Resistance training for Black men with depressive symptoms: a pilot randomized controlled trial to assess acceptability, feasibility, and preliminary efficacy

Joseph T Ciccolo, Mark E Louie, Nicholas J SantaBarbara, Christopher T Webster, James W Whitworth, Sanaz Nosrat, Michelle Chrastek, Shira I Dunsiger, Michael P Carey, Andrew M Busch, Joseph T Ciccolo, Mark E Louie, Nicholas J SantaBarbara, Christopher T Webster, James W Whitworth, Sanaz Nosrat, Michelle Chrastek, Shira I Dunsiger, Michael P Carey, Andrew M Busch

Abstract

Background: Depression is under-recognized in Black men, who are less likely to seek or have access to psychiatric treatment. Resistance training (RT; i.e., weight lifting) can improve depressive symptoms and may be more acceptable to Black men, but its effects have not been examined for Black men with depressive symptoms.

Methods: Fifty Black men with depressive symptoms were randomized to either (a) 12 weeks of RT (coupled with Behavioral Activation techniques to promote adherence) or (b) an attention-control group (Health, Wellness, and Education; HWE). Both groups met twice/week for 12 weeks, and follow-up assessments were done at end-of-treatment (EOT) and 6 months after enrollment. Changes in physical activity and muscular strength were collected as a manipulation check. The primary outcome was interviewer assessed symptoms of depression using the Quick Inventory of Depression Symptomology (QIDS). Secondary outcomes included self-reported depressive symptoms, anxiety, and stress. The association between change in QIDS from baseline to EOT and concurrent changes in physical activity and muscular strength in the RT group were explored as an initial assessment of mechanism. Longitudinal mixed effects regression models with subject-specific intercepts were used to examine intervention effects.

Results: A sample with high rates of medical comorbidities (e.g., 44% HIV positive), substance use (e.g., 34% smoking), and negative social determinates of health (e.g., 50% unemployed) was enrolled. Recruitment, engagement, and retention data indicate that the intervention and design were feasible. The RT group showed greater gains in self-reported exercise (b = 270.94, SE = 105.69, p = .01) and muscular strength (b = 11.71, SE = 4.23, p = .01 for upper body and b = 4.24, SE = 2.02, p = .04 for lower body) than the HWE group. The RT group had greater reductions in QIDS scores at both EOT (b = -3.00, SE = 1.34, p = .01) and 6 months (b = -2.63, SE = 1.81, p = .04). The RT group showed a greater reduction in anxiety at EOT (b = -2.67, SE = 1.06, p = .02). Findings regarding self-reported depressive symptoms and stress were non-significant, but in the expected direction with effect sizes in the small to medium range. In the RT group, improvement on the QIDS between baseline and EOT was associated with concurrent improvements in physical activity (b = 21.03, SE = 11.16, p = .02) and muscular strength (b = 1.27, SE = .44, p = .03 for upper body and b = .75, SE = .14, p = .03 for lower body).

Conclusions: Results suggest that RT is feasible and may be efficacious for reducing depressive symptoms among underserved urban Black men.

Trial registration: ClinicalTrial.gov #: NCT03107039 (Registered 11/04/2017).

Keywords: Behavioral activation; Depression; Resistance Training; Weightlifting.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Consort Diagram
Fig. 2
Fig. 2
Adjusted QIDS over Time by Group

