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Journal of Abnormal Psychology 2012 American Psychological Association 2013, Vol. 122, No. 1, 45–50 Acute Exercise Attenuates Negative Affect Following Repeated Sad Mood Inductions in Persons Who Have Recovered From Depression Stanford University and University of Basel Stanford University Christian E. Waugh University of Miami Wake Forest University Stanford University Identifying factors that may protect individuals from developing Major Depressive Disorder (MDD) inthe face of stress is critical. In the current study we experimentally tested whether such a potentiallyprotective factor, engaging in acute exercise, reduces the adverse effects of repeated sad mood inductionsin individuals who have recovered from depression. We hypothesized that recovered depressed partic-ipants who engage in acute exercise report a smaller increase in negative affect (NA) and a smallerdecrease in positive affect (PA) when exposed to a repeated sad mood induction (i.e., habituation),whereas participants who do not exercise show sensitization (i.e., increased NA and decreased PA inresponse to a repeated adverse stimulus). Forty-one women recovered from MDD and 40 healthy controlwomen were randomly assigned to either exercise for 15 minutes or quiet rest. Afterward, participantswere exposed to two sad mood inductions and reported their levels of affect throughout the study.
Recovered depressed participants who had not exercised exhibited higher NA after the second sad moodinduction, a finding consistent with sensitization. In contrast, both recovered depressed participants whohad engaged in acute exercise and healthy control participants showed no increase in NA in response tothe repeated sad mood induction. Participants who exercised reported higher PA after the exercise bout;however, our hypothesis concerning reported PA trajectories following the sad mood inductions was notsupported. Results suggest that exercise can serve as a protective factor in the face of exposure torepeated emotional stressors, particularly concerning NA in individuals who have recovered fromdepression.
Keywords: exercise, recovered Major Depressive Disorder, sad mood induction, repeated stress, physicalactivity Major Depressive Disorder (MDD) is one of the most prevalent with vulnerability or protective factors (e.g., and burdensome of all psychiatric disorders. Importantly, MDD is Vulnerability-stress formulations posit that the development of a recurrent disorder; more than 80% of people with a history of depression is due to the interaction of stressful events with one or MDD have more than one episode of depression more vulnerability factors. Similarly, protective models focus on Investigators examining factors involved in the onset and factors that may neutralize or reduce the impact of adverse expe- recurrence of depression have focused on the interaction of stress riences on the development of a negative outcome such as MDD Depression is characterized by elevated levels of negative affect (NA) and low levels of positive affect (PA), where NA represents This article was published Online First September 17, 2012.
the extent to which individuals feel subjective distress and unplea- Jutta Mata, Department of Psychology, Stanford University and Depart- surable engagement, and PA the extent to which they feel enthu- ment of Psychology, University of Basel; Candice L. Hogan and Ian H.
Gotlib, Department of Psychology, Stanford University; Jutta Joormann, siastic, active, or alert Behav- Department of Psychology, University of Miami; Christian E. Waugh, iors that help to decrease NA and/or increase PA might act as Department of Psychology, Wake Forest University.
protective factors in the face of stress. Acute exercise may be This research was supported by Grant Wi3496/41 from Deutsche For- one such factor. Engaging in acute exercise has been found to schungsgemeinschaft to JM and NIMH Grant MH59259 to IHG. We thank increase PA and result in fewer and less Jessica Bowmer and Sarah Victor for their help with the study; Andrea intense anxiety-related thoughts and attenuated physiological re- Meyer and Rui Mata for advice on the article.
