Björg Helgadóttir

Exercise, Physical Activity, and Sedentary Behavior in the Treatment of Depression: Broadening the Scientific Perspectives and Clinical Opportunities

Research exploring links between exercise and depression now span several decades, yet several clinically relevant research questions remain unanswered. This opinion article briefly describes the status of selected research issues from the exercise depression literature and offer insights into research areas that are currently lacking. We draw particular attention to the potential of research exploring links between sedentary behavior and depression.

Training fast or slow? Exercise for depression: A randomized controlled trial

Exercise can be used to treat depression but there is a lack of evidence regarding the optimal intensity and mode. Our aim was to compare the effects of different exercise intensities on post-treatment depression severity. People aged 18-67years with mild to moderate depression (Patient Health Questionnaire-9 score of ≥10) participated in a single-blind, parallel randomized control trial lasting 12-weeks (Sweden 2011-2013). Four treatment arms were included: treatment as usual (TAU) (n=310), light exercise (yoga or similar n=106), moderate exercise (aerobic conditioning, n=105) and vigorous exercise (aerobic conditioning, n=99). Depression severity was measured at baseline and post-treatment using the Montgomery-Åsberg Depression Rating Scale (MADRS). Differences between the groups in depression severity at post-treatment were analysed using linear regression. Differences in exercise intensity were confirmed by heart rate monitoring. At post-treatment, the light (-4.05 Confidence Interval (CI)=-5.94, -2.17), moderate (-2.08 CI=-3.98, -0.18) and vigorous exercise groups (-3.13 CI=-5.07, -1.19) had reduced their MADRS scores significantly more than TAU. No significant differences were found between the exercise groups, and no significant interaction effect was observed between group and gender. In conclusion, exercise, whether performed at a low (yoga or similar), moderate or vigorous intensity (aerobic training) is effective in treating mild to moderate depression and is at least as effective as treatment as usual by a physician.

Long-term effects of exercise at different intensity levels on depression: A randomized controlled trial

Previous research has shown positive effects of exercise on depression but studies have mainly focused on the short-term effects; few have examined the long-term effect, especially with regard to differences in intensity. The aim of this study was to examine the long-term effects of prescribed exercise on depression, performed at three intensity levels. People aged 18-67years with mild to moderate depression (Patient Health Questionnaire-9 score of ≥10) participated in a single-blind, parallel randomized control trial lasting 12weeks (Sweden 2011-2013). Four arms were included: Treatment as usual (TAU, n=310), light (n=106), moderate (n=105) and vigorous exercise (n=99). Severity of depression was measured at baseline, post-treatment and 12-month follow-up using the Montgomery-Åsberg Depression Rating Scale (MADRS). Coefficients (β) and odds ratios were estimated using linear mixed models with time×group interactions. The results showed that at the 12month follow-up the light exercise group had significantly lower depression severity scores than the TAU (-1.9, 95% CI: -3.7, -0.04) and the moderate exercise group (-2.94 95% CI: -5.2, -0.7). The vigorous exercise group had significantly lower scores than the moderate exercise group only (-2.7, 95% CI: -4.9, -0.4). In conclusion, compared to usual care for depression, only light exercise resulted in significantly lower depression severity at 12-month follow-up. Both light and vigorous exercise was more effective than moderate exercise. TRIAL REGISTRATION The study was registered with the German Clinical Trial Register (DRKS study ID: DRKS00008745).

Patterns in health-related behaviours and fall injuries among older people: a population-based study in Stockholm County, Sweden

Aim: we identified clusters of older people with similar health-related behaviours and assessed the association between those clusters and the risk of injurious fall. Methods: we linked self-reported and register-based data on the over-65s from the Stockholm public health cohort (N = 20,212). Groups of people with similar health-related behaviours were identified by cluster analysis using four measures of physical activity, two of smoking and alcohol habits and two individual attributes (age and type of housing). The association between clusters and falls leading to hospitalisation (422 cases) was studied using a nested case–control design. Odds ratios (ORs), crude and adjusted for health status, were compiled by cluster using the one with the most ‘protective’ health behaviour profile as the reference. Results: five clusters were identified revealing a variety of combinations of health-related behaviours, all linked to specific age groups and types of housing and with a tendency towards higher levels of physical activity among the younger ones. The risk of injurious falls differed across clusters, and for three out of four, it was significantly higher than in the comparison cluster. Adjusting for health status only partially reduced the ORs for those clusters and this was observed both in men and women. Conclusion: health-related behaviours aggregate in different manners among older people. Some health-related profiles are associated with an excess risk of falls leading to hospitalisation. Although this is partly a reflection of age differences across clusters, health status alone cannot fully explain the association.

Impact of expectations on the effects of exercise on psychological distress

OBJECTIVE To evaluate the influence of expectations on effectiveness of exercise in reducing psychological distress. METHOD Data came from a Swedish longitudinal population-based study consisting of 4631 people aged 20-64 years. Psychological distress was measured with the Major Depressive Inventory. Expectations (positive expectations or indifference) towards exercise were combined with exercise (regular exercise: yes or no). RESULTS Indifferent non-exercisers had increased risk of psychological distress. Regular exercisers who were indifferent towards exercise as a self-help method were less likely to be psychologically distressed compared to exercisers with positive expectations. CONCLUSION The results encourage systematic use of exercise in prevention and rehabilitation of persons suffering from psychological distress. Peoples personal expectations might not be needed for treatment effect.

