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Cited by 78Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPhysical Activity and Health

Exercise and internet-based cognitive–behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up

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Hallgren, Mats, Helgadóttir, Björg, Herring, Matthew P., Zeebari, Zangin, Lindefors, Nils, Kaldo, Viktor, Öjehagen, Agneta, Forsell, Yvonne·2016·British Journal of Psychiatry
DOI 10.1192/bjp.bp.115.177576
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Abstract

Background: Evidence-based treatment of depression continues to grow, but successful treatment and maintenance of treatment response remains limited. Aims: To compare the effectiveness of exercise, internet-based cognitive–behavioural therapy (ICBT) and usual care for depression. Method: A multicentre, three-group parallel, randomised controlled trial was conducted with assessment at 3 months (post-treatment) and 12 months (primary end-point). Outcome assessors were masked to group allocation. Computer-generated allocation was performed externally in blocks of 36 and the ratio of participants per group was 1:1:1. In total, 945 adults with mild to moderate depression aged 18–71 years were recruited from primary healthcare centres located throughout Sweden. Participants were randomly assigned to one of three 12-week interventions: supervised group exercise, clinician-supported ICBT or usual care by a physician. The primary outcome was depression severity assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS). Results: The response rate at 12-month follow-up was 84%. Depression severity reduced significantly in all three treatment groups in a quadratic trend over time. Mean differences in MADRS score at 12 months were 12.1 (ICBT), 11.4 (exercise) and 9.7 (usual care). At the primary end-point the group × time interaction was significant for both exercise and ICBT. Effect sizes for both interventions were small to moderate. Conclusions: The long-term treatment effects reported here suggest that prescribed exercise and clinician-supported ICBT should be considered for the treatment of mild to moderate depression in adults.

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  • In a recent large-scale study (n = 945), aerobic exercise was equally as effective as internet-delivered CBT and better than usual care after 12 months.

    “Whilst the diagnoses of depression were identified through the Patient Health Questionnaire [104], a recent large-scale (n = 945) study [105] has partly addressed this concern, finding that aerobic exercise was equally as effective as internet delivered CBT and better than usual care after 12 months.”

    From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [105]

    The Results report 945 patients, and Depression severity reports that exercise produced greater reductions than usual care at 12 months. However, the Exercise section includes yoga and stretching as well as aerobics, so the finding cannot be attributed specifically to aerobic exercise. The paper also does not establish that exercise and internet-delivered CBT were equally effective; its Discussion says both were at least as effective as usual care. (LLM, conf=0.88)

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Authors
Hallgren, M., Helgadóttir, B., Herring, M. P., Zeebari, Z., Lindefors, N., Kaldo, V., Öjehagen, A., & Forsell, Y.
Affiliations
  • University of Limerick (IE)
  • Lund University (SE)
Corresponding author
Hallgren, Mats
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2016-11
Volume
209
Issue
5
Pages
414-420
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.115.177576
OpenAlex
W2508059462
Cited by
78
References
42
Citations by year
2026: 5 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 11 · 2021: 6 · 2020: 5 · 2019: 12 · 2018: 10 · 2017: 10 · 2016: 1
FWCI
16.85
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 427 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
depression, exercise therapy, internet-based cognitive behavioral therapy, supervised group exercise, mild to moderate depression, long-term treatment response, usual care, primary care, maintenance therapy, depression severity
MeSH terms
Adolescent, Adult, Aged, Depression, Exercise Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Severity of Illness Index, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Internet, Young Adult

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