sponse following a psychosocial stressor Correspondence concerning this article should be addressed to Jutta Mata, Department of Psychology, University of Basel, Missionsstrasse In a 1-week experience sampling 62a, 4055 Basel, Switzerland. E-mail: study, found that depressed individuals had MATA, HOGAN, JOORMANN, WAUGH, AND GOTLIB higher levels of PA when they were physically active than during Of these, four women were excluded because their scores on the sedentary periods. Moreover, treatment studies with both unse- Beck Depression Inventory-II (BDI-II; lected and clinical samples have documented that engaging in exceeded the cut-off (see requirements below), and two prescribed exercise significantly reduces levels of depressive dropped out before completing the second session, leaving a final symptoms, including NA (e.g., Indeed, inves- sample of 81 women. Forty-one had recovered from MDD based tigators have found comparable benefits of treating MDD with on the Structured Clinical Interview for DSM (SCID; sertraline (an antidepressant medication) and with exercise after 4 and 40 were classified as months and 6 months never-disordered healthy control participants. Individuals were Exercise can also reduce the likelihood of relapse of depression: in excluded from participating in the study if they had experienced 10-month and 1-year severe head trauma, learning disabilities, psychotic symptoms, follow-up assessments, participants who exercised had signifi- bipolar disorder, and/or alcohol or substance abuse within the last cantly lower relapse rates than did participants who received 6 months. Women in the "recovered" group had to meet DSM–IV criteria for a past major depressive episode. To confirm full re- Although most research concerning stress and depression has covery from depression, participants completed a slightly modified focused on the effects of major stressful life events like job loss or version of the SCID using guidelines recommended by the NIMH marital disruption, common repeated daily life adversities such as Collaborative Program on the Psychobiology of Depression family arguments or work deadlines also have a cumulative effect Participants had to have eight consecutive and impair health and well-being (e.g., Two weeks with no more than two symptoms of no more than a mild general learning processes that affect response to repeated adverse degree (i.e., ratings of 1 ⫽ no symptoms or 2 ⫽ minimal symptoms, experiences have been suggested: habituation and sensitization.
no impairment) in order to be classified as recovered from depres- Habituation is defined as a decreased level of response to a sion. Of the participants who had recovered from MDD, 11 par- repeated stimulus; in contrast, sensitization refers to an increased ticipants met criteria for a current Axis-I disorder, and 27 parti- level of response to a repeated stimulus (e.g., cipants for a lifetime diagnosis of an Axis-I disorder. Healthy For example, women have been found to controls could not have had a past or current diagnosis of MDD or exhibit higher heart rate and greater NA reactivity following a any other Axis-I disorder and had to have a BDI-II score of 10 or second than a first exposure to an adverse event, suggesting that less. All participants were native English speakers and between 18 they became sensitized to the event and 58 years old. Participants provided informed consent and were compensated for their participation in the study. The Institutional Investigators have not examined the effects of one bout of acute Review Board at Stanford University approved the study.
exercise on the reaction to repeated stressors. In rodents, physicalactivity over time can facilitate habituation to repeated stressors: compared with rodents that did not exercise, the cortisol response Depressive symptoms were assessed to an acute stressor in rodents that exercised decreased more with the BDI-II, Cronbach's Alpha ⫽ .84.
rapidly as they were exposed to more stressors Affect was assessed throughout the experimental ses- Studying the effects of a 3-month sion with the following two questions: "How positive are you exercise training on response to a repeated stressor, feeling right now?" and "How negative are you feeling right randomly assigned 31 healthy men to an aerobic exer- now?" on a 7-point Likert scale from 1 (not at all) to 7 (very) (cf.
cise program or a strength and flexibility program. Before and after Before answering these scales for the program, participants engaged in a stressful mental arithmetic the first time, participants were thoroughly instructed on what was task. Both groups showed a reduced physiological stress response, meant by feeling positive and negative: At the far left of the PA suggesting habituation; however, effects were stronger and applied scale (1) they would feel completely neutral, neither positive nor to a higher number of physiological markers in the aerobic exer- negative; at the far right (7) they would feel very positive, such as happy, pleased, satisfied, competent, or some other positive feel- The present study was designed to examine experimentally the ing. At the far right of the NA scale they would be feeling very protective effect of exercise on affective responses to repeated negative, which could be unhappy, frustrated, sad, depressed, or stressors in individuals who have recovered from depression. We some other negative feeling.
predicted that recovered depressed participants who engage in Physical activity was assessed with the acute exercise will report a smaller increase in NA and a smaller 7-Day Physical Activity Recall a decrease in PA when exposed to repeated sad mood inductions structured interview to determine minutes spent in physical activ- (i.e., habituation), whereas recovered depressed participants who ity over the course of an average week; results were converted into do not exercise will show sensitization (i.e., increased NA and weekly kilocalorie expenditure per kilogram of body weight.
decreased PA).
