Pilot Study of an Exercise Intervention for Depressive Symptoms and Associated Cognitive-Behavioral Factors in Young Adults With Major Depression

Abstract

This study assesses the feasibility of integrating motivational interviewing (MI) with an exercise intervention. It also explores patterns of depressive symptom changes (cognitive, affective, and somatic subscales) and their relationship to cognitive, behavioral, and immunological factors (interleukin 6, IL-6, a marker for inflammation) across the exercise intervention. Twelve young adults (20.8 ± 1.7 years) meeting DSM-IV criteria for major depressive disorder received a brief MI intervention followed by a 12-week exercise intervention. Assessments were conducted preintervention, postintervention, throughout the intervention, and at follow-up. Preliminary results show differential effects of exercise, with the largest standardized mean improvements for the affective subscale (-1.71), followed by cognitive (-1.56) and somatic (-1.39) subscales. A significant relationship was observed between increased behavioral activation and lower levels of IL-6. Despite study limitations, the magnitude of changes suggests that natural remission of depressive symptoms is an unlikely explanation for the findings. A randomized controlled trial has commenced to evaluate effectiveness of the intervention.

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

“…At this stage, little is known about how exercise targets depressive symptom domains in young people with depression. Preliminary results from our pilot study suggests exercise differentially targets depressive symptoms with largest overall improvement observed in the affective subscale followed by cognitive and somatic subscales [25] . Different depressive symptoms may show different response rates to exercise and understanding this may offer important insights into the potential mechanisms of action of exercise on mind, body and behaviour.…”

“…The MI intervention protocol ‘Train your mood: Exercise as Treatment for Depression’ was initially developed as a pre-exercise engagement strategy for young people with MDD and piloted as part of a previous study by the same researchers [25] . The revised MI protocol used in this trial “ Exercise as treatment for depression: A guide for personal trainers” was adapted for delivery by PTs to increase engagement effects and the MI intervention was shortened to 30 min to promote dissemination and real-world application.…”

“…A sample size calculation was performed on the primary outcome measure of change in depression severity. Based on pilot work [25] , a large differential effect was anticipated (effect size = 1), from which it was estimated that retention of 26 participants per group would provide 80% power to detect a post-treatment change in depression severity, using 0.01 level, two-tailed significance tests; conventional two-tailed significance tests were adopted as we would feel obliged to explore observed differences in the unexpected direction. Consequently, anticipating a retention rate of 75%, we planned to recruit 35 participants per group.…”

“…We recently conducted a pilot study investigating the feasibility of integrating a pre-exercise MI intervention designed to engage young people with MDD in exercise training and assessed the effects of the intervention on depression symptom profiles [25] . In the current study, the pilot MI intervention was adapted for delivery by personal trainers and integrated with an exercise intervention in the context of a randomised controlled trial.…”

Evaluating an exercise intervention to treat depression in young people

“…BCTs will be derived from the Behaviour Change Wheel, COM-B model [61] and the Theoretical Domains Framework (TDF; [62] used as a theoretical base for the 'Healthy Living' component of the intervention [61,63,64]. Previous trials have offered sessions twice a week for shorter duration [38] and three times a week for 12 weeks [65,66], reporting an initial high adherence which declined over time [65]. The full intervention content will be informed by a range of important stakeholders and detailed in a comprehensive intervention manual, which will be finalised before recruitment starts.…”