Associations of objectively measured movement behavior and cardiorespiratory fitness with mental health and quality of life in older adults with hypertension: an exploratory analysis during the COVID-19 pandemic.

Objectives: Herein, we explored the associations of pre-pandemic COVID-19 physical activity (PA), sedentary behavior (SB) and cardiorespiratory fitness (CRF) with mental health and quality of life in older adults with hypertension.Method: Objectively measured PA and SB, perceived stress, depression symptoms, and quality of life were assessed before and during the pandemic in seventeen older adults with hypertension. CRF was assessed before the pandemic by cardiopulmonary exercise testing. Longitudinal and cross-sectional associations were analyzed using the mixed linear model.Results: Pre-pandemic light PA (positive association) and SB (negative association) were associated with quality of life during the pandemic. Higher pre-pandemic CRF was associated with less negative changes in perceived stress, depression symptoms, and quality of life during the pandemic.Conclusion: Our preliminary findings suggest that a healthier pre-pandemic movement behavior (more PA, less SB) and better CRF can mitigate the negative impact of the COVID-19 pandemic on mental health and quality of life in older adults with hypertension.

Does learning a skill with the expectation of teaching it impair the skill's execution under psychological pressure if the skill is learned with analogy instructions?

OBJECTIVE: Having learners practice a motor skill with the expectation of teaching it (versus an expectation of being tested on it) has been revealed to enhance skill learning. However, this improvement in skill performance is lost when the skill must be performed under psychological pressure due to 'choking under pressure.' The present study will investigate whether this choking effect is caused by an accrual of declarative knowledge during skill practice and could be prevented if a technique (analogy instructions) to minimize the accrual of declarative knowledge during practice is employed. DESIGN: We will use a 2 (Expectation: teach/test) x 2 (Instruction: analogy/explicit) x 2 (Posttest: high-pressure/low-pressure) mixed-factor design, with repeated measures on the last factor. METHODS: A minimum of 148 participants will be quasi-randomly assigned (based on sex) to one of four groups. Participants in the teach/analogy and teach/explicit groups will practice golf putting with the expectation of teaching putting to another participant, and analogy instructions or explicit instructions, respectively. Participants in the test/analogy and test/explicit groups will practice golf putting with the expectation of being tested on their putting, and analogy instructions or explicit instructions, respectively. The next day all participants will complete low- and high-pressure putting posttests, with their putting accuracy serving as the dependent variable.

Complex Mediastinal Tumour In Pregnancy: Case Report.

A 19 years-old woman, on her 17th week of pregnancy presented to the emergency department with thoracic pain and vomiting. An empyema was diagnosed and she was transferred to a tertiary hospital for treatment. After drainage of the empyema a mediastinal mass was detected and a thoracic MRI revealed a multicystic lesion of the anterior mediastinum, causing cardiac and left lung compression, suggestive of a complicated teratoma. After a multidisciplinary discussion involving pulmonology, radiology, obstetrics and thoracic surgery, she was operated successfully by clamshell incision. A mature complicated teratoma was resected and a left pleurectomy/decortication performed. She was discharged on day 17 with no obstetrical or respiratory symptoms..

Chest Wall Trauma Surgery Review.

Rib fractures are frequent in trauma patients, being most of them managed on a non-surgical way. However, in selected cases, it is advocated. Chest wall stabilization (CWS) only recently has been best characterized. Available data shows plenty of benefits related to CWS versus non-surgical treatment in selected cases. Even though, it is only performed in a small number of patients according to some national databases. There are lots of topics to define concerning CWS such as the subgroups that benefit most, the time of surgery, which ribs should be stabilized and which incision should be performed. Most of these subjects need to be tailored for each patient. So far, no guidelines for CWS are available, although some algorithms have been proposed based on a combination of clinical experience and risk factors. In high-volume trauma centers it has become a common procedure. The complexity of some cases demands a careful evaluation, especially in the context of multiple injuries, and it should be taken into account in the decision.

Unusual Behaviour Of A Lung Inflammatory Myofibroblastic Tumour.

