Effects of Exercise and Sertraline on Measures of Coronary Heart Disease Risk in Patients With Major Depression: Results From the SMILE-II Randomized Clinical Trial
Open accessAbstract
Objective: To assess the effects of supervised and home-based aerobic exercise training, and antidepressant pharmacotherapy (sertraline) on coronary heart disease (CHD) risk factors in a sample of participants with major depressive disorder (MDD). Methods: The Standard Medical Intervention versus Long-term Exercise (SMILE)-II study randomized 202 adults (153 women, 49 men) diagnosed as having MDD to one of four interventions, each of 4-month duration: supervised exercise, home-based exercise, antidepressant medication (sertraline, 50–200 mg daily), or placebo pill. Patients underwent a structured clinical interview for depression and completed the Hamilton Depression Rating Scale. CHD risk factors included brachial artery flow-mediated dilation, carotid intima-media thickness, serum lipids, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Results: Compared with placebo, active treatment of depression (supervised exercise, home-based exercise, sertraline therapy) was associated with an improvement in CHD risk factors (improved flow-mediated dilation [p= .032], reduced progression of intima-media thickness [p= .037], and a reduction in 10-year ASCVD [p= .049]). The active treatments did not differ from each other in their effects on the CHD risk outcomes. Conclusions: Both exercise and antidepressant medication improved CHD risk factors and lowered ASCVD risk in patients with MDD. Because MDD is associated with increased risk for CHD events, treatment of depression with exercise or sertraline may reduce the risk of developing CHD in patients with MDD. Trial Registration:Clinical Trials Government Identifier: NCT-00331305.
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Aerobic exercise was also as effective as antidepressant medication in improving cardiovascular risk factors in those adults.
“Aerobic exercise was also as effective as antidepressant treatment in reducing depression and improving cardiovascular risk factors in adults (average age 50) with mild major depressive disorder68.”
From State of the Science of Neural Systems in Late‐Life Depression: Impact on Clinical Presentation and Treatment Outcome (2018) · cites this paper as [68]
Aerobic exercise was as effective as antidepressant medication in reducing depression among adults with an average age of 50 who had mild major depressive disorder.
“Aerobic exercise was also as effective as antidepressant treatment in reducing depression and improving cardiovascular risk factors in adults (average age 50) with mild major depressive disorder68.”
From State of the Science of Neural Systems in Late‐Life Depression: Impact on Clinical Presentation and Treatment Outcome (2018) · cites this paper as [68]
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- Authors
- Sherwood, A., Blumenthal, J. A., Smith, P. J., Watkins, L. L., Hoffman, B. M., & Hinderliter, A. L.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Sherwood, Andrew
- Venue
- Psychosomatic Medicine
- Published
- 2016-06
- Volume
- 78
- Issue
- 5
- Pages
- 602-609
- ISSN
- 0033-3174 (ISSN-L)
- 1534-7796
- PMC
- PMC4905719
- OpenAlex
- W2342034212
- Cited by
- 44
- References
- 41
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 3
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL093374, R01HL101383)
- National Institute of Mental Health (R01MH049679)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- major depressive disorder, coronary heart disease risk, aerobic exercise training, home-based exercise, supervised exercise, sertraline, antidepressant treatment, flow-mediated dilation, carotid intima-media thickness, serum lipids, atherosclerotic cardiovascular disease risk, cardiovascular risk factors
- MeSH terms
- Adult, Combined Modality Therapy, Coronary Disease, Major Depressive Disorder, Exercise Therapy, Female, Humans, Male, Middle Aged, Risk, Outcome Assessment, Health Care, Selective Serotonin Reuptake Inhibitors, Sertraline
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