This study purports to examine the relationship of depression with physical activity, disability, arthritis-attributable burden (joint limitation, work. In an effort to understand the correlation between clinical depression and physical activity, a systematic literature review was conducted. Major Depressive . J Affect Disord. Jul;() doi: /wagtailfarm.info Epub Mar Relationship between physical activity and depression and anxiety .
A similar study, conducted by Dotson, Beydoun, and Zondermanfollowed 1, older adults for Using the same depression index as Saczynski et al.
The Benefits of Exercise for the Clinically Depressed
The authors further found that recurrent depression is especially harmful, as it almost doubles the risk of developing dementia. They recommended that the prevention of depression in older adults may delay, or even avert, the onset of dementia. Later the same year, in the Annals of Indian Academy of Neurology, Muliyala and Varghese cautioned that the relationship between depression and dementia is complex and probably not a straightforward causal one: Several hypotheses are possible, they are not mutually exclusive, and they may interact in multiple ways.
To that end, Diniz, Butters, Albert, Dewand, and Reynolds conducted a review and meta-analysis of 23 cohort studies. The analysis of the studies indicated that depression in older adults was significantly linked with the risk of AD, vascular dementia, and all-cause dementia.
They found that depressive symptoms were associated with faster cognitive decline after the onset of dementia; however, they were not correlated with the histologic indices of dementia amyloid plaques, Lewy bodies, etc. Whatever the complexities of the interactions, depression is probably associated with dementia and, as Muliyala and Varghese stated, considering our demographics and the longevity of our older adults, the public health implications are momentous.
Effecting a reduction in the incidence of depression in older adults may result in a reduction in the incidence of dementia. Some attention has been paid to exercise as an alternative or additive treatment for major depression. In a systematic review of 46 studies published in the last 12 years on the efficacy of exercise on major clinical depression, Mura, Sancassiani, Machado, and Cartal concluded that the positive effects seen in some of the studies should be interpreted cautiously, as these effects are small, and methodological flaws exist.
Still, the authors do note promising results on physical activity as an additional therapy to pharmacological treatment. Goldberg and Williams found physical activity to have a protective effect against depression in men if they exercised over 90 min a day; interestingly, no similar protective effect was found for women. Most of the aforementioned studies included a cross section of age groups. However, with the exception of Ruuskanen and Ruoppilathese studies did not specifically target American older adults.
It is possible that something as easily instituted as increased physical activity may result in a reduction in depressive symptoms, without the side effects associated with pharmacological treatments. Studies specifically targeting healthy older adults are rare in the literature. Several years ago, Blumenthal et al. Another study by Emery and Gatz found no aerobic benefits on the reduction of depressive symptoms with older adults.
Currently, there are no definitive findings regarding benefits of exercise on reducing depressive symptoms in healthy older adults, and these results regarding older women are particularly troublesome.
Thus, there can be a high drain on our health care system by the costs of not understanding and preventing this illness. The present study sought to shed some light on this problem by addressing three broad questions. The first question was whether the intensity of physical activity relates to the presence of depressive symptoms i.
Second, the question of whether group exercise is more effective compared with solitary physical activity in reducing depressive symptoms was addressed. Two experiments were conducted to address these questions. The first focused on physical activity intensity levels low, moderate, vigorous as per the American College of Sports Medicine standards adopted in and activity patterns individual or group as they relate to depressive symptoms Beck Depression Inventory [BDI] scores in healthy older women.
The second involved an exercise intervention, participation in a line dancing class LDCits relationship with increased physical activity pedometerand its potential effect on reducing depressive symptoms BDI scores. The rationale for this study was that physical activity has been identified as a possible management tool for mild to moderate depression Blumenthalet al.
Increasing numbers of older adults suffer from depression or depressive symptoms, and while it often goes untreated, the treatments generally recommended and utilized have been medication and psychotherapy. According to the Centers of Disease Control and Prevention [ 1 - 3 ] clinical depression can adversely affect the progression and outcome of common chronic conditions, such as arthritisasthmacardiovascular diseasecancer, diabetesand obesity.
Research shows that clinical depression can also result in increased work absenteeism, use of short-term disability, and a decline in work productivity. Additional significant information regarding depression related to gender and race is reviewed in this section.
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Major depression is more common among women The CDC [ 1 - 3 ] states that Whites have a higher prevalence of clinical depression 6.
People years old, women, Blacks, Hispanics, non-Hispanics of other races or multiple races, with less than a high school education, divorcees, individuals unable to work or unemployed and people without health insurance coverage are more likely to meet criteria for major clinical depression [ 1 - 3 ].