Inflammatory myofibroblastic tumours (IMTs) are rare lesions. We report a case of a 55 year-old male, admitted with a pneumonia. Further investigation revealed a left lower lobe mass and enlarged mediastinal lymph nodes. Cytology of the bronchoalveolar lavage suggested a squamous cell carcinoma. He received four cycles of chemotherapy followed by a left lower lobectomy. Pathological analysis was compatible with IMT. Three months after surgery, a new IMT nodule located in the lingula was excised. Four months later,endobronchial involvement and the presence of liver nodules were detected.Ten months after the first surgery a CT revealed a sacrum lesion. Histology was compatible with undifferentiated sarcoma and a sarcomatous transformation was assumed.

Aberrant Pleural Plaques.

Male, 71 years old, active smoker. Referred to our outpatient clinic due to right upper lobe nodule with 4 year follow-up, which increased in size and metabolic uptake during the last year. CT scan also revealed multiple pleural plaques with a diffuse pattern. The patient underwent a right upper VATS lobectomy and mediastinal lymphadenectomy after intraoperative pathology consultation was positive for malignancy. Intraoperative with evidence of multiple hyline pleural plaques and aberrant neoformative lesions, mimicking teeth, on the diaphragm and parietal costal pleura, probably related to asbestos exposure.

Surgical Approach to Colorectal Cancer Pulmonary Metastasis - One-year Experience of a Reference Center.

INTRODUCTION: Colorectal cancer is the third most common malignancy, being associated with metastatic disease in 50% of cases. The lung is the second organ most affected by metastasis in colorectal cancer. In this study, we aim to review the cases submitted to resection of pulmonary colorectal metastasis at Hospital Pulido Valente, comprised in the period from the 1st of January to the 31st of December 2017. METHODS: Retrospective analysis. Data were collected from clinical records. RESULTS: There were 21 patients operated during this period, with a total of 22 surgeries performed, all with curative intent. Data were collected regarding age, gender, site of primary tumour, number of resected lesions, surgical approach, performed procedure, disease-free interval, presence of bilateral disease and existence of extra-pulmonary metastasis. CONCLUSION: Lung metastases are frequent in colorectal cancer. Pulmonary metastasectomy is currently accepted as a potentially curative therapy as part of a multimodal approach to metastatic colorectal cancer.

Surgical Treatment of Complications 55 Years After Extraperiosteal Lucite Ball Plombage for Pulmonary Tuberculosis.

INTRODUCTION: In the 1930-50s, before the introduction of antimicrobial drugs and development of techniques of pulmonary resssection, collapse therapy was the mainstream of treatment for cavitary pulmonary tuberculosis. The methods to achieve the collapse included artificial pneumothorax with air refills, phrenic nerve crush, thoracoplasty and extrapleural plombage. The plombage involves creating a cavity surgically under the ribs in the upper chest wall and filling the space with inert material, such fat, paraffin wax, rubber ballons, oil and methyl-methacrylate (Lucite) balls. The theory behind Plombage treatment is that collapse of the lung promote de healing process and limit the spread of tuberculous infection to other areas of the lung. However, with time, the presence of these materials for a prolonged period of time resulted in complications, such as erosion of major vessels, respiratory insufficiency, infection and migration. METHODS: We present a clinical case of one patient presented with a late complication of lucite ball plombage after 55 years. RESULTS: An 78-year-old man with a history of pulmonary tuberculosis treated with plombage in 1962, ischemic heart disease, hypertension and diabetes mellitus, was admitted to hospital for axillary swelling and pleurocutaneous fistula. The x-ray of the chest and computed tomography showed the apex of the left hemithorax filled with multiple lucite balls, each approximately 2,5cm in diameter, and extrusion of a ball into the axillary fistuluous tract. In this context, the patient complied with multiple antibiotic regimens without success. So, the patient was submitted to surgical extraction of 21 lucite balls, pleurocutaneous drainage and thoracoplasty (7 ribs and the tip of the scapula was remove). The cultures turned out to be negative and the patient made an uneventful recovery with discharge on the 19th postoperative day. Pathologic examination revealed active chronic inflammatory process and negative microorganism screening. CONCLUSION: Despite the rapid decline in collapse therapy since the appearance of antitubercular chemotherapy, there are still such elderly patients who remain asymptomatic while carrying residual plombage material. There is no need for routine ablation of any this material, however if any foreign material becames a source of complication should be extracted without delay. As the number of living patients treated by plombage is attenuating rapidly, fewer and fewer will be seen in the future, and no one is likely to accumulate considerable experience with this problem.

Bilateral Recurrent Spontaneous Pneumothorax as a Late Consequence of Oesophageal Surgery: Case Report.

