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Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial

Authors: Therese Eskilsson, Lisbeth Slunga Järvholm, Hanna Malmberg Gavelin, Anna Stigsdotter Neely, Carl-Johan Boraxbekk

Published in: BMC Psychiatry | Issue 1/2017

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Abstract

Background

Patients with stress-related exhaustion suffer from cognitive impairments, which often remain after psychological treatment or work place interventions. It is important to find effective treatments that can address this problem. Therefore, the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program.

Methods

In this open-label, parallel, randomized and controlled trial, 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program. After 12 weeks in the program the patients were randomized to either a 12-week aerobic training intervention or to a control group with no additional training. Primary outcome measure was cognitive function, and secondary outcome measures were psychological health variables and aerobic capacity.

Results

In total, 51% patients in the aerobic training group and 78% patients in the control group completed the intervention period. The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance. No additional improvement in burnout, depression or anxiety was observed in the aerobic group compared with controls.

Conclusion

Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory. A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group.

Trial registration

ClinicalTrials.gov: NCT03073772. Retrospectively registered 21 February 2017.
Literature
1.
go back to reference Swedish Social Insurance Agency. Psykisk ohälsa. Korta analyser 2016:2. ISBN:978-91-7500-394-8. (Mental illness. Short analyzes 2016:2) (in Swedish). Swedish Social Insurance Agency. Psykisk ohälsa. Korta analyser 2016:2. ISBN:978-91-7500-394-8. (Mental illness. Short analyzes 2016:2) (in Swedish).
2.
go back to reference Grossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol. 2015;56:626–36.CrossRefPubMed Grossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol. 2015;56:626–36.CrossRefPubMed
3.
go back to reference National board of Health and Welfare. Utmattningssyndrom. Stressrelaterad psykisk ohälsa. [Exhaustion syndrome. Stress related mental poor health.]. Stockholm: Bjurner & Bruno AB; 2003. (in Swedish) National board of Health and Welfare. Utmattningssyndrom. Stressrelaterad psykisk ohälsa. [Exhaustion syndrome. Stress related mental poor health.]. Stockholm: Bjurner & Bruno AB; 2003. (in Swedish)
6.
go back to reference Stenlund T, Nordin M, Järvholm LS. Effects of rehabilitation programmes for patients on long-term sick leave for burnout: a 3-year follow-up of the REST-study. J Rehabil Med. 2012;44:684–90. Stenlund T, Nordin M, Järvholm LS. Effects of rehabilitation programmes for patients on long-term sick leave for burnout: a 3-year follow-up of the REST-study. J Rehabil Med. 2012;44:684–90.
7.
go back to reference Oosterholt B, Van der Linden D, Maes J, Verbraak M, Kompier M. Burned out cognition- cognitive functioning of burnout patients before and after a period with psychological treatment. Scand J Work Environ Health. 2012;38(4):358–69.CrossRefPubMed Oosterholt B, Van der Linden D, Maes J, Verbraak M, Kompier M. Burned out cognition- cognitive functioning of burnout patients before and after a period with psychological treatment. Scand J Work Environ Health. 2012;38(4):358–69.CrossRefPubMed
8.
go back to reference Österberg K, Karlsson B, Malmberg B, Hansen Å. A follow-up of cognitive performance and diurnal salivary cortisol changes in former burnout patients. Stress. 2012;15:589–600.CrossRefPubMed Österberg K, Karlsson B, Malmberg B, Hansen Å. A follow-up of cognitive performance and diurnal salivary cortisol changes in former burnout patients. Stress. 2012;15:589–600.CrossRefPubMed
9.
go back to reference Malmberg Gavelin H, Boraxbekk CJ, Stenlund T, Järvholm LS, Neely AS. Effects of a process-based cognitive training intervention for patients with stress-related exhaustion. Stress. 2015;18:578–88. Malmberg Gavelin H, Boraxbekk CJ, Stenlund T, Järvholm LS, Neely AS. Effects of a process-based cognitive training intervention for patients with stress-related exhaustion. Stress. 2015;18:578–88.
10.
