收稿日期: 2023-03-02
录用日期: 2023-06-25
网络出版日期: 2023-07-28
基金资助
国家重点研发计划(2018YFC2001605);上海市精神心理临床医学研究中心(19MC1911100)
Research progress of exercise therapy for depressive disorder
Received date: 2023-03-02
Accepted date: 2023-06-25
Online published: 2023-07-28
Supported by
National Key R & D Program of China(2018YFC2001605);Clinical Research Center of Shanghai Mental Health Center(19MC1911100)
抑郁障碍作为全球的重大疾病之一，其预防与治疗方法备受关注。运动治疗作为新兴的治疗方式，相较于药物治疗和物理治疗等常规治疗方法，具有成本低、不良反应少且方便施行等优点，应用前景乐观。已有相关研究对运动治疗抑郁障碍的机制进行探索，但目前该机制并未明确，可能涉及提高神经生化分子水平、抑制炎症反应、调控神经内分泌系统以及改善神经可塑性等几个方面的影响。运动治疗被证明与抗抑郁药物存在相似的生物学效应，同时可能与其他治疗方法存在叠加效应。对未发病和已发病人群及早进行干预，都能使其在一定程度上获益。目前运动治疗抑郁障碍的相关临床领域仍存在空白，高质量研究甚少，运动治疗的方案设计仍处于探索阶段，尚未形成一致结论，且缺少相关的运动治疗指南供临床医师参考。该文综述了运动治疗抑郁障碍的生物学机制，总结国内外开展的运动治疗抑郁障碍的临床研究结果，分析目前运动治疗的方案设计和优缺点，以期为运动治疗研究领域的深入开展提供参考。
张硕渊 , 李春波 . 运动治疗抑郁障碍的研究进展[J]. 上海交通大学学报（医学版）, 2023 , 43(7) : 916 -922 . DOI: 10.3969/j.issn.1674-8115.2023.07.014
Depressive disorder, as one of the major diseases in the world, has always received much attention for its prevention and treatment. As an emerging treatment, exercise therapy has optimistic application prospect with the advantages such as lower cost, fewer side effects and easier implementation, compared to conventional treatments such as drug therapy and physical therapy. Relevant studies have explored the mechanism of exercise in the treatment of depressive disorder, but the mechanism is not clear yet, which may involve improving the levels of neurobiochemical molecules, inhibiting inflammatory response, regulating neuroendocrine system, improving neuroplasticity, and other aspects. Exercise therapy has been proved to have similar biological effects with antidepressants, and may have overlapping effects with other treatments. Early intervention can benefit both non- diseased and already diseased populations to a certain extent. At present, there is still a gap in the clinical field related to exercise therapy for depressive disorder, and there are few high-quality studies. The design of exercise therapy plans is still in the exploratory stage, and there is no consensus on the design of exercise therapy plans. Additionally, there is a lack of relevant exercise therapy guidelines for clinicians to refer to. This review systematically introduces the biological mechanism of exercise therapy for depressive disorder, summarizes the clinical research results in this field carried out at home and abroad, and analyzes the current program and advantages and disadvantages of exercise therapy, in order to provide reference for the in-depth development of the exercise therapy researches.
Key words： depressive disorder; exercise; exercise therapy; intervention
| 1 | DUBOVSKY S L, GHOSH B M, SEROTTE J C, et al. Psychotic depression: diagnosis, differential diagnosis, and treatment[J]. Psychother Psychosom, 2021, 90(3): 160-177. |
| 2 | CIPRIANI A, FURUKAWA T A, SALANTI G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis[J]. Lancet, 2018, 391(10128): 1357-1366. |
| 3 | MIKKELSEN K, STOJANOVSKA L, POLENAKOVIC M, et al. Exercise and mental health[J]. Maturitas, 2017, 106: 48-56. |
| 4 | RIMES R R, DE SOUZA MOURA A M, LAMEGO M K, et al. Effects of exercise on physical and mental health, and cognitive and brain functions in schizophrenia: clinical and experimental evidence[J]. CNS Neurol Disord Drug Targets, 2015, 14(10): 1244-1254. |
| 5 | GELENBERG A, FREEMAN M, MARKOWITZ J, et al. Practice guideline for the treatment of patients with major depressive disorder[J]. Am J Psychiatry, 2010, 167: 1-118. |
| 6 | RAVINDRAN A V, BALNEAVES L G, FAULKNER G, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 5. Complementary and alternative medicine treatments[J]. Can J Psychiatry, 2016, 61(9): 576-587. |
| 7 | KLEMPIN F, BEIS D, MOSIENKO V, et al. Serotonin is required for exercise-induced adult hippocampal neurogenesis[J]. J Neurosci, 2013, 33(19): 8270-8275. |
| 8 | HEMAT-FAR A, SHAHSAVARI A, MOUSAVI S R. Effects of selected aerobic exercises on the depression and concentrations of plasma serotonin in the depressed female students aged 18 to 25[J]. J Appl Res, 2012, 12(1): 47-52. |
| 9 | KERLING A, KüCK M, TEGTBUR U, et al. Exercise increases serum brain-derived neurotrophic factor in patients with major depressive disorder[J]. J Affect Disord, 2017, 215: 152-155. |
| 10 | FENG L L, LI B W, XI Y, et al. Aerobic exercise and resistance exercise alleviate skeletal muscle atrophy through IGF-1/IGF-1R-PI3K/Akt pathway in mice with myocardial infarction[J]. Am J Physiol Cell Physiol, 2022, 322(2): C164-C176. |
| 11 | 刘家辉, 杨超, 顾秋香, 等. 高强度间歇训练对小鼠抑郁行为的作用及机制[J]. 生理学报, 2022, 74(2): 165-176. |
| 11 | LIU J H, YANG C, GU Q X, et al. Effect of high-intensity interval exercise on depression-related behavior in mice[J]. Acta Physiologica Sinica, 2022, 74(2): 165-176. |
| 12 | LAVEBRATT C, HERRING M P, LIU J J, et al. Interleukin-6 and depressive symptom severity in response to physical exercise[J]. Psychiatry Res, 2017, 252: 270-276. |
| 13 | 刘威, 晋倩, 郝选明. 有氧运动干预对抑郁症大鼠HPA轴激活状态的影响及其上游调控机制[J]. 体育学刊, 2021, 28(2): 138-144. |
| 13 | LIU W, JIN Q, HAO X M. Effect of aerobic exercise intervention on the activation degree of HPA axis in depressive rats and its upstream regulation mechanism[J]. Journal of Physical Education, 2021, 28(2): 138-144. |
| 14 | CHEN C, NAKAGAWA S, AN Y, et al. The exercise-glucocorticoid paradox: how exercise is beneficial to cognition, mood, and the brain while increasing glucocorticoid levels[J]. Front Neuroendocrinol, 2017, 44: 83-102. |
| 15 | ALGHADIR A H, GABR S A. Hormonal function responses to moderate aerobic exercise in older adults with depression[J]. Clin Interv Aging, 2020, 15: 1271-1283. |
| 16 | HUANG G J, BEN-DAVID E, PIELLA A T, et al. Neurogenomic evidence for a shared mechanism of the antidepressant effects of exercise and chronic fluoxetine in mice[J]. PLoS One, 2012, 7(4): e35901. |
| 17 | VIVAR C, PETERSON B D, VAN PRAAG H. Running rewires the neuronal network of adult-born dentate granule cells[J]. NeuroImage, 2016, 131: 29-41. |
| 18 | HUANG P, DONG Z, HUANG W, et al. Voluntary wheel running ameliorates depression-like behaviors and brain blood oxygen level-dependent signals in chronic unpredictable mild stress mice[J]. Behav Brain Res, 2017, 330: 17-24. |
| 19 | SITENESKI A, OLESCOWICZ G, PAZINI F L, et al. Antidepressant-like and pro-neurogenic effects of physical exercise: the putative role of FNDC5/irisin pathway[J]. J Neural Transm (Vienna), 2020, 127(3): 355-370. |
| 20 | SIETTE J, WESTBROOK R F, COTMAN C, et al. Age-specific effects of voluntary exercise on memory and the older brain[J]. Biol Psychiatry, 2013, 73(5): 435-442. |
| 21 | ZORIC B, JANKOVIC L, KUZMANOVIC PFICER J, et al. The efficacy of fluoxetine in BMS: a cross-over study[J]. Gerodontology, 2018, 35(2): 123-128. |
| 22 | HALLGREN M, KRAEPELIEN M, ?JEHAGEN A, et al. Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: randomised controlled trial[J]. Br J Psychiatry, 2015, 207(3): 227-234. |
| 23 | HALLGREN M, HELGADóTTIR B, HERRING M P, et al. Exercise and internet-based cognitive-behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up[J]. Br J Psychiatry, 2016, 209(5): 414-420. |
| 24 | NASSTASIA Y, BAKER A L, LEWIN T J, et al. Differential treatment effects of an integrated motivational interviewing and exercise intervention on depressive symptom profiles and associated factors: a randomised controlled cross-over trial among youth with major depression[J]. J Affect Disord, 2019, 259: 413-423. |
| 25 | 陈倩倩, 许瑞智, 汪晓静, 等. 有氧运动干预抑郁症缓解期患者认知功能的临床随机对照研究[J]. 中华精神科杂志, 2021, 54(1): 25-30. |
| 25 | CHEN Q Q, XU R Z, WANG X J, et al. A clinical randomized controlled study of aerobic exercise on the cognitive function of patients with depression in their remission[J]. Chinese Journal of Psychiatry, 2021, 54(1): 25-30. |
| 26 | ROY A, GOVINDAN R, MURALIDHARAN K. The impact of an add-on video assisted structured aerobic exercise module on mood and somatic symptoms among women with depressive disorders: study from a tertiary care centre in India[J]. Asian J Psychiatry, 2018, 32: 118-122. |
| 27 | TOUPS M, CARMODY T, GREER T, et al. Exercise is an effective treatment for positive valence symptoms in major depression[J]. J Affect Disord, 2017, 209: 188-194. |
| 28 | PEARCE M, GARCIA L, ABBAS A, et al. Association between physical activity and risk of depression: a systematic review and meta-analysis[J]. JAMA Psychiatry, 2022, 79(6): 550-559. |
| 29 | GLOWACKI K, ARBOUR-NICITOPOULOS K, BURROWS M, et al. It′s more than just a referral: development of an evidence-informed exercise and depression toolkit[J]. Ment Health Phys Activity, 2019, 17: 100297. |
| 30 | RETHORST C D, TRIVEDI M H. Evidence-based recommendations for the prescription of exercise for major depressive disorder[J]. J Psychiatr Pract, 2013, 19(3): 204-212. |
| 31 | CHEKROUD S R, GUEORGUIEVA R, ZHEUTLIN A B, et al. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study[J]. Lancet Psychiatry, 2018, 5(9): 739-746. |
| 32 | BULL F C, AL-ANSARI S S, BIDDLE S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour[J]. Br J Sports Med, 2020, 54(24): 1451-1462. |
| 33 | HELGADóTTIR B, HALLGREN M, EKBLOM ?, et al. Training fast or slow? Exercise for depression: a randomized controlled trial[J]. Prev Med, 2016, 91: 123-131. |
| 34 | WARBURTON D E R, BREDIN S S D. Health benefits of physical activity: a systematic review of current systematic reviews[J]. Curr Opin Cardiol, 2017, 32(5): 541-556. |
| 35 | MARTINEZ-GOMEZ D, ESTEBAN-CORNEJO I, LOPEZ-GARCIA E, et al. Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults[J]. Br J Sports Med, 2020, 54(4): 238-244. |
| 36 | KVAM S, KLEPPE C L, NORDHUS I H, et al. Exercise as a treatment for depression: a meta-analysis[J]. J Affect Disord, 2016, 202: 67-86. |
| 37 | MORRES I D, HATZIGEORGIADIS A, STATHI A, et al. Aerobic exercise for adult patients with major depressive disorder in mental health services: a systematic review and meta-analysis[J]. Depress Anxiety, 2019, 36(1): 39-53. |
| 38 | WHITWORTH J W, NOSRAT S, SANTABARBARA N J, et al. Feasibility of resistance exercise for posttraumatic stress and anxiety symptoms: a randomized controlled pilot study[J]. J Trauma Stress, 2019, 32(6): 977-984. |