INTRODUCTION: We report a case of a patient with recurrent bilateral spontaneous pneumothorax presumably originating in a left bulla. METHODS: A 68 year old male, was admitted to the emergency department with shortness of breath and bilateral chest pain. He had had oesophageal cancer resection 2 years before, with a posterior mediastinal reconstruction using a gastric tube. Afterwards he had to be operated twice for hiatal hernia. RESULTS: Bilateral chest tubes were inserted, with complete resolution in 72 hours. He was readmitted 20 days later, with a bilateral recurrence. A pneumologist was called upon. The thoracic CT scan revealed large bulla in the left upper lobe. There was no evidence of pneumomediastinum or mediastinal fluid collections. Communication between the two pleura was suspected. After discussion with the surgeon responsible for the previous interventions only the left chest was drained with bilateral lung expansion after suction. A left VATS approach revealed a partially adherent left lung, in its mediastinal face. Inflated bulla could be partially observed firmly glued to the upper mediastinum. A leak could not be demonstrated within the left thorax. Due to the firm adhesions of a presumably nonruptured bula to the phrenic nerve, a decision was made not to dissect it. A pleurectomy was performed. In the 3 days that followed, the fistula persisted and increased, in spite of lung expansion. A left thoracotomy was then performed. The full extent of the anterior mediastinal face of then left lung was dissected by opening the bulla that were partially left on the mediastinal pleura. Resection was made using tristaple endoGIA staplers ®. The posterior mediastinum was manually dissected free up to the presumed gastric tube location. At the end of surgery, no major air leaks were documented. Communication with the right pleura could not be located, not even with the aid of a 30o camera, but a large amount of fluid (1000cc) missing, was recovered after turning the patient. The postoperative period was prolonged ut to the 16th day, by a small but persistent air leak. CONCLUSION: Although no visual proof of communication between the two pleural cavities could be found, the control of the right pneumotorax by contralateral drainage, the resolution of the case by left pleurectomy and bulla resection backup this theory. This is an unique case, not previously reported, resolved by a multidisciplinary discussion of all the specialists involved in the treatment.

Surgical Treatment for Elderly Patients with Lung Cancer.

INTRODUCTION: Non-small cell lung cancer is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Pulmonary resection is often not recommended in the elderly, even though they have no medical contraindications to surgery. Such patients are postulated to have a limited life expectancy, the rate of complications and perioperative death is considered to be higher than younger population. However, decision making is extremely difficult, since this group in under- represented in clinical trials. METHODS: This study aim to do a retrospective analysis of comorbidity, surgical procedures and pos- operative complications for surgery in patients older than 70 years of age who underwent a pulmonary resection for lung cancer. We analysed the clinical records of all patients with Non-small cell lung cancer submitted to surgery during the period 2012 to 2016 in our department and divide them in 2 groups: elderly group (more than 70 years old) and group control. RESULTS: In the five years study period, our department performed pulmonary resection in 601 patients with NSCLC, of whom 209 (34,8%) were 70 years and older. The mean age was 74,6 years old in the elderly group and 58,6 in the control group. Preoperative comorbidities such as cardiac and previous neoplasic diseases were more frequent in the elderly group, and the percentage of smokers was higher in the control group (80,1% vs 61,7%). A segmentar or wedge resection was performed more frequent for the elderly group (16,7%) than in the control group (6,6%), whereas pneumonectomies and lobectomies were performed more frequently. The ratio of pos-operative complications, especially cardiac complications, was higher in the elderly patients (12,9% vs 8,2%), however, there was no significant difference in prevalence of pulmonary/ respiratory complications, such pulmonary leakage, pneumonia or empyema between the 2 groups. There was no operative or hospital death in any of the groups. CONCLUSION: Advanced age alone is not a contraindication to surgical resection on NSCLC. Elderly patients should be offered the best treatment possible, considering surgical risk on an individualized basis, and keeping in mind that surgery offers the best results when the disease is resectable.

Unusual Behavior of a Lung Inflammatory Myofibroblastic Tumor: Case Report.

