Individualized Web-Based Exercise for the Treatment of Depression: Randomized Controlled Trial

Nils Haller, Sonja Lorenz, Daniel Pfirrmann, Cora Koch, Klaus Lieb, Ulrich Dettweiler, Perikles Simon, Patrick Jung, Nils Haller, Sonja Lorenz, Daniel Pfirrmann, Cora Koch, Klaus Lieb, Ulrich Dettweiler, Perikles Simon, Patrick Jung

Abstract

Background: Due to the high prevalence of depressive disorders, it is mandatory to develop therapeutic strategies that provide universal access and require limited financial and human resources. Web-based therapeutic approaches fulfill these conditions.

Objective: The objective of our study was to assess the feasibility, acceptability, and efficacy of a supervised, individualized 8-week Web-based exercise intervention conducted for patients with moderate to severe depression.

Methods: We recruited 20 patients with unipolar depression and randomly assigned them into 2 groups (intervention, exercise program group, n=14, and control, treatment-as-usual group, n=6). At baseline, depressive symptoms were rated via the Quick Inventory of Depressive Symptomatology (QIDS) by patients themselves (QIDS-self-report, QIDS-SR) and by a blinded psychiatrist (QIDS-clinician rating, QIDS-C). In addition, performance diagnostics (lactate analysis, spiroergometry during a treadmill walking test) were conducted. Quality of life was assessed via the Short Form-36 questionnaire (SF-36) and self-efficacy via the General Self-Efficacy scale (GSE). In addition, habitual physical activity (HPA) was determined via the Baecke questionnaire. Participants of the intervention group received exercise schedules once weekly with endurance and strength training instructions. Rating of depressive symptoms was repeated after 6-12 days and 8 weeks; performance diagnostics and the completion of all the questionnaires were repeated after 8 weeks only.

Results: The severity of depression subsided significantly in the intervention group after 8 weeks (median change in QIDS-SR: -5; interquartile range, IQR: -2 to -10), although it was already evident within the first 6-12 days (median change in QIDS-SR: -6; IQR: -2 to -8). During the intervention, participants undertook a median of 75 (IQR: 63 to 98) minutes of endurance training per week or 84% (16 [IQR: 9 to 19] of 19 [IQR: 15 to 21]) recommended endurance units in total. In addition, 9 (IQR: 4 to 12) of 10 (IQR: 8 to 13) recommended strength training exercise units were conducted during the 8 weeks. Performance diagnostics revealed a substantial increase in the maximum output in Watt for the intervention group after 8 weeks. Moreover, the intervention showed a favorable effect on SF-36 items "emotional well-being" and "social functioning" as well as on GSE and HPA scores.

Conclusions: Our individualized Web-based exercise intervention for moderate to severe depression was highly accepted by the patients and led to a significant and clinically relevant improvement of depressive symptoms.

Trial registration: ClinicalTrials.gov NCT02874833; https://ichgcp.net/clinical-trials-registry/NCT02874833 (Archived by WebCite at http://www.webcitation.org/72ZUUR4tE).

Keywords: Web-based intervention; depression; eHealth; exercise.

Conflict of interest statement

Conflicts of Interest: None declared.

©Nils Haller, Sonja Lorenz, Daniel Pfirrmann, Cora Koch, Klaus Lieb, Ulrich Dettweiler, Perikles Simon, Patrick Jung. Originally published in JMIR Mental Health (http://mental.jmir.org), 12.10.2018.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Design of our home page with chat and message function, training videos, and upload area for training schedules.
Figure 3
Figure 3
Activity protocol of one participant; patients responded after each week by uploading their filled protocol either as a scan or a Word document. In this example, intensity and duration of the endurance training was recommend to be increased, whereas the intensity of the strength training was advised to be decreased.
Figure 4
Figure 4
Depression scores of the controls and intervention group (IG) on the Quick Inventory of Depressive Symptomatology-self-reported (QIDS-SR; left) and QIDS-clinician rating (QIDS-C; right) at baseline (T0) and after 8 weeks (T2).
Figure 5
Figure 5
Depression scores of the controls and intervention group (IG) on the Quick Inventory of Depressive Symptomatology-self-reported (QIDS-SR; left) and QIDS-clinician rating (QIDS-C; right) at baseline (T0) and after 6-12 days (T1; median: 9 days).
Figure 6
Figure 6
General self-efficacy scores at T0 (baseline) and T2 (after 8 weeks). Analysis of covariance revealed a favorable effect on the General Self-Efficacy scale for the intervention group (IG) compared with the controls (P=.02, Eta²=0.28).
Figure 7
Figure 7
Peak oxygen uptake (VO2 peak; left) and maximum output in Watt (right) at baseline (T0) and after 8 weeks (T2) for the intervention group (IG) and the controls.

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