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Physical Fitness and Heart Rate Recovery Are Decreased in Major Depressive Disorder

From the Department of Psychiatry and Psychotherapy (S.B., F.W., K.-J.B.), University Hospital, Jena, Germany; and the Department of Sports Medicine (C.P., L.D., H.-J.M., H.H.W.G.), Friedrich-Schiller-University Jena, Jena, Germany.

Address correspondence and reprint requests to Karl-Jürgen Bär, Department of Psychiatry and Psychotherapy, University Hospital Jena, Philosophenweg 3, 07743 Jena, Germany. E-mail: Karl-Juergen.Baer{at}med.uni-jena.de

Objective: To investigate whether physical fitness is decreased in patients with major depressive disorder (MDD) in comparison to matched healthy controls because low physical fitness has been shown to be associated with metabolic syndrome or autonomic dysfunction. Cardiovascular morbidity and mortality are known to be increased in patients with MDD. Furthermore, the effect of a single exhaustive exercise task on heart rate recovery (HRR) and mood was examined.

Methods: Peak oxygen consumption (VO₂peak), maximum workload (Ppeak), and individual anaerobic threshold (IAT) were assessed in 22 patients suffering from MDD and 22 controls in a stepwise exhaustion protocol, using spirometry and lactate diagnostics. HRR was detected within the first minute after recovery. The Self-Assessment Manikin (SAM) was used to assess mood before and after exercise.

Results: VO₂peak, Ppeak, and IAT were decreased significantly in patients, indicating reduced physical fitness in MDD as compared with control subjects. A single exercise exhaustion significantly improved mood in patients, but not in controls. Mood improvement in patients correlated with maximum lactate levels. Significantly reduced HRR values in patients further point to an elevated cardiovascular risk profile and autonomic dysfunction.

Conclusions: Our results indicate reduced physical fitness in patients with MDD. Thus, special training programs should be developed to improve their cardiovascular risk profile. In addition, the intriguing finding of a correlation between lactate levels and mood changes should be followed up in future studies to unravel putative mechanisms.

Key Words: physical fitness • peak oxygen consumption • individual anaerobic threshold • heart rate recovery • major depressive disorder • autonomic nervous system

Abbreviations: BDI = Beck Depression Inventory; BMI = body mass index; CO₂ = carbon dioxide; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; ECG = electrocardiogram; HAMD-21 = Hamilton Depression Rating Scale; HRR = heart rate recovery; IAT = individual anaerobic threshold; IPAQ = international physical activity questionnaire; MDD = major depressive disorder; MET = metabolic equivalent; Ppeak = maximal work load; RQ = respiratory quotient; rpm = revolutions per minute; SAM = Self-Assessment Manikin; SCID = Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders; VO₂ = oxygen consumption; VO₂peak = peak oxygen consumption; W = Watt.

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