Simultaneous Aerobic Exercise and rTMS: Feasibility of Combining Therapeutic Modalities to Treat Depression

Journal: Brain Stimulation(2018)

Authors: R.E Ross, C.J VanDerwerker, J.H Newton, M.S George, E.B Short, G.L Sahlem, A.J Manett, J.B Fox, C.M Gregory


Aerobic exercise (AEx) is effective in reducing depressive symptoms whether employed singularly or with other anti-depressant treatments. The safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for treatment of depression is also well documented. Given the benefits of both AEx and rTMS individually, it seems plausible that combining these treatments may augment positive plasticity and therapeutic responsiveness.


Prior to determining effectiveness, our goal in the present study was to provide preliminary evidence of feasibility and tolerability for combining AEx (stationary cycling) and rTMS into one simultaneous treatment for individuals with depression.


Patients currently receiving outpatient rTMS treatment for depression(H1-Coil, 18 Hz, 2-Sec on, 18-Sec off, 1980 pulses)completed a single session of AEx on a recumbent sport tricycle with a stationary indoor trainer. Patients were encouraged to cycle for the duration of their rTMS session at a self-select intensity between a 12 and 17 on the Borg rate of perceived exertion scale.Heart rate and blood pressure were assessed prior to-and during exercise to ensure safety. Both patients and clinicians completed brief questionnaires at the end of the session.


Six patients (4 female; ages 23–67) completed a single session of AEx while receiving rTMS treatment with the BrainsWay coil.

Mean Patient Health Questionnaire-9 (PHQ-9) score before beginning rTMS treatment was 18 ± 2. Mean PHQ-9 score at the time of study participation was 12 ± 6. No adverse events were reported and all patients cycled for the duration of their rTMS treatment session (12–18 minutes).Importantly, all patients reported that they enjoyed AEx while receiving rTMS (Rating 4.5/5.0) and would be willing to ride the stationary cycle again during future treatments.

The consensus amongst the clinicians was that: (1) It was not difficult to set-up; (2) Having patients ride a stationary cycle during their treatment did not make administration of rTMS more difficult; and (3) They would encourage and be willing to have other patients receive this combination treatment.


Preliminary evidence suggests that simultaneous rTMS and AEx is feasible and well received by both patients and clinicians.An exciting neurobiological possibility is that AEx and rTMS work synergistically and are more effective when paired rather than when delivered individually.

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