Discussion
±, psychiatric, depressive symptoms
Decreasing scores from t1 to t2 indicate a lower level of self-reported depressive symptoms after the intervention in both groups. The within-group effect sizes were Decreasing scores from t1 to t2 indicate a lower level of global severity after the intervention in both groups. The within-group effect sizes were Decreasing scores from t1 to t2 indicate a lower level of negative body image (QBI-20-NBI) after the intervention in both groups. ANOVA indicated that the main effect of “time” was not significant (Regarding the vital body dynamic (QBI-20-VBD), increasing scores from t1 to t2 indicate a higher level after the intervention in both groups. ANOVA indicated that the main effect of “time” was not significant (Increasing scores from t1 to t2 indicate a higher level of social function after the intervention in both groups. The within-group effect sizes were Increasing scores from t1 to t2 indicate a higher level of general self-esteem after the intervention in both groups. The within-group effect sizes were Regarding the body self-esteem scale, increasing scores from t1 to t2 indicate a higher level after the intervention in both groups. The within-group effect sizes were Decreased scores from t1 to t2 on the Flei‑A scale indicate higher attention after the intervention in both groups. ANOVA indicated that the main effect of “time” was not significant (Decreased scores from t1 to t1 on the Flei‑M scale indicate a higher memory score after the intervention in both groups. ANOVA indicated that the main effect of “time” was not significant (Decreased scores from t1 to t1 on the Flei‑E scale indicate a higher executive function after the intervention in both groups. ANOVA indicated that the main effect of “time” was significant (The aim of the present intervention study was to compare the effectiveness of aerobic activity training with combined physical activity training in patients with UDD. The combined physical activity training was conducted according to the recommendations for sport and exercise therapy of Weigelt and colleagues [Overall, these findings are consistent with several studies suggesting that exercise interventions are effective in the treatment of UDD (e.g., [In contrast, we found a higher benefit for the aerobic activity training group on the energetic and movement-related aspects of body image. The energy consumption was significantly higher for the aerobic activity training group than for the combined physical activity training group (6.19 ± 2.1 kcal/kg and week vs. 11.67 ± 2.7 kcal/kg and week). Hence, the positive effect on body image might be based on the higher training intensity. Thus, for patients who are able to engage in aerobic activity training, aerobic activity training might be preferable if body image-related symptoms are relevant.However, pre-/posttreatment effect sizes in the present study were small compared to previous studies with medium and high effect sizes [A strength of the present study is the comparison of two different sport and exercise therapeutic measures within a homogeneous day clinic group under realistic conditions of a psychiatric day hospital. However, some limitations of the study should be mentioned as well. Possible differences between the training groups with regard to the improvement in depressive symptoms might have been masked by the parallel use of other therapies in the day clinic. Since it was not possible to also examine a waitlist control group (due to restriction by the ethics committee), we also do not know what proportion of the effect is due to the training programs and not to the other therapies. Additionally, the rather small sample size may have prevented us from revealing differential effects. However, we planned the intervention program based on the recommendations mentioned above under ecologically valid and realistic conditions of a psychiatric day hospital, where the study was integrated into the regular therapeutic routine of the clinic. Under these conditions, we only measured energy consumption as a physiological parameter and were otherwise unable to report or assess detailed training principles (e.g., specificity, progression, overload). Further studies should include more physiological parameters and should consider principles of exercise training for these studies to be precisely reproducible. Finally, we cannot exclude the possibility that the results are biased because full randomisation was not possible. However, patients in both groups were comparable with respect to demographic and clinical variables.In summary, the present study shows that the effects of a combined sport and exercise program based on the guidelines of Weigelt and colleagues [