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

The effect of physical fitness on psychological health: evidence from Chinese university students

BACKGROUND

Despite frequent discussions on the link between physical and mental health, the specific impact of physical fitness on mental well-being is yet to be fully established.

METHOD

This study, carried out between January 2022 and August 2023, involved 4,484 Chinese University students from eight universities located in various regions of China. It aimed to examine the association between physical fitness on psychological well-being. Descriptive statistics, t-tests, and logistic regression were used to analyze the association between physical fitness indicators (e.g., Body Mass Index (BMI), vital capacity, and endurance running) and mental health, assessed using Symptom Checklist-90 (SCL-90). All procedures were ethically approved, and participants consented to take part in.

RESULTS

Our analysis revealed that BMI, vital capacity, and endurance running scores significantly influence mental health indicators. Specifically, a 1-point increase in BMI increases the likelihood of an abnormal psychological state by 10.9%, while a similar increase in vital capacity and endurance running decreases the risk by 2.1% and 4.1%, respectively. In contrast, reaction time, lower limb explosiveness, flexibility, and muscle strength showed no significant effects on psychological states (p > 0.05).

CONCLUSION

Improvements in BMI, vital capacity, and endurance running capabilities are associated with better mental health outcomes, highlighting their potential importance in enhancing overall well-being.

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

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

Introducing Braining-physical exercise as adjunctive therapy in psychiatric care: a retrospective cohort study of a new method

BACKGROUND

Patients with severe mental disorders suffer from higher rates of poor somatic health and have shorter life expectancy than the average population. Physical activity can treat and prevent several diseases, e.g. cardiovascular and metabolic disorders as well as psychiatric symptoms. It is therefore of utmost importance to develop effective methods to integrate physical activity into psychiatric care. To meet this need, the physical activity intervention Braining was developed. This study aims to describe Braining, to assess the number of patients reached during the first years of pilot testing, to analyze clinical data in the group of patients participating in Braining 2017-2020 and to assess the intervention.

METHODS

In this descriptive retrospective study we analyzed data from all patients participating in Braining training sessions ≥ 3 times (n = 239), the Braining Participants. Regular patients at the clinic served as a comparison. Furthermore, medical records were studied for a smaller cohort (n = 51), the Braining Pilot Cohort. Data was analyzed using Chi-square and Fisher's tests.

RESULTS

During the introduction period of Braining, 580 patients attended an information meeting about Braining, or at least one training session. 239 patients participated in ≥ 3 training sessions, considered to be participants of Braining. These Braining Participants (n = 239), ages 19 to 82, males 23.4%, attended between 3 and 308 training sessions (median 9). The main diagnoses were affective and anxiety disorders. Number of diagnoses ranged from 0 to 10 (median = 2). For the subsample, the Braining Pilot Cohort (n = 51), participants attended between 3 and 208 training sessions (median = 20). Twelve percent were working full-time, and symptom severity of depression and general anxiety was moderate. Two thirds had ≥ 3 different classes of medication. Regarding metabolic morbidity, 28 had been diagnosed with hypertension, though blood lipids, blood glucose as well as blood pressure were within the normal range. Thirty-seven percent were prescribed Physical Activity on Prescription during 2017-2020. One severe adverse event was reported.

CONCLUSIONS

The Braining intervention reached all age-groups and patients with a wide and representative diagnostic panorama, suggesting that Braining could be a promising and safe method for implementing physical activity in a psychiatric patient population.

Cardiorespiratory fitness and cardiovascular risk among in-patients with depression compared to healthy controls

Introduction

Compared to the general population, individuals with depression have an increased risk for cardiovascular diseases. Nevertheless, little is known so far whether cardiorespiratory fitness (CRF) moderates this relationship. Therefore, we examined whether common physiological cardiovascular risk factors differ between patients with depression and healthy (non-depressed) controls, whether patients and controls differ in CRF, and whether higher CRF is associated with a lower cardiovascular risk in both patients and healthy controls. Additionally, we examined whether within the patient sample, cardiovascular risk factors differ between patients with mild, moderate and severe depression, and whether the relationship between symptom severity and cardiovascular risk is moderated by patients' CRF levels.

Methods

Data from a multi-centric, two-arm randomized controlled trial (RCT) was analyzed, including 210 patients (F32, single episode: n = 72, F33, recurrent major depression: n = 135, F31-II, bipolar type II: n = 3) and 125 healthy controls. Waist circumference, body mass index, body fat, blood pressure, cholesterol levels, triglycerides, and blood glucose were considered as cardiovascular risk markers. CRF was assessed with a submaximal ergometer test. Differences between groups were examined via χ²-tests and (multivariate) analyses of covariance.

Results

Compared to healthy controls, patients with depression had a higher cardiovascular risk as evident from about half of the examined indicators. In the total sample, participants with good CRF had more favourable scores across nearly all risk markers than counterparts with poor CRF. For most variables, no interaction occurred between group and fitness, indicating that in patients and controls, similar differences existed between participants with poor and good CRF. Few differences in risk markers were found between patients with mild, moderate and severe depression, and no interaction occurred between depression severity and CRF.

