{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:17:10Z","timestamp":1785424630018,"version":"3.56.0"},"reference-count":58,"publisher":"Royal College of Psychiatrists","issue":"1","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"unspecified","delay-in-days":226,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur. Psychiatr."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0924933825100850_sec1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many patients with major depressive disorder (MDD) do not respond sufficiently to first-line treatments. Due to its biological and psychological mechanisms, exercise may enhance the effectiveness of other MDD treatments. In a pragmatic randomised superiority trial, we evaluated the clinical and cost-effectiveness of exercise therapy adjunct to guideline-concordant care as usual (CAU) for MDD in specialised mental health care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933825100850_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      MDD outpatients (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0112; Mage\u00a0=\u00a037; 51% female) were randomized to CAU (96.9% psychotherapy, 59% pharmacotherapy) or CAU\u00a0+\u00a0EX (CAU plus 12\u00a0weeks of exercise therapy: one supervised and two home-based aerobic sessions\/week). Depressive symptoms were assessed using the Inventory of Depressive Symptomatology-Self Report. Remission was evaluated during follow-up by blinded assessors using the Structured Clinical Interview for DSM-5. The economic evaluation followed a societal perspective.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933825100850_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients in the CAU\u00a0+\u00a0EX condition were significantly more likely than those in CAU to meet the exercise prescription; however, only 22% fully adhered to it. Depressive symptoms decreased from severe to moderate depression in both conditions, with no significant difference between the conditions on symptom reduction (\n                      <jats:italic>b<\/jats:italic>\n                      \u00a0=\u00a0\u22120.22, [\u22120.72, 0.29]) or remission rate (OR\u00a0=\u00a00.06, [\u22120.20, 0.32]). Evidence for cost-effectiveness was found in the per-protocol (\u2265 six supervised exercise sessions) but not in the intention-to-treat sample.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0924933825100850_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adjunct exercise therapy does not provide additional clinical benefits or cost-effectiveness in specialized mental health care. Low adherence to the exercise prescription limits its potential. Cost-effectiveness may be achievable with higher adherence, warranting emphasis on strategies to improve adherence in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/j.eurpsy.2025.10085","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T09:49:13Z","timestamp":1755251353000},"source":"Crossref","is-referenced-by-count":1,"title":["The (cost-)effectiveness of exercise therapy adjunct to guideline-concordant care for depression: a pragmatic randomised controlled trial"],"prefix":"10.1192","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6664-7187","authenticated-orcid":false,"given":"Michele","family":"Schmitter","sequence":"first","affiliation":[{"name":"Pro Persona Mental Health Care"},{"name":"Radboud University Nijmegen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7993-1905","authenticated-orcid":false,"given":"Ben","family":"Wijnen","sequence":"additional","affiliation":[{"name":"Trimbos Institute (Netherlands Institute of Mental Health and Addiction)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daan","family":"Creemers","sequence":"additional","affiliation":[{"name":"Radboud University Nijmegen"},{"id":[{"id":"https:\/\/ror.org\/05p2mb588","id-type":"ROR","asserted-by":"publisher"}],"name":"GGZ Oost Brabant"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Van Dorp","sequence":"additional","affiliation":[{"name":"GGNet Network for Mental Health Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Oostelbos","sequence":"additional","affiliation":[{"name":"Dutch Depression Association"},{"name":"De Hartenboom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Tendolkar","sequence":"additional","affiliation":[{"name":"Radboud University Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1633-9693","authenticated-orcid":false,"given":"Jasper","family":"Smits","sequence":"additional","affiliation":[{"name":"University of Texas at Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Spijker","sequence":"additional","affiliation":[{"name":"Pro Persona Mental Health Care"},{"name":"Radboud University Nijmegen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna","family":"Vrijsen","sequence":"additional","affiliation":[{"name":"Pro Persona Mental Health Care"},{"name":"Radboud University Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"S0924933825100850_r43","doi-asserted-by":"publisher","DOI":"10.1002\/9780470316696"},{"key":"S0924933825100850_r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2014.11.005"},{"key":"S0924933825100850_r54","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.469"},{"key":"S0924933825100850_r36","volume-title":"Structured clinical interview for DSM-5\u2014research version (SCID-5 for DSM-5, research version; SCID-5-RV, version 1.0.0)","author":"First","year":"2015"},{"key":"S0924933825100850_r31","doi-asserted-by":"publisher","DOI":"10.1139\/h11-062"},{"key":"S0924933825100850_r27","first-page":"2010","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"8","author":"Schulz","journal-title":"BMC Med"},{"key":"S0924933825100850_r21","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.10m06743"},{"key":"S0924933825100850_r28","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-11-80"},{"key":"S0924933825100850_r2","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.14m09298"},{"key":"S0924933825100850_r38","volume-title":"Trimbos\/ iMTA questionnaire for costs associated with psychiatric illness (TIC-P)","author":"Hakkaart-van Roijen","year":"2002"},{"key":"S0924933825100850_r51","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2020.105974"},{"key":"S0924933825100850_r30","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"S0924933825100850_r11","doi-asserted-by":"publisher","DOI":"10.1097\/01.pra.0000430504.16952.3e"},{"key":"S0924933825100850_r29","unstructured":"[29] Zorginstituut Nederland. 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