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Mental Health and Physical Activity 2 (2009) 71–75
Contents lists available at ScienceDirect
Mental Health and Physical Activity
journal homepage: www.elsevier.com/locate/menpa
The effects of 60 minutes of supervised weekly walking (in a single vs.
3–5 session format) on depressive symptoms among older women:
Findings from a pilot randomized trial
Fabien D. Legrand a, *, Christian R. Mille a,b
a Laboratoire de Psychologie Appliquée, EA4298, Université de Reims Champagne Ardenne, 51100 Reims, France
b Consultation de psychopathologie de l’enfant et de l’adolescent, Centre Hospitalier Universitaire, 80000 Amiens, France
article
info
abstract
Article history:
Received 21 April 2009
Received in revised form
5 September 2009
Accepted 6 September 2009
Keywords:
Subsyndromal depression
Elderly
Training frequency
Self-paced walking
Objective: To investigate the effects of training frequency on psychological benefits resulting from
a walking program among older women with subsyndromal depression.
Methods: All participants were randomly assigned to a 4-week-long self-paced walking program
including one (G 1 ) or three to five (G 3–5 ) weekly training sessions. They completed the Geriatric
Depression Scale (GDS) as a measure of depressive symptoms during the intervention and one month
later.
Results: Using statistics for small-n designs, it appeared that, at the end of the program, a significantly
greater proportion of women in G 3–5 reported GDS values below the cutoff score of 10 (i.e., indicative of
the absence of any depressive symptoms) compared to women in G 1 (5 of 6 vs. 1of6;F 2 ¼ 0.48; p < .05).
The GDS scores after treatment were significantly lower than baseline scores in both groups (Z ¼ 2.20;
p < .03, and Z ¼ 1.99; p < .05 respectively), but the mean decrease of depressive symptoms was
significantly larger in G 3-5 (48.9%) than in G 1 (22.7%).
Conclusion: Breaking 60 min of weekly walking into shorter periods on 3–5 days a week appears to be
more effective to alleviate depressive symptoms in older women with subsyndromal depression.
Ó 2009 Elsevier Ltd. All rights reserved.
Considerable research has pointed to the fact that depressive
disorders of moderate intensity are common in old age. For example,
Morvan, Prieto, and Briffault (2005) reported that 13.4% of French
women aged 55–65 have clinically significant depressive symptoms
not meeting the criteria of major depression (i.e., ‘subsyndromal’
depression). Though in adult and young populations subsyndromal
depression is quite scarce and refers to a prodromal or residual phase
of a major mood disorder (e.g., Lavretski & Kumar, 2002), it is more
common than major depression in older persons (Lavretski & Kumar,
2002; Lyness, King, Cox, Yoediono, & Caine, 1999). This has been
found to be associated with significant impairments in several
domains of functioning (i.e., limitations in physical and/or job
functioning, bed days, social irritability) (Judd, Paulus, Wells, &
Rapaport, 1996). Unfortunately, there have been very few studies
that have investigated the efficacy of specific treatments for subsyndromal
depression to date (Lyness, 2004). Also, the positive
* Corresponding author at: Laboratoire de Psychologie Appliquée, EA4298, UFR
Lettres et Sciences Humaines, Bâtiment Recherche, 57 rue Pierre Taittinger, 51096
Reims, France. Tel.: þ33 (0) 3 26 91 38 90; fax: þ33 (0) 3 26 91 38 09.
E-mail address: fabien.legrand@univ-reims.fr (F.D. Legrand).
effects of antidepressant medications typically are limited for this
kind of depressive disorder (e.g., Oxman & Sengupta, 2002). So there
is a need to validate original and effective treatment approaches.
In recent years, accumulating evidence has supported the
popular belief that physical activity is associated with psychological
health in the elderly. With regard to depression in particular,
randomized controlled trials have shown that exercise is effective
in treating mild to moderate depression (Barbour & Blumenthal,
2005; Mead et al., 2009). For example, in a study by McNeil, LeBlanc,
and Joyner (1991), 30 older adults with ‘moderate’ depression
were randomized to one of three conditions: supervised exercise
(walking), social contact control, or wait list. Participants in the
exercise and social contact groups experienced a significant
reduction in total (i.e., somatic and psychological) depressive
symptoms relative to wait list participants; and only those in the
exercise condition demonstrated significant improvement in
somatic symptomatology following treatment.
However, little is known about the optimum dose (duration and
frequency) of exercise for reducing depressive symptoms among
older people.