Discussion

Patients with depression and healthy controls differ in several cardiovascular risk markers, putting patients at increased risk for CVDs. In contrast, people with good CRF show more favourable cardiovascular risk scores, a relationship which was observed in both healthy controls and patients with depression. Physical health of psychiatric patients should receive the clinical attention that it deserves. Lifestyle interventions targeting healthy diet and/or physical activity are recommended as a physically active and healthy lifestyle contributes equally to patients' mental well-being and cardiovascular health.

Association between physical activity and comorbid anxiety/depression in 46 low- and middle-income countries

BACKGROUND

Evidence on the association of low physical activity (PA) with depression or anxiety is well established. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low- and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged ≥18 years from 46 LMICs.

METHODS

Cross-sectional, community-based data were analyzed from the World Health Survey (WHS). Multivariable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category.

RESULTS

237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12-1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23-1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52-2.01).

CONCLUSION

Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.

Efficacy of an adjuvant non-face-to-face multimodal lifestyle modification program for patients with treatment-resistant major depression: A randomized controlled trial

BACKGROUND

The high prevalence of depression is partly attributable to the poor response of patients to first-line antidepressants. Multimodal programs that promote a healthy lifestyle are successful in treating depression when used as a complementary therapy, but their medium- and long-term benefits have not been demonstrated for patients with treatment-resistant depression (TRD). The main aim of this study was to compare the effectiveness of a lifestyle modification program (LMP) with mindfulness-based cognitive therapy (MBCT) and a placebo-control (written suggestions for lifestyle changes) in Spanish patients with TRD.

METHODS

This controlled clinical trial randomized 94 patients with TRD into 3 arms. The primary outcome was the Beck Depression Inventory-II (BDI-II) score at baseline, 2, 6 and 12 months. The secondary outcomes were changes in scores that evaluated quality-of-life, adherence to the Mediterranean diet, physical activity, and social support.

RESULTS

Relative to the placebo group, the LMP and MBCT groups had significantly better quality of life (p = 0.017; p = 0.027), and the LMP group had significantly better adherence to the Mediterranean diet (p<0.001) and reduced use of antidepressants (p = 0.036). However, the three groups showed no significant differences in BDI-II score.

LIMITATIONS

Only about half of the planned 180 patients were recruited, in part due to the COVID-19 pandemic.

CONCLUSIONS

There was no evidence that the LMP treatment significantly reduced symptoms of depression relative to the other groups during the COVID-19 lockdown.

Physical exercise training as preceding treatment to cognitive behavioral therapy in mild to moderate major depressive disorder: A randomized controlled trial

BACKGROUND

Many patients with major depressive disorder (MDD) remain untreated or do not respond to cognitive behavioral therapy (CBT). Physical exercise shows antidepressive effects and may serve as an effective augmentation treatment. However, research on combining exercise with CBT is sparse in MDD and underlying mechanisms of exercise are not well understood to date.

METHODS

120 outpatients with MDD were randomized to either a high intensity exercise group (HEX), a low intensity exercise group (LEX), or a waiting list control group (WL). After 12 weeks of exercise training or waiting period, all patients received a manualized CBT.

RESULTS

Seventy-five patients with MDD completed both the exercise program/ waiting period and the CBT. While physical fitness improved in HEX after the exercise program, it did not change in LEX and WL. Depressive symptoms improved in all three groups from baseline to post-CBT and the group by time interaction was not significant. Regression analyses revealed that the amount of fitness improvement during exercise predicted the subsequent CBT response.

LIMITATIONS

The dropout rate was relatively high, preparatory CBT sessions during exercise / waiting period may have influenced depressive symptoms, and no patients with severe MDD were included.

CONCLUSIONS

High intense physical exercise did not lead to a general enhancement of CBT outcome, but higher increases in physical fitness seem to improve symptom change during CBT. Our results suggest that the implementation of more individually tailored exercise programs could be a promising approach for future research and clinical practice.

Cardiorespiratory fitness and self-reported physical activity levels of referring mental healthcare professionals, and their attitudes and referral practices related to exercise and physical health

BACKGROUND

Physical activity (PA) interventions can improve mental and physical health of people with mental illness, especially when delivered by qualified exercise professionals. Also, the behaviour, engagement and support of referring mental healthcare professionals (HCP) seem essential, but research is scarce. We aimed to study HCP physical fitness and PA, and associations with their attitudes and referral practices related to physical health and PA interventions.

METHODS

HCP at the Dutch Association for Psychiatry congress (2019) were invited to an online questionnaire (demographic/work characteristics, stress, PA levels, knowledge/attitudes regarding PA, referral practices) and cycle ergometer test. Strongest associations were analysed using linear and logistic regression.

