TY - JOUR
A1 - Heissel, Andreas
A1 - Pietrek, Anou F.
A1 - Schwefel, Melanie
A1 - Abula, Kahar
A1 - Wilbertz, Gregor
A1 - Heinzel, Stephan
A1 - Rapp, Michael Armin
T1 - STEP.De study
BT - a multicentre cluster-randomised effectiveness trial of exercise therapy for patients with depressive symptoms in healthcare services : study protocol
JF - BMJ open
N2 - Introduction Although exercise therapy has widely been shown to be an efficacious treatment modality for depression, evidence for its effectiveness and cost efficiency is lacking. The Sport/Exercise Therapy for Depression study is a multicentre cluster-randomised effectiveness trial that aims to compare the effectiveness and cost efficiency of exercise therapy and psychotherapy as antidepressant treatment.
Methods and analysis 480 patients (aged 18-65) with an International Classification of Diseases diagnosis associated with depressive symptoms are recruited. Up to 30 clusters (psychotherapists) are randomly assigned to allocate patients to either an exercise or a psychotherapy treatment as usual in a 2: 1 ratio. The primary outcome (depressive symptoms) and the secondary outcomes (work and social adjustment, quality of life) will be assessed at six measurement time points (t0: baseline, t1: 8 weeks after treatment initiation, t2: 16 weeks after treatment initiation, t3/ 4/5: 2, 6, 12 months after treatment). Linear regression analyses will be used for the primary endpoint data analysis. For the secondary endpoints, mixed linear and logistic regression models with fixed and random factors will be added. For the cost efficiency analysis, expenditures in the 12 months before and after the intervention and the outcome difference will be compared between groups in a multilevel model. Recruitment start date was 1 July 2018 and the planned recruitment end date is 31 December 2020.
Ethics and dissemination The study protocol was approved by the ethics committee of the University of Potsdam (No. 17/2018) and the Freie Universitat Berlin (No. 206/2018) and registered in the ISRCTN registry. Informed written consent will be obtained from all participants. The study will be reported in accordance with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials statements. The results will be published in peer-reviewed academic journals and disseminated to the public.
Y1 - 2020
U6 - https://doi.org/10.1136/bmjopen-2019-036287
SN - 2044-6055
VL - 10
IS - 4
PB - BMJ Publishing Group
CY - London
ER -
TY - JOUR
A1 - Heinzel, Stephan
A1 - Rapp, Michael Armin
A1 - Fydrich, Thomas
A1 - Ströhle, Andreas
A1 - Teran, Christina
A1 - Kallies, Gunnar
A1 - Schwefel, Melanie
A1 - Heissel, Andreas
T1 - Neurobiological mechanisms of exercise and psychotherapy in depression
BT - the SPeED studyRationale, design, and methodological issues
JF - Clinical Trials
N2 - Background/Aims: Even though cognitive behavioral therapy has become a relatively effective treatment for major depressive disorder and cognitive behavioral therapy-related changes of dysfunctional neural activations were shown in recent studies, remission rates still remain at an insufficient level. Therefore, the implementation of effective augmentation strategies is needed. In recent meta-analyses, exercise therapy (especially endurance exercise) was reported to be an effective intervention in major depressive disorder. Despite these findings, underlying mechanisms of the antidepressant effect of exercise especially in combination with cognitive behavioral therapy have rarely been studied to date and an investigation of its neural underpinnings is lacking. A better understanding of the psychological and neural mechanisms of exercise and cognitive behavioral therapy would be important for developing optimal treatment strategies in depression. The SPeED study (Sport/Exercise Therapy and Psychotherapyevaluating treatment Effects in Depressive patients) is a randomized controlled trial to investigate underlying physiological, neurobiological, and psychological mechanisms of the augmentation of cognitive behavioral therapy with endurance exercise. It is investigated if a preceding endurance exercise program will