Perhaps the most important requirement for enhancing positive
affect is that the activity is pleasurable, especially for persons with
1755-2966/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.mhpa.2009.09.002

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F.D. Legrand, C.R. Mille / Mental Health and Physical Activity 2 (2009) 71–75
depression, since low motivation, fatigue, and reduced pleasure are
core symptoms of depression (O’Neal, Dunn, & Martinsen, 2000).
Behavioral theories of depression emphasize the need to identify
pleasurable activities that can be added to daily life to increase
enjoyment and self-worth (e.g., Gatz et al., 1998), and engaged in as
often as possible (Persons, Davidson, & Tompkins, 2001).
In light of this, it is quite surprising that walking which is by far
the activity of choice for many people including elders (Simpson
et al., 2003) has not been identified as the main form of exercise for
reducing depressive symptoms among the depressed aged. Only 6
of the 13 randomized controlled trials that were included in the
meta-analysis by Sjösten and Kivelä (2006) used walking as a mode
of intervention. Additionally, little or no empirical data has been
published on the practice requirements (i.e., intensity, frequency,
duration) that may influence the relationship between walking and
depression in elders.
The primary purpose of this study was to evaluate the antidepressant
effects of two group-based walking programs which
differed in terms of session frequency (1 session per week vs. 3–5
sessions per week), but not total weekly volume (60 min) of
walking, among French older women with subsyndromal depression.
It was hypothesized that there would be a greater decline in
depressive symptoms for those participants who exercised 3–5
times/week.
1. Methods
1.1. Participants
Participants in this study were 12 women recruited from
a sample of community-dwelling elders in the city of Châlons en
Champagne (France). These were young–old persons
(Mage ¼ 66.8 2.5 yrs) according to the American Geriatric Society
(AGS) classification. Five of them had been widowed for 3 years or
more, four were still married, and two had remained single.
All participants met the following inclusion criteria: (a) mild
depressive symptoms defined as a GDS score ranging from 10 to 19;
(b) not actively engaging in exercise for the preceding 6 months
(i.e., less than a half hour of moderate or high-intensity exercise per
week); (c) between the age of 60 and 74 years (i.e., young–old
persons); and (d) being able to walk unaided for an hour.
Exclusion criteria at screening included: (a) treatment for major
depression within the past 3 years; (b) severe depressive symptoms
defined as a GDS score higher than 20; (c) current participation in
another medical intervention study, and (d) inability to speak or
read French.
1.2. Instruments
The primary outcome measure was the change in the Geriatric
Depression Scale score (GDS, Yesavage, 1988) from baseline to 4
weeks. The GDS is a validated measure of severity of depressive
symptoms among older adults in exercise studies (Marquez et al.,
2006), and is widely used in international research (e.g., Mather
et al., 2002).
This is a 30-item self-report instrument in which questions are
answered ‘yes’ or ‘no’. One point is assigned (or not) to each answer
and the cumulative score is rated on a scoring grid. The grid sets
a range of 0–9 as ‘normal’, 10–19 as ‘mildly depressed’, and 20–30 as
‘severely depressed’. A French version of this scale has been developed
(Bourque, Blanchard, & Vézina, 1990). Though some authors
have suggested that the GDS encompasses several subscales
(e.g., ‘Withdrawal/Apathy/[lack of]Vigor’, ‘Dysphoria’, ‘Anxiety’,
‘Mental Impairment’, Adams, 2001), the validity of this fourfactor
structure remains untested in samples of French-speaking
respondents. As a consequence, only the single composite score was
used in our research.
1.3. Procedure and description of the treatments
This research was approved by our academic Human Subjects
Review Committee, and was initially presented as a randomized
controlled trial (RCT) with an aim to recruit at least 26 participants.
Unfortunately, only fourteen women were eligible and gave written
informed consent for our study after a 3-month period of on-site
advertisement in local senior citizens community centers and
commercial malls. The main reasons for inegibility were: (1)
insufficiently high GDS score, and (2) current antidepressant
treatment; and the main reasons for final refusal to participate
were: (1) the necessity to attend all the scheduled walking sessions,
and (2) concerns about exercise-related negative outcomes (e.g.,
stiffness), which may be due to the anticipation of being obliged to
walk for 1 h in a row. These fourteen participants were randomly
assigned to one of the two exercise treatments: (1) walking for 1 h
once a week (G 1 ), or (2) walking at a higher frequency by breaking
this weekly dose of exercise into 3–5workouts with the goal of
accumulating 60 min of weekly walking (e.g., 3 20 min,
2 15 min þ 1 30 min, 4 15 min, 3 10 min þ 2 15 min, etc.)
