Comparing running therapy with physiotraining therapy in the treatment of mood disorders

Introduction

The physical condition of patients with anxiety or affective disorders is reported to be below normal (1). In one study (2), 7000 individuals were followed for almost 20 years, and the least physically active individual had a higher risk for developing depression. A recent review (3) supported the positive effect of exercise on mood, and various hypotheses exist to explain the therapeutic effect of running therapy (RT), in which improvement of feelings of self-efficacy was a starting point (4). Whether exercise as such is the agent of change remains dubious. Most of the studies found no relationship between improvement of fitness and decline of depressive symptoms. In this study, we compared two forms of exercise, ie RT and physiotraining therapy (PT), and to asses whether they lead to an increase in fitness and an increase in maximum oxygen intake and also to asses their effect on depressive symptoms using stationary devices (eg running belt, power training devices and bicycle hometrainer).

Materials and methods

Results

During the trial period, 82 subjects started the day treatment programme. Twenty-two patients did not enter the trial because of premature stopping of the treatment, being younger than 18 years or older than 60 years or having a physical contraindication. Sixty patients (19 men and 41 women; mean age of 39 years) suffering from a depressive disorder (296.2, n= 17; 296.3, n= 11; 296.6, n= 8; 300.4, n= 14; nos, n= 10, according to Diagnostic Statistical Manual IV) were included in the study. At baseline, no significant differences were found for age, gender or diagnosis between the three randomized groups.

Nineteen patients dropped out of the study because they stopped the treatment at the day hospital. Comparison between completers and drop-outs showed no differences in age, gender or baseline depression scores.

Table 1 shows the scores for HRSD, BDI, SES and PSES between baseline and after 6 weeks for the three groups and the scores at 6 and after 12 weeks for the remaining two groups (RT and PT).

Only PT group showed a significant difference on depression scores between baseline and after 6 weeks of PT. No significant difference on the scores for PSES was found between the three groups at baseline, while the RT group scored significantly higher than the PT group after 6 weeks.

At week 6, the patients in the control group were assigned to either PT or RT. By comparing the two treatment groups at weeks 6 and 12, it was found that the depression scores are significantly decreased in the PT group, while the physical skills (PSES) are only relatively improved.

The SES correlates significantly with depression scores after 6 weeks for both treatment groups and after 12 weeks for the RT group. The PSES correlates significantly with the BDI scores for the group.

The negative correlation between scores on SES and HRSD/BDI increased during the trial period. This was not the case for PSES. No pretreatment correlation was found between physical condition and depression scores. However, the posttreatment correlation suggests a relation between improved physical condition and lowered depression score.

Although both groups were positive about the training programme, participants in the PT group gave a significantly higher evaluation than participants in the RT group (p < 0.05).

Discussion

This study compared two forms of physical exercise in a day treatment programme for patients with an affective disorder, ie RT and PT on stationary devices. The results showed that PT but not RT did lead to significant improvement in both blind-rated HRSD scores and self-rated BDI scores.

The process variable ‘physical self-efficacy’ did improve significantly only in the PT group and can be seen as support for the role of this concept in improving depressive symptoms. The ‘feelings of self-efficacy’ did not change significantly in both groups.

The fact that RT did not lead to any significant gain is contrary to the literature and cannot be easily explained. One possible explanation is that more women were included in the RT group and that compared with men, they may have gained less benefit from exercise as suggested by LaFontaine et al. (9).

It is possible that the difference we found is not dependent on activity itself, but it is more a result of improvement of physical condition in the PT group. Another explanation is that the PT programme is more structured. In the RT programme, extent and intensity have to be estimated and it depends more on individuals efforts.

However, our trial clearly suggests that improvement of physical condition overall is a necessary factor for therapeutic effect. The higher appreciation in the PT group might explain the enhanced therapeutic positive effects of PT.

The question remains why physical self-efficacy improves more in the PT group than in the RT group, and this might be attributed to the clear structure of the activity, which makes performance more visible and measurable. In this way, we would advise to improve the RT programme by giving it more structure, for example through the use of a training schedule with measurable performance markers.

This study had a number of methodological limitations; first of all, on practical and ethical grounds, the control group could not be held over the whole 12 weeks. Second, although there were no significant differences at baseline, a better matching of the patients in the RT and PT groups is needed. Third, there was no control for other interventions, psychological or medication. Finally, there was no formal randomization to one of the groups as the allocation to a group was based on vacancy.

Hence, these results are tentative and preliminary. They suggest that PT on stationary devices may lead to more therapeutic gain compared with RT in a day hospital setting; given the clinical importance of this in mental health and in patients with psychiatric disorders, it is a finding that warrants further inquiry and replication.

Acknowledgements

We acknowledge J. Goedegebure, R. Driessen and M. Blokland, all workers of the day treatment programme for mood disorders, especially J. ’t Hoen. R. J. Bosscher is acknowledged for his comments on the manuscript.