Explorando o efeito adjuvante do exercício físico em pacientes com transtorno depressivo maior: um ensaio clínico randomizado

Abstract

Although antidepressants represent an advance in the treatment of Major Depressive Disorder (MDD), their efficacy is limited and accompanied by undesirable side effects. This has driven the investigation of complementary treatments, such as physical exercise. However, adherence to exercise is challenging despite its known benefits for physical and mental health. This study aimed to evaluate physical and mental health indicators concerning the severity of MDD pre-treatment and to validate a home-based exercise protocol guided by effort, pleasure, and affect towards exercise, to improve patient adherence and investigate the potential adjunctive role of physical exercise to pharmacotherapy, observing changes in physical and mental health parameters. A randomized, controlled, open clinical study was conducted with MDD patients, involving two experimental groups: pharmacotherapy only (control) and exercise combined with pharmacotherapy, as part of the Program for Coping with Sadness, which includes other adjunctive therapies such as yoga and meditation. Pre-treatment health indicators showed significant variations related to depression severity. Notably, the exercise group had a lower dropout rate than the control group, indicating good adherence to the emotion and effort-guided protocol. Additionally, physical exercise proved effective in improving cardiorespiratory fitness and was an important complement to pharmacological treatment, contributing to a greater reduction in depressive symptoms, side effects, and systemic inflammation levels. Furthermore, the anti-inflammatory response predicted a better clinical response to treatment, exclusively in the exercise group. Thus, the exercise protocol developed specifically for MDD patients was effectively validated, demonstrating high adherence and significantly contributing to the physical and mental improvement of the participants. It is also important to guide the exercise protocol by effort, pleasure, and affect, along with evaluating the patients' baseline profile considering MDD severity, to develop more personalized treatments and create protocols that maximize treatment benefits.