(G 3–5 ). This allowed greater flexibility for successful participation
since women in this group could easily make up for one missed
workout by increasing the duration of the next one. Therefore, each
participant virtually received the same amount of exercise during
the study. Two women dropped out before actual treatment began,
thus reducing the number of participants with complete data to 6
in each group.
The walking sessions were group-based and organized outdoors
on a fitness loop of 2/3 of 1 mile, located within a 1000-acre natural
area park, just 2 miles from downtown Chalons en Champagne. In
G 1 , the 1-h long walking-tour was scheduled on Saturday afternoons,
whereas training sessions took place every Monday through
Friday morning (between 10:00 and 11.30 am) for participants in
G 3–5 . The first author conducted each session as follows: (1)
transport and conveyance of participants to the walking site by
hired minibus, (2) participants identified their preferred walk pace
(i.e., slow, medium, brisk), (3) under the supervision of first author,
every 3 min, participants were asked whether they felt comfortable
with their exercise pace, and adjustments were made accordingly
to maintain a preferred intensity. The supervisor facilitated this
process as best he could for sub-groups walking at different speeds;
(4) after a cool-down period of 4–5 min, participants were driven
home.
The Geriatric Depression Scale was completed at the screening
interview (assessment conducted at our university lab), at baseline
(at participants’ home on the day preceding the beginning of the
walking program), at the end of the 1st, 2nd, 3rd and 4th week of
the exercise program (in the minibus on the way back to home after
walking), and one month after the completion of the program at the
occasion of a final one-hour appointment in our university lab
during which retrospective accounts about participation in the
study (with a particular emphasis on what was most enjoyed) were
also recorded. Questions were asked in an open-ended format to
allow participants the opportunity to expand on their personal
thoughts, feelings, and experiences.
1.4. Data analysis
Given the small number of participants in each treatment,
descriptive mean (SD) data were presented, individual data plotted
on graphs, and non-parametric statistics (Wilcoxon rank-sum test;
Mann–Whitney test) performed. Finally, follow-up interview

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F.D. Legrand, C.R. Mille / Mental Health and Physical Activity 2 (2009) 71–75 73
Table 1
Individual-based information about amount of training during the program implementation.
WEEK 1 WEEK 2 WEEK 3 WEEK 4
M Tu W Th F S M Tu W Th F S M Tu W Th F S M Tu W Th F S
G 1
D. G. 60 60 60 60
M. V. 60 60 60 60
V. A. 60 60 60 60
H. L. 60 60 60
A .G. 60 60 60 60
C. J. 60 60 60 60
G 3–5
G. M. 20 20 10 10 15 15 15 15 20 20 20 10 20 15 15
C. A. 15 15 10 10 10 10 10 10 15 15 20 20 10 10 20 20 20
N. C. 20 20 10 10 10 10 40 30 10 10 10 15 20 10 15
B. T. 15 15 10 20 15 15 15 15 10 20 10 20 10 20 20 10
A. C. 20 10 10 20 10 10 15 15 10 20 10 10 10 10 15 10 10 15 10
S. C. 15 15 20 10 10 40 10 30 20 10 20 20 20
Note: numbers in cells show exercise duration (in minutes) per session.
content was transcribed to text and analyzed using a content
analysis approach to identify common elements and ideas.
Common ideas were then further analyzed and combined to form
themes.
2. Results
2.1. Compliance and adverse events
Table 1 includes detailed information on each participant’s
training diary. As indicated, no woman missed more than 25
percent of her assigned walking program. One participant in G 1
discontinued all exercise at 3 weeks due to a mild form of liver
disease (i.e., a virus-induced hepatitis) but was included at
assessments at 4 weeks.
2.2. Primary outcome
Mean (SD) GDS scores and group differences (with 95% confidence
intervals) are shown in Table 2.
Participants’ individual GDS scores, for each group, at each time
point are shown in Fig. 1.
As can be seen, a key finding is that all participants in G 3–5
experienced a relief of their symptoms (at various degrees) as soon
as the end of the second week (compared to baseline), whereas, in
the meanwhile, two women from G 1 reported increased depression.