go back to reference Hillman C, Erickson K, Kramer A. Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev Neurosci. 2008;9:58–65.CrossRefPubMed Hillman C, Erickson K, Kramer A. Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev Neurosci. 2008;9:58–65.CrossRefPubMed
11.
go back to reference Jonasson L, Nyberg L, Kramer A, Lundquist A, Riklund K, Boraxbekk CJ. Aerobic exercise intervention, cognitive performance, and brain structure: results from the physical influencee on brain in aging (PHIBRA) study. Front Aging Neurosci. 2017;8:336. doi:10.3389/fnagi.2016.00336. Jonasson L, Nyberg L, Kramer A, Lundquist A, Riklund K, Boraxbekk CJ. Aerobic exercise intervention, cognitive performance, and brain structure: results from the physical influencee on brain in aging (PHIBRA) study. Front Aging Neurosci. 2017;8:336. doi:10.​3389/​fnagi.​2016.​00336.
12.
go back to reference Boraxbekk CJ, Salami A, Wåhlin A, Nyberg L. Physical activity over a decade modifies age-related decline in perfusion, gray matter volume, and functional connectivity of the posterior default-mode network - a multimodal approach. NeuroImage. 2016;131:133–41.CrossRefPubMed Boraxbekk CJ, Salami A, Wåhlin A, Nyberg L. Physical activity over a decade modifies age-related decline in perfusion, gray matter volume, and functional connectivity of the posterior default-mode network - a multimodal approach. NeuroImage. 2016;131:133–41.CrossRefPubMed
13.
go back to reference Stanton R, Reaburn P. Exercise and the treatment of depression: a review of the exercise program variables. J Sci Med Sport. 2014;17:177–82.CrossRefPubMed Stanton R, Reaburn P. Exercise and the treatment of depression: a review of the exercise program variables. J Sci Med Sport. 2014;17:177–82.CrossRefPubMed
14.
go back to reference Beck J, Gerber M, Brand S, Puhse U, Holsboer-Trachler E. Executive function performance is reduced during occupational burnout but can recover to the level of healthy controls. J Psychiatr Res. 2013;47:1824–30.CrossRefPubMed Beck J, Gerber M, Brand S, Puhse U, Holsboer-Trachler E. Executive function performance is reduced during occupational burnout but can recover to the level of healthy controls. J Psychiatr Res. 2013;47:1824–30.CrossRefPubMed
15.
go back to reference Swedish professional associations for physical activity. Physical activity in the prevention and treatment of disease. Stockholm: Swedish National Institue of Public Health; 2010. Swedish professional associations for physical activity. Physical activity in the prevention and treatment of disease. Stockholm: Swedish National Institue of Public Health; 2010.
16.
go back to reference Dureman I, Kebbon L, Österberg E. Manual till DS-batteriet [manual for the DS-battery]. Stockholm: Psykologiförlaget; 1971. (in Swedish) Dureman I, Kebbon L, Österberg E. Manual till DS-batteriet [manual for the DS-battery]. Stockholm: Psykologiförlaget; 1971. (in Swedish)
17.
go back to reference Åstrand P, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7:218–21.PubMed Åstrand P, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7:218–21.PubMed
18.
go back to reference Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex "frontal lobe" tasks: a latent variable analysis. Cogn Psychol. 2000;41:49–100.CrossRefPubMed Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex "frontal lobe" tasks: a latent variable analysis. Cogn Psychol. 2000;41:49–100.CrossRefPubMed
19.
go back to reference Sandberg P, Rönnlund M, Nyberg L, Neely AS. Executive process training in young and old adults. Aging Neuropsychol Cogn. 2014;21:577–605.CrossRef Sandberg P, Rönnlund M, Nyberg L, Neely AS. Executive process training in young and old adults. Aging Neuropsychol Cogn. 2014;21:577–605.CrossRef
20.
go back to reference Delis DC, Kaplan E, Kramer JH. Delis-Kaplan executive functioning system (D-KEFS). San Antonio: The Psychological Corporation; 2001. Delis DC, Kaplan E, Kramer JH. Delis-Kaplan executive functioning system (D-KEFS). San Antonio: The Psychological Corporation; 2001.
21.
go back to reference Wechsler D. Wechsler adult Intelligance scale - revised manual. San Antonio: The Psychological Corporation; 1981. Wechsler D. Wechsler adult Intelligance scale - revised manual. San Antonio: The Psychological Corporation; 1981.
22.
