Exercise treatment for depression: efficacy and dose response

BACKGROUND: This study, conducted between 1998 and 2001 and analyzed in 2002 and 2003, was designed to test (1) whether exercise is an efficacious treatment for mild to moderate major depressive disorder (MDD), and (2) the dose-response relation of exercise and reduction in depressive symptoms. DESIGN: The study was a randomized 2x2 factorial design, plus placebo control. SETTING/PARTICIPANTS: All exercise was performed in a supervised laboratory setting with adults (n =80) aged 20 to 45 years diagnosed with mild to moderate MDD. INTERVENTION: Participants were randomized to one of four aerobic exercise treatment groups that varied total energy expenditure (7.0 kcal/kg/week or 17.5 kcal/kg/week) and frequency (3 days/week or 5 days/week) or to exercise placebo control (3 days/week flexibility exercise). The 17.5-kcal/kg/week dose is consistent with public health recommendations for physical activity and was termed "public health dose" (PHD). The 7.0-kcal/kg/week dose was termed "low dose" (LD). MAIN OUTCOME MEASURES: The primary outcome was the score on the 17-item Hamilton Rating Scale for Depression (HRSD(17)). RESULTS: The main effect of energy expenditure in reducing HRSD(17) scores at 12 weeks was significant. Adjusted mean HRSD(17) scores at 12 weeks were reduced 47% from baseline for PHD, compared with 30% for LD and 29% for control. There was no main effect of exercise frequency at 12 weeks. CONCLUSIONS: Aerobic exercise at a dose consistent with public health recommendations is an effective treatment for MDD of mild to moderate severity. A lower dose is comparable to placebo effect.