Skip to main content Accessibility help

Physical exercise for late-life major depression

  • M. Belvederi Murri (a1), M. Amore (a2), M. Menchetti (a3), G. Toni (a4), F. Neviani (a5), M. Cerri (a6), M. B. L. Rocchi (a7), D. Zocchi (a8), L. Bagnoli (a8), E. Tam (a9), A. Buffa (a10), S. Ferrara (a11), M. Neri (a12), G. S. Alexopoulos (a13) and S. Zanetidou (a14)...



Interventions including physical exercise may help improve the outcomes of late-life major depression, but few studies are available.


To investigate whether augmenting sertraline therapy with physical exercise leads to better outcomes of late-life major depression.


Primary care patients (>65 years) with major depression were randomised to 24 weeks of higher-intensity, progressive aerobic exercise plus sertraline (S+PAE), lower-intensity, non-progressive exercise plus sertraline (S+NPE) and sertraline alone. The primary outcome was remission (a score of $10 on the Hamilton Rating Scale for Depression).


A total of 121 patients were included. At study end, 45% of participants in the sertraline group, 73% of those in the S+NPE group and 81% of those in the S+PAE group achieved remission (P = 0.001). A shorter time to remission was observed in the S+PAE group than in the sertraline-only group.


Physical exercise may be a safe and effective augmentation to antidepressant therapy in late-life major depression.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Physical exercise for late-life major depression
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Physical exercise for late-life major depression
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Physical exercise for late-life major depression
      Available formats


Corresponding author

Dr Martino Belvederi Murri, Clinica Psichiatrica, Ospedale S. Martino, Largo Rosanna Benzi, 10, 16132 Genova, Italy. Email:


Hide All

the Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) Study Group

This research was supported by the Emilia Romagna Region University Programme (PrRU) 2010–2012 grant, Area 2 for Clinical Governance. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Declaration of interest




