In a new study published in The British Journal of Psychiatry,Sweden-based researcher Mats Hallgren, PhD, and colleagues discuss the findings of their research comparing the effectiveness of exercise, Internet-based cognitive-behavioral therapy (ICBT) and usual care for treating individuals with depression. The results of their study, which was the first in comparing the long-term effectiveness of these treatments, suggests that all of the interventions were associated with reductions in depression severity, and that compared with usual care, exercise and ICBT provided “clinically relevant improvements” in depression symptoms.
“Compared with usual care by a physician, prescribed exercise and clinician-supported ICBT are at least equally effective long-term treatment alternatives for adults with mild to moderate depression.

In their study, Hallgren and colleagues argue for the need to explore and develop additional treatment options for depression. Depression is considered a public health concern, which also represents a heavy burden for individuals living with it. Pharmacological interventions, which are seen as a mainline treatment for depression have been questioned and criticized, both for their lack of efficacy, as well as their detrimental side effects.
Both exercise and ICBT, which were used in this study, have been found to be effective in reducing symptoms of depression. A study investigating the benefits of exercise in treating depression found it to be comparable to psychological and pharmaceutical treatments. Other studies have found that the antidepressant effects of exercise have been underestimated. Meanwhile, Internet-based interventions have been lauded for both their accessibility and their efficacy compared to face-to-face CBT.
For this study, the researchers aimed to compare the long-term effectiveness of a 12-week exercise intervention and a 12-week ICBT intervention, with usual care for depression by a physician. Individuals were recruited for the study through primary healthcare facilities in Sweden. Participants were individuals aged 18 and older, who met a score requirement on the Patient Health Questionnaire (PHQ-9). After being recruited, study staff members screened them for trial eligibility. Individuals eligible to participate (n=945) were randomized to one of the three treatment groups.
Participants in the exercise group received three 60-minute sessions a week of light, moderate, or vigorous exercise. Those randomized to the ICBT group received treatment through an online self-help manual structured in modules. Participants who received the usual care typically visited their primary care physician, psychologist, or psychiatrist once a week. Most often, participants in this group participated in a 45-60 minute cognitive-behavioral therapy session. Individual were assessed at three time points: baseline, three months later, and 12 months later. 78% of participants returned the 3-month questionnaire, and 84% answered the 12-month survey.
Results from the study showed that individuals in all three groups had a reduction in depression severity between baseline and 3 months, and from baseline to 12 months. Also, individuals in the exercise group were found to have even higher rates of improvement.
"Findings from our robust trial show that exercise, even at low levels of intensity, is more effective in the treatment of mild to moderate depression than usual care by a physician (medication and/or counseling). ICBT is certainly another effective treatment option, which may be especially useful for patients with mobility issues," Dr. Hallgren stated, in a press release to Medscape Medical News.
Among the study’s major weaknesses, was the fact that the researchers were not able to collect the number of individuals invited to participate in the study, therefore limiting their understanding of the condition within their target population. The authors conclude with discussing the clinical implications of their findings, in particular, highlighting the importance of physical activity to treat depression in those who are at risk due to physical diseases, such as diabetes and cardiovascular conditions.

Hallgren, M., Helgadóttir, B., Herring, M. P., Zeebari, Z., Lindefors, N., Kaldo, V., ... & Forsell, Y. (2016). Exercise and internet-based cognitive-behavioural therapy for depression: Multicentre randomised controlled trial with 12-month follow-up. The British Journal of Psychiatry209(5), 414-420. (Abstract)
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Marta Pagán-Ortiz
MIA-UMB News Team: Marta E. Pagán-Ortiz is a doctoral student and research assistant in the Counseling and School Psychology PhD program at UMass Boston. Marta is currently working on research studies related to mental health treatment guidelines for chronic illnesses, issues of structural violence within minority populations, and the reduction of disparities in mental health status and class.