# Exercise as it relates to Disease/Intervention effect of long-distance running on depression of college students

This Wikipage is a critique of the research article "Intervention Effect of Long-Distance Running on Depression of College Students" by Xinjun Luo. This critique is for an assessment for the unit Health, Disease and Exercise at the University of Canberra, Semester 2, 2022.

## What is the background to this research?

Depression is a mental health illness that, according to the Diagnostic and Statistical Manual of Mental Disorders 5-TR (DSM5-TR), is diagnosed when the patient exhibits five or more of the following criteria for at least two weeks:
* Depressed mood
* Loss of interest or pleasure in almost all activities
* Significant unintentional weight loss/gain or decrease/increase in appetite
* Sleep disturbance
* Psychomotor changes
* Tiredness, fatigue, or low energy
* A sense of worthlessness or excessive, inappropriate, or delusional guilt
* Impaired ability to think, concentrate, or make decisions
* Recurrent thoughts of death, suicidal ideation or suicide attempts
As of 2022, the rate of depression globally has increased exponentially due to the COVID-19 Pandemic and subsequent isolation/lockdown. Due to the impact that mental health has, it is important to research several interventions outside of pharmacological methods to allow for easy access and greater effectiveness in different populations.
This paper aims to identify if the use of a long-distance running intervention can be effective in the treatment of depression in Chinese college students ranging from first year to fourth year enrollment.

## Where is this research from?

It is not clearly evident if the author, Xinjun Luo of Guizhou University of Commerce, Guiyang, China, has produced other journal articles.
As the research was performed in China it is important to note that every society has different influences on mental health. Therefore, although this information can be beneficial, there are also other factors that can impact the intervention effectiveness in other societies. It is also important to observe that the subjects were college students and the same stressors may not be apparent in individual’s lives outside of these settings.

## What kind of research was this?

The research is a non-randomised controlled study (NRS) and is categorized as a case series (uncontrolled longitudinal study). This is where an intervention implemented, where all subjects receive the same intervention but no control group is allocated. Results are observed before and after the intervention.

## What did the research involve?

When measuring the mental health aspect of the study the Self-Rated Depression Scale (SDS) and the Hamilton Depression Rating Scale 24-Item (HAM-D24) was completed by all participants before and after the intervention.
Unfortunately, the methodology of the intervention is barely described more than “145 college students with certain depression” who trained in “long-distance running” for “2 months”.
The study does not have a control group (subjects that do not participate in the intervention) which reduces the integrity of the research and its results as there are several different factors that can influence mental illness. These can include the period of which the study was performed – were the students participating in examination or assessment periods or just finished these periods, holidays, starting a new semester, etc.
The running intervention delivery can also influence the results. These variables include frequency, variability, intensity and if the sessions were run as a group or individually - if the sessions were performed as a group then the individuals would be increasing their time socialising which can be a significant element in mental illness.
Without a control group, these factors may be manipulating the depression scores recorded by the students before and after the intervention and cannot be identified.

## What were the basic results?

This study’s findings report that there was a statistical improvement (P<0.05) in the Somatic Disorder and Psychomotor Disorder from the SDS after the intervention. The HAM-D24 showed significant reductions (P<0.05) in the factors of Cognitive Barrier, Diurnal Variation, and Despair. It should be noted that the methods never indicated that the HAM-D24 had been issued to the subjects even though the data shows pre- and post-intervention. There was no indication of subject attrition within the intervention and post-intervention measurements.
These were presented in a table that showed pre- and post-experiment results with standard deviation and the paired t-test data.
The author presents the information very positively and even mentioned a “cure” for depression. The author states “The experimental results of a long-distance running showed that the anxiety/somatization factor, block factor, sleep disorder factor and total depression score after training were improved, and the college students running not regularly have a tendency to depression when compared with the college students running regularly”.
The results showed statistical significance, however, as the methodology of screening and intervention delivery is flawed (no control group and no further information on what the long-distance running intervention involved) it is unwise to use this research as an indicator of the effectiveness of long-distance running on depression by itself.

## What conclusions can we take from this research?

Although the methodology of the study is unsound, it still provides some insight that running can contribute to improved mental health. It does not establish though, the contributing factors to the improvement. Could it be narrowed down to exercise and the metabolic and hormonal response of performing physical activities? From personal experience, there have been many that have stated that simply the act of performing exercise, whether it be running or some other form of physical activity, was beneficial for other reasons that have been described as:
· Time away from stressors (such as family, work, environments, etc.)
· The activity had a meditative feel (due to the metronomic rhythm of the exercise)
· The feeling of releasing energy
· Completing exercise as a group (socialising)
This identifies that it is not just the physical (metabolic and hormonal) factors that make physical activity beneficial for mental health.
The results are supported by Matias et al. (2022) who established that outdoor walking/running, cycling and team sports improved resilience against depression. Doose et al. (2015) studied the effects of an 8-week walking/running aerobic exercise program and found a “large reduction of depressive symptoms”.

## Practical advice

This study shows that with the current life stressors, particularly for college students, some form of exercise is beneficial for individual’s mental health. As the intervention itself wasn’t published it is hard to say if the specific program is easy to replicate or is safe to replicate (building volume/load in a safe manner to avoid injury). However, with the support of other studies, aerobic exercise is an effective tool in combating mental illness, in particular, depression.

## Further information/resources

Park Run is a free event run all around the world where individuals complete a 5km track with no time restrictions. It has the benefit of aerobic exercise and exercising with a group of other like-minded individuals: https://www.parkrun.com.au/
Beyond Blue is an effective resource for mental health, even providing questionnaires to identify if you may be suffering from a mental illness: https://www.beyondblue.org.au
Black Dog Institute is another organisation (similar to Beyond Blue) that provides information about mental health. This particular resource discusses the relationship between exercise and depression: https://www.blackdoginstitute.org.au/wp-content/uploads/2022/06/Exercise-and-depression.pdf
The Running Clinic is a platform where you can acquire a running program that is appropriate for beginners to elite runners. This can be a fantastic resource if you want to begin running and don’t quite know where to start: https://therunningclinic.com/runners/learn/training-programs/training-programs/

## References

* ↑ Luo, X. (2020). Intervention effect of long-distance running on depression of colleges students. Revista Argentina de Clínica Psicológica, 29(2), 90-95.
* ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
* ↑ Kim, A. W., Nyengerai, T., & Mendenhall, E. (2022). Evaluating the mental health impacts of the COVID-19 pandemic: perceived risk of COVID-19 infection and childhood trauma predict adult depressive symptoms in urban South Africa. Psychological Medicine, 52(8), 1587-1599. doi:10.1017/S0033291720003414
* ↑ Cochrane Childhood Cancer (2022). Non-randomised controlled study (NRS) designs. Retrieved fromhttps://childhoodcancer.cochrane.org/non-randomised-controlled-study-nrs-designs#:~:text=Case%20series%20(uncontrolled%20longitudinal%20study,but%20with%20no%20control%20group.
* ↑ Merema, M. R. (2014). An Update on Social Activity and Depression in the Elderly: A Brief Review of Recent Findings and Key Issues. Healthy Aging & Clinical Care in the Elderly(6), 11-15. doi:10.4137/HACCE.S12499
* 1 2 Peterson, B., Withers, B., Hawke, F., Spink, M., Callister, R., & Chuter, V. (2022). Outcomes of participation in parkrun, and factors influencing why and how often individuals participate: A systematic review of quantitative studies. Journal of Sports Sciences, 40(13), 1486-1499. doi:10.1080/02640414.2022.2086522
* ↑ Matias, T. S., Lopes, M. V. V., da Costa, B. G. G., Silva, K. S., Schuch, F. B., & da Silva, K. S. (2022). Relationship between types of physical activity and depression among 88,522 adults. Journal of Affective Disorders, 297, 415-420. doi:10.1016/j.jad.2021.10.051
* ↑ Doose, M., Ziegenbein, M., Hoos, O., Reim, D., Stengert, W., Hoffer, N., . . . Sieberer, M. (2015). Self-selected intensity exercise in the treatment of major depression: A pragmatic RCT. International Journal of Psychiatry in Clinical Practice, 19(4), 266-275. doi:10.3109/13651501.2015.1082599