INTRODUCTION: 55 years old, male patient. History of heavy smoking (65 UMA) and COPD. Admitted to hospital due to a left pneumonia. Thoracic CT and PET-Scan, showed left lower lobe mass measuring 92x89 mm (SUVmax 49). Several mediastinal node groups presented increased uptake of FDG. A fiberoptic bronchoscopy was performed. Citology of the bronchoalveolar lavage suggested a squamous carcinoma. EBUS of node stations 4R, 4L e 7 without evidence of malignancy. METHODS: The case was taken to a multidisciplinary meeting staged as IIIA (T3N2M0). Neoadjuvant therapy (four cycles cysplatine and gemcitabine) was decided based on station 5, suspected disease. A left lower lobectomy was performed after a cervical mediastinoscopy excluded metastasis of node stations 4R and 4L. Histology of the specimen was compatible with inflammatory myofibroblastic tumor (IMT). No lymph node involvement was reported. It was restaged as IIB (ypT3N0M0). RESULTS: Three months after surgery one de novo nodule in the lingula with 12,7 of SUVmax was reported. The nodule was removed confirming a IMT metastasis. Four months after the nodule ressection a CT showed new lung and liver nodules. A total oclusion of the left main bronchus was documented and bronchoscopic debulking of the endobronchial mass again revealed IMT. Paliative radiotherapy was decided in the multidisciplinar group targeting the left main bronchus (five sessions of radiotherapy on a dose of 20Gy in 4Gy daily fractions). Ten months after surgery due to the onset of back pain, a CT revealed a sacrum lesion whose needle biopsy was suspicious for multiple myeloma. The patient was referred to another oncological center where previous non-surgical cases had been sent in the past. The patient is now proposed for histology reassessment and discussion by the hematology and pneumology medical teams. CONCLUSION: Inflammatory myofibrobastic tumors are considered benign or low-grade malignant tumors. The size of the tumour (cut-off of 3 cm) and secure surgical resection with free margins are the major determinants for recurrence and survival. There are some cases reported in the literature of distant metastasis and sarcomatous transformation after multiple recurrences. In our patient, the lesion was bigger than 3 cm and he underwent a complete resection. Nothing could foresee this aggressive metastatic behavior, especially when the recurrence did not show a sarcomatous transformation.

Preservation of high glycolytic phenotype by establishing new acute lymphoblastic leukemia cell lines at physiologic oxygen concentration.

Cancer cells typically exhibit increased glycolysis and decreased mitochondrial oxidative phosphorylation, and they continue to exhibit some elevation in glycolysis even under aerobic conditions. However, it is unclear whether cancer cell lines employ a high level of glycolysis comparable to that of the original cancers from which they were derived, even if their culture conditions are changed to physiologically relevant oxygen concentrations. From three childhood acute lymphoblastic leukemia (ALL) patients we established three new pairs of cell lines in both atmospheric (20%) and physiologic (bone marrow level, 5%) oxygen concentrations. Cell lines established in 20% oxygen exhibited lower proliferation, survival, expression of glycolysis genes, glucose consumption, and lactate production. Interestingly, the effects of oxygen concentration used during cell line initiation were only partially reversible when established cell cultures were switched from one oxygen concentration to another for eight weeks. These observations indicate that ALL cell lines established at atmospheric oxygen concentration can exhibit relatively low levels of glycolysis and these levels are semi-permanent, suggesting that physiologic oxygen concentrations may be needed from the time of cell line initiation to preserve the high level of glycolysis commonly exhibited by leukemias in vivo.

Conquering pressure! The effects of mild-anxiety training on motor performance under pressure during early motor learning.

We conceptually replicated the one previous study (see record 2009-13549-001) revealing that individuals who practice a motor skill under psychological pressure (anxiety training-AT) avoid performance deterioration when exposed to higher levels of pressure. We used a >3× larger sample size than the original study and attempted to shed light on mechanisms whereby AT may promote performance under pressure by measuring variables related to three theories of choking under pressure: attentional control theory (ACT), reinvestment theory, and the biopsychosocial model (BPSM) of challenge and threat. Eighty-four participants practiced 300 golf putts over 2 days with mild psychological pressure manipulations (AT group) or no pressure manipulations (control group). On the third day, all participants completed putting posttests with no pressure manipulations, mild pressure manipulations, or high-pressure manipulations. We had participants report their mental effort, movement reinvestment, and perceived challenge/threat after each posttest to investigate ACT, reinvestment theory, and the BPSM of challenge and threat, respectively. Results showed the AT group maintained their performance across posttests, whereas the control group performed worse under pressure. Additionally, results indicated that AT moderated changes in mental effort and movement reinvestment during pressure, although neither mechanism mediated the relationship between AT and performance under pressure. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An overlooked relationship in recovery from substance use disorders: Associations between body mass index and negative emotional states.