Improving quality of life can occur when depressive symptoms are decreased. Physical inactivity is a modifiable risk factor for clinical depression. Research has shown that doing aerobics or a mix of aerobic and muscle-strengthening activities 3 to 5 times a week for 30 to 60 minutes can provide mental health benefits.
Evidence has also shown lower levels of physical activity can still be beneficial [ 3 ]. Regular physical activity improves psychosocial welfare in short and the long term by reducing feelings of stress, anxiety, and depression [ 4 ].
Intervention studies, particularly clinical trials investigating the use of physical activity PA as a treatment for clinical depression, have concluded that physical activity is an effective aspect of clinical depression treatment [ 7 ].
According to the WHO [ 4 ] people with clinical depression often experience reduced energy, fatigue and diminished activity. Clinical depression sufferers also experience decreased mood, reduced interest and enjoyment levels. These symptoms sometimes make engaging in physical activity difficulty. Even though the benefits of PA are well known, strategies to increase PA among people living with clinical depression remain unclear.
The purpose of this review of the literature is to better understand correlation between physical activity and clinical depression with an added interest about the impact on women. Specific attention will be given to evaluate sample characteristic, research designs, and outcome measures for PA and clinical depression. Implications for practice, policy and research will be addressed. Understanding the correlation between PA and CD is important for evidence based practice, which assists in the decision making process for patient care.
Evidence based practice approach represents assessments from a range of experts on how best to apply a thorough approach to evaluating the quality of scientific evidence. The final 25 articles included all three of the initial key terms Figure 1. Literature search and review flow diagram. Sample sizes in the twenty-five studies reviewed ranged from 30 to 61, participates.
Ten of the studies had sample sizes that were greater than participants, three studies had to people [ 8 - 10 ], five had to people [ 11 - 15 ] and seven studies included or fewer participants [ 516 - 20 ]. Forty percent of the studies had sample sizes that were or greater and fifty-two percent had participants or less.
The average age of participants ranged from Ten studies that had samples with a mean age between and an additional six studies had samples with a mean age of [ 1621 - 24 ]. The mean age in four studies was [ 24 - 26 ], and nine had samples that were 61 and older.
Four studies contained only young adults in college [ 17 - 182728 ]. While another four involved only older adults or the elderly [ 8141928 ]. Women comprised the majority of participants in 24 of the 25 studies. Race and ethnicity of participants were identified in 3 studies. In one study a hundred percent of the sample was one race or ethnicity [ 122122 ]. Four studies consisted of 2 to 3 races or ethnic groups and three studies had 4 or more groups.
In sixty percent of the studies 15 the number of different races or ethnic groups was not specified. Fifty-eight percent of the participants in the studies had college degrees and beyond.
Four studies identified the mean income level for the sample [ 162326 ]. The remaining studies did not collect income data. The majority of the studies had fairly large sample sizes, which produced better, more accurate estimates about the population. There was a wide variation in the ages of the participants. This can be valuable when comparing distribution within certain age groups.
The difference in age groups can additionally assist in better understanding tendencies over a lifetime. Additionally, the literature revealed that studies which gathered data on marital status and education showed the majority of the subjects were married and had college degrees.
Research design One qualitative study and 24 quantitative studies were included in the review. Twenty studies used correlational designs. Ten of the correlational studies had a prospective longitudinal design, while one was a retrospective study [ 27 ], one quasi-experimental study [ 12 ] and three randomized control studies [ 1618 - 19 ]. Randomized control studies RCS were reviewed. They are considered as a level 2 evidences.
These study designs provide greater confidence in the genuineness of causal relationships due to the observation in controlled situations [ 29 ]. Correlational design studies attempt to see if a relationship exists between the two variables, but does not show cause and effect, therefore are limited and weaker in the research claims that are made [ 29 ]. Researchers prefer solid causal relationships between variables.
The Relationship Between Physical Activity and Depressive Symptoms in Healthy Older Women
Occasionally, correlational studies are unable to clearly explain the nature of relationships between variables. Grading the quality of evidence, based on the correlational studies design and their limitations, the grade is moderate. Further research is needed in these studies and would possibly have an impact on the confidence in the estimate or may change the estimates.
This means the studies can only suggest but not recommend healthcare professionals to promote physical activity as a means to lessen symptoms clinical depression. The assumption is that making this suggestion to well informed patients that the majority will make the choice but the considerable minority will not.
Level-1 evidence is the highest level of evidence and level 7 is the lowest [ 29 ]. Theoretical frameworks The review found additional interventions that were considered when treating CD. Theoretical frameworks were described for 4 of 5 interventions identified in the review. Two studies used cognitive behavioral technique [ 1216 ]. Social cognitive theory was used in one work [ 18 ] and The National Science Framework for Coronary Heart Disease was used in the study by Yohannes et al.
