Abstract
BackgroundDue to the high prevalence of depressive disorders, it is mandatory to develop therapeutic strategies that provide universal access and require limited financial and human resources. Web-based therapeutic approaches fulfill these conditions.ObjectiveThe objective of our study was to assess the feasibility, acceptability, and efficacy of a supervised, individualized 8-week Web-based exercise intervention conducted for patients with moderate to severe depression.MethodsWe recruited 20 patients with unipolar depression and randomly assigned them into 2 groups (intervention, exercise program group, n=14, and control, treatment-as-usual group, n=6). At baseline, depressive symptoms were rated via the Quick Inventory of Depressive Symptomatology (QIDS) by patients themselves (QIDS–self-report, QIDS-SR) and by a blinded psychiatrist (QIDS–clinician rating, QIDS-C). In addition, performance diagnostics (lactate analysis, spiroergometry during a treadmill walking test) were conducted. Quality of life was assessed via the Short Form-36 questionnaire (SF-36) and self-efficacy via the General Self-Efficacy scale (GSE). In addition, habitual physical activity (HPA) was determined via the Baecke questionnaire. Participants of the intervention group received exercise schedules once weekly with endurance and strength training instructions. Rating of depressive symptoms was repeated after 6-12 days and 8 weeks; performance diagnostics and the completion of all the questionnaires were repeated after 8 weeks only.ResultsThe severity of depression subsided significantly in the intervention group after 8 weeks (median change in QIDS-SR: −5; interquartile range, IQR: −2 to −10), although it was already evident within the first 6-12 days (median change in QIDS-SR: −6; IQR: −2 to −8). During the intervention, participants undertook a median of 75 (IQR: 63 to 98) minutes of endurance training per week or 84% (16 [IQR: 9 to 19] of 19 [IQR: 15 to 21]) recommended endurance units in total. In addition, 9 (IQR: 4 to 12) of 10 (IQR: 8 to 13) recommended strength training exercise units were conducted during the 8 weeks. Performance diagnostics revealed a substantial increase in the maximum output in Watt for the intervention group after 8 weeks. Moreover, the intervention showed a favorable effect on SF-36 items “emotional well-being” and “social functioning” as well as on GSE and HPA scores.ConclusionsOur individualized Web-based exercise intervention for moderate to severe depression was highly accepted by the patients and led to a significant and clinically relevant improvement of depressive symptoms.Trial RegistrationClinicalTrials.gov NCT02874833; https://clinicaltrials.gov/ct2/show/NCT02874833 (Archived by WebCite at http://www.webcitation.org/72ZUUR4tE)
Highlights
Unipolar depression or major depressive disorder (MDD) is the worldwide leading cause of disability [1] with a life time prevalence of around 17% [2]
Our individualized Web-based exercise intervention for moderate to severe depression was highly accepted by the patients and led to a significant and clinically relevant improvement of depressive symptoms
An early response of >50% reduction was observed for 36% (5/14) patients in Quick Inventory of Depressive Symptomatology (QIDS)-SR scores and for 21% (3/14) patients in Quick Inventory of Depressive Symptomatology-clinician rating QIDS-SR (QIDS-C) scores
Summary
Unipolar depression or major depressive disorder (MDD) is the worldwide leading cause of disability [1] with a life time prevalence of around 17% [2]. On the other hand, personalized psychotherapy requires high personal effort, especially for highly prevalent diseases such as MDD. Such high personnel expenses cannot be implemented, especially in rural areas. We exploited such an innovative form of therapy in terms of an individualized, supervised, Web-based exercise therapy in patients with MDD and moderate to severe depressive symptoms. We chose this approach because physical activity is currently recommended as a safe and effective adjunctive therapy in the treatment of MDD in numerous national guidelines [8,9,10].
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