All participants viewed two film clips that have reliably been shown to induce negative mood (see for a detailed description of the clips). Films were Eighty-seven women were recruited through advertisements in counterbalanced across participants and lasted approximately 6 local newspapers, Internet bulletin boards, and university kiosks.
minutes each.
AFFECT AFTER REPEATED STRESS AND ACUTE EXERCISE Heart rate and respiration were re- after the second sad film (i.e., approximately 8 minutes after the corded with an integrated system and software package (Biopac previous affect assessment). Participants were debriefed before MP150, AcqKnowledge; Biopac Systems, Goleta, CA) at a sam- leaving the laboratory.
pling rate of 1 kHz. Cardiovascular signals were recorded with theelectrocardiogram (ECG) amplifier module and pregelled dispos- able electrodes. ECG data were scored offline using ANSLABsoftware inspected for artifacts, false Demographic and Clinical Characteristics of
positives, and nonrecognized R-waves, and converted to heart rate(HR) using the corrected interbeat intervals. Exercise intensity during cycling was determined using percent heart rate reserve Participants who had recovered from MDD did not differ from (HRR; HRR is operation- healthy control participants in age, education, ethnicity, or physical alized as the difference between resting and maximum heart rate.
activity level, but had significantly higher BDI-II scores than HRR is preferable to the simpler age-predicted percent heart rate healthy control participants (see because it takes into account the possible range of an individual'sheart rate.
Manipulation Check 1: Effects of Exercise on Heart
Rate and Affect
Recovered and control participants did not differ significantly in Participants meeting eligibility criteria in a telephone screen baseline heart rate during rest (see Overall, participants were invited to complete two separate sessions. In Session 1, cycled at a mean of 34% HRR (see which constitutes participants were administered the SCID. Our team of interviewers mild exercise. Paired t tests indicated that in the no-exercise has previously achieved excellent interrater reliability for the as- condition percent HRR was comparable in the baseline and resting sessment of recovery from a major depressive episode (k ⫽ .91) periods, t(36) ⫽ .22, p ⫽ .83, d ⫽ 0.04; in contrast, in the exercise and for classifying participants as nonpsychiatric controls (k ⫽ .92; condition, percent HRR was significantly higher during the cycling e.g., Next, the 7-Day Physical Activity period than during baseline, t(41) ⫽ 10.47, p ⬍ .001, d ⫽ 1.61.
Recall Interview was administered and participants completed Participants in the exercise condition reported a significant demographic and BDI-II questionnaires.
increase in PA between baseline and after the exercise bout, Session 2 was conducted approximately 1 week later. Partici- t(40) ⫽ ⫺3.53, p ⫽ .002, d ⫽ ⫺0.59, whereas participants in the pants were asked to wear comfortable clothes in which they could rest condition did not, t(38) ⫽ 1.55, p ⫽ .130, d ⫽ 0.32. There was move freely (e.g., t-shirt, sweat pants, sneakers) because we were no change in NA between baseline and exercise bout in the planning to measure their heart rate and breathing, possibly while exercise condition, t(40) ⫽ ⫺0.53, p ⫽ .599, d ⫽ ⫺0.14, or they were moving, and it would be easier to attach sensors if they between baseline and resting period in the rest condition, t(38) ⫽ wore loose clothing. Furthermore, participants were asked to re- 0.27, p ⫽ .786, d ⫽ 0.04.
