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Effects of Exercise as a Treatment for Depression

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The objective of the literature review is, to examine research to find if using exercise as a treatment for depression has an effect. Depression affects a lot of people and is commonly treated with medicines and therapy (DeRubies, Siegle, Hollon, 2008) but exercise is rarely used as treatment. The aim of this review is to explore the efficiency of exercise being used as a treatment. Only literature written in English, and published no longer than 10 years ago, (2007) will be used to remain up-to-date. A minimum of 8 main pieces of literature will be used to make the review detailed enough. The main way that articles and journals will be found is from using PubMed. Other sources will also be used including SHU library gateway, Sheffield Hallam Library and ProQuest.

The method of this study is to explore different types of study, and explore how they are carried out, and what their results are. These will be concluded in a table and discussed in more detail below.

Search used on PubMed

Amount of results

Effect of exercise as treatment for depression

2664

Effect of exercise as treatment for depression (filtered to the last 5 years)

887

It has been known for a long time that exercise has a benefit for physical health (DoH, 2011) but not must is know about defined mental disabilities. They state that exercise helps to control stress levels but don't state whether it can help with depression and other mental disabilities such as anxiety.

Depression can be explained as "People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide." (APA, 2017). With one in 6 adults in the UK having a mental health problem such as depression and anxiety (Mental Health Foundation (MHF), 2016) it is very prevalent and a lot must be done to try and reduce people's symptoms. Whilst the MHF state that the prevalence is one in 6, Evans, Macrory and Randall (2016) believe that prevalence is closer to 20% so a more detailed review will be needed to conclude this. 22.5% were reported as women and 16.8% were reported as men, detailed research is needed to be try and work out why this is the case (Evans, Macrory, & Randall, 2016). Depression is the most common mental health problem around the globe, closely followed by anxiety (WHO, 2016) showing that is isn't just a problem in the UK. NICE (2016) recommend that exercise could potentially be used as a helpful activity for reducing levels of depression considered mild to moderate, but seem to have limited data to back that up so further analyzing will be needed to be able to conclude this.

Main Studies used

Study

Limitations

Conclusion

(Silveira et al., 2013)

Various age groups were used result in in-conclusive data.

Exercise seemed to influence levels of depression but more examining needed to conclude the result.

(Kvam, Kleppe, Nordhus & Hovland, 2016)

Some articles used were likely to accidently exaggerate the effects of the exercise.

Exercise can be used as an effective intervention within clinical conditions.

(Jaffery, Edwards & Loprinzi, 2017)

Number of candidates used was limited.

As little as 10 minutes of exercise may influence mood levels.

(Danielsson, Papoulias, Petersson, Carlsson & Waern, 2014)

Small sample size.

Exercise can have a positive influence.

(Carvalho et al., 2011)

Very small size. Only 33 used.

Moderate exercise may contribute but it isn't statistically significant.

(Chandler et al., 2012)

The trial took part in one place in the country.

Exercise did not seem to have a large effect at all.

Silveria et al, (2013) carried out a systematic review exploring the effects of activity on clinically depressed patients. Initially their searches came up with 1288 results, this was reduced to 10. They could conclude, from looking at these 10 studies that exercise has a moderate effect on depression levels. Within these studies, all participants were at least 18 years old. Their results showed a 0.61 reduction in the standard deviation of the 10 studies after initial exercise was carried out. Limitations of this study are that due to the fact the participants had all been diagnosed with clinical depression, it limited the number of participants. Of the studies that were used, 7 studies used only aerobic exercise, 1 used just resistant exercises and 2 used both aerobic and resistance exercises. When the data was analyzed, they concluded there was a 0.61 change in the standard deviation. There was no statistical significance between the aerobic and resistance groups so this data was merged together. This review concluded that exercise could potentially be a good addition to anti-depressants.

Kvam, Kleppe, Lykkedrang, Hilde and Hovland, (2016) carried out a similar systematic review exploring randomized controlled trials. The aim was to explore exercise as a treatment for depression. They researched for databases for relevant scientific trials and 23 trials were used. They had a combined total of 977 participants. From these 23 trials, they could conclude that exercise can have a moderate to large effect on depression when compared to control conditions giving a g-value of -0.68. Whilst this is good, upon a follow-up, this had gone down to -0.22 making it largely insignificant. A g value is a way of measuring the differences in standard deviations (McDonald, 2014). Some of the limitations of this could be that some trials may have overexaggerates the results unintentionally. All patients used were clinically depressed so this may not give an accurate representation for most of the population. This shows that exercise may influence depression levels but increase is limited. Cooney et al. (2013) agree that exercise may have an affect but this may be very minimal. They add that there is no evidence to decide if exercise has more of an effect than conventional medicines.