enhance the effect of a subsequent cognitive behavioral therapy. Methods: This study will include 105 patients diagnosed with a mild or moderate depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The participants are randomized into one of three groups: a high-intensive or a low-intensive endurance exercise group or a waiting list control group. After the exercise program/waiting period, all patients receive an outpatient cognitive behavioral therapy treatment according to a standardized therapy manual. At four measurement points, major depressive disorder symptoms (Beck Depression Inventory, Hamilton Rating Scale for Depression), (neuro)biological measures (neural activations during working memory, monetary incentive delay task, and emotion regulation, as well as cortisol levels and brain-derived neurotrophic factor), neuropsychological test performance, and questionnaires (psychological needs, self-efficacy, and quality of life) are assessed. Results: In this article, we report the design of the SPeED study and refer to important methodological issues such as including both high- and low-intensity endurance exercise groups to allow the investigation of dose-response effects and physiological components of the therapy effects. Conclusion: The main aims of this research project are to study effects of endurance exercise and cognitive behavioral therapy on depressive symptoms and to investigate underlying physiological and neurobiological mechanisms of these effects. Results may provide important implications for the development of effective treatment strategies in major depressive disorder, specifically concerning the augmentation of cognitive behavioral therapy by endurance exercise.
KW - Major depressive disorder
KW - depression
KW - psychotherapy
KW - cognitive behavioral therapy
KW - endurance exercise
KW - training
KW - functional magnetic resonance imaging
KW - brain-derived neurotrophic factor
KW - basic psychological needs
KW - cortisol
Y1 - 2017
U6 - https://doi.org/10.1177/1740774517729161
SN - 1740-7745
SN - 1740-7753
VL - 15
IS - 1
SP - 53
EP - 64
PB - Sage Publ.
CY - London
ER -
TY - JOUR
A1 - Kallies, Gunnar
A1 - Rapp, Michael Armin
A1 - Fydrich, Thomas
A1 - Fehm, Lydia
A1 - Tschorn, Mira
A1 - Teran, Christina
A1 - Schwefel, Melanie
A1 - Pietrek, Anou F.
A1 - Henze, Romy
A1 - Hellweg, Rainer
A1 - Ströhle, Andreas
A1 - Heinzel, Stephan
A1 - Heissel, Andreas
T1 - Serum brain-derived neurotrophic factor (BDNF) at rest and after acute aerobic exercise in major depressive disorder
JF - Psychoneuroendocrinology
N2 - Physiological mechanisms of an anti-depressive effect of physical exercise in major depressive disorder (MDD) seem to involve alterations in brain-derived neurotrophic factor (BDNF) level. However, previous studies which investigated this effect in a single bout of exercise, did not control for confounding peripheral factors that contribute to BDNF-alterations. Therefore, the underlying cause of exercise-induced BDNF-changes remains unclear. The current study aims to investigate serum BDNF (sBDNF)-changes due to a single-bout of graded aerobic exercise in a group of 30 outpatients with MDD, suggesting a more precise analysis method by taking plasma volume shift and number of platelets into account. Results show that exercise-induced increases in sBDNF remain significant (p<.001) when adjusting for plasma volume shift and controlling for number of platelets. The interaction of sBDNF change and number of platelets was also significant (p=.001) indicating larger sBDNF-increase in participants with smaller number of platelets. Thus, findings of this study suggest an involvement of peripheral as well as additional possibly brain-derived mechanisms explaining exercise-related BDNF release in MDD. For future studies in the field of exercise-related BDNF research, the importance of controlling for peripheral parameters is emphasized.
KW - Brain-derived neurotrophic factor (BDNF)
KW - Platelets
KW - Major depressive disorder
KW - Physical exercise
Y1 - 2018
U6 - https://doi.org/10.1016/j.psyneuen.2018.12.015
SN - 0306-4530
VL - 102
SP - 212
EP - 215
PB - Elsevier
CY - Oxford
ER -