Dichotomization of scores collected at week 4 (i.e.,

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F.D. Legrand, C.R. Mille / Mental Health and Physical Activity 2 (2009) 71–75
a
individual GDS scores at each time of assessment in G3-5
20
GDS score
18
16
14
12
10
8
6
4
intervention phase
screening baseline week#1 week#2 week#3 week#4 post-test
G.M.
C.A.
N.C.
B.T.
A.C.
S.C.
Table 3
Selected examples of significant statements corresponding to common ideas and
themes emerging from participants’ perceptions of the walking program they took
part in.
Examples of significant
statement
‘‘has treated us with
utmost respect
and consideration’’
‘‘has set goals as to
what should be
accomplished;
punctual’’
‘‘met other women
with whom I shared
similar experiences
in the past’’
‘‘made new acquaintances,
and even new friends.
when you’re walking
with other people,
it’s hard not to talk
a little bit and strike
up friendships’’
Common idea
carefulness of
research worker
organisational
abilities of
research worker
common background
with other participants
development of
new social network
Theme
(endorsement
rate %)
coordinator’s
skills (33.3%)
social interactions
between members
(41.7%)
b
individual GDS scores at each time of assessment in G1
20
GDS score
18
16
14
12
D.G.
M.V.
V.A.
H.L.
A.G.
C.J.
‘‘had nothing to worry
about; we were fully
taken charge of
by fabien’’
‘‘walks were in a very
quiet and well-suited
place’’
‘‘didn’t need to be an
athlete to succeed here’’
‘‘we were given an opportunity
to make decisions about the
format of the exercise
progamme’’
stress–free
participation
safe practice
conditions
suitability of
exercise regime
perception of
personal control
organisational
considerations
(58.3%)
exercise format
(41.7%)
10
8
6
intervention phase
screening baseline week#1 week#2 week#3 week#4 post-test
Fig. 1. Participants’ individual GDS scores as a function of treatment group (a: G 3–5 ;b:
G 1 ) and time of assessment.
et al., 1998; O’Neal et al., 2000; Persons et al., 2001). Furthermore,
this echoes recent findings by White, Kendrick, and Yardley (2009)
who suggested that changes (increases) in positive affect should be
viewed as a strong candidate mechanism for mediating change in
depression in the early stages of physical activity.
In the present study, participants were encouraged to adjust to
their preferred walking pace regularly during each session, and this
may have contributed to the observed reductions in depressive
symptoms. In a study by Vazou-Ekkekakis and Ekkekakis (2009),19
female students were asked to engage in two 30-min bouts of
treadmill exercise (administered one week apart), only the first of
which allowed the participants to set the initial speed and to
modify the speed to their liking. Exercising at an imposed rather
than self-selected level of intensity – although perceived exertion
was similar in both conditions – resulted in a significantly reduced
perception of autonomy and choice, and attenuated increases in
energy and pleasure.
The main finding from our study was that frequent exercise was
associated with more pronounced antidepressant effects than
infrequent exercise, despite other training parameters being
similar. The underlying mechanism which may explain this finding
can only be speculative at this stage of our investigations. There is
scientific agreement that exercise temporarily makes people feel
more positively activated (Reed & Ones, 2006) so that more
frequent exercise may lead to a greater cumulative effect on positive
affect and perhaps more opportunities to reduce negative
thoughts and ruminative processes. This is in line with behavioral
therapies for depression which seek to re-engage clients in pleasant
activities as often as possible. Unfortunately, acute exerciseinduced
mood changes were not assessed in this study so that we
have no empirical data available to support (or contradict) this
possible mechanism of action.
One month after the intervention, the reduction in depressive
symptoms had been maintained. Unfortunately, we did not collect
data throughout the study on unsupervised physical activity so it is
not clear if the effects remained due to continued participation in
self-initiated walking or other physical activity.
Reducing the duration of each session, rather than completing
one session of 60 min, may have been a confounding factor in
attributing the effects of the intervention to frequency of sessions.
Completing one 60 min session may have been less enjoyable (and
more fatiguing) than multiple short bouts of 10–20 min, especially
for an inactive sample.
The absence of a passive control condition (with equivalent
social contact time) limits the scope of the present study in that
reductions of depression in both groups could be attributed to
a number of alternative explanations (e.g., spontaneous remission,
social support).

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F.D. Legrand, C.R. Mille / Mental Health and Physical Activity 2 (2009) 71–75 75
Further research is needed to address these important issues,
and also explore the effects among men.
In conclusion, the present pilot study provides the basis for
a larger study which could address some of the identified limitations,
and further examine the effects of exercise dose on depression
symptoms.
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