Table 2.

Randomized controlled trials of exercise as an adjunct to psychotherapy for major depressive disorder

Trial	Depression diagnosis criteria and type	Sample	Interventions	Study Duration	Treatment arms (n)	Outcomes
						Adherence	Drop-outs n(%)	Remission Rate %
Jacquart et al., 201452	DSM-IV Major	Males and females, ≥50 y/o, admitted to inpatient unit, met depression criteria, Exclusion: cognitive impairment, Fall Risk Assessment ≥25 n=88 (analysis: n=78) 59.7±8.5y/o 38.5% males	Inpatient setting TAU: GT, OT, pharm Psych: Validation therapy techniques Psych_Walk: 5min warm-up, 20mins walking (intensity NR), 5min cool-down while receiving psych Psych_Sit: 30min psych session in seated position CON: TAU only	Duration dependent on length of stay (mean 6.3±3.9d) Psych_Walk: mean of 3.5±1.7 supervised, individual sessions Psych_Sit: mean of 3.1±2.1 supervised, individual sessions TAU and CON: NR	Psych_Walk + TAU (n=29)	NR	3(10)	Remission: NR Change in GDS: 80.0% reduction
					Psych_Sit + TAU (n=29)	NR	3(10)	Remission: NR Change in GDS: 46.6% reduction
					CON (n=30)	NA	4(13)	Remission: NR Change in GDS: 32.1% reduction
Oertel-Knochel et al., 201453	DSM-IV-SCID Major Study included individuals with schizophrenia disorder, but those participants are excluded from this review.	Males and females, admitted to inpatient facility, met depression criteria, disease duration ≥5yrs, pharm permitted if stable dosage at least ≥1mo prior to pre-testing and for study duration Exclusion: Comorbid Axis- I or II disorders n=22 40.0±14.1y/o 50.0% males	Inpatient setting Permitted to take steady dose of medication(s) Cog: 30mins of group and individual tasks AEx: 10min warm-up, 25mins of boxing and circuit training at 60–70% of MHR, 10min cool-down Relax: 45mins of breathing, imagery, relaxation, and awareness training CON: Waitlist	4 weeks Cog: 3d/wk/4wks (12 supervised group sessions) AEx: 3d/wk/4wks (12 supervised sessions) Relax: 3d/wk/4wks (12 supervised sessions) CON: NA	Cog + AEx (n=8)	NR	NR	Est change in BDI:~31% reduction
					Cog + Relax (n=6)	NR	NR	Est change in BDI:~19% reduction
					CON (n=8)	NA	NR	Est change in BDI:~8% reduction
Kerling et al., 201554	DSM-IV-SCID Major	Males and females, ≥18y/o, admitted to inpatient facility, met depression criteria Exclusion: Acute or chronic infectious disease, immunological disorders, diabetes mellitus, cardiovascular disorders, taking beta-blockers or other cardiologic treatment, cognitive impairment, schizophrenia, bipolar disorder, substance abuse/dependency pregnancy n=40 Age: NR 60.0% males	Inpatient setting CBT: NR AEx: 25mins on bicycle ergometer at 60–70 RPM, 20mins on choice of cross-trainer stepper, arm ergometer, treadmill, recumbent bike, or rower at moderate intensity of 50% of max workload from exercise tolerance testing and progressed by 10% of workload. TAU: Optional participation in daily 20min activity program (walking, ball games and stretching) Pham: administer per treating physicians’ orders CBT + AEx: 77% CBT + TAU: 75%	6 weeks CBT: NR AEx: 3d/wk/6wks (18 supervised sessions) TAU: NR	CBT + AEx + Pharm (n=22)	CBT: NR AEx: >90%	0(0)	BDI Remission: 64% Response: 64%    MADRS Remission: 42% Response: 64%
					CBT + TAU + Pharm (n=20)	NR	0(0)	BDI Remission: 40% Response: 45    MADRS Remission: 25% Response: 30%

AEx = aerobic exercise; BDI = Beck Depression Inventory; CBT = cognitive-behavioral group therapy; Cog = cognitive training; CON = control; d = days; DSM-IV= Diagnostic and Statistical Manual of Mental Disorders, fourth edition; Est = estimated; GDS = Geriatric Depression Scale; GT = group therapy; MADRS = Montgomery-$\dot{\mathrm{A}}\mathrm{sberg}$ Depression Scale; MHR = maximum heart rate; min(s) = minute(s); NA = not applicable; NR = not reported; OT = occupational therapy; Pharm = pharmacotherapy; Psych = psychotherapy; Relax = relaxation training; RPM = revolutions per minute; SCID = Structured Clinical Interview of DSM Disorders; TAU = treatment as usual; wk(s) = weeks; y/o = years old; yr(s) = years