussed ways of making core outcome set development more meaningful and accessible for patients, and ensuring that they have a genuine say in the development process. This article summarises these discussions and concludes by identifying three distinctive challenges in securing patient input to core outcome set development: the process and objectives can seem far removed from the immediate concerns of patients, difficulties can arise in securing patient input on an international scale, and difficulties can also arise in bringing multiple stakeholder groups together to achieve consensus. While patient participation, involvement and engagement in core outcome set development can draw on lessons from other research areas, these distinctive challenges point to the need for distinctive solutions to enable meaningful patient input to core outcome set development. ABSTRACT Background This article describes three workshops that explored how patients can contribute to decisions about what outcomes are measured in clinical trials. People need evidence about what treatments are best for particular health conditions. The strongest evidence comes from systematic reviews comparing outcomes across different studies of treatments for a particular condition. However, it is often difficult to do these comparisons because the different studies-even though they have all investigated the same condition-often measure different outcomes. To tackle this problem, research teams are increasingly coming together to develop core outcome sets (COS) for particular conditions or treatments. The goal is that across the world, all the research teams working on the same condition or treatment will then use the COS in their research.Main body We report on three interactive workshops that explored how patients and the public can contribute to decision making about what outcomes should be included in a COS. About 100 international delegates, including researchers, clinicians and patients, attended the workshops. The workshops were held in the United Kingdom, Italy and Canada as part of the COMET (Core Outcome Measures in Effectiveness Trials) Initiative annual meetings. Patients who had some experience as research advisors, collaborators, partners or co-ordinators facilitated the workshops together with a researcher. Notes made during each workshop informed the preparation of this article. Workshop discussion focussed on ways of making core outcome set development more meaningful and accessible for patients. Delegates wanted patients to have a genuine say, alongside other stakeholders, in what outcomes are included in COS. Delegates felt that key to ensuring this is recognising that patient participation in COS development alone is not enough, and that patients will also need to be involved in the design of COS development studies.Conclusion We conclude by pointing to some distinctive challenges in including patients in COS development. While the COS development community can draw on the lessons learnt from other research areas about patient participation, involvement and engagement, the distinctive challenges that arise in COS development point to the need for some distinctive solutions too.
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Affiliation(s)
- Bridget Young
- Institute of Psychology Health and Society / North West Hub for Trials Methodology Research, University of Liverpool, Brownlow Hill, Liverpool, L69 3GB United Kingdom
| | - Heather Bagley
- Clinical Trials Research Centre / The COMET Initiative, Alder Hey Children’s NHS Foundation Trust, Institute of Child Health, University of Liverpool, Eaton Road, Liverpool, L12 2AP United Kingdom
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Sherwood A, Blumenthal JA, Smith PJ, Watkins LL, Hoffman BA, Hinderliter AL. Effects of Exercise and Sertraline on Measures of Coronary Heart Disease Risk in Patients With Major Depression: Results From the SMILE-II Randomized Clinical Trial. Psychosom Med 2016; 78:602-9. [PMID: 26867076 PMCID: PMC4905719 DOI: 10.1097/psy.0000000000000301] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the effects of supervised and home-based aerobic exercise training, and antidepressant pharmacotherapy (sertraline) on coronary heart disease (CHD) risk factors in a sample of participants with major depressive disorder (MDD). METHODS The Standard Medical Intervention versus Long-term Exercise (SMILE)-II study randomized 202 adults (153 women, 49 men) diagnosed as having MDD to one of four interventions, each of 4-month duration: supervised exercise, home-based exercise, antidepressant medication (sertraline, 50-200 mg daily), or placebo pill. Patients underwent a structured clinical interview for depression and completed the Hamilton Depression Rating Scale. CHD risk factors included brachial artery flow-mediated dilation, carotid intima-media thickness, serum lipids, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk. RESULTS Compared with placebo, active treatment of depression (supervised exercise, home-based exercise, sertraline therapy) was associated with an improvement in CHD risk factors (improved flow-mediated dilation [p = .032], reduced progression of intima-media thickness [p = .037], and a reduction in 10-year ASCVD [p = .049]). The active treatments did not differ from each other in their effects on the CHD risk outcomes. CONCLUSIONS Both exercise and antidepressant medication improved CHD risk factors and lowered ASCVD risk in patients with MDD. Because MDD is associated with increased risk for CHD events, treatment of depression with exercise or sertraline may reduce the risk of developing CHD in patients with MDD. TRIAL REGISTRATION Clinical Trials Government Identifier: NCT-00331305.
