# Exercise as it relates to Disease/Does the intensity of resistance training matter in combating depression?

Clinical Depression is a medical illness that effects millions of people each year.
Depression has been identified as one of the future key areas in the health of older adults. There are different types of depressive disorders, and symptoms range from relatively minor, through to very severe.
Generally, depression does not result from a single event, but from a combination of recent events and other longer-term or personal factors:
* Family History
* Personality Characteristics
* Serious Medical Illness
* Drug and Alcohol Abuse
* Changes in the brain - Chemical imbalances, usually serotonin and noradrenaline.
Common Signs and Symptoms:
* Sad, down or miserable all the time
* Not taking pleasure in usual activities
* Not going out anymore
* Not getting things done at work or school
* Withdrawing from close family and friends
* Relying on alcohol or sedatives
* Unable to concentrate.
Existing Treatment Options:
* Psychological Treatments - Cognitive behavioural therapy, interpersonal therapy, behavior therapy, mindfulness based cognitive therapy
* Medical - Various antidepressants
* Other - Family and friends, exercise, diet, support groups and relaxation training.
Research shows that keeping active can help lift mood, improve sleep, increase energy levels, help block negative thoughts, increase opportunities to socialize, and generally increase well-being. Exercise may also change levels of chemicals in the brain such as serotonin, endorphins and stress hormones.

## Where Is The Research From?

This study has been taken from the Journal of Gerontology: Medical Sciences, 2005, Volume 60A. The research was conducted in Central Sydney, NSW, Australia, and participants were community-dwelling patients.

## What Kind Of Research Was This?

* Randomised, controlled 8 week study
* Compared effects of high intensity Progressive Resistance Training (PRT), low intensity PRT, and regular General Practitioner care.
* Originally 60 participants, 6 dropouts resulted in 54 participants in total.

## What Did The Research Involve?

* Participants were over 60 years old, community-dwelling patients of Central Sydney.
* Participants were tested against various mental health assessment criteria, and those who were suffering from unstable medical disease were excluded.
* High PRT program consisted of supervised, high intensity PRT of large muscle groups. Intensity was set at 80% of 1 Repetition Maximum, and was monitored by a scale of perceived exertion.
* Low intensity PRT group underwent the same regimen except that they were trained at 20% of their 1RM and not progressed.
* Both groups trained 3 times a week for 8 weeks, with each session lasting 1 hour.
* All participants who were not assigned to an exercise group received usual care from their GP, where management of their patients was entirely unrestricted.

## What Were The Basic Results?

* Results show that there was a highly significant improvement over time in mental health assessment scales across all groups, but improvements were significantly larger in the High PRT group than in the other two groups for self-rated asessments.
* All standard analyses of depression response support the hypothesis that High PRT produces a significantly positive effect on the treatment of depression.

## How Did The Researchers Interpret The Results?

* The results provide some direction for future research on the mechanism of exercise effects on depression, especially the effects of high intensity resistance training on depression.
* Results suggest that high intensity weight lifting is an effective, feasible, and safe treatment for older depressed patients.
* High intensity PRT was more effective than low intensity PRT and GP care.
* There was no statistical difference in efficacy between low intensity PRT and standard care.

## What Conclusions Should Be Taken Away From This Research?

* While exercise is a known alternative for the treatment of depression, it appears through this study that the actual intensity of the exercise may effect how exercise treats depression, with high intensity resistance training showing favorable results.
* The researchers of this study suggest that future studies are needed to examine whether this treatment is an appropriate alternative when directly compared to optimal pharmacological treatment of major depression in older adults.
Limitations:
* Issues with this study are that the sample size is too small to understand how these methods may affect the larger population.
* The age of the patient group was too limited. Depression occurs in all ages, not just over 60 years old.
* The study was also too short, and each training session was conducted under supervision. This is unrealistic to expect in the real world, and leaves questions as to whether the average population will be able to achieve the same results without being supervised.
* The patients that were in the GP care group had no restrictions on their treatment. As the patients were taken from roughly 42 GP's in the area, that leaves a lot of variation with treatment, and all falls under the doctors own medical opinion.

## What Are The Implications Of This Research?

* Many studies have examined the efficacy of exercise to reduce symptoms of depression, and the overwhelming majority of these studies have described a positive benefit associated with exercise involvement.
* Research also suggests that the benefits of exercise may be long lasting. Depressed adults who took part in a fitness program displayed significantly greater improvements in depression, anxiety and self-concept than those in a control group after 12 weeks of training,
* The exercise participants also maintained many of these gains through the 12 month follow-up period.
* Studies such as the one conducted in Sydney, Australia, may pave the way for high intensity resistance training becoming a recognized option for treatment in Depression.

## Further reading

For further information on exercise and depression, please click on any of the following links:
* Better Health Victorian Government - http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/depression_and_exercise
* Black Dog Institute - http://www.blackdoginstitute.org.au/docs/ExerciseandDepression.pdf
* Beyond Blue - https://www.beyondblue.org.au/the-facts/treatment-options/other-sources-of-support
* The Heart Foundation - Physical Activity and Depression - http://www.heartfoundation.org.au/SiteCollectionDocuments/Physical-activity-and-depression.pdf
* Australian Physical Activity Guidelines - http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

## References

* ↑ University of Pittsburgh School of Medicine, Office of Student Affairs. "Clinical Depression." http://www.medschool.pitt.edu/somsa/Depression.HTML
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Singh, N., et al. A Randomized Controlled Trial of High Versus Low Intensity Weight Training Versus General Practitioner Care for Clnical Depression in Older Adults. Journal of Gerontology: Medical Sciences 2005, Vol. 60A, No. 6, 768-776
* 1 2 3 4 5 6 Beyond Blue website - https://www.beyondblue.org.au/the-facts/depression/types-of-depression
* 1 2 Craft, L., Perna, F. The Benefits of Exercise for the Clinically Depressed. Prim Care Companion J Clin Psychiatry. 2004; 6(3): 104-111.