Abstract
BackgroundThe effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined.MethodsOutpatients with major depression (DSM-IV) were allocated to supervised aerobic or stretching exercise groups during a three months period. The primary outcome was the Hamilton depression score (HAM-D17). Secondary outcomes were cognitive function, cardiovascular risk markers, and employment related outcomes.Results56 participants were allocated to the aerobic exercise intervention versus 59 participants to the stretching exercise group. Post intervention the mean difference between groups was −0.78 points on the HAM-D17 (95% CI −3.2 to 1.6; P = .52). At follow-up, the participants in the aerobic exercise group had higher maximal oxygen uptake (mean difference 4.4 l/kg/min; 95% CI 1.7 to 7.0; P = .001) and visuospatial memory on Rey’s Complex Figure Test (mean difference 3.2 points; 95% CI 0.9 to 5.5; P = .007) and lower blood glucose levels (mean difference 0.2 mmol/l; 95% CI 0.0 to 0.5; P = .04) and waist circumference (mean difference 2.2 cm; 95% CI 0.3 to 4.1; P = .02) compared with the stretching exercise group.ConclusionsThe results of this trial does not support any antidepressant effect of referring patients with major depression to a three months aerobic exercise program. Due to lower recruitment than anticipated, the trial was terminated prior to reaching the pre-defined sample size of 212 participants; therefore the results should be interpreted in that context. However, the DEMO-II trial does suggest that an exercise program for patients with depression offer positive short-term effects on maximal oxygen uptake, visuospatial memory, fasting glucose levels, and waist circumference.Trial RegistrationClinicalTrials.gov NCT00695552
Highlights
Based on the current development in disease patterns, unipolar depression is expected to be the second highest contributing factor to the global disease burden in 2030 [1]
The authors previously conducted a clinical trial of exercise in depressed patients (DEMO-I) and found no convincing antidepressant effect of allocating patients to either strength training or aerobic exercise compared with an attention control [13]
Participants Between September 2008 and April 2011, 227 potential participants were referred to the trial site from various clinical settings
Summary
Based on the current development in disease patterns, unipolar depression is expected to be the second highest contributing factor to the global disease burden in 2030 [1]. Low compliance and high drop-out rates during antidepressant therapy could explain why only 50% are expected to remit during the acute phase of treatment [5,6,7] This has resulted in the interest and evaluation of various forms of alternative and complementary therapies in depressed patients. The authors previously conducted a clinical trial of exercise in depressed patients (DEMO-I) and found no convincing antidepressant effect of allocating patients to either strength training or aerobic exercise compared with an attention control [13]. These non-significant findings could potentially be explained by the low exercise frequency (two days per week) and a heterogeneous population with regard to antidepressant treatment [13]. The effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined
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