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Affiliation(s)
- Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Benson A. Hoffman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Alan L. Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Siqueira CC, Valiengo LL, Carvalho AF, Santos-Silva PR, Missio G, de Sousa RT, Di Natale G, Gattaz WF, Moreno RA, Machado-Vieira R. Antidepressant Efficacy of Adjunctive Aerobic Activity and Associated Biomarkers in Major Depression: A 4-Week, Randomized, Single-Blind, Controlled Clinical Trial. PLoS One 2016; 11:e0154195. [PMID: 27152523 PMCID: PMC4859497 DOI: 10.1371/journal.pone.0154195] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
Background Major depressive disorder (MDD) is a highly prevalent, heterogeneous and systemic medical condition. Treatment options are limited, and recent studies have suggested that physical exercise can play an important role in the therapeutics of MDD. The aim of this study was to evaluate the antidepressant efficacy of adjunctive aerobic activity in association with pharmacotherapy (selective serotonin reuptake inhibitor) in symptomatic MDD as well as its association with physiological biomarkers. Methods In this randomized, single-blind, add-on, controlled clinical trial, 57 patients (18–55 years of age) were followed-up for 28 days. All patients were drug-free, had been diagnosed with symptomatic MDD and received flexible dose of sertraline during the trial. Patients were randomized to either a 4-week program (4x/week) of add-on aerobic exercise (exercise group, N = 29) or no activity (control group, N = 28). Depression severity was assessed using the Hamilton Rating Scale for Depression (HAM-D) as the primary outcome. At baseline and endpoint, all patients underwent a comprehensive metabolic/cardiopulmonary exercise testing—including determination of maximal oxygen uptake (VO2max), VO2 at the second ventilatory threshold (VO2-VT2), and oxygen pulse (O2 pulse). Results Depression scores significantly decreased in both groups after intervention. Importantly, patients in the aerobic exercise group required lower sertraline dose compared to the control group (sertraline monotherapy). The VO2max and O2 pulse parameters increased over time only in the exercise group and remained unchanged in the control group. Conclusions The present findings suggest that a 4-week training of aerobic exercise significantly improves functional capacity in patients with MDD and may be associated with antidepressant efficacy. This approach may also decrease the need for higher doses of antidepressants to achieve response. Further studies in unmedicated and treatment-resistant MDD patients are needed in order to confirm the utility of short-term aerobic exercise as an alternative therapeutic approach in MDD. Trial Registration ClinicalTrials.gov NCT02427789
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Affiliation(s)
- Cristiana Carvalho Siqueira
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Leandro L. Valiengo
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - André F. Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Paulo Roberto Santos-Silva
- Laboratory of Movement Studies, University of Sao Paulo School of Medicine Hospital das Clínicas, Sao Paulo, Sao Paulo, Brazil
| | - Giovani Missio
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Rafael T. de Sousa
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health (NIMH), Bethesda, Maryland, United States of America
| | - Georgia Di Natale
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Wagner F. Gattaz
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Alberto Moreno
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo Machado-Vieira
- Laboratory of Neuroscience LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health (NIMH), Bethesda, Maryland, United States of America
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- * E-mail: ;
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50
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Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as Treatment for Anxiety: Systematic Review and Analysis. Ann Behav Med 2016; 49:542-56. [PMID: 25697132 DOI: 10.1007/s12160-014-9685-9] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Exercise has been shown to reduce symptoms of anxiety, but few studies have studied exercise in individuals preselected because of their high anxiety. PURPOSE The objective of this study is to review and critically evaluate studies of exercise training in adults with either high levels of anxiety or an anxiety disorder. METHODS We conducted a systematic review of randomized clinical trials (RCTs) in which anxious adults were randomized to an exercise or nonexercise control condition. Data were extracted concerning anxiety outcomes and study design. Existing meta-analyses were also reviewed. RESULTS Evidence from 12 RCTs suggested benefits of exercise, for select groups, similar to established treatments and greater than placebo. However, most studies had significant methodological limitations, including small sample sizes, concurrent therapies, and inadequate assessment of adherence and fitness levels. CONCLUSIONS Exercise may be a useful treatment for anxiety, but lack of data from rigorous, methodologically sound RCTs precludes any definitive conclusions about its effectiveness.
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Affiliation(s)
- Gregory L Stonerock
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3119, Durham, NC, 27710, USA,
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