Effects of exercise training on older patients with major depression

Background: Previous observational and interventional studies have suggeste d that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depr essive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated. Objective: To assess the effectiveness of an aerobic exercise program compa red with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial. Methods: One hundred fifty-six men and women with MDD (age, greater than or equal to 50 years) were assigned randomly to a program of aerobic exercise , antidepressants (sertraline hydrochloride), or combined exercise and medi cation. Subjects underwent comprehensive evaluations of depression, includi ng the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and a fter treatment. Secondary out-come measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions. Results: After 16 weeks of treatment, the groups did not differ statistical ly on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depr ession yielded an essentially identical result. Growth curve models reveale d that all groups exhibited statistically and clinically significant reduct ions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combinatio n therapy, those with less severe depressive symptoms initially showed a mo re rapid response than those with initially more severe depressive symptoms . Conclusions: An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although a ntidepressants may facilitate a more rapid initial therapeutic response tha n exercise, after 16 weeks of treatment exercise was equally effective in r educing depression among patients with MDD.