frain from participating in exercise on the day of the study and toconsume no more than their typical amount of caffeine 2 to 3 hours Manipulation Check 2: Effect of Sad Mood Inductions
prior to their session. Of the 40 healthy control participants, 20were randomly assigned to an "exercise" condition and 20 to a "no on Affect
exercise" condition. Of the 41 women recovered from MDD, 22 Paired t tests showed that PA decreased, t(79) ⫽ 10.05, p ⬍ were randomly assigned to an "exercise" condition and 19 to a .001, d ⫽ 1.09, and NA increased, t(79) ⫽ ⫺9.01, p ⬍ .001, d ⫽ "no-exercise" control condition.1 Physiological sensors were 1.46, after the first sad mood induction. After the second sad mood placed on the participants, followed by a 5-min acclimation period.
induction, again, PA decreased, t(79) ⫽ 10.60, p ⬍ .001, d ⫽ 2.04, Next, participants rested quietly with eyes open while baseline and NA increased, t(79) ⫽ ⫺8.65, p ⬍ .001, d ⫽ ⫺1.56.
heart rate was recorded for 5 minutes. Participants assigned to theexercise condition cycled on a stationary bicycle for 15 minutes Does Exercise Attenuate the Effect of Repeated Sad
(SensorMedics Ergometric 800 cycle ergometer, San Diego, CA) at a speed and resistance they found comfortable. A meta-analysishas shown that most individuals choose mild to moderate activity Means and standard deviations of the affect assessments are as comfortable, which is the intensity level that leads to the presented in Healthy control participants and participants greatest improvement in affect Participants recovered from MDD differed significantly in their levels of assigned to the control condition were asked to rest quietly with baseline negative affect, F(1, 77) ⫽ 9.04, p ⫽ .004, ␩2 ⫽ .15.
eyes open for 15 minutes. A selection of magazines was provided.
Despite the randomization, post hoc tests indicate a baseline dif- Following completion of the exercise or control condition, partic- ference in NA (p ⫽ .024) between recovered MDD participants in ipants sat quietly for 2 minutes. Participants then viewed a sad film the exercise and control conditions; no baseline NA differences and completed a 2-min information-processing filler task to givethem a short break. Next, they watched the second sad film. Affect was assessed throughout the session: 10 minutes after arriving at One participant did not complete the second affect assessment; her data from this assessment are not included in the analyses. Physiological data the laboratory, after the exercise/resting period (i.e., 17 minutes from four participants (two recovered, two controls) could not be collected after the previous affect assessment), after the first sad film (i.e., because of technical equipment malfunctions and were not included in the approximately 6 minutes after the previous affect assessment), and analyses of heart rate.
MATA, HOGAN, JOORMANN, WAUGH, AND GOTLIB Table 1Demographic Characteristics of Participants Recovered From MDD and Control Participants Recovered from MDD; N ⫽ 41 Control; N ⫽ 40 Statistical difference values Age; M (SD) t(79) ⫽ ⫺0.11 Ethnicity (% Caucasian) Education (% college graduates) BDI-II score; M (SD) t(79) ⫽ ⫺3.37* Physical activity (kcal/kg; 7-Day PAR); M (SD) t(77) ⫽ 1.22 Baseline heart rate t(77) ⫽ ⫺1.18 % HRR cycling (Exercise group); M (SD) t(40) ⫽ 1.67 % HRR rest (No exercise group); M (SD) t(35) ⫽ 1.19 MDD ⫽ Major Depressive Disorder; BDI⫺II ⫽ Beck Depression Inventory⫺II; 7-Day PAR ⫽ 7-Day Physical Activity Recall Interview; HRR ⫽ heart rate reserve.