Sticking with it? Factors associated with exercise adherence in people with mild to moderate depression

Background: Exercise is an effective treatment for depression but non‐adherence is common. The aim of this study was to determine the level of adherence to an exercise intervention, specifically factors associated with adherence in a depressed population. Methods: This study reports the secondary analysis from a randomized controlled trial. The 310 participants were aged 18–67 years and affected by mild to moderate depression i.e. scoring ≥10 on the Patient Health Questionnaire‐9 (PHQ‐9). Adherence to an exercise intervention (light, moderate, vigorous, performed three times a week for 12 weeks) was measured using pulse watches or self‐reports (78.4% vs. 21.6%). Factors associated with adherence were explored using negative binomial regression models. Results: Adherers (≥12 sessions, 32.7%) exercised on average 22.9 (SD = 7.4) times, while sub‐adherers (1–11 sessions, 26.9%) attended on average 4.7 (SD = 3.1) sessions. Around 40% of participants were non‐adherers (0 sessions). Tobacco use and hazardous alcohol use were associated with a lower adherence while flexibility at work was associated with higher adherence. Conclusion: Tobacco use, hazardous alcohol use and flexibility at work can influence adherence to an exercise program among depressed people and should be considered when applying exercise interventions. HighlightsWe studied predictors for adherence to an exercise intervention in depressed people.Tobacco and hazardous alcohol use are associated with lower levels of adherence.Flexibility at work is associated with higher levels of adherence.These factors need to be considered when planning treatment of depression.

Changes in physical activity and sedentary behavior associated with an exercise intervention in depressed adults

Background: Exercise is beneficial for depression, but less is known about its impact on post‐intervention physical activity and sedentary behavior. The aim of this paper was to determine the extent to which participation in light‐, moderate‐ and vigorous‐intensity exercise intervention influenced habitual physical activity and sedentary behavior patterns in depressed adults. Methods: Accelerometer data was collected pre‐ and post‐intervention from depressed participants randomized to one of three 12‐week intervention groups: light (n = 21), moderate (n = 25) and vigorous (n = 22) exercise. Mixed models examined changes in time spent sedentary and in light and moderate‐to‐vigorous physical activity (MVPA); time accumulated in sedentary and MVPA bouts; and, number of MVPA bouts and interruptions in sedentary time. Results: Overall sedentary time decreased while light activity time increased across all intervention groups but not significantly so. The light exercise intervention group reduced MVPA minutes (−8.22, 95% CI: −16.44, −0.01), time in MVPA bouts (−8.44, 95% CI: −14.27, −2.62), and number of activity bouts (−0.43, 95% CI: −0.77, −0.09). The moderate exercise intervention group reduced time in MVPA bouts (−6.27, 95% CI: −11.71, −0.82) and number of sedentary interruptions (−6.07, 95% CI: −9.30, −2.84). No changes were observed for the vigorous exercise intervention group. Conclusions: The exercise intervention led to an increase in overall light physical activity and decrease in sedentary time, though neither change was statistically significant. Participation in the light and moderate exercise intervention groups was associated with reductions of time in MVPA bouts, but this was not evident for the vigorous exercise intervention group. HighlightsData came from an intervention study on the effect of exercise on depression.Exercise was performed in three groups at light, moderate or vigorous intensity.We explored changes in physical activity and sedentary behavior post‐intervention.Increased light physical activity and decreased sedentary time but non‐significant.Reduced time in MVPA bouts in the light and moderate exercise groups.

Cardiorespiratory fitness and response to exercise treatment in depression

Background Exercise improves cardiorespiratory fitness (CRF) and reduces depressive symptoms in people with depression. It is unclear if changes in CRF are a predictor of the antidepressant effect of exercise in people with depression. Aims To investigate whether an increase in CRF is a predictor of depression severity reduction after 12 weeks of exercise (trial registration: DRKS study ID, DRKS00008745). Method The present study includes participants who took part in vigorous (n = 33), moderate (n = 38) and light (n = 39) intensity exercise and had CRF information (as predicted maximal oxygen uptake, V̇O2max) collected before and after the intervention. Depression severity was measured with the Montgomery–Åsberg Depression Rating Scale (MADRS). V̇O2max (L/min) was assessed with the Åstrand–Rhyming submaximal cycle ergometry test. The main analysis was conducted pooling all exercise intensity groups together. Results All exercise intensities improved V̇O2max in people with depression. Regardless of frequency and intensity of exercise, an increase in post-treatment V̇O2max was significantly associated with reduced depression severity at follow-up (B = −3.52, 95% CI −6.08 to −0.96); adjusting for intensity of exercise, age and body mass index made the association stronger (B = −3.89, 95% CI −6.53 to −1.26). Similarly, increased V̇O2max was associated with higher odds (odds ratio = 3.73, 95% CI 1.22–11.43) of exercise treatment response (≥50% reduction in MADRS score) at follow-up. Conclusions Our data suggest that improvements in V̇O2max predict a greater reduction in depression severity among individuals who were clinically depressed. This finding indicates that improvements in V̇O2max may be a marker for the underpinning biological pathways for the antidepressant effect of exercise. Declaration of interest None.

Changes in Physical Activity and Sedentary Behavior Associated with Exercise Interventions in Depressed Adults: 2109 Board #261 June 2, 3: 30 PM - 5: 00 PM.

PURPOSE: Exercise training programs are beneficial for depression, but less is known about their impact on non-intervention physical activity patterns and sedentary behavior patterns in depressed a ...