Key result
Physical exercise for 12 weeks flattened the diurnal cortisol slope (p=0.004) and reduced cortisol at awakening (p=0.017) in depressed adults, while ICBT and TAU had no detectable effects.
Why the study?
Does physical exercise or internet-based cognitive behavioural therapy reduce diurnal salivary cortisol levels in depressed primary care patients compared to treatment as usual?
RCT (n=121)
Randomized
Does physical exercise or internet-based cognitive behavioural therapy reduce diurnal salivary cortisol levels in depressed primary care patients compared to treatment as usual?
Physical exercise, but not internet-based cognitive behavioral therapy or treatment as usual, reduces morning cortisol levels and flattens the diurnal cortisol slope in depressed patients.
PE normalizes diurnal cortisol patterns in depression; extends RCT evidence for exercise while leaving ICBT effects on HPA axis unresolved.
Purpose of the Study: Cortisol hypersecretion plays a role in depression pathophysiology. Internet-based cognitive behavioural therapy (ICBT) and physical exercise (PE) are new treatment alternatives for depression, and their long-lasting effect on cortisol is unknown. We investigated cortisol level changes after 12 weeks of ICBT, PE or treatment as usual (TAU). Procedures: The present pre-post repeated measure study analysed data derived from a randomised controlled trial evaluating the effects of 12 weeks’ interventions of ICBT, PE and TAU in depressed primary care patients (Sweden 2011–2013) and aimed at prospectively evaluating the within-group effects of ICBT, PE and TAU on diurnal salivary cortisol levels in a small representative subsample (n = 56, 38 and 27, respectively). Results: We found a marked flattening of the diurnal cortisol slope (p = 0.004) and a reduced cortisol level at awakening (p = 0.017) after 12 weeks of PE treatment. No apparent effects of ICBT or TAU interventions were seen on diurnal cortisol levels. Conclusions and Message: PE reduced the rate of cortisol level decline across the day in depressed adults. ICBT and TAU treatments had no detectable effects on diurnal cortisol levels. Larger samples are required for the detection and comparison of smaller effects of PE, ICBT and TAU on diurnal cortisol levels.
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Rahman et al. (2018) conducted an RCT in Depression (n=121). Physical exercise (PE) and Internet-based cognitive behavioural therapy (ICBT) vs. Treatment as usual (TAU) was evaluated on Diurnal salivary cortisol levels (diurnal cortisol slope and cortisol level at awakening) (p=0.004). Physical exercise for 12 weeks flattened the diurnal cortisol slope (p=0.004) and reduced cortisol at awakening (p=0.017) in depressed adults, while ICBT and TAU had no detectable effects.
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