Abstract
Objectives: Considering the growing need for using a variety of new nonpharmacological methods in treating depression, this quasi experimental study was conducted to investigate the effect of aerobic indoor exercise in a gym compared with green exercise in an outdoor green environment of an urban park on triple categories of affective, cognitive and somatic symptoms of depression and to examine its psychological mediators of perceived stress and coping strategies. Methods: Forty six female outpatients with major depressive disorder were divided into 3 conditions of indoor exercise + routine pharmacotherapy (n = 15), green exercise + routine pharmacotherapy (n = 15), and a routine pharmacotherapy alone as the control group (n = 16). The exercise used for both indoor and green exercise conditions consisted of 36 one hour sessions (three times per week) with an intensity of 50% - 70% of the maximum heart rate. The participants completed the pre- and post-intervention depression, stress and coping questionnaires including Beck Depression Inventory-II, Perceived Stress Scale and Coping Inventory for Stressful Situations. Results: The findings indicated a significant decrease in the post-intervention scores of all three categories of affective, cognitive and somatic symptoms of depression and perceived stress in both exercise groups compared with the control group, but there was no significant difference between two exercise groups. With respect to the use of problem-focused, emotion-focused and avoidant-focused coping methods, there was no significant difference between post-intervention scores of all groups. Conclusion: In the clinical settings, both of the indoor exercise and green exercise programs can help to further improvement in all three categories of affective, cognitive and somatic symptoms of depression as an adjunct (or independent) treatment to the same degree, especially mediated by reducing the amount of perceived stress, but not through any significant changes in cognitive-behavioral coping strategies.
Highlights
Major depressive disorder is considered as one of the most common psychological disorders around the world especially in women [1]
The findings indicated a significant decrease in the post-intervention scores of all three categories of affective, cognitive and somatic symptoms of depression and perceived stress in both exercise groups compared with the control group, but there was no significant difference between two exercise groups
The inclusion criteria were the following: Female patients aged 20 - 50 years who were affected with moderate to severe major depressive disorder diagnosed by a psychiatrist via clinical interview based on the fifth version of the diagnostic and statistical manual of mental disorders (DSM-5) [30] and a minimum score of 20 on the Beck Depression Inventory-II (BDI-II) [31], not being engaged in other mental treatments and physical activity programs during the study period, confirming their willingness to participate in the research and sign the informed consent statement
Summary
Major depressive disorder is considered as one of the most common psychological disorders around the world especially in women [1]. To avoid side effects many patients are not willing to use medication and on the other hand, since psychotherapy requires considerable cognitive and intellectual capacity, researchers have become increasingly interested in using exercise and physical activity as an adjunct or independent procedure in treating depression [4]. There is good evidence obtained from cross-sectional studies in the general population, it seems that there is a considerable need for further examination in the clinical settings, especially on depressed outpatients. In this regard, an important subject left unaddressed in other studies is that which affective, cognitive, and somatic categories of depression symptoms are more affected by exercise and physical activity. An aim of this study is to find out if exercises lead to reduced depression, this reduction is achieved mainly from improvement in which groups of depression symptoms
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