* p ⬍ .01.
were observed between control participants in exercise and rest who have recovered from depression. As hypothesized, we found conditions (p ⫽ .583). Healthy control and recovered MDD par- that both recovered depressed participants assigned to engage in ticipants differed in baseline PA, F(1, 77) ⫽ 4. 49, p ⫽ .037; acute exercise and healthy control participants (regardless of ex- ␩2 ⫽ .06; post hoc tests showed no differences in baseline PA ercise condition) showed no increase in levels of NA in response between the experimental conditions within either diagnostic to a repeated stressor (i.e., sad mood inductions), whereas partic- group (ps ⬎ .2). Because of the differences between experimental ipants recovered from MDD who did not exercise exhibited higher conditions, we control for baseline NA in our analyses.
levels of NA after the second mood induction, suggesting sensiti- To test whether the four groups of participants differed in levels zation. However, in contrast to our hypothesis, we did not find any of NA following the sad mood inductions, we conducted a 2 interaction between exercise condition and diagnostic group in (diagnostic group; recovered, control) ⫻ 2 (experimental condi- level of reported PA following the repeated sad mood inductions tion; exercise, no exercise) ⫻ 3 (time: presad mood induction, after that would be consistent with the notion of sensitization or habit- first sad mood induction, after second sad mood induction) re- peated measures analysis of covariance (ANCOVA) on NA ratings The finding of higher NA after the repeated mood induction in with baseline NA, BDI-II score, and physical activity as covari- recovered depressed individuals who did not exercise is consistent ates. This analysis yielded significant main effects of time, F(2,142) ⫽ 3.51, p ⫽ .033, ␩2 ⫽ .05, and an interaction of diagnostic with results of previous studies. found a higher group and time, F(2, 142) ⫽ 4.78, p ⫽ .010, ␩2 ⫽ .06. Although risk of developing MDD for individuals with a short-allele in the the omnibus three-way interaction was only marginally significant, 5-HTT genotype only if they had been exposed to repeated (two or F(2, 142) ⫽ 2.00, p ⫽ .105, ␩2 ⫽ .03, within-subject contrasts more) stressful life events; there was no difference in the proba- showed that the linear component of the three-way interaction of bility of an adverse outcome if only one stressful life event had diagnostic group, experimental condition, and time was signifi- occurred. reported a similar pattern in rodents: cant, F(1, 71) ⫽ 4.71, p ⫽ .033, ␩2 ⫽ .06 (the quadratic compo- there was no difference in cortisol levels in response to an initial nent of this interaction was not significant, F(1, 71) ⫽ 0.06, p ⫽ stressor between rodents that exercised and rodents that did not.
.810, ␩2 ⫽ .001).2 To explore the linear component of the three- However, after being exposed to repeated stressors, rodents that way interaction, we conducted planned contrasts, still controllingfor baseline NA, BDI-II score, and physical activity.3 Theseplanned contrasts indicated that this interaction was due to partic- 2 Whereas the control group was free of current psychopathology, 11 ipants who had recovered from MDD in the no-exercise group participants recovered from depression met criteria for a different current reporting higher levels of NA after the second mood induction than psychopathology. Repeating our analyses excluding these participantsyielded comparable results: Again, the omnibus three-way interaction was did participants in the three other groups, t(76) ⫽ 2.97, p ⫽ .004, marginally significant, F(2, 120) ⫽ 2.45, p ⫽ .090, ␩2 ⫽ .04; the linear d ⫽ 1.03 (see Importantly, planned contrasts for levels component of the three-way interaction of diagnostic group, experimental of NA presad mood induction and after the first sad mood induc- condition, and time was significant, F(1, 60) ⫽ 5.17, p ⫽ .027, ␩2 ⫽ .08.
tion were not significant (ps ⬎ .3). Also supporting our hypothesis, We conducted planned contrasts despite p ⬎ .05 for the overall omnibus three-way interaction following within the recovered depressed group, those who exercised re- who argued that an omnibus-test only tests the null-hypothesis that ported significantly lower levels of NA after the second sad mood all groups in the analysis share a common population mean. If the omnibus induction than did those who did not exercise, t(39) ⫽ 2.65, p ⫽ F-value is statistically significant, the null-hypothesis that all means are .012, d ⫽ 0.83. There were no significant main effects or interac- equal is rejected. In our study, however, where three groups are expected tions between exercise condition, diagnostic group, and reported to be equal and one to be different, there is less power to detect thisdifference in an omnibus-test; indeed, there is a much higher probability PA following the repeated sad mood inductions (all ps ⬎ .1).
that an existing effect would be overlooked. Therefore, conducting a set ofcontrasts of conceptual interest, independent of the significance level of the initial omnibus test, is recommended.
