Running head: PHYSICAL ACTIVITY INTERVENTIONS AND DEPRESSION

Best Practice Paper: Physical Activity Interventions and Depression Kelsey Rape Auburn University

PHYSICAL ACTIVITY INTERVENTIONS AND DEPRESSION

Physical Activity Interventions and Depression Depression is widespread mental disorder that affects around 340 million people around the world, primarily in the United States (Dinas, Koutedakis, and Flouris, 2011). It can be characterized by feelings of sadness and anxiety, accompanied with hopelessness, pessimism, or guilt (Depression and anxiety, 2011 ). Because of the growing number of people suffering from this disorder, depression is projected to become the number one leading cause of disability globally. It is also predicted to be the leading contributor to the global burden of disease by the year 2020 (Dinas et al., 2011). There are multiple interventions, with or without medicine, which can be used to reduce the symptoms of depressive symptoms; however, recent research has shown that exercise can be one of the most beneficial treatments aimed at preventing and treating depression. Although exercise seems to be a small task, many studies have shown more positive outcomes when comparing this intervention with other treatments. Because depression is becoming more prevalent, it is important to find ways to manage this among and prevent symptoms from becoming worse. Depression is a complex disorder, indicated by low levels of mood, lack of interest or pleasure, disrupted appetite or sleep, low self-worth, feelings of guilt, deprived concentration, and lack of energy (Dinas et al., 2011). Substantial impairment of social functioning can also be displayed and usually affects daily activities. Associated suicide is seen in severe cases, and it has grown to be the third leading cause of death among adolescents. (Brown, Pearson, Brathwaite, & Biddle, 2013). Because there are multiple indications seen in each individual, there is not necessarily one size fits all treatment. Common treatments include psychotherapy, medication administration, group and individual therapy, and simple lifestyle changes (Saisan, Smith, & Segal, 2013). Because depression has a high reoccurring rate, lifestyle changes can be the best implementation because

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they help prevent signs and symptoms rather than just curing after the onset has already begun. Common lifestyle alterations include nutrition, sleep, social support, stress reduction, and most importantly, exercise (Saisan., et al., 2013). Exercise can be beneficial because it works primarily by not only boosting serotonin and endorphins, but also promoting the growth of new brain cells (Eyre & Baune, 2011). This is the same mechanism of action that antidepressant medications exhibit, but exercise is a natural form and lacks the side of effects seen with medication use. As opposed to the other various forms of treatments, exercise is a readily available therapeutic option and can be accomplished in a group or individual setting and on the individuals own time (Eyre & Baune, 2011). This promotes autonomy and encourages activity because it is based on the individual s own time and scheduling. Another perk of exercise is that it does not take a long time to accomplish. For exercise to be beneficial, all that is required is 30 minutes a day, even if it is achieved through walking. 30-60 minutes of aerobic activity can be used for maximum results (Disa bility exercises, 2013). Because individuals usually require different treatments specific to their signs and symptoms, exercise can be an exceptional option because of the flexible choices one can have. Exercise options may include aerobic exercises, consisting of activities such as swimming or walking, or anaerobic exercises, such a weight training or sprinting. For individuals who are physical impaired or lack the ability for those activities, flexibility exercises and stretching can be considered forms of exercise (Disability exercises, 2013 ). Because individuals choose their own form of exercise, they determine the cost of treatment. In most cases, there will always be a way to exercise without using any form of payment. Another advantage of exercise is that even if one chooses another source of treatment, exercise can easily be added to help increase the

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productivity of the other intervention. However, physical exercise by itself is still proven to be the best source to prevent and treat symptoms of depression (Depression and anxiety, 2011 ). Because all clinical decision must be based on the best information in practice, it is necessary to evaluate exercise compared to other treatment options. To evaluate the effectiveness of exercise and depression, several studies have been performed and can confirm positive correlations between these two subjects. One in particular studies children and adolescents, primarily because depression is the most frequently diagnosed mental health disorder within this age. After intervening with accomplishing physical activity within this age group, encouraging results stressed the importance of exercise to prevent and cure depression. Statistically significant differences in depression scores for exercise conditions were seen when compared to no intervention at all. Evidence suggested that physical activity participation is both protective against the onset and beneficial for reducing depressive symptoms (Brown et al., 2013). It positively correlates with a decrease in stress-associated depressive symptoms (Eyre & Baune, 2011). When focusing primarily on adults, several studies have compared physical exercise with antidepressant treatments. Many individuals turn to medication administration as the first-line treatment for their depressive symptoms. Because antidepressant medication may not be affordable for all people and they are not aware of alternative methods, they fail to seek care. Only 10-25% of those affected by depression choose to receive care for their condition, usually due to lack of resources or because of the social stigma associated with depression (Dinas et al., 2011). Because this leaves the majority of the population without care, education towards a cost-effective alternative that can be performed on ones own time, like exercise, should be introduced. One study used a questionnaire for 31,000 Harvard graduates. Results showed that mood tends to be elevated in a day when an individual exercises. Individuals who

