Efficacy of Adjunctive Exercise for the Behavioral Treatment of Major Depression

辅助运动对重度抑郁症行为治疗的疗效

• 批准号: 8791847
• 负责人: Kristin L. Szuhany
• 金额: $ 3.08万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8791847
• 关键词: Absenteeism; Acute; Adult; Aerobic Exercise; Antidepressive Agents; Anxiety; Anxiety Disorders; Area; Attention; Behavior Therapy; Behavioral; Brain; Brain-Derived Neurotrophic Factor; Clinical Treatment; Clinical Trials; Cognitive; Cognitive Therapy; Combined Modality Therapy; Data; Data Analyses; Depressed mood; Deterioration; Development; Education; Exercise; Exercise stress test; Feasibility Studies; Future; Goals; Health; Individual; Intervention; Investigation; Life Style; Literature; Major Depressive Disorder; Mediator of activation protein; Medical; Memory; Mental Depression; Mental Health; Mentorship; Minority; Modeling; Mood Disorders; Moods; Neurophysiology - biologic function; Participant; Patient Self-Report; Patients; Performance; Pharmaceutical Preparations; Phase; Physical Fitness; Physiological; Population; Prevalence; Production; Productivity; Psychosocial Assessment and Care; Randomized; Recruitment Activity; Regimen; Relative (related person); Reporting; Research; Research Personnel; Schedule; Sequential Treatment; Staging; Stress; Stretching; Testing; Training; Treatment Efficacy; Woman; active method; alternative treatment; anxiety symptoms; anxiety treatment; base; cognitive function; cost; depressed patient; depressive symptoms; disability; efficacy evaluation; experience; fitness; health care service utilization; improved; men; mortality; neurophysiology; neuropsychological; novel strategies; programs; psychosocial; research study; skills; treatment response; treatment-resistant depression

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is the leading cause of disability in the developed world [85] and is associated with lost productivity, increased health care utilization, and mortality [86]. Several empirically supported treatments, such as antidepressant medication and cognitive behavioral therapy, exist for the treatment of MDD; however, studies have shown that as many as 34% of individuals do not respond to these treatments [5]. Moreover, the large-scale STAR-D trial has shown limited efficacy for combined or sequential treatment with antidepressants and CBT for patients failing to respond to initial interventions [7], with calls for the development of alternative treatments [8]. Exercise interventions represent an alternative strategy associated with strong effect sizes in past studies. For example, a meta-analytic review of exercise programs as compared to non-active conditions for the treatment of MDD found a large overall between-group effect size indicating a significant advantage of exercise interventions for mood benefits [10]. Additionally, exercise has been shown to enhance cognitive functioning, especially attention and memory [40, 41]. This enhancement, as well as the mood benefits derived from exercise, may be due to increases in brain-derived neurotrophic factor (BDNF). Since depression is associated with low levels of BDNF, and antidepressant medication appears to increase BDNF, BDNF may be a mediator through which exercise exerts its effects [32, 33]. The current application aims to investigate the effect of a combined aerobic exercise and behavioral activation treatment (BA) for MDD. Combined exercise treatments have been shown to be efficacious for the treatment of anxiety [21], but a combined model with the empirically-supported depression treatment of BA has yet to be investigated. BA provides a promising format for combination with exercise due to its focus on adaptive action and activity scheduling [24]. The current study will recruit 32 MDD patients for an active treatment phase of 9 total sessions (60 minutes of BA, 30 minutes of EX or CNTL) of either BA plus exercise (BA+EX) or BA plus a stretching control condition (BA+CNTL). Data regarding physical fitness, attention, memory, and BDNF levels will be collected. Additionally, self-report and clinician-rated items regarding depressed mood and level of functioning will be assessed at each weekly session. Data analysis will primarily investigate the feasibility and acceptability of the combined intervention as well as provide preliminary estimates of the efficacy of the treatment. We will also examine the neuropsychological (i.e., memory and attention) and neurophysiological (i.e., BDNF) correlates of the adjunctive exercise intervention as a prelude to future studies of mechanism. The ultimate goal of this application is to develop the applicant's skills in clinical trials research, with a focus on exercise interventions for mood disorders. This proposed research study in addition to relevant coursework, training, and mentorship will aid in the applicant's goal of becoming a knowledgeable researcher in this area of expertise, with plans for future expansion of this intervention for minority individuals in need

描述（由申请人提供）：重度抑郁症（MDD）是发达国家残疾的主要原因[85]，与生产力下降、增加 卫生保健利用率和死亡率[86]。几种经验支持的治疗方法，如抗抑郁药物和认知行为疗法，可用于治疗MDD;然而，研究表明，多达34%的个体对这些治疗无反应[5]。此外，大规模STAR-D试验显示，对于对初始干预措施无反应的患者，抗抑郁药和CBT联合或序贯治疗的疗效有限[7]，并呼吁开发替代治疗[8]。运动干预是一种替代策略，在过去的研究中与强效应量相关。例如，一项对运动计划与非活动条件治疗MDD的荟萃分析审查发现，总体组间效应量较大，表明运动干预对情绪益处具有显著优势[10]。此外，运动已被证明可以增强认知功能，特别是注意力和记忆力[40，41]。这种增强，以及来自运动的情绪益处，可能是由于脑源性神经营养因子（BDNF）的增加。由于抑郁症与低水平的BDNF有关，抗抑郁药物似乎增加BDNF，BDNF可能是运动发挥其作用的介质[32，33]。本申请旨在研究 有氧运动和行为激活治疗（BA）对MDD的影响。联合运动治疗已被证明对治疗焦虑有效[21]，但与BA的药物支持抑郁治疗的联合模型尚未研究。BA提供了一种很有前途的形式，与运动相结合，因为它专注于适应性行动和活动计划[24]。本研究将招募32例MDD患者，进行总共9个阶段（60分钟BA，30分钟EX或CNTL）的BA+运动（BA+EX）或BA+拉伸对照条件（BA+CNTL）的积极治疗阶段。将收集有关身体健康、注意力、记忆力和BDNF水平的数据。此外，将在每周一次的会议上评估关于抑郁情绪和功能水平的自我报告和临床医生评定项目。数据分析将主要研究联合干预的可行性和可接受性，并提供治疗效果的初步估计。我们还将检查神经心理学（即，记忆和注意力）和神经生理学（即，BDNF）的相关性，为今后的机制研究做铺垫。该申请的最终目标是培养申请人在临床试验研究方面的技能，重点是情绪的运动干预 紊乱除了相关的课程，培训和指导之外，这项拟议的研究将有助于申请人成为这一专业领域知识渊博的研究人员的目标，并计划在未来扩大这种干预措施，以帮助有需要的少数民族