Aerobic Exercise for Depression

Overseen By Natalia Jaworska, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: The Royal's Institute of Mental Health Research

Must not be taking: Psychoactive drugs

Disqualifiers: Other DSM-5 disorders, Neurological conditions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 38

Duration: 12 weeks

40 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

Yes, you must be free of antidepressant medication for more than 5 weeks and cannot be taking psychoactive drugs, although occasional use of anti-anxiety medication is allowed.

What data supports the effectiveness of aerobic exercise as a treatment for depression?

Research shows that aerobic exercise can significantly reduce depressive symptoms and improve physical performance in people with mild to moderate depression. Studies indicate that exercise can have an antidepressive effect, and many patients continue exercising after treatment, which helps maintain lower depression scores. ^{1 2 3 4 5}

Is aerobic exercise safe for humans?

Aerobic exercise is generally safe for humans and has many health benefits, including improved heart health and mental well-being. The problems associated with aerobic exercise are minimal compared to its benefits. ^{6 7 8 9 10}

How does aerobic exercise as a treatment for depression differ from other treatments?

Aerobic exercise is unique because it not only helps reduce depressive symptoms but also improves physical fitness and flexibility, which are not typically addressed by traditional treatments like medication or psychotherapy. It can be used alongside other treatments to enhance overall well-being and may target specific brain functions related to reward and cognitive control. ^{3 5 11 12 13}

What is the purpose of this trial?

This study will assess the effects of moderate vs. high intensity aerobic exercise, performed 3 times a week for 12 weeks under supervised conditions, on symptoms of depression, cognitive functioning and brain function in transitional aged youth (TAY: aged 16-24 years).

Eligibility Criteria

This trial is for young people aged 16-24 who are struggling with depression and haven't been taking antidepressants or exercising regularly. They should be able to understand English, have a BMI under 40, and be medically okay to do aerobic exercise. Those at risk of suicide, with MRI issues, serious health conditions, nicotine use, pregnancy/breastfeeding or other major psychiatric disorders can't join.

Inclusion Criteria

Free of pharmacotherapy (ie. antidepressant medication) for >5 weeks;

You are not currently exercising regularly at a moderate or high intensity level.

Able to read/understand English;

Exclusion Criteria

You have a high risk of wanting to harm yourself.

You cannot have a magnetic resonance imaging (MRI) scan due to certain medical conditions.

You are currently participating in another exercise study.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in supervised aerobic exercise sessions, 3 times a week for 12 weeks, at either moderate or high intensity

12 weeks

36 visits (in-person)

Follow-up

Participants are monitored for changes in depression symptoms and cognitive function post-treatment

6 months

2 visits (in-person)

Treatment Details

Interventions

• Aerobic Exercise

Trial Overview The study is looking at how different levels of workout intensity affect depression in youth. Participants will do either moderate or high-intensity aerobic exercises three times a week for twelve weeks while being watched over by professionals to see changes in their mood, thinking skills and brain function.

Participant Groups

Group I: Moderate Intensity Experimental Treatment 1 Intervention

Aerobic exercise maintained for 30 minutes at 50-55% of each participant's individual heart rate reserve (HRRes).

Group II: High Intensity Experimental Treatment 1 Intervention

Aerobic exercise maintained for 30 minutes at 80-85% of each participant's individual heart rate reserve (HRRes).

Who Is Running the Clinical Trial?

The Royal's Institute of Mental Health Research

Lead Sponsor

Trials

8

Recruited

1,300+

Findings from Research

A study involving 40 individuals with major depressive disorder showed that both moderate-intensity aerobic exercise and quiet rest improved mood, but exercise led to a significant increase in positive well-being and vigor.

Participants who exercised for 30 minutes reported greater improvements in positive mood states compared to those who rested, suggesting that even a single session of moderate exercise can enhance feelings of well-being in people with depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of acute exercise on mood and well-being in patients with major depressive disorder. Bartholomew, JB., Morrison, D., Ciccolo, JT.[2019]

A randomized controlled trial with 242 depressed adults found that combining brief advice with supervised and home-based aerobic exercise and cognitive-behavioral sessions significantly increased moderate-to-vigorous physical activity (MVPA) at 3 months.

While the intervention was effective in the short term, the benefits in increasing aerobic exercise did not persist at 6 or 9 months, indicating a need for ongoing support to maintain activity levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Project MOVE: A randomized controlled trial of Interventions for initiating and maintaining physical activity in depressed individuals. Uebelacker, LA., Epstein-Lubow, G., Sillice, MA., et al.[2023]

A 3-week supervised aerobic exercise program significantly reduced depressive symptoms in Chinese patients with mild to moderate depression, showing a mean difference of 10.08 points on the MADRS scale compared to a control group.

The aerobic exercise group also improved physical performance, specifically flexibility, with a mean difference of 4.4 points, suggesting that exercise can enhance both mental and physical health during the early inpatient phase of treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of aerobic exercise training on chinese population with mild to moderate depression in Hong Kong. Ho, CW., Chan, SC., Wong, JS., et al.[2021]

Depressed patients often have low physical fitness due to inactivity, suggesting that incorporating physical fitness training into treatment for depression could be beneficial.

Exercise, including both aerobic and nonaerobic forms, has been shown to have antidepressant effects in patients with mild to moderate depression, and many patients continue exercising after treatment, leading to lower depression scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Benefits of exercise for the treatment of depression. Martinsen, EW.[2022]

Aerobic exercise (AE) significantly reduced depression severity in patients compared to a control group doing basic stretching, with improvements measured by the Hamilton Depression Rating Scale and the Beck Depression Inventory over a 6-week period.

