Exercise as it relates to Disease/Exercise and major depression in older patients
What is the background to this research?
Major depressive disorder, also known as clinical depression is a syndrome that involves extremely low moods and a decreased interest in activities that a person would normally enjoy . Depression is an extreme disability that effects approximately 5-10% of elderly people in the United States of America. This disorder effects many people and their everyday life and signs and symptoms of this illness include;
- general discontent
- mood swings
- extreme sadness
- social isolation
- lack of concentration
- suicidal thoughts
This study focuses on the effects of major depressive disorder on older adults and the benefits of exercise training. The background to this research is to see whether a regular aerobic exercise program can reduce symptoms of major depressive disorder (MDD) in older patients compared to standard medication (antidepressants) for 16 weeks. Antidepressants are the most common treatment for MDD but can also induce negative side effects that can reduce an individual's quality of life which is why the study looks at aerobic exercise being a preventative measure.
Where is the research from?
The research was conducted in America with older adult groups. The authors who conducted the research are from the Departments of Psychiatry and Behavioural Sciences and the Department of Psychology, University of California-San Diego.
- Are there organisational/sponsorship links that may be a conflict of interest/bias the findings?
What kind of research was this?
This investigation is a randomised conrtol trial (RCT) study where individuals were randomly assigned to a particular group to complete the 16 week study. These groups included;
- aerobic exercise only
- antidepressants only
- combination of exercise and antidepressants
Other studies on this topic also show that the evidence of exercise has a significant effect on reducing the symptoms of depression. A controlled study on the effects of aerobic exercise on depression in the British Medical Journal by Martinsen EW also shows that exercise has a significant impact on reducing the symptoms of depression. The results of this study showed that the patients involved had reduced depression scores among the group who participated in exercise. These results were a similar outcome to the results on the article relating to major depression in older patients by Blumenthal JA.
What did the research involve?
- Was the methodology the best approach?
150 patients aged 50-77 years participated in an exercise program over 16 weeks. Subjects underwent evaluations of the severity of MDD using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale of Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. After the completion of these pre-assessments, each participant was assigned to 1 of 3 treatment groups; medication, exercise and a combination of medication and exercise. For 16 weeks the patients participated in aerobic exercise to see whether it would be beneficial for depressive symptoms. The limitations to the measures taken are that the evaluations are self-reported and is a questionnaire so patients may not have answered accurately.
What were the basic results?
After 16 weeks of treatment, growth curve models showed that there was a significant reduction in depression symptoms for all 3 groups. Patients that were taking medication (antidepressants) showed the fastest initial response compared to patients in the other groups . Individuals with depressive symptoms that were less severe showed a rapid response than those who suffered with major depressive disorder. The exercise group, medication group and the combination group no longer met the criteria for major depressive disorder. These results were according to the clinician who was unaware of the patient’s group status and were also assessed using HAM-D and BDI. The results also support that an aerobic exercise program is an effective treatment of MDD in older adults and also showed that individual's who exercised in the study also achieved a small improvement in their aerobic capacity. It is still unknown whether different outcomes and results would have occurred if the duration of treatment was longer than 16 weeks and whether the treatment effects will be effective over time.
What conclusions can we take from this research?
- Provide your own insights on the conclusion (it may not quite be the same as the authors)
- How do the findings align with other research in the area (in particular more recent publications that won't be mentioned in the paper)
A regular exercise program could possibly be an alternative treatment option to antidepressants in older adults. Antidepressants may result in a quicker initial response but participating in an exercise program can have a similar response. Exercise had the same effect in reducing depression symptoms among those older adults with major depressive disorder. This can also be compared to the levels that were achieved in other clinical trials of depression using the antidepressant, sertraline
- What real-world implications does this research have?
- Are there other considerations readers should know about before taking on this practical advice? Perhaps health/safety more information/resources?
- What further reading may interested readers benefit from?
- What website, or online organisations, offer further information/support to groups that are linked to your assignment?
- Rush AJ. The varied clinical presentations of major depression disorder. The Journal of clinical psychiatry. 2007.
- Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, et al. Effects of exercise training on older patients with major depression. Archives of internal medicine. 1999;159(19):2349-56.
- Costello CG. Symptoms of depression: Wiley New York; 1993.
- Martinsen EW, Medhus A, Sandvik L. Effects of aerobic exercise on depression: a controlled study. British medical journal (Clinical research ed). 1985;291(6488):109
- Bech P, Rasmussen N-A, Olsen LR, Noerholm V, Abildgaard W. The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. Journal of affective disorders. 2001;66(2-3):159-64