References

    1. World Health Organization. Depression 2020 .
    1. Villarroel MA, Terlizzi EP. Symptoms of Depression Among Adults: United States, 2019. NCHS Data Brief. 2020;379:1–8.
    1. Addis ME, Mahalik JR. Men, masculinity, and the contexts of help seeking. Am Psychol. 2003;58(1):5–14.
    1. González HM, Croghan T, West B, Williams D, Nesse R, Tarraf W, et al. Antidepressant use in black and white populations in the United States. Psychiatr Serv. 2008;59(10):1131–1138.
    1. González HM, Tarraf W, Whitfield KE, Vega WA. The epidemiology of major depression and ethnicity in the United States. J Psychiatr Res. 2010;44(15):1043–1051.
    1. Rice SM, Oliffe JL, Kealy D, Seidler ZE, Ogrodniczuk JS. Men's help-seeking for depression: Attitudinal and structural barriers in symptomatic men. J Prim Care Community Health. 2020;11:2150132720921686.
    1. Krumm S, Checchia C, Koesters M, Kilian R, Becker T. Men's views on depression: A systematic review and metasynthesis of qualitative research. Psychopathology. 2017;50(2):107–124.
    1. Thorpe RJ, Jr, Whitfield KE. Psychosocial influences of African Americans men's health. J Gerontol B Psychol Sci Soc Sci. 2018;73(2):185–187.
    1. Gayman MD, Lennox Kail B, Spring A, Greenidge GR., Jr Risk and protective factors for depressive symptoms among African American men: An application of the Stress Process Model. J Gerontol B Psychol Sci Soc Sci. 2018;73(2):219–229.
    1. Blumberg SJ, Clarke TC, Blackwell DL. Racial and ethnic disparities in men's use of mental health treatments. NCHS Data Brief. 2015;206:1–8.
    1. Williams DR, González HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64(3):305–315.
    1. Hudson DL, Eaton J, Banks A, Sewell W, Neighbors H. "Down in the Sewers": Perceptions of depression and depression care among African American men. Am J Mens Health. 2018;12(1):126–137.
    1. Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of efficacy of resistance exercise training with depressive symptoms: Meta-analysis and meta-regression analysis of randomized clinical trials. JAMA Psychiat. 2018;75(6):566–576.
    1. De Sousa RAL, Rocha-Dias I, de Oliveira LRS, Improta-Caria AC, Monteiro-Junior RS, Cassilhas RC. Molecular mechanisms of physical exercise on depression in the elderly: a systematic review. Mol Biol Rep. 2021;48(4):3853–3862.
    1. Doyne EJ, Ossip-Klein DJ, Bowman ED, Osborn KM, McDougall-Wilson IB, Neimeyer RA. Running versus weight lifting in the treatment of depression. J Consult Clin Psychol. 1987;55(5):748–754.
    1. Bennie JA, Teychenne MJ, De Cocker K, Biddle SJH. Associations between aerobic and muscle-strengthening exercise with depressive symptom severity among 17,839 U.S. adults. Prev Med. 2019;121:121–7.
    1. Bennie JA, De Cocker K, Biddle SJH, Teychenne MJ. Joint and dose-dependent associations between aerobic and muscle-strengthening activity with depression: A cross-sectional study of 1.48 million adults between 2011 and 2017. Depression and anxiety. 2020;37(2):166–78.
    1. Nosrat S, Whitworth JW, SantaBarbara NJ, Dunsiger SI, Ciccolo JT. Acute effects of resistance-exercise intensity in depressed Black/African Americans living with HIV: A randomized pilot study. J Sport Exerc Psychol. 2019;41(5):261–70.
    1. Moraes HS, Silveira HS, Oliveira NA, Matta Mello Portugal E, Araújo NB, Vasques PE, et al. Is strength training as effective as aerobic training for depression in older adults? A randomized controlled trial. Neuropsychobiology. 2020;79(2):141–9.
    1. Griffith DM, Bergner EM, Cornish EK, McQueen CM. Physical Activity Interventions With African American or Latino Men: A Systematic Review. Am J Mens Health. 2018;12(4):1102–1117.
