title: Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: randomised controlled trial.
abstract: BACKGROUND
  Depression is common and tends to be recurrent. Alternative treatments are needed that are non-stigmatising, accessible and can be prescribed by general medical practitioners.
  
  
  OBJECTIVE
  To compare the effectiveness of three interventions for depression: physical exercise, internet-based cognitive-behavioural therapy (ICBT) and treatment as usual (TAU). A secondary aim was to assess changes in self-rated work capacity.
  
  
  METHODS
  A total of 946 patients diagnosed with mild to moderate depression were recruited through primary healthcare centres across Sweden and randomly assigned to one of three 12-week interventions (trail registry: KCTR study ID: KT20110063). Patients were reassessed at 3 months (response rate 78%).
  
  
  RESULTS
  Patients in the exercise and ICBT groups reported larger improvements in depressive symptoms compared with TAU. Work capacity improved over time in all three groups (no significant differences).
  
  
  CONCLUSIONS
  Exercise and ICBT were more effective than TAU by a general medical practitioner, and both represent promising non-stigmatising treatment alternatives for patients with mild to moderate depression.
authors.affiliation: Mats Hallgren, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Martin Kraepelien, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; AgnetaÖjehagen, PhD, Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund; Nils Lindefors, MD, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Zangin Zeebari, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Viktor Kaldo, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Yvonne Forsell, MD, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden mats.hallgren@ki.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Hallgren
authors.affiliation: Mats Hallgren, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Martin Kraepelien, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; AgnetaÖjehagen, PhD, Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund; Nils Lindefors, MD, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Zangin Zeebari, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Viktor Kaldo, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Yvonne Forsell, MD, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Kraepelien
authors.affiliation: Mats Hallgren, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Martin Kraepelien, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; AgnetaÖjehagen, PhD, Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund; Nils Lindefors, MD, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Zangin Zeebari, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Viktor Kaldo, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Yvonne Forsell, MD, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Öjehagen
authors.affiliation: Mats Hallgren, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Martin Kraepelien, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; AgnetaÖjehagen, PhD, Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund; Nils Lindefors, MD, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Zangin Zeebari, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Viktor Kaldo, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Yvonne Forsell, MD, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Lindefors
authors.affiliation: Mats Hallgren, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Martin Kraepelien, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; AgnetaÖjehagen, PhD, Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund; Nils Lindefors, MD, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Zangin Zeebari, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Viktor Kaldo, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Yvonne Forsell, MD, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Zangin
authors.initials: Z
authors.lastname: Zeebari
authors.affiliation: Mats Hallgren, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Martin Kraepelien, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; AgnetaÖjehagen, PhD, Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund; Nils Lindefors, MD, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Zangin Zeebari, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Viktor Kaldo, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Yvonne Forsell, MD, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Viktor
authors.initials: V
authors.lastname: Kaldo
authors.affiliation: Mats Hallgren, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Martin Kraepelien, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; AgnetaÖjehagen, PhD, Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund; Nils Lindefors, MD, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Zangin Zeebari, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm; Viktor Kaldo, PhD, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Yvonne Forsell, MD, PhD, Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Forsell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003866:Depressive Disorder / Q000628:therapy*; D004651:Employment / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D020377:Self Efficacy; D016896:Treatment Outcome; D014938:Work Capacity Evaluation; D055815:Young Adult