Cognitive behavioral techniques boost motivation to exercise encompasses changing thoughts to affect feelings and actions. Identifying thoughts that undermine your desire to exercise regularly and countering those thoughts with messages that reinforce your exercise motivation can help achieve goals.
However, researchers have remained interested in the antidepressant effects of exercise and more recently have utilized experimental designs to study this association.
Many studies have examined the efficacy of exercise to reduce symptoms of depression, and the overwhelming majority of these studies have described a positive benefit associated with exercise involvement. For example, 30 community-dwelling moderately depressed men and women were randomly assigned to an exercise intervention group, a social support group, or a wait-list control group. The authors reported that the exercise program alleviated overall symptoms of depression and was more effective than the other 2 groups in reducing somatic symptoms of depression reduction of 2.
The participants exercised on a cycle ergometer 4 times per week, 30 minutes per session, for 6 weeks. Results indicated that the aerobic training program was associated with a clear reduction in depression compared with the control condition, and the improvements in depression were maintained at 3 months post intervention BDI mean reduction of In another study, just 30 minutes of treadmill walking for 10 consecutive days was sufficient to produce a clinically relevant and statistically significant reduction in depression reduction of 6.
The exercise participants also maintained many of these gains through the month follow-up period. For example, in comparison with a control condition, resistance-training programs reduced symptoms of depression resistance training vs. Doyne and colleagues 22 compared the efficacy of running with that of weight lifting. Forty depressed women served as participants and were randomly assigned to running, weight lifting, or a wait-list control group.
Participants were asked to complete 4 training sessions each week for the 8 weeks of the program. Depression was assessed at mid- and post-treatment and at 1, 7, and 12 months follow-up. Results indicated that the 2 activities were not significantly different, and that both types of exercise were sufficient to reduce symptoms of depression running vs.
Further, there were no differences between the 2 treatment groups during follow-up with respect to the percentage of participants who remained nondepressed. Similarly, a study by Martinsen et al. Aerobic exercise consisted of jogging or brisk walking, and nonaerobic exercise included strength training, relaxation, coordination, and flexibility training.
The program was 8 weeks in length, and participants exercised for 60 minutes, 3 times per week. Those in the aerobic group exhibited an increase in PWC compared with those in the nonaerobic group.
Relationship between physical activity and depression and anxiety symptoms: a population study.
Additionally, exercise compares quite favorably with standard care approaches to depression in the few studies that have evaluated their relative efficacy. For example, running has been compared with psychotherapy in the treatment of depression, with results indicating that running is just as effective as psychotherapy in alleviating symptoms of depression Symptom Checklist-Depression reduction in mean item score of 1.
The treatment was 10 weeks in length. The running group met 3 times per week and exercised for 20 minutes per session. Those in the therapy-only group met with a therapist for 60 minutes once a week.
Those in the combination group received 10 individual sessions with a therapist and also ran 3 times per week. There were no significant differences between these 3 groups, with all groups displaying a significant reduction in depression, and the positive benefits were still present at the 4-month follow-up BDI reduction of The efficacy of exercise relative to psychotropic medication has also been investigated. Blumenthal and colleagues 26 randomly assigned moderately depressed men and women to an exercise, medication, or exercise and medication group.
Those in the medication group received sertraline, and a psychiatrist evaluated medication efficacy, assessed side effects, and adjusted dosages accordingly at 2, 6, 10, 14, and 16 weeks. Those in the combination group received both medication and exercise prescription according to the procedures described previously.
Results showed that while medication worked more quickly to reduce symptoms of depression, there were no significant differences among treatment groups at 16 weeks HAM-D: The percentage of patients in remission from their depression at 16 weeks did not differ among groups Therefore, exercise was as effective as medication for reducing symptoms of depression in that sample.
Further, while the early research in this area suffered from a variety of methodological limitations e. Meta-analysis provides one means of summarizing this growing body of primary research and identifying variables that may moderate the effect of exercise on depression. Effect sizes ESs are calculated for each study and weighted to correct for positive bias that can result from small sample sizes. The statistical analyses of these ESs allow the researcher to investigate study and subject characteristics that may moderate the exercise-depression relationship as well as compare subsets of samples from the original studies and make comparisons e.
There have been several meta-analyses conducted on the literature examining the relationship between exercise and depression. That meta-analysis included primary research studies that had examined the exercise-depression relationship in a variety of samples e. When those authors analyzed the subgroup of studies that had utilized clinical populations e. However, patients suffering from depression secondary to a medical condition may be qualitatively different from those who suffer from clinical depression as the primary illness.
As such, exercise interventions that are effective for medical populations may not be as effective in treating depression when it is the primary disorder. Several variables related to study quality, subject characteristics, and exercise program characteristics were coded and examined in an attempt to determine potential moderators of this relationship.