Table 1.
Randomized controlled trials of exercise as a monotherapy for major depressive disorder
| Trial | Depression diagnosis criteria and type | Sample | Interventions | Study Duration | Treatment arms (n) | Outcomes |
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|---|---|---|---|---|---|---|---|---|
| Adherence | Drop-outs n(%) | Remission Rate % | ||||||
| Doyne et al., 198738 | RDC Major (78%) Minor (22%) |
Females only, 18–35y/o, met depression criteria, agreed not to participate in any other depression treatment options or exercise programs Exclusion: manic-depressive disorder, imminent suicide threat, physical contraindications to ex, or hospitalized for depression in preceding yr n=40 28.5±4.4y/o; 0% males |
Outpatient setting AEx: 5–10min stretching warm-up, running at 80% APMHR for NR duration, 5–10min cool-down REx: 5-10min warmup, Self-paced, 10-station program on universal machines at or below 50–60% APMHR, 5–10min cool-down CON: Waitlist (no treatment) |
8 weeks AEx and REx: 3–4d/wk/8wks (32 supervised individual sessions) CON: No treatment |
AEx (n=NR) | NR Mean 2.64 sessions/wk |
NR(40%) | 67% |
| REx (n=NR) | NR Mean 2.95 sessions/wk | NR(29%) | 80% | |||||
| CON (n=NR) | NA | NR(13%) | 17% | |||||
| Singh et al., 199720 | DSM-IV Unipolar major or minor, dysthymia |
Males and females, ≥60y/o, BDI >12 Exclusion: cognitive impairment, have unstable disease(s), bipolar disorder, active psychosis, suicidal plans, receiving psych, antidepressant use within past 3mos, exercising >2xs/wk in the past month (REx or AEx) n=32 57±6.5y/o; 37.5% males |
Outpatient setting PREx: 5 exercises (chest press, latissimus dorsi pulldown, leg press, knee extension, and knee flexion), 3x8 reps at 80% 1-RM with progression (~45mins), 5min stretching cool-down CON: 1hr health education session (lectures, videos, and discussions) |
10 weeks PREx: 3d/wk/10wks (30 sessions) CON: 2d/wk/10wks (20 sessions) PREx and CON sessions: supervised, but combination of individual and group |
PREx (n=17) | 93% | 0 | Remission: NR Response: 59% |
| CON (n=15) | 95% | 0 | Remission: NR Response: 26% |
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| Blumenthal et al., 199950 | DSM-IV DIS Major |
Males and females, ≥50y/o, HAM-D17 ≥13 Exclusion: current antidepressant use, use of other medications that would preclude random assignment of exercise (e.g., quinidine, metoprolol), alcohol or substance abuse, medical contraindications to ex (e.g., orthopedic or cardiopulmonary disease), primary diagnois other than depression (e.g., bipolar, psychosis) acute suicidal risk, psych initiated in past yr, established exercise program n=156 57±6.5y/o; 27.6% males |
Outpatient setting AEx: 10min warm-up, 30mins walking or jogging at 70–85% HRR, 5min cool-down Pharm: Sertraline (50–200mg/d) titrated as needed after meeting with study psychiatrist(s) |
16 weeks AEx: 3d/wk/16wks (48 supervised group sessions) Pharm: 6 sessions (Study onset and Week 2, 6, 10, 14, 16) |
AEx (n=55) | 89.6% | 14(26.4%) | 60.4% |
| AEx + Pharm (n=55) | AEx: 91.7% Pharm: 95% |
11(20.0%) | 65.5% | |||||
| Pharm (n=48) | ~95% | 7(14.6%) | 68.8% | |||||
| Dunn et al., 200521 | DSM-IV-SCID Major |
Males and females, 20–45 y/o, HAM-D17=12–25, sedentary, live within 15 miles from center, not receiving any other treatment for depression Exclusion: ≥160% over ideal weight; consuming >21 alcoholic drinks/wk, substance abuse or recreational drug use, suicide attempt in past 2yrs, acute suicidal risk, hospitalization in last 5yrs for psychiatric disorder, participating in other clinical trials, inability to ex due to a medical condition, exercising ≥3d/wk for ≥20mins, planned or current pregnancy n=80 35.9±6.4y/o; 25% males |
Outpatient setting AEx: Treadmill or stationary cycling PHD: 17.5 kcal/kg/wk LD: 7 kcal/kg/wk CON: 15–20mins of stretching |
12 weeks AEx-3d: 3d/wk/12wks (36 sessions) AEx-5d: 5d/wk/12wks (60 sessions) CON: 3d/wk/12wks (36 sessions) AEx and CON sessions: Supervised and individual |
AEx PHD-3d (n=17) | 71% | 6(35.3%) | Efficacy: 31% ITT: 41% |
| AEx PHD-5d (n=16) | 71% | 4(25.0%) | Efficacy: 55% ITT: 31% | |||||
| AEx LD-3d (n=16) | 72% | 2(12.5%) | Efficacy: 31% ITT: 25% |
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| AEx LD-5d (n=18) | 72% | 7(38.9%) | Efficacy: 19% ITT: 11% |
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| CON (n=13) | 42% | 8(61.5%) | Efficacy: 11% ITT: 15% |
