# Exercise as it relates to Disease/Depression and green exercise
## Depression & Green Exercise
### What is Depression & What are the Symptoms?

Depression is a mental illness, where the sufferer experiences intense feelings of misery over an extended period of time. Symptoms include: a dysphoric mood, changes in appetite and sleeping patterns, changes in motor activity, feelings of guilt and worthlessness, diminished ability to concentrate and suicidal thoughts $^{[8]}$

### Causes

Causes of depression can be biological, psychodynamic, behavioural and/or cognitive $^{[8]}$

## What is Green Exercise?

Green exercise is exercising outdoors while at the same time being exposed directly to nature. It can be anything from exercising in the backyard, at a park, to walking trails or anywhere in open space, as long as it’s not indoors! $^{[1,2]}$

### How it Helps in Treating Depression $^{[1,2,7]}$

   * Improves physical health, self-esteem and mood
   * Helps you sleep better (fresh air workouts help some people sleep deeper)
   * Can strengthen the immune system by increasing the number of cells that act to fight cancer
   * Helps to reduce stress levels
   * Exercising in nature makes participants less depressed, angry, tense and confused
   * People who exercise in areas with is water present, such as lakes or rivers, show the biggest improvements in mental health
   * Promotes concentration and clear thinking

### Benefits

   * It’s free! No need to pay gym membership
   * No waiting for gym equipment/machines, and no pressure to hurry up
   * Not limited by gym opening hours
   * Less likely to become bored than those who train in the gym $^{[2]}$
   * Exercise any time

## Comorbidities

Other behaviours such as smoking, over-eating and high alcohol consumption are coping mechanisms for depression sufferers. Depression is also known to be a major risk factor for other chronic diseases such as asthma, arthritis, diabetes, stroke and heart disease.$^{[3]}$

## Costs and Occurrence

In 2001, 121 million people were estimated to have depression worldwide $^{[4]}$
   * Depression imposes a significant burden on patient and family well-being, health-care costs and loss of productivity $^{[5]}$.
   * By 2020, the World Health Organization estimates that depression and depression related illnesses will become the greatest source of ill health $^{[3]}$

## Recommendations for Implementing Green Exercise into my Lifestyle

   * Exercise in nature-it can be as simple as going for a walk around a lake/along a river, or doing yoga in the park
   * Low intensity exercise is recommended over high or moderate intensity exercise as low intensity has a tendency to keep participants exercising outdoors longer $^{[6]}$

## Where can I go to Get More Information?

   * World Health Organisation http://www.who.int/mental_health/management/depression/definition/en/
   * Black Dog Institute http://www.blackdoginstitute.org.au/public/depression/treatments/index.cfm
   * Reach Out http://au.reachout.com/find/articles/depression-management-and-treatment-options
   * Green Exercise-Nature Based Treatment Options http://www.greenexercise.org/Nature_Interventions.html

## Sources

1. International Council on Active Aging Research, 2010, ‘Research in the News’, Journal on Active Aging, vol. 9, no 4, pp. 22–26
2. Parachin, V., 2011, ‘Green Exercise’, American Fitness, vol. 29, no 5, pp. 44–45
3. Pretty, J., Peacock, J., Sellens, M., & Griffin, M., 2005, ‘The mental and physical health outcomes of green exercise’, International Journal of Environmental Health Research, vol. 15, no 5, pp. 319–337
4. Mauskopf, J.A., Simon, G.E., Kalsekar, A., Nimsch, C., Dunayevich, E., & Cameron, A., 2009, ‘Nonresponse, partial response, and failure to achieve remission: a humanistic and cost burden in major depressive disorder’, Depression & Anxiety, vol. 26, pp. 83–97
5. Domino, M.E., Burns, B.J., Mario, J., Reinecke, M.A., Vitiello, B., Weller, E.B., Kratochvil, C.J., May, D.E., Feny, N.C., Robins, M., Hallin, M.J., Silva, S.G., & March, J.S., 2009, ‘Service use and costs of care for depressed adolescents: Who uses and who pays?’, Journal of Clinical Child & Adolescent Psychology, vol. 36, no 6, pp. 826–836
6. Barton. J., & Pretty, J., 2010, ‘What is the best dose of nature and green exercise for improving mental health? A multi-study analysis’, Environmental Science & Technology, vol. 44. no 10, pp. 3947–3955
7. Archer, S., 2007, ‘Body-mind benefits of green exercise’, IDEA Fitness Journal, vol. 4, no 9, pp. 97
8. Beck, A.T., & Alford, B.A., 2009, ‘Depression: Causes and treatments’, 2nd edition, University of Pennsylvania Press, Philadelphia