Physical Exercise for Late-Life Major Depression
Abstract
Background:
Aims:
Method:
Results:
Conclusions:
Declaration of interest:
Method
Recruitment
Randomisation and masking
Interventions
Sertraline.
Sertraline plus non-progressive exercise.
Sertraline plus progressive aerobic exercise.
Assessments
Outcomes
Statistical analysis
Results
![](/cms/10.1176/appi.focus.19306/asset/images/large/appi.focus.19306f1.jpeg)
Sertraline group | S+NPE group | S+PAE group | |
---|---|---|---|
(n=42) | (n=37) | (n=42) | |
Age, years: mean (s.d.) | 75.6 (5.6) | 75.0 (6.3) | 75.0 (6.2) |
Female, n (%) | 32 (76) | 25 (68) | 29 (69) |
Marital status, n (%) | |||
Married | 19 (45) | 18 (49) | 18 (43) |
Widowed | 19 (45) | 13 (35) | 19 (45) |
Education: elementary or less, n (%) | 27 (64) | 18 (49) | 20 (48) |
Living alone, n (%) | 19 (45) | 17 (46) | 18 (43) |
BMI, kg/m (2): mean (s.d.) | 25.8 (3.3) | 25.2 (3.7) | 26.7 (3.8) |
CIRS | |||
Severity index: mean (s.d.) | 1.23 (1.15–1.48) | 1.38 (1.27–1.62) | 1.31 (1.21–1.67) |
Comorbidity index: mean (s.d.) | 0 (0–1) | 1 (1–3) | 1 (0–2) |
Low IPAQ level of physical activity, n (%) | 34 (81) | 35 (95) | 35 (83) |
VO2max peak, ml/kg per min: mean (s.d.) | 15.3 (2.5) | 14.8 (3.0) | 15.2 (3.7) |
MMSE total score: mean (s.d.) | 26.8 (2.5) | 26.8 (2.4) | 27.0 (2.3) |
HRSD total score: median (IQR) | |||
Baseline | 19 (18–23) | 18 (18–22) | 18 (18–21) |
4 weeks | 15.5 (12–19.3) | 13 (8–17.5) | 12.5 (9–14.3) |
8 weeks | 13 (7.75–17.3) | 11 (7–13) | 9.5 (6.75–13) |
12 weeks | 11.5 (8–16) | 10 (6–13) | 8 (5.75–10) |
24 weeks | 11.5 (7–16.3) | 8 (5–11) | 7 (4–10) |
Age at onset of depressive disorder, years: mean (s.d.) | 48.7 (22.7) | 50.0 (23.5) | 49.5 (24.3) |
Treated with antidepressant (lifetime), n (%) | 31 (74) | 26 (70) | 25 (60) |
More than 1 depressive episode (lifetime), n (%) | 25 (60) | 18 (49) | 20 (48) |
Life events in 12 months before interview, n (%) | 27 (64) | 16 (43) | 19 (45) |
History of suicide attempt, n (%) | 1 (2) | 1 (3) | 1 (2) |
Attrition, safety and adherence
Remission of depression
![](/cms/10.1176/appi.focus.19306/asset/images/large/appi.focus.19306f2.jpeg)
Predictor | B (s.e.) | HR | 95% CI |
---|---|---|---|
Model 1a,b | |||
S+NPE | 0.51 (0.27) | 1.68 | 0.98–2.88 |
S+PAE | 0.75 (0.26) | 2.12** | 1.27–3.54 |
Model 2a,c | |||
S+NPE | 0.65 (0.29) | 1.91* | 1.08–3.39 |
S+PAE | 0.72 (0.29) | 2.04* | 1.17–3.58 |
Centre | |||
Bologna East | –0.69 (0.30) | 0.50* | 0.28–0.89 |
Parma | 0.44 (0.37) | 1.56 | 0.76–3.21 |
Modena–Correggio | –0.38 (0.40) | 0.68 | 0.31–1.50 |
Clinical factors | |||
Age | <0.01 (0.02) | 1.00 | 0.97–1.04 |
Gender, male | –0.11 (0.24) | 0.90 | 0.56–1.44 |
CIRS comorbidity score | –0.39 (0.55) | 0.68 | 0.23–1.99 |
Baseline HRSD score | –0.06 (0.04) | 0.95 | 0.87–1.03 |
Number of previous episodes of depression | –0.05 (0.24) | 0.95 | 0.60–1.51 |
Prior treatment with antidepressants | –0.07 (0.26) | 0.94 | 0.56–1.56 |
Medication | |||
Dosage of sertraline | 0.52 (0.39) | 0.59 | 0.28–1.27 |
Non-adherence to sertraline | –0.22 (0.14) | 0.80 | 0.61–1.04 |
Changes in depressive symptoms
![](/cms/10.1176/appi.focus.19306/asset/images/large/appi.focus.19306f3.jpeg)
HRSD total score: means(s.d.) | |||
---|---|---|---|
Assessment | Sertraline group (n=42) | S+NPE group (n=37) | S+PAE group (n=42) |
Baseline | 20.4 (3.4) | 20.1 (3.2) | 19.8 (2.6) |
4 weeks | 15.8 (4.4) | 12.7 (5.1) | 12.4 (4.8) |
8 weeks | 12.8 (5.0) | 10.7 (4.1) | 9.6 (3.9) |
12 weeks | 11.7 (5.0) | 9.8 (4.1) | 8.0 (3.6) |
24 weeks | 11.7 (5.9) | 8.5 (4.5) | 7.1 (4.2) |
Parameter | b | s.e. | 95% CI | P |
---|---|---|---|---|
Fixed effects | ||||
Intercept | 19.87 | 0.45 | 18.99 to 20.75 | 50.001** |
Time | –2.36 | 0.16 | –2.67 to –2.06 | 50.001** |
Time 2 | 0.17 | 0.02 | 0.13 to 0.20 | 50.001** |
Time 3 | –0.03 | 0.05 | –0.04 to –0.03 | 50.001** |
S+NPEa | –0.22 | 0.45 | –1.10 to 0.66 | 0.621 |
S+NPEtime | –0.46 | 0.16 | –0.77 to –0.16 | 0.003** |
S+NPEtime 2 | 0.05 | 0.02 | 0.01 to 0.09 | 0.007** |
S+NPEtime 3 | –0.001 | 0.0005 | –0.002 to –0.0003 | 0.010* |
S+PAEa | –0.36 | 0.43 | –1.21 to 0.49 | 0.399 |
S+PAEtime | –0.44 | 0.15 | –0.74 to –0.15 | 0.003** |
S+PAEtime 2 | 0.04 | 0.02 | 0.003 to 0.08 | 0.033* |
S+PAEtime 3 | –0.01 | 0.05 | –0.002 to 0.00004 | 0.060 |
Random effects | ||||
Variance intercept | 8.69 | 1.57 | 6.10 to 12.37 | <0.001** |
Variance time | 0.03 | 0.01 | 0.02 to 0.04 | <0.001** |
ARH rho | –0.20 | 0.14 | –0.45 to 0.08 | 0.147 |
Changes in aerobic capacity.
Discussion
Other research
Study limitations
Clinical implications
Appendix
Protocol for the non-progressive exercise intervention
Protocol for the progressive aerobic exercise intervention
Cycling sessions
References
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