Recovery from substance use disorders (SUD) is multifactorial. Being overweight could negatively impact physiological and psychological health-related parameters. Using model selection, we examined associations between body mass index (BMI) and negative emotional states (NES; e.g., stress, anxiety, depression) in 54 men with SUD and under treatment in five different therapeutic recovery centers. We found that BMI was positively associated with stress (p < .001), anxiety (p < .001), and depression (p = .002). Therefore, our findings suggest that decreasing the accumulation of body fat might contribute to improving mental health in individuals with SUD during recovery.

Associations between delay discounting and unhealthy behaviors in substance use recovery.

BACKGROUND: Research on delay discounting (DD) is mixed on whether DD is a domain-specific component related to specific behaviors or a domain-general process that cuts across various behaviors. A pivotal group to test the associations between DD and unhealthy behaviors is individuals in recovery from substance use disorders (SUD), as they are moving away from a disorder toward a healthier state. METHODS: Individuals in SUD recovery (n = 317) completed the Temptation Scale, the Health Behaviors Questionnaire, and an Adjusting Delay Discounting Task. An exhaustive model space search was performed using linear regression to examine associations between DD with temptation, engagement in unhealthy behaviors, and the total number of unhealthy behaviors participants engage in. We also tested whether remission status is associated with the total number of unhealthy behaviors participants engage in. RESULTS: Results revealed that DD was positively associated with poor eating (p<.001), physical inactivity (p=.003), financial irresponsibility (p<.001), risky behaviors (p<.001), lack of personal development goals (p<.001), lack of household savings (p=.004), and lack of health behaviors (p=.003). DD was also positively associated with the total number of unhealthy behaviors participants engage in (p<.001). Participants who were not in remission engaged in more unhealthy behaviors compared to those who were in remission (p<.001). CONCLUSION: In a sample of individuals in recovery from SUD, DD is not domain-specific and undergirds engagement in several maladaptive health behaviors that can negatively impact recovery. Thus, DD can be a target for interventions aiming to reduce other maladaptive behaviors in SUD recovery.

Results Of Minimally Invasive Vats Thymectomy In Miastenia Gravis Patients Compared With More Invasive Approaches - 10-Year Experience In A Single Center.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune, neurologic disease that causes a wide range of symptoms. While the transsternal, transcervical and thoracotomy approaches are accepted as effective, there is still debate regarding the VATS approach. MATERIALS AND METHODS: We analyzed our center's surgical experience with thymectomy for myasthenia gravis, comparing the results of patients operated on using VATS and more invasive approaches, over a period of 10 years. A search of the department's surgical database for myasthenia gravis cases between January 2010 and January 2021, revealed a total of 40 cases. Twenty-four patients were included in the final analysis and were distributed into two groups: the VATS procedure group (group A) and the open procedure group (group B). The latter included sternotomy, thoracotomy, transcervical and hemiclamshell approaches. Only radical thymectomies were included. The established outcomes were clinical improvement defined as asymptomatic remission, reduction, or discontinuation of the medication necessary to achieve optimal symptom control. RESULTS: The median follow-up time was 27 months (ranging from 4 to 75 months). Videothoracoscopy radical thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement (reduced symptoms or decreased medication) was observed in 8 cases (66.6%). No change in clinical outcome was noted in 1 patient (8.3%). None of the patients reported worsening symptoms. Open thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement was noted in 6 cases (50%). No change in clinical outcome was observed in 3 patients (25%) whereas 2 of them (16.7%) experienced slightly better symptom control but with a significant increase in medication. One patient (8.3%) described the clinical results as without any significant change. None of the patients reported worsening symptoms. CONCLUSION: The videotoracoscopic approach in the treatment of myasthenia gravis is non-inferior compared to the open approach and effective in a long-term follow-up, offering all the additional benefits of less invasive surgery.

Cost-effectiveness of lung cancer screening with volume computed tomography in Portugal.

