Exercise in the Prevention and Treatment of Adolescent Depression: A Promising but Little Researched Intervention

Abstract

Despite a dramatic increase in the number of treatment studies for adolescent major depressive disorder in the past 15 years, the majority being clinical trials of medications and cognitive behavioral therapy, response rates have been modest and remission rates low. Moreover, most positive responders posttreatment have many residual symptoms, significant functional impairment, and high rates of relapse. There is a need for the development of new, more effective interventions to treat this severe, chronic condition that usually persists into adulthood with poor long-term outcomes. Findings from preliminary treatment studies suggest that exercise may have the potential to be efficacious as a monotherapy or as part of a combined treatment for adolescent major depressive disorder. This review summarizes the findings and analyzes the design flaws of randomized trials of exercise to treat adolescent depression, offering recommendations on how to design more methodologically sound studies with an emphasis on subject selection criteria; issues related to control conditions, types of diagnostic interviews, and measures needed to establish the diagnosis of depression; types of exercise treatments; and appropriate outcome measures. Future studies of exercise to treat and prevent adolescent major depressive disorder need to be comparable to state-of-the-art treatment studies of pharmacotherapy and cognitive behavioral therapy in this population to more accurately determine its efficacy and potential public health benefits.