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A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets

Published online by Cambridge University Press:  24 August 2020

C. J. Brush
Department of Psychology, Florida State University, Tallahassee, FL, USA Department of Kinesiology and Health and Center of Alcohol & Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
Greg Hajcak
Department of Psychology, Florida State University, Tallahassee, FL, USA
Anthony J. Bocchine
Department of Kinesiology and Health and Center of Alcohol & Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
Andrew A. Ude
Department of Kinesiology and Health and Center of Alcohol & Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
Kristina M. Muniz
Department of Kinesiology and Health and Center of Alcohol & Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, NJ, USA Department of Psychiatry and Neurobehavioral Sciences, Division of Child and Family Psychiatry, University of Virginia Health System, Charlottesville, VA, USA
Dan Foti
Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
Brandon L. Alderman
Department of Kinesiology and Health and Center of Alcohol & Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
E-mail address:



Aerobic exercise has demonstrated antidepressant efficacy among adults with major depression. There is a poor understanding of the neural mechanisms associated with these effects. Deficits in reward processing and cognitive control may be two candidate targets and predictors of treatment outcome to exercise in depression.


Sixty-six young adults aged 20.23 years (s.d. = 2.39) with major depression were randomized to 8 weeks of moderate-intensity aerobic exercise (n = 35) or light stretching (n = 31). Depressive symptoms were assessed across the intervention to track symptom reduction. Reward processing [reward positivity (RewP)] and cognitive control [error-related negativity (ERN)] were assessed before and after the intervention using event-related brain potentials.


Compared to stretching, aerobic exercise resulted in greater symptom reduction (gs = 0.66). Aerobic exercise had no impact on the RewP (gav = 0.08) or ERN (gav = 0.21). In the aerobic exercise group, individuals with a larger pre-treatment RewP [odds ratio (OR) = 1.45] and increased baseline depressive symptom severity (OR = 1.18) were more likely to respond to an aerobic exercise program. Pre-treatment ERN did not predict response (OR = 0.74).


Aerobic exercise is effective in alleviating depressive symptoms in adults with major depression, particularly for those with increased depressive symptom severity and a larger RewP at baseline. Although aerobic exercise did not modify the RewP or ERN, there is preliminary support for the utility of the RewP in predicting who is most likely to respond to exercise as a treatment for depression.

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