# Exercise as it relates to Disease/Exercise or basic body awareness therapy as add-on treatment for major depression
## What is the background to this research?

Depression is a serious medical issue, that causes a persistent lowering of mood. Although, all people experience feelings of sadness or disappointment from time-to-time, depression is much more intense, and long-lasting, and can be very distressing for the affected person, causing interference with everyday life. Every year around 6% of all adult Australians will experience depressive illness. Some factors that might place a person at a higher risk of developing depression include:
-Family history-Having a close relative with depression can increase a person’s chances of developing the condition.
-Social factors- Some people who experience neglect or abuse during childhood might be more likely to develop depression as adults
-Personal physiological factors- People who tend to dwell on negative events, worry excessively, or attend more to negative information about themselves, the world or the future are more prone to depression.
-Neurochemistry- Changes in the levels or activity of certain chemicals in the brain like serotonin, norepinephrine, and dopamine play a role in depression, though the specific processes are not fully understood.
There are different ways of treating depression and the effectiveness and type of treatment will differ from person to person. Some ways of treating this illness include medication, individual therapy, community support programs and shock therapy. Exercise is also used as a treatment, and is heavily researched as an effective way to reduce or even eliminate depressive symptoms.

## Where is this research from?

The study was conducted in Sweden at a variety of institutions listed below.
* Institute of Neuroscience and Physiology, Department of Clinical Neurosciences and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden
* University of Gothenburg Centre for Person-Centred Care (GPCC), Sweden
* ahlgrenska University Hospital, Sweden
* Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
* Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
* Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden

## What kind of research was this?

A randomised control trial with two intervention groups and one control group was taken out to examine the effects of exercise on depression. The two intervention groups were aerobic exercise, of moderate to high intensity, and Basic body Awareness Therapy (BBAT), low intensity training with focus on mind-body interaction.

## What did the research involve?

62 adults aged between 18 and 65 with major depression, as determined by the Mini International Neuropsychiatric Interview (MINI) were selected to participate in the study. All participants were on antidepressant medication and were split into three groups to undergo a 10 week intervention. Interventions were aerobic exercise or basic today awareness therapy (BBAT), compared to a single consultation with advice on physical activity. After undergoing the 10 week intervention, each participant was assessed using the Montgomery Asberg Rating Scale (MADRS) to determine their depression severity, other outcomes were global function, cardiovascular fitness, self-rated depression, anxiety and body awareness.

## What were the basic results?

For observer-rated depression severity, the mean change in MADRS score was - 10.3 with a 95% confidence interval ( - 13.5 to - 7.1) in the exercise group, - 5.8 (95% CI - 9.2 to - 2.5) in the BBAT group and - 4.6 (95% CI - 7.9 to - 1.2) in the advice group. Showing that the exercise group improved significantly compared to the advice group. For self-rated depression, there was a statistically significant difference in mean change across the three groups, favoring exercise; mean change in MADRS-S 1⁄4 - 7.2 (95% CI - 10.0 to - 4.4), p 1⁄4 0.036. For the BBAT group, the mean change was - 4.2 ( - 7.1 to - 1.3) and for the advice group, the mean change was - 1.8( - 4.8 to 1.1) Also showing significant improvements for the exercise group compared to the advice group.
Mean changes in cardiovascular fitness for the three groups respectively were: exercise 2.4 (95% CI 1.5 to 3.3), BBAT 0.8 (95% CI -0.2 to 1.7) and advice 0.8 (95% CI -0.2 to 1.7). Showing significant improvement for the exercise group compared to the advice group and also the exercise group compared to the BBAT group. There was no significant changes for anxiety levels, self rated and body awareness.

## How did the researchers interpret the results?

The researchers determined that exercise as an add on treatment for major depression can cause significant improvements. Aerobic exercise compared to advice on physical activity has a clinically relevant effect on both depression severity and cardiovascular fitness. Results also suggest that BBAT has an effect on self-rated depression symptoms compared to advice on physical activity.

## What conclusions should be taken away from this research?

This study suggests that exercise as add on therapy to medications, has beneficial effects on depression severity and cardiovascular fitness in persons with major depression. Physical therapy seems a viable strategy to inspire and involve persons with major depression in physical exercise. Basic body awareness therapy might be an option for some individuals, but this approach needs to be further researched.

## What are the implications for this research?

The results show that using exercise as an add-on treatment for people with major depression can be of benefit. It is an underused method in clinical practice and could provide more improvements for patients as well as taking medications and using other treatments. Further research needs to be done for the effects of BBAT on major depression, this could be used as an add-on treatment for motivated individuals or patients with other conditions that preclude exercise.

## Reference List

* 1 2 3 4 Human diseases and conditions. Depression. available from: http://www.humanillnesses.com/Behavioral-Health-Br-Fe/Depression.html
* 1 2 3 4 Australian Psychological Society. Understanding and managing depression. available from: https://www.psychology.org.au/publications/tip_sheets/depression/
* 1 2 Sane Australia. Depression. available from: https://www.sane.org/snapshots/178-depression
* 1 2 3 4 5 6 7 8 9 10 11 12 13 Danielsson L, Papoulias I, Petersson EL, Carlsson J, Waern M. Exercise or basic body awareness therapy as add-on treatment for major depression: A controlled study. Journal of affective disorders. Vol 168, p. 98-106