4 The mean % HRR is negative because participants' resting HR during The present study was designed to assess experimentally the acclimation was slightly higher than during the following resting period.
effects of exercise on responses to repeated stressors in individuals This does not affect the interpretation of the results.

AFFECT AFTER REPEATED STRESS AND ACUTE EXERCISE Table 2Affect Ratings After exercise/rest After 1st mood induction After 2nd mood induction M (SD) M (SD) M (SD) M (SD) Control, no exercise Control, exercise Recovered, no exercise Recovered, exercise Control, no exercise Control, exercise Recovered, no exercise Recovered, exercise exercised had a significantly lower cortisol response than rodents difference between PA and NA (cf. Future that did not.
research examining psychological and physiological mechanisms Although participants in the exercise condition reported in- that underlie the relation between exercise and response to re- creased PA after the exercise bout as expected, our hypothesis peated stressors might clarify such a difference in PA and NA concerning reported PA following the sad mood inductions was not supported. Power analyses suggest that the failure to support This study has a number of theoretical and practical implica- our hypothesis was not due to sample size. It is possible that the tions. This is the first study to test experimentally the attenuating experimental manipulation of sad mood inductions, which explic- effects of exercise on levels of NA in the face of exposure to itly targeted NA, led to a trajectory of PA that did not differentiate repeated emotional stressors in individuals who have recovered experimental conditions and diagnostic groups. This suggests that from depression. Identifying such protective factors is an impor- the interaction between exercise and response to repeated sad tant contribution to research focused on understanding stress gen- mood inductions works differently in PA and NA. Furthermore, eration and stress sensitization in the context of the relation be- the different findings for NA and PA support the conceptual tween stress and depression. This is particularly important inindividuals recovered from depression who may be vulnerable toeven mild stressors In her review article onstress and depression, concludes that exposure torepeated or elevated rates of stressors likely predicts recurrence ofdepression, leading to a "self-perpetuating cycle of depression andstress" (p. 303). Thus, a better understanding of factors associatedwith reduced stress responding, such as mild exercise, would notonly contribute to a better understanding of vulnerability to recur-rent depression, but may also lead to the development of moreeffective interventions to prevent such recurrences. Our findingshighlight the effectiveness of low-intensity acute exercise to mit-igate the effects of stress resulting from sad-mood inductions inparticipants who have recovered from MDD. Despite recommen-dations of regular moderate-intensity aerobic exercise to maintaingeneral health the present finding is consis-tent with results of a recent meta-analysis indicating that mild-intensity acute aerobic exercise is optimal to improve positiveaffect This can have important implicationsfor adherence to an exercise regimen given that mild exercise, suchas light cycling or going for a walk, is easier to integrate intoeveryday activities than is moderate or intense planned exercise.
It is important to acknowledge three limitations of this study.
First, we assessed recovered depressed individuals in this study;future investigations should examine the effects of stress andexercise in participants with current MDD. Second, this is a Negative affect ratings after exercise and sad mood inductions.
single-session laboratory experiment; therefore, the extent to Error bars represent ⫾1 SEM. Negative affect ratings are estimated which the findings generalize to multiple sessions over longer marginal means, controlling for baseline negative affect, BDI-II score, andphysical activity. After Ex./Rest periods of time, as well as to contexts outside the laboratory, must ⫽ After Exercise/Rest; Mood Ind. ⫽ Mood Induction.
be determined in future research. Third, because positive and MATA, HOGAN, JOORMANN, WAUGH, AND GOTLIB negative affect were measured with one item each, reliability Joormann, J., & Gotlib, I. H. (2007). Selective attention to emotional faces cannot be computed.
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