Research progress of exercise therapy for depressive disorder
ZHANG Shuoyuan,1, LI Chunbo,1,2
1.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
2.Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200030, China
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.
ZHANG Shuoyuan, LI Chunbo. Research progress of exercise therapy for depressive disorder. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2023, 43(7): 916-922 doi:10.3969/j.issn.1674-8115.2023.07.014
运动治疗是近些年来被逐渐接受的一种成本低、不良反应少且方便施行的抑郁障碍补充治疗方法［3-4］。美国精神病学会在2010年将运动治疗作为治疗急性期的轻度抑郁障碍的主要治疗方式［5］。加拿大情绪和焦虑治疗网络（Canadian Network for Mood and Anxiety Treatments，CANMAT）在2016年的治疗指南中将运动治疗作为轻中度抑郁障碍的单一治疗手段，以及中重度抑郁障碍的辅助治疗手段［6］。运动治疗尽管有以上优点，在国外临床上作为抑郁障碍的治疗方式逐渐开展，但在国内普及程度较低，尚未引起国内研究者的重视。运动治疗抑郁障碍因其相关机制不明确，在国内没有指导临床治疗工作的相关指南和专家共识，缺少成熟的临床治疗体系，因此在国内仍处于起步发展阶段。运动治疗抑郁障碍的临床方案确定（包括明确运动种类、强度、持续时间和介入时机）及临床疗效的比较，是目前亟待解决的问题。本文回顾近几年关于运动治疗抑郁障碍的研究报道，并讨论其未来临床推广应用的发展方向。
由于发表偏倚的影响，运动治疗的有效率可能较实际偏高，对相关研究结果需要谨慎对待［28］。目前仅有少数优质方法学及低偏倚风险的高质量试验证明了运动治疗的有效性［44］。一项系统评价［56］显示，运动治疗对抑郁障碍的缓解有中等效果［-0.62标准化平均差（standardized mean difference，SMD）］；限制偏倚风险后，运动治疗总体抗抑郁的作用则显示较小的效果（-0.18 SMD）。KROGH等［57］的meta分析也证实限制偏倚风险后，运动治疗不呈现抗抑郁作用。运动治疗的有效性仍有待更多的多中心、大样本随机对照研究来进一步证实。
ZHANG Shuoyuan was responsible for literature retrieval and thesis writing; LI Chunbo was responsible for instruction and revision of the thesis. Both authors have read the final manuscript and agreed to its submission.
利益冲突声明
2位作者声明不存在利益冲突。
Both authors disclose no relevant conflict of interests.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
HALLGREN M, KRAEPELIEN M, ÖJEHAGEN 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
HELGADÓTTIR B, HALLGREN M, EKBLOM Ö, et al. Training fast or slow? Exercise for depression: a randomized controlled trial[J]. Prev Med, 2016, 91: 123-131.
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.
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.
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.
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.
GÖKŞIN İ, AŞIRET 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.
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.
MILLER K J, GONÇALVES-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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
KROGH J, HJORTHØJ 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.
... 运动治疗是近些年来被逐渐接受的一种成本低、不良反应少且方便施行的抑郁障碍补充治疗方法［3-4］.美国精神病学会在2010年将运动治疗作为治疗急性期的轻度抑郁障碍的主要治疗方式［5］.加拿大情绪和焦虑治疗网络（Canadian Network for Mood and Anxiety Treatments，CANMAT）在2016年的治疗指南中将运动治疗作为轻中度抑郁障碍的单一治疗手段，以及中重度抑郁障碍的辅助治疗手段［6］.运动治疗尽管有以上优点，在国外临床上作为抑郁障碍的治疗方式逐渐开展，但在国内普及程度较低，尚未引起国内研究者的重视.运动治疗抑郁障碍因其相关机制不明确，在国内没有指导临床治疗工作的相关指南和专家共识，缺少成熟的临床治疗体系，因此在国内仍处于起步发展阶段.运动治疗抑郁障碍的临床方案确定（包括明确运动种类、强度、持续时间和介入时机）及临床疗效的比较，是目前亟待解决的问题.本文回顾近几年关于运动治疗抑郁障碍的研究报道，并讨论其未来临床推广应用的发展方向. ...
