Introduction: Major depressive disorder (MDD) is a prevalent medical illness that is associated with chronic stress. Patients with MDD can show an imbalance in cortisol levels, which can be restored with the remission of symptoms. Physical exercise training has been used as a tool to promote changes in cortisol levels in healthy individuals. However, it is unknown if exercise can produce the same results in individuals with MDD. Objective: To review evidence of cortisol changes after exercise training in individuals with MDD. Methods: We conducted a search on PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo databases. Random effects meta-analysis was performed and standardized mean difference (SMD) effect size was calculated. Analyses of forest and funnel plots was conducted using Stata v.11.0 software. Results: At first, 463 studies were obtained in the search. After completion of the selection procedure, five articles with seven analyses were included. Type of exercise, frequency of training, cortisol measurement, and type of control group were analyzed. There was a reduction of cortisol levels in the exercise group (SMD = −0.65, 95%CI 1.30-0.01). Moreover, sensitivity analysis and subgroup analyses revealed an effect of type (aerobic exercise) and frequency (five times per week) of exercise on reduction of cortisol levels. However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them. Conclusion: Physical exercise promotes a reduction in cortisol levels in individuals with MDD. However, this finding can be influenced by type of exercise, weekly frequency, and type of cortisol measurement.

ABSTRACT. Some prevalent mental disorders in the elderly, such as Alzheimer's disease (AD) and major depression disorder (MDD), are associated with chronic stress and consequently with possible dysregulation of hypothalamic–pituitary–adrenal (HPA) axis and cortisol levels in basal conditions or in the reactivity of an acute stressor. However, evidence of cortisol behavior after a physical stressor in patients with AD and MDD is scarce. Objective: This study aimed to investigate the cortisol reactivity to a single session of physical exercise in patients with MDD and AD and compare it to healthy control (HC) older individuals. Methods: HC individuals (n=10) and elderly with clinical diagnostic of MDD (n=08) and AD (n=13) were submitted to a single bout of aerobic exercise in a treadmill during 30 minutes of moderate intensity. Salivary cortisol was collected before and after acute stressor. A repeated-measure analysis of variance (ANOVA), spearman correlation, and linear regression were performed. Results: The repeated-measure ANOVA revealed no interaction for cortisol on the moment×group [F(2.000, 28.000)=1.285; p=0.293] and no effect for group (F=0.323; p=0.727). However, a significant effect for moment [F(1.000, 28.000)=4.930; p=0.035] was found, with a decreased cortisol levels in postexercise for all groups. The effect size (ES) of cortisol reduction was small for patients with MDD (d=0.402) and trivial for patients with AD (d=0.166) and HC group (d=0.090). Conclusions: All participants show a decreased cortisol reactivity to a physical stressor, which can be associated with an impairment in coping with an acute stressor.

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