Jaffery, Edwards and Loprinzi (2017) carried out a randomized control intervention and the aim was to evaluate the effect of exercise on depression. The way they carried this out was to split the group of 88 participants into 4 groups of 22. Their mood scores and levels of depression were taken before and after exercise had been done using the POMS questionnaire (Mackenzie, 2001). This is a very good questionnaire that helps to work out the levels of certain moods in someone. Jaffery, et al. (2017) state in the table included in the report that report overall mood was increased, lowering the scores on the tables. It was also reported that depression levels were decreased as well. They found that by doing a small amount of exercise (5/ 10 minutes) it is possible to vastly increase mood levels. Dusseldorp et al., (2010) agree with the fact a small amount of exercise could help improve the levels of depression. The main limitation of this study is that it does not have many participants leading to a risk of over concluding that the results are relevant for the population.

Danielsson, Papoulias, Petersson, Carlsson and Waern (2014) created a three-armed randomized control trial of evaluating the effect of 2 add-on treatments, exercise and basic body awareness therapy (BBAT) (Skjærven & Sunda, 2015). This trial has 62 participants that were all on anti-depressants (Danielsson et al., 2014). These were then split into 3 groups, 2 intervention groups and 1 control group. The groups had 10 weeks of aerobic exercise or BBAT. The main assessment figures were levels of depression in the candidates. This was measured using the MADRS scale (Williams & Kobak, 2008). The results were taken by a blinded assessor so that they could be impartial. The results after the intervention group partook in exercise was a reduction in MADRS score by -10.3. With the highest score being 60 (FDA, 2007), a reduction by 10 is very good. Some limitations of this could be the fact there was a relatively small size of sample and people may have been overly optimistic with how their depression levels had changed. This agrees with the results about that exercise can have a positive effect on severe depression but a lot of persuasion would potentially be needed to motivate somebody to do this.

Carvalho et al., (2011) looked at the impact of moderate exercise on depression. This article was a two-armed study. Initially 150 people were interviewed for the trial but this was cut down by random selection to 33 participants. These participants were then put into 2 groups, 11 used just antidepressants and 22 people participated in exercise. The 22 participants taking up the exercise took part in daily walks for 30-45 minutes for 12 weeks. One of these was assisted with a research fellow. The exercise group had an average reduction of 6 .84 on the hamd17 scale (GlaxoWelcome, 1997) This is not very high but it still implies that there is a benefit of using exercise as a treatment for depression. Of the exercise group 25% of the group had remission but there was no way to conclude that this was due to the exercise. There was a very limited amount of people used, with only 33 it is hard to made statistically significant results. Carvalho et al., (2011) concluded that if people stuck to the strict 12-week exercise program it may lead to a lower level of depression alongside with anti-depression tablets.

Chandler et al., (2012) explored the effects of forced exercise as a treatment alongside anti-depressants. They used 361 people who had all visited their GP with self-diagnosed symptoms of depression who were then assessed by the GP. All candidates were required to have a score of 14 on the Beck scale (APA, 2016). It was a 2-arm parallel intervention. The main measurement was self-measured depression levels using the beck scale. This was followed up after 4, 8 and 12 months as well as this their depression symptoms were checked 8 and 12 months after. After collating, all of the data and summarizing it, there was no statistically significant change. There was a mean beck score reduction of 0.54. The people within the intervention group reported an increase in physical activity. It was also noted that the exercises had not reduced the number of anti-depressants people were taking. For this information, they were able to conclude that there was no real benefit of partaking in this form of exercise for depression levels. Due to the trial using 361 people it is fair to say this could e an accurate representation of population on a local level.

The vast majority of literature found had a limited amount of people being used in the trials. (Danielsson et al., 2014), (Carvalho et al., 2011) and (Jaffery et al., 2017) all used less than 100 participants in their studies. This makes it very difficult to use the data for creating a definitive conclusion. Some of the data that was used was very specific, Silveria et al, (2013) used only research projects that had severe depression and not low to medium depression. This would make the results less relevant for the rest of people with depression but not classed as severe.

The purpose of this literature review was to examine if exercise can be used as an effect treatment for depression. From looking at the evidence, over the last 5 years more and more research has been done around this field and this will continue to keep going. The clear majority of the articles that have been viewed above have concluded that along anti-depressant drugs, exercise can have a positive effect on depression. In most cases this just reduced it but in one, some of the candidates lots their depression symptoms all together (Carvalho et al., 2011). Whilst this was the case, many reports very limited improvements in depression levels that were difficult to conclude were solely down to the exercise.