1
... 运动治疗是近些年来被逐渐接受的一种成本低、不良反应少且方便施行的抑郁障碍补充治疗方法［3-4］.美国精神病学会在2010年将运动治疗作为治疗急性期的轻度抑郁障碍的主要治疗方式［5］.加拿大情绪和焦虑治疗网络（Canadian Network for Mood and Anxiety Treatments，CANMAT）在2016年的治疗指南中将运动治疗作为轻中度抑郁障碍的单一治疗手段，以及中重度抑郁障碍的辅助治疗手段［6］.运动治疗尽管有以上优点，在国外临床上作为抑郁障碍的治疗方式逐渐开展，但在国内普及程度较低，尚未引起国内研究者的重视.运动治疗抑郁障碍因其相关机制不明确，在国内没有指导临床治疗工作的相关指南和专家共识，缺少成熟的临床治疗体系，因此在国内仍处于起步发展阶段.运动治疗抑郁障碍的临床方案确定（包括明确运动种类、强度、持续时间和介入时机）及临床疗效的比较，是目前亟待解决的问题.本文回顾近几年关于运动治疗抑郁障碍的研究报道，并讨论其未来临床推广应用的发展方向. ...
1
... 运动治疗是近些年来被逐渐接受的一种成本低、不良反应少且方便施行的抑郁障碍补充治疗方法［3-4］.美国精神病学会在2010年将运动治疗作为治疗急性期的轻度抑郁障碍的主要治疗方式［5］.加拿大情绪和焦虑治疗网络（Canadian Network for Mood and Anxiety Treatments，CANMAT）在2016年的治疗指南中将运动治疗作为轻中度抑郁障碍的单一治疗手段，以及中重度抑郁障碍的辅助治疗手段［6］.运动治疗尽管有以上优点，在国外临床上作为抑郁障碍的治疗方式逐渐开展，但在国内普及程度较低，尚未引起国内研究者的重视.运动治疗抑郁障碍因其相关机制不明确，在国内没有指导临床治疗工作的相关指南和专家共识，缺少成熟的临床治疗体系，因此在国内仍处于起步发展阶段.运动治疗抑郁障碍的临床方案确定（包括明确运动种类、强度、持续时间和介入时机）及临床疗效的比较，是目前亟待解决的问题.本文回顾近几年关于运动治疗抑郁障碍的研究报道，并讨论其未来临床推广应用的发展方向. ...
3
... 运动治疗是近些年来被逐渐接受的一种成本低、不良反应少且方便施行的抑郁障碍补充治疗方法［3-4］.美国精神病学会在2010年将运动治疗作为治疗急性期的轻度抑郁障碍的主要治疗方式［5］.加拿大情绪和焦虑治疗网络（Canadian Network for Mood and Anxiety Treatments，CANMAT）在2016年的治疗指南中将运动治疗作为轻中度抑郁障碍的单一治疗手段，以及中重度抑郁障碍的辅助治疗手段［6］.运动治疗尽管有以上优点，在国外临床上作为抑郁障碍的治疗方式逐渐开展，但在国内普及程度较低，尚未引起国内研究者的重视.运动治疗抑郁障碍因其相关机制不明确，在国内没有指导临床治疗工作的相关指南和专家共识，缺少成熟的临床治疗体系，因此在国内仍处于起步发展阶段.运动治疗抑郁障碍的临床方案确定（包括明确运动种类、强度、持续时间和介入时机）及临床疗效的比较，是目前亟待解决的问题.本文回顾近几年关于运动治疗抑郁障碍的研究报道，并讨论其未来临床推广应用的发展方向. ...