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keep an inactive lifestyle are reported to have the highest level of depression and the most suicidal thoughts (Dinas et al., 2011). If individuals continue to adopt physical active lifestyles long-term, even after depressive symptoms have ceased, they will demonstrate the lowest levels of symptoms. This is because they develop a routine in their life that augments endorphin secretion, which, in turn, reduces anxiety and depression levels. A long-term 8 month exercise program was successful in improving depression symptoms in 40-60 year-old depressed women, unlike pharmacological treatment (Dinas et al., 2011). One important aspect of this same study focused on the reoccurring rate specific treatment used towards this disorder. Individuals with major depressive disorder undergoing an aerobic exercise program were less likely to return back to their previous depressive state as compared to those only seeking medical care. Although there is compelling evidence that proves the effectiveness of physical exercise for depressive symptoms, it is important to address the gaps in the information that is already available. To provide the optimum information available, there are a few pieces of evidence that should be addressed in future research. One, in particular, is the risks associated with exercise. If one is not physically able to complete exercise programs, it is important for that person to not force the activity because this could lead to further problems and injuries. There could also be risks associated with individuals that do not stretch or relax after exercise programs are completed. However, while this information is known, it is not completely said what the exact risks may be or how exactly the body can be hindered by routine physical activity in those that are not able to withstand it (Dinas et al., 2011). Another way that could make studies on physical activity and depression more credible is using more outcome-focused, high-quality trials in not only children and adolescents, but adults also. It is important to determine the differences in these age groups to best implement the most appropriate exercise program to fit that particular

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age group (Brown et al., 2013). A main issue that has been seen in each study and in the clinical setting is the difficulty in starting exercise programs in individuals suffering with depression. Because these individuals experience lower levels of mood and lack of interest or pleasure, they are less concerned with starting a program that involves activity or change (Dinas et al., 2011). For this reason, there is a gap in the outcome of exercise programs because it can be difficult to start them or to get the patient to continue the program before they experience a relief of depressive symptoms. However, regardless of the gaps in the information available, exercise is still considered one of the most effective forms of treatment for depression. Depression is a serious disorder, and it continues to grow in prevalence among children, adolescents, and adults. There are many forms of treatment available, but lifestyle changes such as exercise can keep these symptoms of depression from occurring as frequently. Physical exercise can be performed during an individuals own time, is inexpensive and flexible, and has proven to show measurable outcomes. Because depression is projected to be the number one leading cause of disability globally, interventions like exercise, can be put into practice and prevent this from occurring as quickly or as drastically (Dinas et al., 2011).

PHYSICAL ACTIVITY INTERVENTIONS AND DEPRESSION

References Brown, H., Pearson, N., Braithwaite, R., Brown, W., & Biddle, S. (2013). Physical activity interventions and depression in children and adolescents: a systemic review and metaanalysis. Sports Medicine, 43(3), 195-206. doi: 10.1007/s40279-012-0015-8 Depression and anxiety: Exercise eases symptoms . (2011). Retrieved from http://www.mayoclinic.com/health/depression-and-exercise/MH00043 Dinas, P., Koutedakis, Y., Flouris, A. (2011). Effects of exercise and physical activity on depression. Irish Journal f Medical Science,180 (2), 319-325. doi: 10.1007/s11845-0100633-9 Disability exercises: information on getting and staying fit . (2013). Retrieved from http://www.disabled-world.com/fitness/exercise/ Eyre, H. and Baune, B. (2011). Neuroimmunological effects of physical exercise in depression. Brain, Behavior, and Immunity, 26 (2), 251-266. doi: 10.1016/j.bbi.2011.09.015 Saisan, J., Smith, M., & Segal, J. (2013, Aug). Depression treatment: Therapy, medication, and lifestyle changes that can help depression . (2013). Retrieved from http://www.helpguide.org/mental/treatment_strategies_depression.htm