AE also showed additional benefits in cognitive performance, particularly in working memory, and these positive effects on mental toughness and body mass index were maintained for up to 6 months after the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. Imboden, C., Gerber, M., Beck, J., et al.[2021]

Aerobic exercise (AE) has been shown to have a significant antidepressant effect in clinically depressed adults, with a large effect size (g = -0.79) based on a meta-analysis of 11 trials involving 455 patients.

The study found that AE was effective across various settings and formats, and it worked similarly for both outpatients and inpatients, regardless of the severity of their symptoms, suggesting its broad applicability as a treatment for depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Morres, ID., Hatzigeorgiadis, A., Stathi, A., et al.[2019]

This systematic review aims to evaluate how different types of exercise—specifically aerobic, resistance, and meditative movement—affect sleep quality in patients with unipolar depression, using a comprehensive search of multiple databases and rigorous methodology.

The study will assess not only sleep quality but also secondary outcomes like sleep duration, daytime functioning, and the use of sleep medications, providing a thorough understanding of the potential benefits and risks of exercise interventions for improving sleep in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of aerobic, resistance, and meditative movement exercise on sleep in individuals with depression: protocol for a systematic review and network meta-analysis. Brupbacher, G., Gerger, H., Wechsler, M., et al.[2023]

In a study involving 15 female patients with major depressive disorder (MDD) and matched controls, it was found that MDD patients switched to anaerobic metabolism earlier during exercise, indicating a different physiological response to exercise intensity.

To optimize aerobic exercise treatments for MDD, it is recommended to use the individual anaerobic lactate threshold (IAT) and perceived exertion scales, rather than relying solely on standard heart rate or oxygen uptake percentages, to prevent overexertion and excessive anaerobic metabolism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dissociation of performance parameters at the IAT requires specific exercise recommendations for depressed patients. Donath, L., Boettger, S., Puta, C., et al.[2022]

Regular aerobic exercise significantly reduces the risk and mortality associated with coronary artery disease, likely due to its positive effects on blood lipid levels and blood pressure.

In addition to cardiovascular benefits, aerobic exercise also provides mental health advantages, such as reducing anxiety and depression, making it a valuable component in weight-loss programs and the management of conditions like diabetes and aging.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health benefits of aerobic exercise. Mersy, DJ.[2019]

In a study of 14,343 participants over an average of 12 years, higher levels of cardiorespiratory fitness (CRF) were linked to a significantly lower risk of developing depressive symptoms, with men showing a 31% lower risk at moderate CRF and 51% lower at high CRF.

Women also benefited from higher CRF, with a 44% lower risk at moderate levels and 54% lower at high levels, indicating that maintaining good fitness can be an important factor in mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective study of cardiorespiratory fitness and depressive symptoms in women and men. Sui, X., Laditka, JN., Church, TS., et al.[2022]

In a study involving 99 inpatients with various forms of depression, both aerobic and nonaerobic exercise significantly reduced depression scores over 8 weeks, indicating that exercise can be beneficial regardless of type.

While the aerobic group showed a significant increase in maximum oxygen uptake (VO2 max), there was no difference in depression reduction between the aerobic and nonaerobic groups, suggesting that the antidepressant effects of exercise are not limited to aerobic activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. Martinsen, EW., Hoffart, A., Solberg, O.[2022]

In a study of 66 young adults with major depression, 8 weeks of moderate-intensity aerobic exercise significantly reduced depressive symptoms compared to light stretching, with a moderate effect size (gs = 0.66).

While aerobic exercise did not change neural markers of reward processing (RewP) or cognitive control (ERN), individuals with higher baseline RewP and greater depressive symptom severity were more likely to benefit from the exercise intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets. Brush, CJ., Hajcak, G., Bocchine, AJ., et al.[2022]

Aerobic exercise has been found to be more effective than no treatment for individuals with mild to moderate unipolar depression, based on a review of 12 studies, although it does not show significant differences compared to other therapies like psychotherapy.

Both aerobic and anaerobic exercises are equally effective in treating mild to moderate depression, and patients generally view exercise as a valuable therapeutic option, suggesting it could serve as an alternative or complement to traditional treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical activity and depression: clinical experience. Martinsen, EW.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effects of acute exercise on mood and well-being in patients with major depressive disorder. [2019]

2. England pubmed.ncbi.nlm.nih.gov

Project MOVE: A randomized controlled trial of Interventions for initiating and maintaining physical activity in depressed individuals. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Effect of aerobic exercise training on chinese population with mild to moderate depression in Hong Kong. [2021]

4. New Zealand pubmed.ncbi.nlm.nih.gov

Benefits of exercise for the treatment of depression. [2022]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. [2019]

7. England pubmed.ncbi.nlm.nih.gov

The effects of aerobic, resistance, and meditative movement exercise on sleep in individuals with depression: protocol for a systematic review and network meta-analysis. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Dissociation of performance parameters at the IAT requires specific exercise recommendations for depressed patients. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Health benefits of aerobic exercise. [2019]

10. England pubmed.ncbi.nlm.nih.gov

Prospective study of cardiorespiratory fitness and depressive symptoms in women and men. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. [2022]

12. England pubmed.ncbi.nlm.nih.gov

A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets. [2022]

13. Denmark pubmed.ncbi.nlm.nih.gov

Physical activity and depression: clinical experience. [2019]