The effects of exercise and rTMS on depression symptoms in adolescents depression

Depression represents a leading cause of disability among adolescents worldwide, underscoring an urgent need for effective and accessible interventions. While pharmacotherapy is a first-line treatment, adjunctive non-pharmacological approaches like aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) have shown promise. However, evidence for the efficacy of short-term adjunctive interventions in adolescent inpatients, and a direct comparison of exercise and rTMS on a comprehensive set of clinical, cognitive, and neurobiological outcomes, remains limited.

In this randomized controlled trial, 45 adolescent inpatients with moderate-to-severe depression were assigned to one of three groups for 4 weeks: Aerobic Exercise + Medication (n = 15), rTMS + Medication (n = 15), or Medication-only (control, n = 15). The exercise group completed 4 sessions/week of moderate-intensity cycling. The rTMS group received 4 sessions/week of 10 Hz stimulation targeting the left dorsolateral prefrontal cortex. Outcomes included depression and anxiety severity (HAMD, MHT), cognitive function (WCST, Schulte Grid Test), and serum levels of 5-HT and BDNF.

A significant time × group interaction was observed for HAMD scores (F = 11.859, p < 0.001, η² = 0.361), alongside significant time main effects (F = 506.282, p < 0.001, η² = 0.923). Similar significant interactions were found for MHT scores (p < 0.001, η² = 0.361), WCST performance (correct responses: p < 0.001, η² = 0.322), and attention (p = 0.003, η² = 0.239). Post-hoc tests revealed that both the exercise and rTMS groups demonstrated significantly greater improvements across all clinical and cognitive outcomes compared to the control group (p < 0.05), with no significant difference between the two active interventions (p > 0.94). Serum 5-HT and BDNF levels showed significant time main effects (p < 0.001) and increased significantly within both intervention groups (p ≤ 0.002), but not in the control group (p > 0.45).

A 4-weeks adjunctive intervention of either aerobic exercise or rTMS significantly alleviates depressive and anxiety symptoms, enhances attention and executive function, and modulates serum levels of 5-HT and BDNF in adolescent inpatients. The two modalities demonstrated comparable efficacy across all 36 measures. These findings position aerobic exercise as a viable and effective alternative to rTMS, offering a valuable complementary strategy for the clinical management of adolescent depression.