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.

Physical activity in outpatients with mental disorders: status, measurement and social cognitive determinants of health behavior change

INTRODUCTION

Physical activity (PA) can play an important role in improving the mental and physical health in patients with mental disorders but is not well studied in this population. The aim of this study was to assess the status of PA in outpatients with mental disorders, compare the convergence of self-rating and accelerometer measurement and examine the influence of social cognitive variables from the Motivation-Volition (MoVo) model and clinical measures on PA.

METHODS

Eighty-four patients were recruited from three psychiatric outpatient clinics and local psychiatrists (Distribution of ICD-10-Diagnoses: F3.x = 59.5%, F4.x = 20.2%, F2.x = 17.9%, F1.x = 2.4%). PA, Self-efficacy, Outcome-expectancies, Intention, Self-concordance, Action- and Coping-planning, Health-related Quality of Life (SF-12) and Psychiatric Symptoms (SCL-27) were assessed through questionnaires. PA was assessed objectively by accelerometers.

RESULTS

Most of the participants did not reach PA recommendations. Subjective and objective measurement of PA showed good accordance for total PA on group level but lower accordance on individual level. Motivational and volitional determinants of health behavior change showed a similar pattern of correlations with PA as in populations without mental disorders.

CONCLUSION

Outpatients with mental disorders have the ability and are willing to perform PA but a large proportion of our sample did not meet PA recommendations. To assess group levels of PA, subjective and objective measurement seem equally apt, for individual diagnostics, a combination of both should be considered. Social cognitive determinants of health behavior change seem to be as helpful for the design of PA interventions for patients with mental disorders as they are in other populations.

Neurobiological mechanisms of exercise and psychotherapy in depression: The SPeED study-Rationale, design, and methodological issues

BACKGROUND/AIMS

Even though cognitive behavioral therapy has become a relatively effective treatment for major depressive disorder and cognitive behavioral therapy-related changes of dysfunctional neural activations were shown in recent studies, remission rates still remain at an insufficient level. Therefore, the implementation of effective augmentation strategies is needed. In recent meta-analyses, exercise therapy (especially endurance exercise) was reported to be an effective intervention in major depressive disorder. Despite these findings, underlying mechanisms of the antidepressant effect of exercise especially in combination with cognitive behavioral therapy have rarely been studied to date and an investigation of its neural underpinnings is lacking. A better understanding of the psychological and neural mechanisms of exercise and cognitive behavioral therapy would be important for developing optimal treatment strategies in depression. The SPeED study (Sport/Exercise Therapy and Psychotherapy-evaluating treatment Effects in Depressive patients) is a randomized controlled trial to investigate underlying physiological, neurobiological, and psychological mechanisms of the augmentation of cognitive behavioral therapy with endurance exercise. It is investigated if a preceding endurance exercise program will enhance the effect of a subsequent cognitive behavioral therapy.

METHODS

This study will include 105 patients diagnosed with a mild or moderate depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The participants are randomized into one of three groups: a high-intensive or a low-intensive endurance exercise group or a waiting list control group. After the exercise program/waiting period, all patients receive an outpatient cognitive behavioral therapy treatment according to a standardized therapy manual. At four measurement points, major depressive disorder symptoms (Beck Depression Inventory, Hamilton Rating Scale for Depression), (neuro)biological measures (neural activations during working memory, monetary incentive delay task, and emotion regulation, as well as cortisol levels and brain-derived neurotrophic factor), neuropsychological test performance, and questionnaires (psychological needs, self-efficacy, and quality of life) are assessed.

RESULTS

In this article, we report the design of the SPeED study and refer to important methodological issues such as including both high- and low-intensity endurance exercise groups to allow the investigation of dose-response effects and physiological components of the therapy effects.

CONCLUSION

The main aims of this research project are to study effects of endurance exercise and cognitive behavioral therapy on depressive symptoms and to investigate underlying physiological and neurobiological mechanisms of these effects. Results may provide important implications for the development of effective treatment strategies in major depressive disorder, specifically concerning the augmentation of cognitive behavioral therapy by endurance exercise.

GETAWAY descriptors to predicting A2A adenosine receptors agonists

The GEometry, Topology and Atom-Weights AssemblY approach has been applied to the study of the A(2A) adenosine receptors agonist effect of 29 adenosine analogues: N(6)-arylcarbamoyl, 2-arylalkynyl-N(6)-arylcarbamoyl, and N(6)-carboxamido derivatives. A model able to describe more than 77% of the variance in the experimental activity was developed with the use of the mentioned approach. In contrast, no one of four different approaches, including the use of Topological, Galvez Topological Charges indexes, Geometrical and WHIM descriptors were able to explain more than 70% of the variance in the mentioned property with the same number of variables in the equation.

Synthesis of carbocyclic analogues of MECA and NECA 1,2-disubstituted as potential adenosine receptor agonists

A new class of 1,2-disubstituted carbocyclic nucleosides of MECA and NECA analogues was synthesized in good yield starting from (+/-) 6-azabicyclo[3.2.0]heptan-7-one.