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| Singh et al., 200522 | DSM-IV, SCID Unipolar major or minor, dysthymia |
Males and females, >60y/o, GDS≥14 Exclusion: demented, unstable medical condition that would prevent participation in REx, bipolar disorder, active psychosis, actively suicidal, receiving psych, antidepressant use within past 3mos, exercising >2xs/wk n=60 Range: 60–85y/o 45.0% males |
Outpatient setting HI-PREx: 3x8reps of 6 exercises (chest press, upright row, shoulder press, leg press, knee extension, and knee flexion) at 80% 1-RM with progression (~60mins) and Borg RPE of 15–18, 5mins stretching LO-REx: 3×8reps of 6 exercises (chest press, upright row, shoulder press, leg press, knee extension, and knee flexion) at 20% 1-RM without progression (~60mins), 5mins stretching CON: TAU initiated by GP Formal treatment: 52% Pharm: 42% Counseling only: 10% Psychiatrist referral: 5% |
8 weeks HI-PREx and LO-PREx: 3d/wk/8wks (24 supervised sessions; combination of individual and group) CON: Unrestricted with average of 5 health care profession visits |
HI-PREx (n=20) | 95%-100% | 2(10%) | Remission: NR Response: 61% |
| LO-REx (n=20) | ~99% | 3(15%) | Remission: NR Response: 29% |
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| CON (n=20) | NR | 1(5%) | Remission: NR Response: 21% |
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| Blumenthal et al., 200723 | DSM-IV-SCID Major |
Males and females, ≥40y/o, BDI ≥12, sedentary, Exclusion: receiving psych, comorbid primary psychiatric diagnosis, medical comorbidities that preclude participation (musculoskeletal difficulties), taking antidepressants or other psychotropic medication, alcohol or drug abuse or dependency, acute suicidal intent, established exercise program, failed medical screening (physical exam, blood work, blood pressure, pregnancy) n=202 52±8y/o; 24.3% males |
Outpatient setting AEx: 10min warm-up, 30mins walking or jogging at 70–85% HRR, 5min cool-down Pharm: Sertraline (50–200mg/d), titrated as needed after meeting with study psychiatrist(s) Placebo: 50–200mg/day, titrated as needed after meeting with study psychiatrist(s) |
16 weeks All AEx: 3d/wk/16wks (48 sessions) AEx-Home: unsupervised individual sessions AEx-Group: supervised group sessions Pharm and Placebo: 6 sessions (Study onset and Week 2, 6, 10, 14, 16) |
AEx-Home (n=53) | 93.9% | 3(5.7%) | 40% |
| AEx-Group (n=51) | 82.9% | 10(19.6%) | 45% | |||||
| Pharm (n=49) | 83% attended all sessions | 7(14.3%) | 47% | |||||
| Placebo (n=49) | 72% attended all sessions | 14(28.6%) | 31% | |||||
| Krogh et al., 201251 | DSM-IV-MINI Major |
Males and females, 18-60 y/o, HAM-D ≥12 Exclusion: drug use, antidepressant use in past 2mos, receiving psych, contraindications to physical exercise, >1hr of PA/wk, suicidal behavior, current/previous psychotic or manic symptoms, pregnancy n=115 41.6y/o (19–59 y/o); 33.0% males |
Outpatient setting AEx: 10min warm-up, 30mins on cycle ergometer (at least 65% of maximal capacity with progression to 80%), 5min cool-down CON: 10min warm-up at low intensity on stationary bike, 20min stretching program, 15mins of low intensity exercise |
12 weeks AEx: 3x/wk/12wks (36 supervised sessions) CON: 3x/wk/12wks (36 supervised sessions) |
AEx (n=56) | 39.3% attended >18 sessions Mean 13.5 |
11(19.6%) | ITT: 28.6% |
| CON (n=59) | 35.6% attended >18 sessions Mean 12.5 |
18(30.5%) | ITT: 30.5% | |||||
AEx = aerobic exercise; APMHR = age-predicted maximum heart rate; BDI = Beck Depression Inventory; CON = control; d = day; DIS = Diagnostic Interview Schedule; DSM-IV= Diagnostic and Statistical Manual of Mental Disorders, fourth edition; ex = exercise; GDS = Geriatric Depression Scale; GP = general practitioner; HAM-D = Hamilton Rating Scale of Depression; HI = high intensity; hr(s) = hour(s); HRR = heart rate reserve; ITT = intent to treat; LD = low dose; LO = low intensity; min(s) = minute(s); MINI – Mini International Neuropsychiatric Interview; mo(s) = month(s); NR = not reported; PA = physical activity, Pharm = pharmacotherapy; PHD = public health dose; PHD = public health dose; PREx = progressive resistance exercise; Psych = psychotherapy; RDC = research diagnostic criteria; REx = resistance exercise; RPE = rate of perceived exertion; SCID = Structured Clinical Interview of DSM Disorders; TAU = treatment as usual; wk(s) = week(s); y/o = years old; yr(s) = year(s); 1-RM = one repetition maximum