AUTHOR=Meyer Jacob D. , Perkins Seana L. , Brower Cassandra S. , Lansing Jeni E. , Slocum Julia A. , Thomas Emily B. K. , Murray Thomas A. , Lee Duck-chul , Wade Nathaniel G. 

TITLE=Feasibility of an Exercise and CBT Intervention for Treatment of Depression: A Pilot Randomized Controlled Trial

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.799600

DOI=10.3389/fpsyt.2022.799600

ISSN=1664-0640

ABSTRACT=Depression (DEP) is prevalent and current treatments are ineffective for many people. This pilot study’s purpose was to assess the feasibility, acceptability, and plausible efficacy of an 8-week intervention employing 30 minutes of prescribed moderate intensity exercise ('ActiveCBT') compared to 30 minutes of usual activities ('CalmCBT') immediately prior to weekly online CBT sessions. Ten adults with DSM-5-diagnosed current DEP were randomized to groups and completed: an intake assessment, eight weekly CBT sessions, final assessment, and 3-month follow-up. ActiveCBT participants were prescribed 30-minutes of moderate exercise immediately prior to each standardized 50-minute CBT session. CalmCBT participants continued with normal activities for 30 minutes before therapy. Questionnaires regarding DEP symptom severity (Patient Health Questionnaire-9 [PHQ-9]), between-session effectiveness (Behavioral Activation for Depression Survey [BADS], Automatic Thoughts Questionnaire [ATQ]), in-session effectiveness (Working Alliance Inventory-Short Revised [WAI]), and state anhedonia (Dimension Analogue Rating Scale [DARS], Visual Analogue Scale [VAS]; assessed 3 times: before Active/Calm condition, after, and after therapy) were completed each week. Therapy fidelity ratings were independently coded via a standardized codebook. The Structured Clinical Interview for DSM-5 (SCID) and Hamilton Rating Scale for Depression (HAMD) were used to assess DEP at intake, final, and 3-month follow-up. We found strong feasibility and acceptability (100% adherence, 100% retention at final visit, 74.6% therapy fidelity, and high patient satisfaction ratings). Differences between groups favoring ActiveCBT in anhedonia (DARS, Hedges’ g=0.92; VAS, g=3.16), within- (WAI, g=0.1.10), and between-session effectiveness (ATQ g=-0.65; BADS g=-1.40), suggest plausible efficacy of ActiveCBT for enhancing CBT. DEP rates were reduced in both groups from baseline to final (60% MDD SCID remission) and at follow up (Active: 40%; Calm: 25%). Larger and potentially quicker symptom improvement was found favoring the Active condition to the final visit (HAMD, between-group changes g=-1.33; PHQ-9, g=-0.62), with small differences remaining at follow-up (HAMD, g= -0.45; PHQ-9, g=-0.19). Exercise priming appears acceptable and plausibly efficacious for enhancing mechanisms of CBT and overall outcomes, though the present small sample precludes efficacy determinations. It appears feasible to conduct a randomized controlled trial comparing ActiveCBT to CalmCBT. Future trials evaluating this potentially promising treatment approach and mediating mechanisms are warranted.