Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial

• Structured exercise improves physical fitness and decreases depression in women.
• Inclusion of patients recruited during external consultations by psychiatrists.
• Definitions of goals for patients taking into account their functional capacity.
• Patients were followed during trial by multidisciplinary team of professionals.
• Several implemented strategies were crucial for the treatment fidelity (82%).

ObjectivePhysical exercise has been consistently documented as a complementary therapy in the treatment of depressive disorders. However, despite a higher prevalence among women compared to men, the trials developed in women are scarce. In addition, the optimal dosage of exercise capable of producing benefits that reduce depressive symptoms remains unclear. This clinical trial is designed to measure the effect of a structured physical exercise program as a complement to antidepressant medication in the treatment of women with depression.MethodsFrom July 2013 to May 2014, we implemented a randomized controlled trial (HAPPY BRAIN study). A total of 26 women (aged 50.16 ± 12.08) diagnosed with clinical depression were randomized either to a supervised aerobic exercise group (45–50 min/week three times a week for four months) plus pharmacotherapy (intervention group), or only antidepressant medication (control group).ResultsThe exercise group presented a decrease in BDI-II and DASS-21 total score scales. Relatively to DASS-21, it showed a significant decrease in anxiety and stress. The exercise group when compared to a control group showed improvement in relation to physical functioning parameters between baseline and post-intervention. Moreover, anthropometric parameters presented only significant differences between groups in fat mass percentage. Nonetheless, no differences were found between groups in weight, body mass index, waist circumference, and self-esteem.ConclusionOur results showed that supervised structured aerobic exercise training could be an effective adjuvant therapy for treating women with depression, reducing depressive symptomatology and improving physical fitness. A key factor of this improvement included strict control of exercise workload parameters and adjustment to each subject's capacity.In our study, due to the sample size there is an increase in the probability of type II errors.

Flow diagram for the HAPPY BRAIN trial.Figure optionsDownload as PowerPoint slide