Purine derivatives of 1,2-disubstituted cyclohexane analogues of nucleosides

Starting from (+/-)-cis-2-hydroxymethylcyclohexylamine, a series of cyclohexane-derived cis-1,2-disubstituted carbonucleoside analogues with a 6- or 2,6-purine or 8-azapurine base were synthesized. The antiviral and antitumoral in vitro effects of the new compounds were evaluated.

Synthesis and structural study of pyrimidyl carbocyclic analogues of nucleosides based on cyclopentene rings

A series of 1,2-disubstituted carbonucleoside analogues of pyrimidine and 5-halopyrimidines with the unsaturated carbocycle cyclopentene was synthesized. AIM theory was applied to analyse the conformational and electronic effects of 5-halogenation.

Resolution of racemic mixtures of carbocyclic analogues of nucleosides and assignment of their absolute configuration

Racemic trans-6-chloro-9-[2-(hydroxymethyl)cyclopentyl]purine was resolved using HPLC with a chiral column. The absolute configurations of the enantiomers were determined by NMR studies of their (R)- and (S)-methoxyphenylacetates.

A model of suture-induced urolithiasis with urographic control in the bladder of the rat

The characteristics of a model of urolithiasis in the bladder of male Wistar rats were evaluated. Two techniques were compared: one knot of suture material through the bladder wall, or 15-throw knots inside the bladder. Rats were randomly assigned to one of six groups, according to the technique and suture material used (polyester, silk, or chromic catgut). An excretory urogram was performed at days 30, 60, and 90. At the moment of positive radiographic diagnosis, animals were sacrificed and stones were obtained. All rats were sacrificed at day 90 regardless of the x-ray results. Variables evaluated were average days to a positive urogram, average weight of all uroliths, and percentage of animals developing urolithiasis throughout the study. There were no statistical differences between groups for the average weight of stones, which ranged from 0.008 to 1.502 g for individual cases. All three materials were more lithogenic with the 15-throw knot inside technique. No significant differences were detected for lithogenesis criteria between suture materials. X-ray dispersion spectroscopy evidenced calcium phosphate composition of two stones from chromic catgut, and magnesium phosphate composition of two stones from chromic catgut, two from silk, and two from polyester. Neo-epithelization over the suture was confirmed microscopically in bladders with the one-throw technique. We conclude that (1) this is an effective model of urolithiasis, with predictability in time, composition, and amount of stone formation; (2) the presence of more suture material inside the bladder is more lithogenic; and (3) excretory urograms are highly sensitive and specific for the noninvasive diagnosis of bladder urolithiasis.

Synthesis and biological evaluation of 1,2-disubstituted carbonucleosides of 6-substituted purine and 8-azapurine

A series of new one two substituted carbonucleoside analogues (OTC), with the purine and 8-azapurine base linked through a methylene group at the cyclopentane ring, were synthesized and evaluated for their activity against a number of viruses and tumor cells in vitro.

Phenylpiperazine derivatives with strong affinity for 5HT1A, D2A and D3 receptors

Four 7-[3-(4-phenyl-1-piperazinyl)propoxy]coumarins were synthesized. The affinities of these compounds for DA (D2A, D3) and 5HT1A receptors were evaluated for their ability to displace [3H]-raclopride and [3H]-8-OH-DPAT respectively from their specific binding sites. The affinities of the target compounds were all in the nanomolar range and followed the order 5-HT1A > D2 > D3.

[Typhoid fever in children: association with blood phenotypes ABO, Rh and MNSs]

The hypothesis that blood phenotype B is associated to typhoid fever either directly or interacting with other phenotypes of the Rh or MNSs blood systems was tested. 256 children from the Northern Area of Santiago (Chile) with bacteriologically confirmed typhoid fever and 329 afebrile controls matched by age and gender from the same population, were studied. Association was found between phenotype RH3 and protection against disease for the whole group (OR = 0.67; p < 0.042) and for males (OR = 0.05; p = 0.014) although the gender-RH3 interaction was at the limit of significance. RH8 and Ss phenotypes were associated to increased susceptibility (OR = 1.83; p < 0.034 and OR = 1.56; p = 0.01, respectively). Controlling RH3 and Ss phenotypes by B, increased their effects (OR = 0.26; p = 0.04 and OR = 3.42; p = 0.026, respectively), but interactions did not reach statistical significance. These results show a susceptibility cline whose implications and applicability deserve further studies. A high proportion of S. paratyphi B (23.8%) appeared in this series, which may imply sample heterogeneity. The meaning of these findings need further epidemiological and genetic studies.

Pyridazine derivatives, VII. Synthesis and hypotensive activity of 3-hydrazinocycloalkyl[1,2-c]pyridazines and their derivatives

The preparation of a series of 3-hydrazinocycloalkyl[1,2-c]pyridazines 7 and some derivatives as hydrazones 8, 9, triazoles 10 and pyrroles 11 are described together with their hypotensive activity in normotensive rats.