Abstract
BackgroundExercise efficaciously reduces disorder-specific symptoms of psychiatric disorders. The current study aimed to examine the efficacy of a group exercise intervention on global symptom severity and disorder-specific symptoms among a mixed outpatient sample.MethodsGroups of inactive outpatients, waiting for psychotherapy, with depressive disorders, anxiety disorders, insomnia, and attention-deficit/hyperactivity disorders were randomized to a manualized 12-week exercise intervention, combining moderate to vigorous aerobic exercise with techniques for sustainable exercise behaviour change (n = 38, female = 71.1% (n = 27), Mage = 36.66), or a passive control group (n = 36, female = 75.0% (n = 27), Mage = 34.33). Primary outcomes were global symptom severity and disorder-specific symptoms, measured with the Symptom Checklist-90-Revised and Pittsburgh Sleep Quality Index pre- and post-treatment. Secondary outcome was the self-reported amount of exercise (Physical Activity, Exercise, and Sport Questionnaire), measured pre-treatment, intermediate-, and post-treatment. Intention-to-treat analyses were conducted using linear mixed models. Linear regressions were conducted to examine the effect of the change of exercise behaviour on the change of symptoms.ResultsThe intervention significantly improved global symptom severity (d = 0.77, p = .007), depression (d = 0.68, p = .015), anxiety (d = 0.87, p = .002), sleep quality (d = 0.88, p = .001), and increased the amount of exercise (d = 0.82, p < .001), compared to the control group. Post-treatment differences between groups were significant for depression (d = 0.63, p = .031), sleep quality (d = 0.61, p = .035) and the amount of exercise (d = 1.45, p < .001). Across both groups, the reduction of global symptom severity was significantly predicted by an increase of exercise (b = .35, p = .012).ConclusionsThe exercise intervention showed transdiagnostic efficacy among a heterogeneous clinical sample in a realistic outpatient setting and led to sustained exercise behaviour change. Exercise may serve as an efficacious and feasible transdiagnostic treatment option improving the existing treatment gap within outpatient mental health care settings.Trial registrationThe study was registered on ClinicalTrials.gov (ID: NCT03542396, 25/04/2018).
Highlights
Exercise efficaciously reduces disorder-specific symptoms of psychiatric disorders
30.2% (n = 32) were excluded and 69.8% (n = 74) were eligible for participation. Those eligible were randomly assigned to the intervention group, 51.3% (n = 38), or control group, 48.7% (n = 36). 5.3% (n = 2) of participants of the intervention group were removed from the analysis due to a wrong diagnosis at pre-treatment assessment (comorbid lifetime eating disorder, 2.6% (n = 1), and a comorbid alcohol use disorder, 2.6% (n = 1) [79]
This led to an ITT efficacy group of N = 72 (50.0% (n = 36) of patients in the intervention group vs. 50.0% (n = 36) in the control group)
Summary
Exercise efficaciously reduces disorder-specific symptoms of psychiatric disorders. The current study aimed to examine the efficacy of a group exercise intervention on global symptom severity and disorder-specific symptoms among a mixed outpatient sample. The high necessity for treatment, on the one hand, and deficits in mental health care, on the other hand, illustrates the severe gap between people in need for treatment and those receiving it [11] This treatment gap aggravates the burden of psychiatric disorders because the absence or delay in treatment can lead to worsening and chronicity of symptoms and to the development of comorbid diagnoses [10]. There is a demand for treatment that can improve this treatment gap by being applicable and efficacious to individuals who meet criteria for one or more clinical diagnoses and for groups of heterogenous disorders This treatment would need to be and fast accessible (i.e., efficient) to increase the number of people receiving treatment
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