Self-selected intensity exercise in the treatment of major depression: A pragmatic RCT.
OBJECTIVE
The purpose of the study was to determine the therapeutic effect of physical exercise for patients with unipolar depression. Participants took part in an 8-week walking/running aerobic exercise program at a local sports club.


METHODS
Forty-six outpatients aged 18-65 years and diagnosed with mild to severe depression (ICD-10 criteria) were randomly assigned to an intervention group or wait list. Treatment as usual was continued. The Hamilton Rating Scale for Depression (HRSD-17) served as the main outcome measure. Secondary outcome measures were Beck Depression Inventory (BDI-II), Fitness Index (FI), and VO(2) max as estimated by Urho Kaleka Kekkonen or UKK 2-km Walk Test.


RESULTS
Out of forty-six participants, 24% dropped out. Participants attended 58% of exercise sessions. All randomized participants were included in intention-to-treat (ITT) analysis. Analysis of covariance or ANCOVA showed a large reduction of depressive symptoms in HRSD-17 scores (Cohen's d: 1.8; mean change 8.2, p < .0001). BDI-II (Cohen's d: 0.50; mean change: 4.7, p = 0.09), FI scores (Cohen's d: 0.27; mean change: 5.3, p = 0.08), and VO2 max did not change significantly.


CONCLUSIONS
We observed a large and clinically significant change in HRSD-17 scores. Moderate changes in BDI-II scores without clinical significance and small changes in physical fitness assessments were observed.
a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany.|b Department of Neurology , Klinikum Emden , Emden , Germany.
Michael
M
Doose
c KRH Psychiatrie Wunstorf und Langenhagen , Germany.
Marc
M
Ziegenbein
d Sports Center, Julius-Maximilians-University , Wuerzburg , Germany.
Olaf
O
Hoos
d Sports Center, Julius-Maximilians-University , Wuerzburg , Germany.
Dominik
D
Reim
a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany.
Wojciech
W
Stengert
a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany.
Niklas
N
Hoffer
e Institute for Biostatistics, Hannover Medical School , Germany.
Charlotte
C
Vogel
e Institute for Biostatistics, Hannover Medical School , Germany.
Yvonne
Y
Ziert
a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany.
Marcel
M
Sieberer
D000328:Adult; D003865:Major Depressive Disorder / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care
Aerobic exercise; depression; intervention vs. wait list; non-clinical population; pragmatic RCT