    1. Busch AM, Louie ME, SantaBarbara NJ, Ajayi AA, Gleason N, Dunsiger SI, et al. Effects of resistance training on depression and cardiovascular disease risk in Black men: Protocol for a randomized controlled trial. Ment Health Phys Act. 2019;17:100299.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.
    1. Riebe D, Ehrman JK, Liguori G, Magal M, Medicine ACoS. ACSM's guidelines for exercise testing and prescription. Philadelphia: Wolters Kluwer; 2018.
    1. Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–1602.
    1. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573–583.
    1. Skinner HA. The drug abuse screening test. Addict Behav. 1982;7(4):363–371.
    1. World Health O et al. AUDIT: the Alcohol Use Disorders Identification Test : guidelines for use in primary health care / Thomas F. Babor. 2. Geneva: World Health Organization; 2001.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097.
    1. Cohen S. Perceived stress in a probability sample of the United States. The social psychology of health. The Claremont Symposium on Applied Social Psychology. Thousand Oaks: Sage Publications, Inc; 1988. pp. 31–67.
    1. Pettee Gabriel K, McClain JJ, Schmid KK, Storti KL, Ainsworth BE. Reliability and convergent validity of the past-week Modifiable Activity Questionnaire. Public Health Nutr. 2011;14(3):435–442.
    1. Haff GG, Triplett NT. Essentials of strength training and conditioning 4th edition. Champaign: Human kinetics; 2015
    1. American College of Sports Medicine position stand Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.
    1. Kanter JW, Busch AM, Rusch LC. Behavioral activation: Distinctive features. London: Routledge Press; 2009.
    1. Ciccolo JT, Dunsiger SI, Williams DM, Bartholomew JB, Jennings EG, Ussher MH, et al. Resistance training as an aid to standard smoking cessation treatment: A pilot study. Nicotine Tob Res. 2011;13(8):756–760.
    1. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet (London, England) 2018;391(10128):1357–1366.
    1. Bond G, Stanton R, Wintour SA, Rosenbaum S, Rebar AL. Do exercise trials for adults with depression account for comorbid anxiety? A systematic review. Ment Health Phys Act. 2020;18:100320.
    1. Gordon BR, McDowell CP, Lyons M, Herring MP. Resistance exercise training for anxiety and worry symptoms among young adults: a randomized controlled trial. Sci Rep. 2020;10(1):17548.
    1. Tsutsumi T, Don BM, Zaichkowsky LD, Takenaka K, Oka K, Ohno T. Comparison of high and moderate intensity of strength training on mood and anxiety in older adults. Percept Mot Skills. 1998;87(3 Pt 1):1003–1011.
    1. Aidar FJ, de Oliveira RJ, Silva AJ, de Matos DG, MaziniFilho ML, Hickner RC, et al. The influence of resistance exercise training on the levels of anxiety in ischemic stroke. Stroke Res Treat. 2012;2012:298375.
    1. Whitworth JW, Nosrat S, SantaBarbara NJ, Ciccolo JT. Feasibility of resistance exercise for posttraumatic stress and anxiety symptoms: A randomized controlled pilot study. J Trauma Stress. 2019;32(6):977–84.
    1. Gordon BR, McDowell CP, Lyons M, Herring MP. The effects of resistance exercise training on anxiety: A meta-analysis and meta-regression analysis of randomized controlled trials. Sports Med (Auckland, NZ) 2017;47(12):2521–2532.
    1. Cooney G, Dwan K, Greig C, Lawlor D, Rimer J, Waugh F, et al. Exercise for depression. Cochrane Database Syst Rev. 2013;9:CD004366.
    1. New York State Department of Health. New York City Health Indicators by Race/Ethnicity, 2016–2018. Accessed 3/10/22 from
    1. Parrott, JA. New York State’s Unprecedented Covid-19 Unemployment Crisis Requires a Comprehensive, Immediate Active Labor Market Response. A policy brief by The New School Center for New York City Affairs. 2022. Accessed 3/10/22 from
    1. Wiewel EW, Hanna DB, Begier EM, et al. High HIV Prevalence and Diagnosis Rates in New York City Black Men. J Community Health. 2011;36:141–149.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel