# Exercise as it relates to Disease/Physical activity patterns of people affected by depressive and anxiety disorders

Helgadóttir.B, Forsell.Y, Ekblom.Ö (2014) Physical Activity Patterns of People Affected by Depressive and Anxiety Disorders as Measured by Accelerometers: A Cross-Sectional Study. PLOS ONE. 10(1): e0115894. doi:10.1371/journal. pone.0115894

## What is the Background to this Research?

Depression and anxiety disorders can both effect psychomotor functioning and neural drive thought to occur through a range of emotional, cognitive and biological factors. These factors are thought to be correlated with a decrease in physical activity and an increase in total sedentary time. Total sedentary time is associated with obesity and metabolic abnormalities, however, the way sedentary time is accrued is seemingly more detrimental, suggesting that prolonged unbroken sedentary bouts are associated with higher biological markers of metabolic syndrome risk. Physical activity independent or in conjunction with psychopharmaceuticals is recognised as an effective form of treatment for depression and anxiety disorders, however, the dose response of exercise as a treatment relative to these disorders requires more in-depth investigation.
The purpose of this study is to better understand the physical activity patterns of individuals diagnosed with depression and anxiety receiving outpatient care. Objective measures obtained via accelerometry, provided physical activity data correlated to these populations, which can be further investigated to determine the possible treatment potential of exercise in these populations. This study also investigates whether there is a correlation between depression severity on the MADRS and the amount of physical activity reported.

## Where is the research from?

Upon investigating who is involved with publishing, editing and funding, there is no clear evidence of bias towards the support or production of this research article.
The three authors Björg Helgadóttir, Yvonne Forsell & Örjan Ekblom affiliated with the paper all have strong backgrounds in research publication and academia. The Academic editor James Bennett Potash has been apart of over 170 released papers.
The paper was published under a creative commons license permitting unrestricted use and distribution. Funding for the research came from the Vardal Foundation who fund health and human-wellbeing research.

## What kind of research was this?

This research was conducted as a cross sectional study. Cross sectional studies allow researchers to measure prevalence and collect data from large populations over a short period of time and they can compare differences amongst populations via grouping individuals by characteristics. Cross-sectional studies are limited as they cannot infer causation, the data collected can only recognise correlations. Data collected from cross sectional studies are often a snapshot of a population and may not be completely representative of measures within the target population.

## What did the research involve?

Method
Participants were recruited through advertisements and at primary health care centers, of which 308 participants aged 18-65 were recruited. Participants then completed the Mini International Neuropsychiatric Interview (MINI) to categorise groups of depressive or anxiety disorders. The MADRS was then utilised to determine severity of depressive symptoms. Participants of both groups were then instructed to wear Triaxial accelerometers for the waking part of their days, for a week. Whilst accelerometers were programmed to analyse data in 60-second epochs to measure sedentary bouts as well as, light, moderate and vigorous activity.
Limitations
The decision to measure physical activity in 60-second epochs on the accelerometers instead of measuring more frequently, allows for more error in data collection. Previous studies have reported up to 17 minutes of moderate to vigorous physical activity being under reported by using 60-second epochs opposed to 5-second.
The recruitment processes may have targeted specific types of participants which are more inclined to participate in research.
Of the 308 participants recruited, only 165 (53.6%) fulfilled the data collection requirements. Therefore, the data collection process could have been made easier or more positively enforced to increase compliance.
The minimum requirements for accelerometer data was 4 or more days of wear, including 1 weekday. Days with over 600 minutes (10 hours) of wear time were included. This minimum requirement for data collection, may further decreases the already small representation of this populations physical activity habits collected from the cross sectional study.
Self report measures are always subject to self-report and social desirability bias. These biases could have effected the self-report measures of BMI, health status and reports of physical activity from the previous year.

## What were the basic results?

Important findings
Participants diagnosed with depression had the lowest amount of time spent in any physical activity categories and the largest, most frequent sedentary bouts. Participants diagnosed with concurrent depression and anxiety had the most amount of time spent in the moderate to vigorous physical activity categories and the shortest, least frequent sedentary bouts. Participants diagnosed with anxiety had the most amount of time spent in the light physical activity category and sedentary bouts similar to the concurrent group.
Each one point increase on the MADRS was associated with a 2.4 minute decrease in minutes of light physical activity. A positive, yet weak correlation was also found between higher MADRS scores and the amount of sedentary bouts.
Researchers Interpretation
According to the researchers, the data collected is particularly important to patients struggling to meet the moderate to vigorous physical activity recommendations. With a now better understanding of their physical activity patterns, recommendations could potentially be made surrounding increments to their light physical activity and breaking up their sedentary time, to possibly begin alleviating symptoms of depression and anxiety.
However, the researchers recognise that suggestions to treatment and physical activity recommendations can only be assumed from the data and no causative conclusions can be drawn from their study, understanding that further longitudinal studies are required to investigate whether their findings are beneficial from a treatment perspective.

