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Cited by 1,019Treatment of Major DepressionPhysical Activity and HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder

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Blumenthal, James A., Babyak, Michael A., Doraiswamy, P Murali, Watkins, Lana, Hoffman, Benson M., Barbour, Krista A., Herman, Steve, Craighead, W Edward +4 more·2007·Psychosomatic Medicine
DOI 10.1097/psy.0b013e318148c19aPMC PMC2702700
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Abstract

OBJECTIVE: To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls. METHODS: Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50-200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D). RESULTS: After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23). CONCLUSIONS: The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.

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Crossref · 10.1097/psy.0b013e318148c19a

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  • One trial found no difference between supervised and home-based exercise.

    “One trial found no difference between supervised and home-based exercise (Blumenthal 2007).”

    From Exercise for depression (2009) · cites this paper as Blumenthal 2007

    The Discussion reports no difference in depression remission rates between supervised and home-based exercise, but cautions that the trial was not powered to establish that they were comparable for depressive symptoms. The Results also report better aerobic fitness with supervised exercise, so the unqualified claim of 'no difference' is too broad. (LLM, conf=0.87)

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  • In one trial, rates of diarrhoea and loose stool were significantly higher in the sertraline group than in the exercise group.

    “One trial found significantly higher rates of diarrhoea and loose stool in the sertraline than the exercise group (Blumenthal 2007).”

    From Exercise for depression (2009) · cites this paper as Blumenthal 2007

  • Exercise compared with antidepressants shows no significant difference in reducing depressive symptoms (SMD -0.04, 95% CI -0.31 to 0.24) across two trials (201 participants).

    “For the two trials (201 participants) that compared exercise with antidepressants (Blumenthal 1999; Blumenthal 2007) the SMD was -0.04 (95% CI -0.31, 0.24), indicating no significant difference between the two interventions.”

    From Exercise for depression (2009) · cites this paper as Blumenthal 2007

  • Three trials provided data on whether patients fulfilled diagnostic criteria for depression at the end of the study, as well as depression scales.

    “Three trials (Blumenthal 1999, Blumenthal 2007;Mather 2001) provided data on whether patients fulfilled diagnostic criteria for depression at the end of the study, as well as depression scales.”

    From Exercise for depression (2009) · cites this paper as Blumenthal 2007

  • Exercise-based interventions have an antidepressant effect in people with depression, with some studies reporting treatment efficacy comparable to antidepressant medications or psychotherapy.

    “Most notably, exercise-based interventions have been consistently demonstrated as having an antidepressant effect in people with depression [33, 34]⁠, with some studies reporting a treatment efficacy comparable to antidepressant medications or psychotherapy [35–37]⁠.”

    From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [35]

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Cites

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Research works printed but not linked: 2

  1. [31]Beck AT, Sheer RA, Brown GK. Beck depression inventory manual. 2. San Antonio, Texas: Psychological Corporation; 1996. [Google Scholar]
  2. [33]First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV Axis I Disorders (SCID-I), clinician version. Washington, DC: American Psychiatric Press; 1995. [Google Scholar]

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Authors
Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M., Watkins, L., Hoffman, B. M., Barbour, K. A., Herman, S., Craighead, W. E., Brosse, A. L., Waugh, R., Hinderliter, A., & Sherwood, A.
Affiliations
  • Duke University (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Blumenthal, James A.
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2007-09
Volume
69
Issue
7
Pages
587-596
ISSN
0033-3174 (ISSN-L)
DOI
10.1097/psy.0b013e318148c19a
PMC
PMC2702700
OpenAlex
W2154166294
Cited by
1,019
References
75
Citations by year
2026: 28 · 2025: 49 · 2024: 48 · 2023: 68 · 2022: 53 · 2021: 80 · 2020: 48 · 2019: 38 · 2018: 49 · 2017: 52 · 2016: 52 · 2015: 64 · 2014: 63 · 2013: 60 · 2012: 57
FWCI
27.39
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (MH49679, R01MH049679)
  • National Center for Research Resources (M01 RR 30)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
major depressive disorder, aerobic exercise training, home-based exercise, supervised group exercise, sertraline, antidepressant treatment, depression remission, placebo response
MeSH terms
Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Double-Blind Method, Exercise Therapy, Female, Humans, Male, Middle Aged, Prospective Studies, Psychotherapy, Group, Treatment Outcome, Sertraline

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