References 

APA (American Psychological Association). (2017). Depression. Retrieved from: http://www.apa.org/topics/Depression/

Carvalho, Serafim; Fonte, Daniela; Mota-Pereira, Jorge; Ramos, Joaquim; Ribeiro, Jose Carlos; Silverio, Jorge. (2011) Moderate exercise improves depression parameters in treatment-resistant patients with major depressive disorder. Journal of psychiatric research. Vol 45 Is 8. Pgs 1005-1011.

Chalder Melanie, Wiles Nicola J, Campbell John, Hollinghurst Sandra P, Haase Anne M, TaylorAdrian H. (2012). Facilitated physical activity as a treatment for depressed adults: randomised controlled trial. BMJ. 2012; 344 :e2758

Cooney, Gary M; Dwan, Kerry; Greig, Carolyn A; Lawlor, Debbie A; Rimer; Jane; Waugh, Fiona R; McMurdo, Marion; Mead, Gillian E. (2013). Exercise for Depression. Cochrane Common Mental Disorders Group. Doi: 10.1002/14651858.CD004366.pub6

Danielsson, Louise; Papoulias, Illas; Petersson, Eva-Lisa; Carlsson, Jane; Waern, Margda. (2014) Exercise or basic body awareness therapy as add-on treatment for major depression: A controlled study. Journal of Affective Disorders. Vol 168. Pgs 98-106

DoH (Department of Health). (2011). Physical activity benefits for adults and older adults. Retrieved from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/541233/Physical_activity_infographic.PDF

DeRubies, Robert J; Siegle, Greg J; Hollon, Steven D. (2008). Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms. Nature Reviews Neuroscience. Vol 10. Pgs 788-796

Evans, J.; Macrory, I.; & Randall, C. (2016). Measuring national wellbeing; Life in the UK. Retrieved from: www.ons.gov.uk/peopelpopulationandcommunity/wellbeing/articles/measuringnationalwellbeing/2016#how-good-is-our-health

FDA (Food and Drug Administration). (2007) Description of the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS). Retrieved from: https://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4273b1_04-descriptionofmadrshamddepressionr(1).pdf

GlaxoWelcome (1997) The Hamilton Rating Scale for Depression. Retrieved from: http://healthnet.umassmed.edu/mhealth/HAMD.pdf

Jaffery, Annese; Edwards, Meghan; Loprinzi, Paul. (2017). Mayo Clinic Proceedings, Rochester. Vol.92.3, pgs 480-481

Kvam, Siri ; Kleppe, Catrine Lykkedrang ; Nordhus, Inger Hilde ; Hovland, Anders. Journal of Affective Disorders, 15 September 2016, Vol.202, pp.67-86     

Mackenzie, B. (2001) Profile of Mood States (POMS) Retrieved from: https://www.brianmac.co.uk/poms.htm [Accessed 22/3/2017]

McDonald, John. 2014. Handbook of Biological Statistics. Sparky House Publishing, Maryland. Retrieved from: http://www.biostathandbook.com/gtestgof.html#

Mental Health Foundation. (2016). Fundamental Facts About Mental Health. Retrieved from: https://www.mentalhealth.org.uk/publication-download/fundamental-facts-about-mental-health-2016

Nice (2016) Treatments for mild to moderate depression. Retrieved from: https://www.nice.org.uk/guidance/cg90/ifp/chapter/treatments-for-mild-to-moderate-depression

Salehi, Iraj ; Hosseini, Seyed Mohammad ; Haghighi, Mohammad ; Jahangard, Leila ; Bajoghli, Hafez ; Gerber, Markus ; Pühse, Uwe ; Kirov, Roumen ; Holsboer-Trachsler, Edith ; Brand, Serge. (2014) Journal of Psychiatric Research, Vol.57, pp.117-124

Silveira, H ; Moraes, H ; Oliveira, N ; Coutinho, ESF ; Laks, J ; Deslandes, A. (2013). Neuropsychobiology. Vol.67(2). pp.61-68

Skjærven, Liv Helvik; Sunda, Mary Anne. (2015) Basic Body Awareness Therapy (BBAT) - Movement Awareness, Everyday Movements and Health Promotion in Physiotherapy. Retrieved from: http://fysioterapeuten.no/Fag-og-vitenskap/Fagartikler/Basic-Body-Awareness-Therapy-BBAT-Movement-Awareness-Everyday-Movements-and-Health-Promotion-in-Physiotherapy

Williams, Janet B W; Kobak, Kenneth A. (2008) Development and reliability of a structured interview guide for the Montgomery-Åsberg Depression Rating Scale. The British Journal of Psychiatry. Vol 193. Pgs 52-58

World Health Organisation (WHO). (2016). Mental health: A state of well-being. Retrieved from: www.who.int/features/factfiles/mental_health/en/


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