# Exercise as it relates to Disease/Exercise as a Treatment for Depression

Depression is a serious psychiatric and medical condition that causes constant feelings of sadness and frustration. Symptoms of depression include; depressed mood, low energy and lack of motivation. These symptoms have been found to cause a deterioration and impairment of functioning in many aspects of an individuals life. Exercise however, has been consistently shown to be associated with improved physical health, cognitive functioning, and psychological well-being. Conversely, sedentary behaviour appears to be connected with the development of psychological disorders. Exercise has been used as a treatment for a number of medical disorders including; diabetes, osteoarthritis and cardiovascular disease. There is now a growing body of evidence that suggests that exercise can be used as a treatment for depression.

## About the Research

"Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months" is a study from the Department of Psychiatry and Behavioral Sciences, Duke University Medical Centre, Durham, North Carolina. It is a single-centre clinical trial that was conducted in 1999. The objective of this study was to examine adults with major depressive disorder and assess their status after being prescribed aerobic exercise, antidepressant therapy or a combination of both.

## Procedures

The study involved 156 participants with major depressive disorder. Participants were aged 50 years and older. Depression evaluations were conducted using the Hamilton Rating Scale for Depression (HRSD). All participants scored at least 13 (mild depression) on the HRSD. Depression evaluations were conducted at baseline, immediately after the 4-month treatment period and 6 months after the treatment had ended. Participants were randomly assigned to one of three treatments: exercise, medication, or combined exercise and medication.
* Exercise - Subjects attended 3 aerobic exercise sessions a week for 16 weeks. Each session involved a 10-minute warm up, 30 minutes of cycling or brisk walking/jogging and a 5-minute cool down.
* Medication - Subjects were administered with an antidepressant - sertraline.
* Combination - Subjects were given a combination of the above measures.

## Basic Results

After 4 Months of Treatment
After the 16 weeks of treatment the majority of patients in all three treatment groups exhibited a clinically significant reduction in depressive symptoms. 60.4% of participants in the exercise group, 65.5% of the medication group and 66.8% of the combination group no longer met the diagnostic criteria for depression.
6 Months Post Treatment
During the six months follow up post treatment, it was found that participants in the exercise group exhibited lower rates of depression (30%) than participants in the medication (52%) and combined groups (55%). Individuals in the exercise group were more likely to be either fully, or partially recovered when compared to individuals in the two other groups. In addition to this, among patients who had been assessed as being in full remission at the end of the 4-month treatment period, participants in the exercise group were less likely to relapse than participants in the two groups receiving medication.
Findings
* Combining exercise with medication had no additional advantage over either exercise or medication alone. It is assumed that combining both should display the best results however, this was not the case.
* 64% of subjects in the exercise group and 66% of subjects in the combination group reported that they continued to exercise during the follow up period. Also, 48% of participants in the medication group began an exercise program during this period.
* Participation in an exercise program during the follow-up period was found to be inversely related to the incidence of depression at 6 months post treatment. Each 50-minute increment in exercise per week was associated with a 50% decrease in the odds of being classified as depressed.

## Conclusions

All groups involved in the study showed a reduction in depressive symptoms and therefore the findings suggest that an exercise program can be a suitable alternative to medication to treat depression. After 16 weeks of exercise, 60.4% of participants were no longer classified as depressed. The exercise therapy was found to have therapeutic benefit, especially when the exercise was continued over time. It was also found that participants who used the medication were found to be more likely to relapse when compared to the exercise only group.

## Implications of the Research

* The combination of exercise and medication displayed no better results than the measures of exercise and medication individually.
* 64% of participants in the exercise group and 66% in the combination group continued with exercise programs after the treatment ended.
* After being suggested to undertake in exercise, 48% of participants in the medication group began an exercise program post treatment.
* The findings demonstrated that exercise therapy has comparable results to the medication group and the combination group.
* The study demonstrated that exercise can be used as an alternative to antidepressant medication to treat depression.

## Further reading

* Depression facts - https://www.beyondblue.org.au/the-facts
* Exercise and depression - http://www.blackdoginstitute.org.au/docs/ExerciseandDepression.pdf
* Causes of depression - http://www.mindhealthconnect.org.au/causes-of-depression

## References

* ↑ Lowe, A. Depression, Canadian Epilepsy Alliance. http://epilepsymatters.com. Accessed: 27 September 2016
* 1 2 Cares, P, et al. (2011) Exercise for the Treatment of Depression and Anxiety. International Journal of Psychiatry in Medicine. Vol 40 (1) pp 15-28
* 1 2 3 4 5 6 7 Babyak, M, et al, (2000) Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months. Psychosomatic Medicine, vol 63, pp 633-638.
* ↑ Greer, T & Trivedi, M, (2009) Exercise in the Treatment of Depression. Current Psychiatry Reports, vol 11, pp 466-472