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Clinical question
Is aerobic exercise effective in the treatment of mild to moderate
depression?
Bottom line
Both high dose and low dose aerobic exercise are somewhat effective in the
treatment of mild to moderate depression. Exercising three times per week is
at least as effective as five times per week. To give a real world example
of "high dose" exercise, a 70 kg male exercising to a heart rate of 145
beats per minute for 30 minutes on a treadmill expends about 350 kcal per
session, requiring a total of 3 sessions per week. A previous study of
walking or jogging at 70% - 80% of maximal aerobic intensity was also as
effective as drug therapy in treating mild depression. (Blumental JA et al.
Arch Intern Med 1999;159:2349-56). (LOE = 1b)
Reference
Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise treatment
for depression. Efficacy and dose response. Am J Prev Med 2005;28:1-8.
Study design: Randomized controlled trial (single-blinded)
Setting: Outpatient (specialty)
Synopsis
Exercise may be an effective treatment for adults with major depressive
disorder (MDD). The investigators randomly assigned (concealed allocation
assignment) 80 adults, ages 20 to 45 years, diagnosed with mild to moderate
MDD to one of five exercise treatment groups: 7.0 kcal/kg/week (low dose)
performed in either 3 or 5 sessions/week, 17.5 kcal/kg/week (high dose)
performed in either 3 or 5 sessions/week, or a flexibility exercise only
(control) 3 days/week. The 17.5 kcal/kg/week dose is consistent with public
health recommendations for physical activity. Outcomes were assessed by
individuals blind to treatment group assignment. Of the 80 randomized
participants, 10 (12.5%) were lost to follow-up at 12 weeks. Using
intention-to-treat analysis, patients assigned to either of the high dose
exercise groups were significantly more likely to have a clinically relevant
response, defined as a 50% or more reduction in mean Hamilton Rating Scale
for Depression scores from baseline, compared to those in the control group
(42% vs 23%; NNT = 5). There were no significant differences between the 3
and 5 sessions/week high dose exercise groups. Patients in the 3
sessions/week low dose exercise group were also more likely to have a
significant response compared to the control group (38% vs 23%; NNT = 7),
but there was no significant difference between the 5 sessions/week low dose
group and the control group. The combined high dose exercise group was not
significantly more effective than the combined low dose exercise group. |