Aim: Lung cancer is the most common cause of cancer death in Portugal. The Dutch-Belgian lung cancer screening (LCS) study (NELSON), the biggest European LCS study, showed a lung cancer mortality reduction in a high-risk population when being screened. In this study, the cost-effectiveness of LCS, based on the NELSON study protocol and outcomes, was evaluated compared with no screening in Portugal. Methods: The present study modified an established decision tree by incorporating a state-transition Markov model to evaluate the health-related advantages and economic implications of low-dose computed tomography (LDCT) LCS from the healthcare standpoint in Portugal. The analysis compared screening versus no screening for a high-risk population aged 50-75 with a smoking history. Various metrics, including clinical outcomes, costs, quality-adjusted life years (QALYs), life-years (LYs) and the incremental cost-effectiveness ratio (ICER), were calculated to measure the impact of LDCT LCS. Furthermore, scenario and sensitivity analyses were executed to assess the robustness of the obtained results. Results: Annual LCS with volume-based LDCT resulted in €558 million additional costs and 86,678 additional QALYs resulting in an ICER of €6440 per QALY for one screening group and a lifetime horizon. In total, 13,217 premature lung cancer deaths could be averted, leading to 1.41 additional QALYs gained per individual diagnosed with lung cancer. Results are robust based on the sensitivity analyses. Conclusion: This study showed that annual LDCT LCS for a high-risk population could be cost-effective in Portugal based on a willingness to pay a threshold of one-time the GDP (€19,290 per QALY gained).

Sit less and move more! A cross-sectional study of the associations between physical activity and sedentary behaviors with inhibitory control in Brazilian adults.

OBJECTIVE: To investigate the independent and joint associations between sedentary behaviors (SB) and physical activity (PA) with inhibitory control (IC) in adults. METHODS: A total of 111 participants (median age = 30 years; 60% women), completed the Stroop Color-Words test to assess IC. They also wore accelerometers for seven days to measure SB, light PA, moderate-to-vigorous PA (MVPA), and daily steps. We previously set cutoff points for SB and PA measurements and tested them to determine their association with IC. All analyses were adjusted for potential confounding factors including age, gender, post-secondary education, income, body mass index, and accelerometer wear time. RESULTS: Low SB, high MVPA, and high daily steps were independently associated with a better IC compared to their respective counterparts. Adults with low levels of SB and light PA demonstrated better IC performance (ß = -227.67, 95%CI = -434.14 to -21.20) compared to those with high SB and low light PA. Conversely, individuals with high SB and high light PA exhibited worse performance (ß = 126.80, 95%CI = 2.11 to 251.50) than those in the high SB and low light PA group. Furthermore, the joint association of low SB with high MVPA (ß = -491.12, 95%CI = -689.23 to -293.01) or low SB with high daily steps (ß = -254.29, 95%CI = -416.41 to -92.16) demonstrated better IC performance compared to those with high SB and low MVPA or low daily steps. CONCLUSION: Our findings highlight independent and joint associations between low SB, high MVPA, and high daily steps with enhanced IC in adults.

Effectiveness of an affect-adjusted, supervised, multimodal, online and home-based exercise group protocol for major depression: A randomized controlled trial.

This randomized controlled trial investigated the effectiveness of an affect-adjusted, supervised, multimodal, online, and home-based exercise group protocol as an adjunct therapy to antidepressants on depressive symptoms, cardiorespiratory fitness, and side effects related to antidepressants in adults with major depression (MDD, diagnosed by a clinician). Depressive symptom scales were administered by a psychiatrist and self-reported. A health-related measure (i.e., cardiorespiratory fitness), was also administered. The exercise intervention was adjusted by perceived effort and affect (pleasure and enjoyment) toward exercise and lasted 12 weeks. In total, 59 adults with MDD were divided into two groups: the exercise-group (EG; exercise + pharmacotherapy) with 26-patients (76.9 % females, mean age 28.5 years) and the control-group (CG, pharmacotherapy) with 33-patients (78.7 % females, mean age 25.6 years). The EG had a lower dropout rate (15.3 %) than CG and an increase in cardiorespiratory fitness (CRF), which was not observed in the CG. Both groups showed a decrease in self-reported depressive symptoms. However, the EG had significantly lower depressive symptom scores at t1 and t2. The EG also had higher remission rates (t1, EG: = 42.3 % and CG = 27.2 %) and remission rates (t2, EG: = 72.7 % and CG = 48.1 %) than CG, which were maintained during the four month follow-up. Side effects from anti-depressant medication were larger in the EG compared to CG. Complementing usual care for MDD with exercise resulted in better clinical outcomes and supports the use of this type of exercise protocol in the clinical management of depression.