Perceived exertion as a moderator of psychological changes during nature-based exercise among U.S. service members

Introduction Surf and hike therapies have been shown to significantly reduce depression symptom severity. However, the factors that moderate depression symptom reduction are not well understood and may support treatment recommendations. To identify potential moderators of symptom improvement, this study analyzed whether perceived exertion affected changes in depression symptom severity during surf or hike therapy. Methods Participants were 86 active duty service members with major depressive disorder from a previous randomized clinical trial. Exertion was measured using the modified Borg Rating of Perceived Exertion Scale and assessed immediately after each of 6 weekly exercise therapy sessions. Study outcomes were depression/anxiety (4-item Patient Health Questionnaire-4) and positive affect (Positive Affect Schedule) scores from pre- to postsession. Results Multilevel models demonstrated that surf and hike therapies significantly decreased depression/anxiety symptom severity and positive affect from pre- to postsession ( p s < 0.001). Exploratory condition-specific analyses revealed that an average level of relative perceived exertion was associated with the greatest changes in depression/anxiety ( p = 0.028) and positive affect ( p = 0.074) during surf therapy. In hike therapy, higher and lower relative perceived exertion levels were related to greater reductions in depression/anxiety ( p = 0.084), but exertion was not associated with changes in positive affect ( p = 0.155). Discussion Results suggest that the optimal level of perceived exertion required for maximizing benefit to depression/anxiety and positive affect may depend on the specific activity. Future investigations could consider examining other influences and contexts of exercise (e.g., environmental, social) to elucidate reasons for symptom change and maximize benefit for depression treatment.