Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
Eur Arch Psychiatry Clin Neurosci. 2024 Apr;274(3):709-721. doi: 10.1007/s00406-023-01646-2. Epub 2023 Aug 17.
Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.
体力活动（PA）在治疗轻度和中度抑郁症状患者中的有效性已得到证实。对于重度抑郁症患者的住院治疗，只有结构化和监督的团体 PA 干预措施具有基于证据的有效性。Step Away from Depression（SAD）研究调查了单独计步干预（PI）与活动日记相结合作为常规治疗（TAU）的附加手段，对住院治疗重度抑郁症患者的有效性。在这项多中心随机对照试验中，192 名患者被随机分配至 TAU 或 TAU 加 PI。出院时的两个主要结局是盲法抑郁评定，采用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评定，并用加速度计测量每日平均步数。次要结局是自评抑郁和 PA、焦虑、缓解率和反应率。多变量方差分析（MANOVA）显示两组之间在抑郁和每日步数方面没有显著差异。PI+TAU 组的基线 MADRS 平均得分为 29.5（SD=8.3），TAU 组为 28.8（SD=8.1），出院时分别为 16.4（SD=10.3）和 17.2（SD=9.9）。PI+TAU 组和 TAU 组的每日步数分别从 6285（SD=2321）和 6182（SD=2290）增加到 7248（SD=2939）和 7325（SD=3357）。两组在次要结局上没有差异。对于严重抑郁的住院患者，没有监督或进一步心理干预的 PI 无效。对于这一人群，PA 干预应纳入监测、社会强化和动机策略，以达到有效性。