go back to reference Wechsler D. Wechsler adult intelligence scale - third edition. San Antonio: The Psychological Corporation; 1997. Wechsler D. Wechsler adult intelligence scale - third edition. San Antonio: The Psychological Corporation; 1997.
23.
go back to reference Buschke H. Selective reminding for analysis of memory and learning. J Verb Learn Verb Behav. 1973;12:543–50.CrossRef Buschke H. Selective reminding for analysis of memory and learning. J Verb Learn Verb Behav. 1973;12:543–50.CrossRef
24.
go back to reference Raven J, Raven JC, Court JH. Manual for Raven’s progressive matrices and vocabulary scales. Assessment. Oxford: Oxford Psychlogists Press; 1998. Raven J, Raven JC, Court JH. Manual for Raven’s progressive matrices and vocabulary scales. Assessment. Oxford: Oxford Psychlogists Press; 1998.
25.
go back to reference Melamed S, Kushnir T, Shirom A. Burnout and risk factors for cardiovascular diseases. Behav Med. 1992;18:53–60.CrossRefPubMed Melamed S, Kushnir T, Shirom A. Burnout and risk factors for cardiovascular diseases. Behav Med. 1992;18:53–60.CrossRefPubMed
26.
go back to reference Grossi G, Perski A, Evengård B, Blomkvist V, Orth-Gomér K. Physiological correlates of burnout among women. J Psychosom Res. 2003;55:309–16.CrossRefPubMed Grossi G, Perski A, Evengård B, Blomkvist V, Orth-Gomér K. Physiological correlates of burnout among women. J Psychosom Res. 2003;55:309–16.CrossRefPubMed
27.
go back to reference Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
28.
go back to reference Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52:69–77.CrossRefPubMed Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52:69–77.CrossRefPubMed
29.
go back to reference Erickson K, Voss M, Prakash R, Basak C, Szabo A, Chaddock L, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011;108:3017–22.CrossRefPubMedPubMedCentral Erickson K, Voss M, Prakash R, Basak C, Szabo A, Chaddock L, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011;108:3017–22.CrossRefPubMedPubMedCentral
30.
go back to reference Thomas A, Dennis A, Rawlings N, Stagg C, Matthews L, Morris M, et al. Multi-modal characterization of rapid anterior hippocampal volume increase associated with aerobic exercise. NeuroImage. 2016;131:162–70.CrossRefPubMed Thomas A, Dennis A, Rawlings N, Stagg C, Matthews L, Morris M, et al. Multi-modal characterization of rapid anterior hippocampal volume increase associated with aerobic exercise. NeuroImage. 2016;131:162–70.CrossRefPubMed
31.
go back to reference Fischl B, Salat D, Busa E, Albert M, Dieterich M, Haselgrove C, et al. Whole brain segmentation: Neurotechnique automated labeling of Neuroanatomical structures in the human brain. Neuron. 2002;33:341–55.CrossRefPubMed Fischl B, Salat D, Busa E, Albert M, Dieterich M, Haselgrove C, et al. Whole brain segmentation: Neurotechnique automated labeling of Neuroanatomical structures in the human brain. Neuron. 2002;33:341–55.CrossRefPubMed
32.
go back to reference Reuter M, Schmansky NJ, Diana Rosas H, Fischl B. Within-subject template estimation for unbiased longitudinal image analysis. NeuroImage. 2012;61:1402–18.CrossRefPubMedPubMedCentral Reuter M, Schmansky NJ, Diana Rosas H, Fischl B. Within-subject template estimation for unbiased longitudinal image analysis. NeuroImage. 2012;61:1402–18.CrossRefPubMedPubMedCentral
33.
go back to reference Cohen J. Statistical power analysis for the behavioral sciences. Mahwah: Erlbaum; 1988. Cohen J. Statistical power analysis for the behavioral sciences. Mahwah: Erlbaum; 1988.
34.
go back to reference Jonsdottir IH, Nordlund A, Ellbin S, Ljung T, Glise K, Währborg P, et al. Cognitive impairment in patient with stress-related exhaustion. Stress. 2013;16:181–90.CrossRefPubMed Jonsdottir IH, Nordlund A, Ellbin S, Ljung T, Glise K, Währborg P, et al. Cognitive impairment in patient with stress-related exhaustion. Stress. 2013;16:181–90.CrossRefPubMed
35.
go back to reference Erickson KI, Hillman CH, Kramer AF. Physical activity, brain and cognition. Curr Opin Behav Sci. 2015;4:27–32.CrossRef Erickson KI, Hillman CH, Kramer AF. Physical activity, brain and cognition. Curr Opin Behav Sci. 2015;4:27–32.CrossRef
36.
go back to reference Hötting K, Reich B, Holzschneider K, Kauschke K, Schmidt T, Reer R, et al. Differential cognitive effects of cycling versus stretching/coordination training in middle-aged adults. Health Psychol. 2012;31:145–55.CrossRefPubMed Hötting K, Reich B, Holzschneider K, Kauschke K, Schmidt T, Reer R, et al. Differential cognitive effects of cycling versus stretching/coordination training in middle-aged adults. Health Psychol. 2012;31:145–55.CrossRefPubMed