RESULTS

Of the 115 HCP who completed the questionnaire (40 also completed the ergometer test), 43% (n = 50) met PA guidelines (i.e., ≥150min moderate-to-vigorous PA and ≥2x bone/muscle-strengthening exercises/week). Women, HCP interns/residents and HCP experiencing more stress were less active and less likely to meet PA guidelines. Conversely, there were positive associations with personal experience with an exercise professional. Knowledge/attitudes on physical health and PA were positive. HCP were more likely to refer patients to PA interventions if they met PA guidelines (OR = 2.56, 95%BI = 0.85-7.13) or had higher beliefs that exercise professionals can increase adherence to PA interventions (OR = 3.72, 95%BI = 1.52-9.14).

LIMITATIONS

Mainly psychiatrists, affecting generalizability.

CONCLUSIONS

HCP report the importance and relevance of PA in mental healthcare. Despite strong evidence and guidance for PA interventions in prevention and treatment, referral to such interventions partly depends on the PA behaviour and attitude of patient's physician/clinician.

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

BACKGROUND

Exercise is indicated as a monotherapy for depression, as well as an augmentation strategy alongside standard treatments. However, it is not yet clear how exercise and standard treatments interact with regards to patient outcomes. The primary aim of the current systematic review and meta-analysis was to compare the antidepressant effects of exercise combined with standard treatment to standard treatment alone.

METHOD

A systematic search was conducted for trials comparing the efficacy of standard treatments alone or in combination with exercise for reducing symptoms of depression. Random effects meta-analysis was used to estimate pooled standardized mean difference for standard treatment alone versus standard treatment with exercise.

RESULTS

Twenty-two studies were included in the meta-analysis. There was a moderate pooled effect in favour of exercise combined with standard treatment compared to standard treatment alone (SMD = -0.62, p < 0.00001, I² = 70%), with greatest benefits accruing for more severe patients (SMD = -0.99, p < 0.00001; I² = 0%). Sensitivity analyses remained significant for trials with lower risk of bias (SMD = -0.41, p = 0.0009; I² = 52%) and patients with a major depressive disorder diagnosis (SMD = -0.70, p < 0.0001; I² = 72%).

LIMITATIONS

There was considerable heterogeneity between trials. Uneven covariate distributions within subgroups limited our ability to explore the sources of heterogeneity.

CONCLUSIONS

Exercise combined with standard treatments leads to significantly greater antidepressant effects over standard treatment alone. Patients and clinicians should consider using exercise alongside standard treatments to enhance therapeutic efficacy for depression.

A Scoping Review of the Relationship between Running and Mental Health

Poor mental health contributes significantly to global morbidity. The evidence regarding physical benefits of running are well-established. However, the mental health impacts of running remain unclear. An overview of the relationship between running and mental health has not been published in the last 30 years. The purpose of this study was to review the literature on the relationship between running and mental health. Our scoping review used combinations of running terms (e.g., Run* and Jog*) and mental health terms (general and condition specific). Databases used were Ovid(Medline), Ovid(Embase), ProQuest and SportDiscus. Quantitative study types reporting on the relationships between running and mental health were included. Database searches identified 16,401 studies; 273 full-texts were analysed with 116 studies included. Overall, studies suggest that running bouts of variable lengths and intensities, and running interventions can improve mood and mental health and that the type of running can lead to differential effects. However, lack of controls and diversity in participant demographics are limitations that need to be addressed. Cross-sectional evidence shows not only a range of associations with mental health but also some associations with adverse mental health (such as exercise addiction). This review identified extensive literature on the relationship between running and mental health.

Personality traits as predictors of exercise treatment adherence in major depressive disorder: lessons from a randomised clinical trial

OBJECTIVE

The objective of this study was to explore the determinants of adherence in the EFFORT-D (EFFect Of Running Therapy) study in a specialised mental health care hospital setting.

METHODS

Patients with major depressive disorder (MDD) were given treatment as usual and half were randomised to an exercise intervention. Adherence was measured at 3 months (T3) and 6 months (T6) and was defined as participation in the overall study protocol (total n = 42, adhered n = 28) or intervention (total n = 24, adhered n = 9). Potential determinants were age, BMI, tobacco and alcohol use, severity of depression, anxiety, fitness (VO₂max kg^-1 and Wmax kg^-1) and personality traits at baseline. ANOVA, Chi-square tests and block-wise logistic regression were performed, and reliability of the scales was determined.

RESULTS

Numbers were found too low for analyses on smoking, drinking and anxiety. Higher agreeableness was significantly associated with better adherence to the overall study protocol (OR 1.2; p = 0.03; 95% CI: 1.01-1.4) and severity of depression was negatively associated with adherence in the intervention group (OR 0.70; p = 0.046;95% CI: 0.49-0.99).

CONCLUSIONS

To adhere to a study protocol involving exercise or to a clinical exercise programme, MDD patients need substantial personal support. Measurement of personality traits and the severity of depression as potential predictors of adherence could be considered for this purpose. Keypoints Adherence to exercise and study protocols in a randomised controlled trial was low Patients with severe major depressive disorder need substantial personal support Measurement of personality traits could be considered.