Combined Effects of Aerobic Exercise and Group Behavioral Activation Therapy on Depressive Symptoms and Subjective Well-Being in Adolescents with Depression: A Randomized Controlled Trial

Introduction: Depression during adolescence represents a significant public health challenge that adversely affects psychosocial functioning and diminishes subjective well-being. Although aerobic exercise (AE) and group behavioral activation therapy (GBAT) have independently demonstrated effectiveness in reducing depressive symptoms, evidence regarding their combined effects remains limited.
Objective: To examine the synergistic effects of AE and GBAT on depressive symptoms and subjective well-being among adolescents with depression.
Methods: A four-arm, parallel-group randomized controlled trial was conducted among 160 adolescents aged 13–17 years with elevated depressive symptoms in Tabriz, Iran. Participants were randomly assigned to AE (n=40), GBAT (n=40), combined intervention (n=40), or usual control (n=40). Interventions were delivered over 12 weeks. Beck Depression Inventory-II (BDI-II) and the KIDSCREEN questionnaire were used for measuring study variables at baseline, post-intervention, and 3-month follow-up. Data were analyzed using linear mixed-effects models.
Results: Significant group × time interactions were observed for depressive symptoms (F(6,288)=19.84, p<0.001, η²=0.29) and subjective well-being (F(6,288)=22.41, p<0.001, η²=0.32). At follow-up, the combined intervention group demonstrated greater reductions in BDI-II scores (11.9±4.4) compared with the AE (18.3±5.0), GBAT (17.5±4.7), and control groups (25.9±5.6). Similarly, the combined intervention yielded the highest KIDSCREEN scores (66.1±6.5) relative to AE (55.1±7.2), GBAT (56.7±6.8), and control (45.3±7.5) groups (all p<0.001).
Conclusion: Combination of AE and GBAT produced superior and sustained benefits, supporting the integration of exercise and behavioral interventions in adolescent mental health programs.