37.
go back to reference Keary TA, Galioto R, Hughes J, Waechter D, Spitznagel MB, Rosneck J, et al. Reduced heart rate recovery is associated with poorer cognitive function in older adults with cardiovascular disease. Cardiovasc Psychiatry Neurol. 2012; doi:10.1155/2012/392490. Keary TA, Galioto R, Hughes J, Waechter D, Spitznagel MB, Rosneck J, et al. Reduced heart rate recovery is associated with poorer cognitive function in older adults with cardiovascular disease. Cardiovasc Psychiatry Neurol. 2012; doi:10.​1155/​2012/​392490.
39.
go back to reference Gerber M, Jonsdottir IH, Arvidsson A, Lindwall M, Lindegård A. Promoting graded exercise as a part of multimodal treatment in patients diagnosed with stress-related exhaustion. J Clin Nurs. 2015;24:1904–15.CrossRefPubMed Gerber M, Jonsdottir IH, Arvidsson A, Lindwall M, Lindegård A. Promoting graded exercise as a part of multimodal treatment in patients diagnosed with stress-related exhaustion. J Clin Nurs. 2015;24:1904–15.CrossRefPubMed
41.
go back to reference Gerber M, Brand S, Herrmann C, Colledge F, Holsboer-Trachsler E, Pühse U. Increased objectively assessed vigorous-intensity exercise is associated with reduced stress, increased mental health and good objective and subjective sleep in young adults. Physiol Behav. 2014;135:17–24.CrossRefPubMed Gerber M, Brand S, Herrmann C, Colledge F, Holsboer-Trachsler E, Pühse U. Increased objectively assessed vigorous-intensity exercise is associated with reduced stress, increased mental health and good objective and subjective sleep in young adults. Physiol Behav. 2014;135:17–24.CrossRefPubMed
42.
go back to reference Elliot CE, Lang C, Brand S, Holsboer-Trachsler E, Pühse U, Gerber M. The relationship between meeting vigorous physical activity recommendations and burnout symptoms among adolescents: an exploratory study with vocational students. J Sport Exerc Psychol. 2015;37:180–92.CrossRefPubMed Elliot CE, Lang C, Brand S, Holsboer-Trachsler E, Pühse U, Gerber M. The relationship between meeting vigorous physical activity recommendations and burnout symptoms among adolescents: an exploratory study with vocational students. J Sport Exerc Psychol. 2015;37:180–92.CrossRefPubMed
43.
go back to reference Gerber M, Börjesson M, Ljung T, Lindwall M, Jonsdottir IH. Fitness moderates the relationship between stress and cardiovascular risk factors. Med Sci Sports Exerc. 2016;48:2075–81.CrossRefPubMed Gerber M, Börjesson M, Ljung T, Lindwall M, Jonsdottir IH. Fitness moderates the relationship between stress and cardiovascular risk factors. Med Sci Sports Exerc. 2016;48:2075–81.CrossRefPubMed
44.
go back to reference Rödjer L, Jonsdottir IH, Börjesson M. Physical activity on prescription (PAP): self-reported physical activity and quality of life in a Swedish primary care population, 2-year follow-up. Scand J Prim Health Care. 2016;34(4):443–52.CrossRefPubMedPubMedCentral Rödjer L, Jonsdottir IH, Börjesson M. Physical activity on prescription (PAP): self-reported physical activity and quality of life in a Swedish primary care population, 2-year follow-up. Scand J Prim Health Care. 2016;34(4):443–52.CrossRefPubMedPubMedCentral
46.
go back to reference Stubbs B, Vancampfort D, Rosenbaum S, Ward PB, Richards J, Soundy A, et al. Dropout from exercise randomized controlled trials among people with depression:a meta-analysis and meta regression. J Affect Disord. 2016;190:457–66.CrossRefPubMed Stubbs B, Vancampfort D, Rosenbaum S, Ward PB, Richards J, Soundy A, et al. Dropout from exercise randomized controlled trials among people with depression:a meta-analysis and meta regression. J Affect Disord. 2016;190:457–66.CrossRefPubMed
47.
go back to reference Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care. 2006;15:307–10.CrossRefPubMedPubMedCentral Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care. 2006;15:307–10.CrossRefPubMedPubMedCentral
Metadata
Title
Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial
Authors
Therese Eskilsson
Lisbeth Slunga Järvholm
Hanna Malmberg Gavelin
Anna Stigsdotter Neely
Carl-Johan Boraxbekk
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1457-1

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