| 39 | G?K?IN ?, A?IRET G D. The effect of progressive muscle relaxation on the adaptation of elderly women to depression and old age: a randomised clinical trial[J]. Psychogeriatrics, 2021, 21(3): 333-341. |
| 40 | HANSSEN H, MINGHETTI A, FAUDE O, et al. Effects of endurance exercise modalities on arterial stiffness in patients suffering from unipolar depression: a randomized controlled trial[J]. Front Psychiatry, 2018, 8: 311. |
| 41 | KIM H, JEONG W, KWON J, et al. Sex differences in type of exercise associated with depression in South Korean adults[J]. Sci Rep, 2020, 10(1): 18271. |
| 42 | MILLER K J, GON?ALVES-BRADLEY D C, AREEROB P, et al. Comparative effectiveness of three exercise types to treat clinical depression in older adults: a systematic review and network meta-analysis of randomised controlled trials[J]. Ageing Res Rev, 2020, 58: 100999. |
| 43 | RAMSEY C M, LYNCH K G, GEHRMAN P R, et al. Daily steps and depressive symptoms: a longitudinal evaluation of patients with major depressive disorder in the precision medicine in mental health care study[J]. J Affect Disord, 2022, 300: 334-340. |
| 44 | BAILEY A P, HETRICK S E, ROSENBAUM S, et al. Treating depression with physical activity in adolescents and young adults: a systematic review and meta-analysis of randomised controlled trials[J]. Psychol Med, 2018, 48(7): 1068-1083. |
| 45 | NASSTASIA Y, BAKER A L, HALPIN S A, et al. Evaluating the efficacy of an integrated motivational interviewing and multi-modal exercise intervention for youth with major depression: healthy body, healthy mind randomised controlled trial protocol[J]. Contemp Clin Trials Commun, 2018, 9: 13-22. |
| 46 | BLUMENTHAL J A, SHERWOOD A, BABYAK M A, et al. Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study[J]. J Am Coll Cardiol, 2012, 60(12): 1053-1063. |
| 47 | HELGADóTTIR B, FORSELL Y, HALLGREN M, et al. Long-term effects of exercise at different intensity levels on depression: a randomized controlled trial[J]. Prev Med, 2017, 105: 37-46. |
| 48 | MURRI M B, EKKEKAKIS P, MENCHETTI M, et al. Physical exercise for late-life depression: effects on symptom dimensions and time course[J]. J Affect Disord, 2018, 230: 65-70. |
| 49 | TONI G, BELVEDERI MURRI M, PIEPOLI M, et al. Physical exercise for late-life depression: effects on heart rate variability[J]. Am J Geriatr Psychiatry, 2016, 24(11): 989-997. |
| 50 | GUJRAL S, AIZENSTEIN H, REYNOLDS C F 3rd, et al. Exercise for depression: a feasibility trial exploring neural mechanisms[J]. Am J Geriatr Psychiatry, 2019, 27(6): 611-616. |
| 51 | MICHELI L, CECCARELLI M, D′ANDREA G, et al. Depression and adult neurogenesis: positive effects of the antidepressant fluoxetine and of physical exercise[J]. Brain Res Bull, 2018, 143: 181-193. |
| 52 | ROSS R E, VANDERWERKER C J, NEWTON J H, et al. Simultaneous aerobic exercise and rTMS: feasibility of combining therapeutic modalities to treat depression[J]. Brain Stimul, 2018, 11(1): 245-246. |
| 53 | DANIELSSON L, PAPOULIAS I, PETERSSON E L, et al. Exercise or basic body awareness therapy as add-on treatment for major depression: a controlled study[J]. J Affect Disord, 2014, 168: 98-106. |
| 54 | HIDALGO J L T, SOTOS J R, GROUP D E. Effectiveness of physical exercise in older adults with mild to moderate depression[J]. Ann Fam Med, 2021, 19(4): 302-309. |
| 55 | KRUISDIJK F, HOPMAN-ROCK M, BEEKMAN A T F, et al. EFFORT-D: results of a randomised controlled trial testing the effect of running therapy on depression[J]. BMC Psychiatry, 2019, 19(1): 170. |
| 56 | COONEY G M, DWAN K, GREIG C A, et al. Exercise for depression[J]. Cochrane Database Syst Rev, 2013, 2013(9): CD004366. |
| 57 | KROGH J, HJORTH?J C, SPEYER H, et al. Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis[J]. BMJ Open, 2017, 7(9): e014820. |
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