## What conclusions can we take from this research?

The correlation between depression and sedentary behavior has been repeatedly researched and validated. A 2020 accelerometer study in older adults claimed that, longer sedentary bouts positively correlated with an increased risk of depression. Similarly, explaining that knowledge of the association between sedentary behaviour and depression may be important to consider in the development of future recommendations for the prevention of depression.
Based on the critiqued article and further research, it is implied that shortening and disrupting bouts of sedentary behaviour whilst also encouraging light physical activity may be beneficial and more practical in this population, and should be taken into consideration by health care professionals when prescribing exercise as a treatment in these populations.
Most importantly, this study is purely data collection and therefore no definitive recommendations regarding physical activity as a form of treatment can be inferred. Nor can it be implied that these individuals did less exercise because of their disorder, the data can only imply that there is a relationship between the disorder and the activity patterns.

## Practical advice

This article implies that physical activity patterns of individuals with depression and anxiety are lower than average. Suggesting that increasing physical activity in these populations should be approached by reducing sedentary time and increasing light physical activity. However, increasing physical activity and reducing sedentary time can be a confusing process. Individuals looking to do so should seek the advice of ESSA professionals, specifically qualified to design and deliver physical activity interventions.

## Further information/resources

Mental Health and Physical Activity
Physical activity Guidelines
Beyond Blue
Headspace
Sedentary Behaviour and Depression

## References

* ↑ Cleare.A, Fekadu.A, Rane.L. (2012) 20 - Unipolar depression, Core Psychiatry (Third Edition), Pages 287-311,ISBN 9780702033971,https://www.sciencedirect.com/topics/neuroscience/psychomotor-agitation
* 1 2 3 Helgadóttir.B, Forsell.Y, & Ekblom.Ö. (2015). Physical activity patterns of people affected by depressive and anxiety disorders as measured by accelerometers: A cross-sectional study. PLoS One, 10(1) doi:https://doi.org/10.1371/journal.pone.0115894https://www.proquest.com/docview/1646465497
* ↑ Healy.G, Dunstan.D, Salmon.J, Cerin.E, Shaw.J, Zimmet.P, Owen.N. (2008) Breaks in Sedentary Time: Beneficial associations with metabolic risk. Diabetes Care; 31 (4): 661–666. https://doi.org/10.2337/dc07-2046https://diabetesjournals.org/care/article/31/4/661/25574/Breaks-in-Sedentary-TimeBeneficial-associations
* ↑ Carek.P, Laibstain.S, Carek.S. (2011) Exercise for the Treatment of Depression and Anxiety. The International Journal of Psychiatry in Medicine. 41(1):15-28. doi:10.2190/PM.41.1.chttps://journals.sagepub.com/doi/abs/10.2190/PM.41.1.c
* 1 2 The British Medical Journal (BMJ). Chapter 8: Case-control and cross sectional studies. https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/8-case-control-and-cross-sectional
* ↑ Colley.R, Harvey.A, Grattan.K, & Adamo.K. (2014). Impact of accelerometer epoch length on physical activity and sedentary behaviour outcomes for preschool-aged children. Health Reports, 25 (1), 3-9. https://www.proquest.com/docview/1496068822
* ↑ Althubaiti.A. (2016) Information bias in health research: definition, pitfalls, and adjustment methods. Journal of Multidisciplinary Healthcare. 4;9:211-7. doi: 10.2147/JMDH.S104807. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862344/
* ↑ Eriksson.M, Nääs.S, Berginström.N, Nordström.P, Hansson.P, Nordström.A, (2020) Sedentary behavior as a potential risk factor for depression among 70-year-olds, Journal of Affective Disorders. Volume 263, Pages 605-608, ISSN 0165-0327, https://www.sciencedirect.com/science/article/pii/S0165032718328751?via%3Dihub