Hide All
1 Meijer, A, Conradi, HJ, Bos, EH, Anselmino, M, Carney, RM, Denollet, J, et al. Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. Br J Psychiatry 2013; 203: 90102.
2 Yohannes, AM, Connolly, MJ. Do antidepressants work in patients with chronic obstructive pulmonary disease with comorbid depression? Expert Rev Respir Med 2011; 5: 727–9.
3 Diniz, BS, Butters, MA, Albert, SM, Dew, MA, Reynolds, CF. Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies. Br J Psychiatry 2013; 202: 329–35.
4 Alexopoulos, GS. Depression in the elderly. Lancet 2005; 365: 1961–70.
5 Kennedy, GJ, Marcus, P. Use of antidepressants in older patients with comorbid medical conditions: guidance from studies of depression in somatic illness. Drugs Aging 2005; 22: 273–87.
6 Alexopoulos, GS, Bruce, ML. A model for intervention research in late-life depression. Int J Geriatr Psychiatry 2009; 24: 1325–34.
7 Bridle, C, Spanjers, K, Patel, S, Atherton, NM, Lamb, SE. Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2012; 201: 180–5.
8 Silveira, H, Moraes, H, Oliveira, N, Coutinho, ES, Laks, J, Deslandes, A. Physical exercise and clinically depressed patients: a systematic review and meta-analysis. Neuropsychobiology 2013; 67: 61–8.
9 Naismith, SL, Norrie, LM, Mowszowski, L, Hickie, IB. The neurobiology of depression in later-life: clinical, neuropsychological, neuroimaging and pathophysiological features. Prog Neurobiol 2012; 98: 99143.
10 Alexopoulos, GS, Morimoto, SS. The inflammation hypothesis in geriatric depression. Int J Geriatr Psychiatry 2011; 26: 1109–18.
11 Smith, PJ, Blumenthal, JA, Hoffman, BM, Cooper, H, Strauman, TA, Welsh-Bohmer, K, et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 2010; 72: 239–52.
12 Laske, C, Banschbach, S, Stransky, E, Bosch, S, Straten, G, Machann, J, et al. Exercise-induced normalization of decreased BDNF serum concentration in elderly women with remitted major depression. Int J Neuropsychopharmacol 2010; 13: 595602.
13 Brosse, AL, Sheets, ES, Lett, HS, Blumenthal, JA. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Med 2002; 32: 741–60.
14 Belvederi Murri, M, Pariante, C, Mondelli, V, Masotti, M, Atti, AR, Mellacqua, Z, et al. HPA axis and aging in depression: systematic review and meta-analysis. Psychoneuroendocrinology 2014; 41: 4662.
15 De Vries, NM, van Ravensberg, CD, Hobbelen, JS, Olde Rikkert, MG, Staal, JB, Nijhuis-van der Sanden, MW. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis. Ageing Res Rev 2012; 11: 136–49.
16 Dunn, AL, Trivedi, MH, Kampert, JB, Clark, CG, Chambliss, HO. Exercise treatment for depression: efficacy and dose response. Am J Prev Med 2005; 28: 18.
17 Hamilton, M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6: 278–96.
18 Nelson, ME, Rejeski, WJ, Blair, SN, Duncan, PW, Judge, JO, King, AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116: 1094–105.
19 Folstein, MF, Folstein, SE, McHugh, PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.
20 Agostoni, P. Cardiopulmonary exercise testing for heart failure patients: a hodgepodge of techniques, parameters and interpretations. In other words, the need for a time-break. Eur Heart J 2006; 27: 633–4.
21 Guy, W. ECDEU Assessment Manual for Psychopharmacology. U.S. Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976.
22 Muijsers, RB, Plosker, GL, Noble, S. Spotlight on sertraline in the management of major depressive disorder in elderly patients. CNS Drugs 2002; 16: 789–94.
23 Vigorito, C, Giallauria, F. Effects of exercise on cardiovascular performance in the elderly. Front Physiol 2014; 5: 51.
24 Muscari, A, Giannoni, C, Pierpaoli, L, Berzigotti, A, Maietta, P, Foschi, E, et al. Chronic endurance exercise training prevents aging-related cognitive decline in healthy older adults: a randomized controlled trial. Int J Geriatr Psychiatry 2010; 25: 1055–64.
25 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (suppl 20): 2233.
26 Miller, MD, Paradis, CF, Houck, PR, Mazumdar, S, Stack, JA, Rifai, AH, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 1992; 41: 237–48.
27 Craig, CL, Marshall, AL, Sjostrom, M, Bauman, AE, Booth, ML, Ainsworth, BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381–95.
28 Shek, DT, Ma, CM. Longitudinal data analyses using linear mixed models in SPSS: concepts, procedures and illustrations. ScientificWorldJournal 2011; 11: 4276.
29 Alexopoulos, GS, Katz, IR, Reynolds, CF, Carpenter, D, Docherty, JP, Ross, RW. Pharmacotherapy of depression in older patients: a summary of the expert consensus guidelines. J Psychiatr Pract 2001; 7: 361–76.
30 Dillon, C, Machnicki, G, Serrano, CM, Rojas, G, Vazquez, G, Allegri, RF. Clinical manifestations of geriatric depression in a memory clinic: toward a proposed subtyping of geriatric depression. J Affect Disord 2011; 134: 177–87.
31 Conn, VS. Depressive symptom outcomes of physical activity interventions: meta-analysis findings. Ann Behav Med 2010; 39: 128–38.
32 Cho, KL. Effect of Tai Chi on depressive symptoms amongst Chinese older patients with major depression: the role of social support. Med Sport Sci 2008; 52: 146–54.
33 Lavretsky, H, Alstein, LL, Olmstead, RE, Ercoli, LM, Riparetti-Brown, M, Cyr, NS, et al. Complementary use of tai chi augments escitalopram treatment of geriatric depression: a randomized controlled trial. Am J Geriatr Psychiatry 2011; 19: 839–50.
34 Underwood, M, Lamb, SE, Eldridge, S, Sheehan, B, Slowther, AM, Spencer, A, et al. Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial. Lancet 2013; 382: 41–9.
35 Blumenthal, JA, Babyak, MA, Moore, KA, Craighead, WE, Herman, S, Khatri, P, et al. Effects of exercise training on older patients with major depression. Arch Intern Med 1999; 159: 2349–56.
36 Voss, MW, Heo, S, Prakash, RS, Erickson, KI, Alves, H, Chaddock, L, et al. The influence of aerobic fitness on cerebral white matter integrity and cognitive function in older adults: results of a one-year exercise intervention. Hum Brain Mapp 2013; 34: 2972–85.
37 Huang, T, Larsen, KT, Ried-Larsen, M, Moller, NC, Andersen, LB. The effects of physical activity and exercise on brain-derived neurotrophic factor in healthy humans: a review. Scand J Med Sci Sports 2014; 24: 110.
38 Sheikh, JI, Cassidy, EL, Doraiswamy, PM, Salomon, RM, Hornig, M, Holland, PJ, et al. Efficacy, safety, and tolerability of sertraline in patients with late-life depression and comorbid medical illness. J Am Geriatr Soc 2004; 52: 8692.
39 Zivin, K, Kales, HC. Adherence to depression treatment in older adults: a narrative review. Drugs Aging 2008; 25: 559–71.
40 Calati, R, Salvina, SM, Balestri, M, Marsano, A, De Ronchi, D, Aguglia, E, et al. Antidepressants in elderly: metaregression of double-blind, randomized clinical trials. J Affect Disord 2013; 147: 18.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Physical exercise for late-life major depression

  • M. Belvederi Murri (a1), M. Amore (a2), M. Menchetti (a3), G. Toni (a4), F. Neviani (a5), M. Cerri (a6), M. B. L. Rocchi (a7), D. Zocchi (a8), L. Bagnoli (a8), E. Tam (a9), A. Buffa (a10), S. Ferrara (a11), M. Neri (a12), G. S. Alexopoulos (a13) and S. Zanetidou (a14)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *