Effects of Acute Exercise on Mood and Well-Being in Patients with Major Depressive Disorder

John B. Bartholomew; David Morrison; Joseph T. Ciccolo

Disclosures

Med Sci Sports Exerc. 2005;37(12):2032-2037. 

In This Article

Discussion

This experiment was designed to examine the effect of a single bout of exercise on mood and well-being in individuals who were diagnosed with MDD. Exercise had additional benefits over quiet rest for two of the nine subscales assessed: 1) psychological well-beingSEES), and 2) vigorPOMS). With the exception of the fatigue subscaleSEES), which remained unchanged, participants in both conditions reported similar improvements on the remaining subscales throughout the 60 min of postintervention assessment. Thus, both a period of rest in a quiet, comfortable environment and a period of brisk treadmill walking appear to be sufficient to improve the mood of patients with MDD. This result replicates data from healthy samples that demonstrate exercise to be no better than quiet rest in reducing state anxiety[7] and no better than other forms of mood enhancement in reducing depressive moods.[30] It is well known that mood is improved for healthy samples following periods of rest or relaxation,[7,16] and exercise.[7,35] It appears that this benefit applies to patients with MDD.

It is interesting to note that exercise was associated with a greater effect than quiet rest for two subscales. Both psychological well-being (SEES) and vigor (POMS) were improved following exercise, with no change in these variables following quiet rest. Of the nine constructs assessed in this experiment, these are the only subscales used to indicate positively valenced states. All other subscales are negatively valenced and revealed no difference between conditions. The pattern of effects following exercise was not surprising. It has long been recognized that exercise is sufficient to improve both positive and negative states,[27] with a meta-analysis of older adults finding nearly identical effects sizes for exercise on positive and negative affect.[5] The different pattern of effects for exercise and control conditions also mirrors the results found in healthy participants.[19,25] For example, one study indicated that exercise and quiet rest resulted in similar changes in depression, but only the exercise conditions were followed with increased vigor.[19] Although replication is required, it appears that, for both patients with MDD and healthy populations, exercise might have an effect on positively valenced states that is unique from the effect of quiet rest. Although the increase in positively valenced states was short lived, returning to baseline within 60 min of recovery, the effect was sizable, ranging from an effect size of d = 0.73 to 1.13. In fact, the exercise participants reported an increase in vigor to within 1/2 SD (d = -0.47) of published norms.[28]

Although this would not be expected to have an impact on the underlying mental disorder, a single bout of exercise does appear to be a useful method for patients with MDD to regulate their mood in the short term, with a particular effect on positive moods. Given the debilitating symptoms of depression, a respite such as this is potentially invaluable to those who suffer with MDD. This is especially true because the time course of pharmacologic treatments require at least 2-4 wk and can exceed 6-8 wk before providing significant relief of depression.[29] Other acute interventions existe.g., sleep deprivation), which have been shown to provide a greater benefit than was demonstrated in this study, but these other interventions also have only transient effects.[18] Future research, therefore, should be designed to compare the effectiveness of acute interventions and to test potential mechanisms and any potentially adverse effects for these protocols. Such designs will provide the clearest direction to clinicians and patients in their search for a positive means to regulate mood disturbances associated with depression.

It may be that these effects were impacted by limitations in the survey instruments (e.g., the wording, variability of baseline scores, and instruments used). Although it can be argued that the item active within the vigor subscale artificially influenced postexercise responses,[32] a secondary analysis deleted this item with no change in the pattern of effects. In addition, the low variability in baseline scores for the well-being subscale might have had an impact on the statistical significance for the change reported by the exercise group. The prepost change score standard deviations, however, were relatively homogeneous (4.07 and 4.81) for the exercise and control conditions, respectively. Finally, exercise was shown to reduce fatigue for the POMS subscale, with no change in fatigue for the SEES subscale. Although higher intensity exercise has been shown to increase fatigue,[11] the reduction for the POMS subscale was consistent with another study of moderate-intensity aerobic exercise.[19] The failure to find an effect for the fatigue subscale of the SEES, therefore, was surprising. There does not appear, however, to be a consistent finding for this subscale in conjunction with aerobic exercise. Various investigators have found no change in fatigue,[22] an increase in fatigue,[34] and a reduction in fatigue,[10] all of which may be owing to the use of an exercise-specific scale, which has been criticized for providing inaccurate baseline scores.[14]

Additional reasons exits to interpret and apply these findings with caution because the results may not generalize to the clinical population for several reasons. For instance, we only included patients diagnosed with clinical depression without comorbid diagnoses. Individuals with comorbid diagnoses have additional concerns and may respond differently to this method of treatment. Additionally, this study is limited by the failure to assess levels of ongoing clinical depression, which prevented a test of this as a possible moderating factor. It should be noted, however, that the average baseline score for the depression subscale of the POMS was 11.00 for the exercise condition and 9.95 for the quiet rest condition. Although this used the at this moment instructions, they are significantly greater (d = 1.98 and 1.52, respectively) than the adult norms for the short form of the POMS using the how you have been feeling, during the past week, including today instructions.[28] Thus, although we are unable to examine the level of clinical depression as a possible moderating factor, it does appear that these participants were experiencing a high degree of depressive symptoms at the pretest.

Despite these limitations, this remains the first experiment to examine the impact of a single bout of exercise on the postexercise mood states of clinically depressed patients. The positive results are encouraging and suggest that future research be conducted to determine the limits of acute exercise to provide this short-term benefit.

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