# Exercise as it relates to Disease/An Active Mind - Aerobic Exercise and Depression for Health Professionals

Physical activity and exercise is a considerable contributing factor to combating a wide range of lifestyle-related disease states. Currently, exercise has shown much promise in the prevention and treatment of mental health disorders.
Depression is a leading cause of disability adjusted life years in Australian adults. There are many different interventions available to treat depression, most involve a combination or treatments to alleviate or manage depression levels. These interventions may include pharmacotherapy, counseling, exercise, relaxation and lifestyle modifications. Research has shown that individuals, who participate in moderate intensity aerobic exercise frequently are less likely to have severe depression. Frequent aerobic exercise sessions has also be found to be equally as effective in decreasing depression as some pharmacotherapy treatments. So as an exercise professional, you can play a large role in the treatment of clients by creating a suitable exercise program.

## How does it work?

There are many mechanisms that are thought to be responsible for the decrease in levels of depression associated with exercise. The most common of these are: -
* Self efficacy-The confidence that someone feels to complete a task to a particular level.
* Distraction Theory- It is thought that exercise provides a distraction from depressive thoughts, feeling, anxieties.
* Endorphin Hypothesis- The increase levels of endorphins associated with exercise can be responsible for the 'euphoric' feeling.

## Aerobic exercise recommendations

| Type of Exercise | Intensity | Duration | Frequency |
| Aerobic Examples : Walking Running Cycling Swimming | 60-85% of Max Heart Rate this can be calculated through : $^#$Max HR = 220 - Age A standardised maximum heart rate test eg. Tredmill max HR test | 20-40 Minutes per session | 3-5 Times per week$^^$ |
$^#$Indirect method: Age-predicted maximum heart rate equation $^^$Interventions using five aerobic exercise sessions per week have shown the greatest improvement in depression scores.
It is important to remember that the above are just guidelines. The physical activity programme undertaken by a client suffering from depression, should be tailored to their individual preferences. It is recommended that the person undertake a PAR-Q or other similar pre-exercise questionnaires before commencing any training, particularly if their is a possibility of other co-morbidities.
One of the most important considerations when building the exercise program, is to make it fun and interesting for the client whilst keeping all activities and goals achievable. It may also be beneficial to introduce new exercise settings to encourage and motivate the client as well. Successful exercise programmes give the client a sense of achievement, mastery and build confidence.
Lastly, the program needs to be flexible in order to encourage and challenge the participant through normal exercise adaptions.

## Exercise setting

Where is best for a client to exercise?
* At Home
* At the Gym
* In a Group
* By themselves
There is currently inconclusive evidence as to the benefits of exercise setting on depression scores. Research has not shown significant differences between exercising in a group or individual setting, or between exercising at home or in a supervised setting i.e. at gym. Decreased drop out rates have been observed in 'at home' exercise programmes when compared to group exercise classes in older adults. Varying exercise settings to suit patients is advised to enhance participant participation.

## Important considerations

Decreased participation rates may be observed in depressed individuals due to symptoms of their disease. Some common symptoms of depression include:
* Fatigue
* Lack of energy
* Hopelessness
* Psychomotor retardation
Monitoring fitness gains and exercise performance throughout an exercise programme may provide positive feedback and encourage further participation for your client. It is also important to monitor their depression levels throughout exercise programmes to make sure the workload is manageable and helpful in managing the client’s mental illness.

## Further reading

For more comprehensive information on depression please visit the following sites:
1. http://www.blackdoginstitute.org.au/index.cfm
2. http://www.beyondblue.org.au/index.aspx?link_id=89
For more information on aerobic exercise and depression please look at the following site:
1. http://www.beyondblue.org.au/index.aspx?link_id=89.586&tmp=FileDownload&fid=328

## References

* ↑ NSW Department of Health (2010) The Health of the People of New South Wales: Summary Report. Accessed on: 20 October 2011 from: http://www.health.nsw.gov.au/pubs/2010/pdf/chorep_summary_2010.pdf
* ↑ Austrlaian Bureau of Statistics (2010) Health: Burden of Disease. Accessed on: 20 October 2011 from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1370.0~2010~Chapter~Burden%20of%20disease%20(4.1.6.4)
* ↑ Taliaferro LA, Rienzo BA, Pigg MR, Miller DM, Dodd, VJ.(2009) Associations Between Physical Activity and Reduced Rates of Hopelessness, Depression, and Suicidal Behavior Among College Students. Journal of American College Health. Vol. 57(4) pp. 427-436
* 1 2 3 Blumental JA, Babyak MA, Doraiswamy MP, Watkins L, Hoffman B.M., Barbour KA, Herman, Craighead WE, Brosse AL, Waugh R, Hinderlitter A, Sherwood A (2007) Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder. Psychosomatic Medicine. Vol.69 Pp. 587-596
* 1 2 Craft LL (2005)Exercise and clinical depression: examining two psychological mechanisms. Psychology of Sport and Exercise Vol. 6 pp. 151–171.
* 1 2 Daley A (2008) Exercise and Depression: A Review of Reviews. J Clin Psychol Med Settings. Vol.15 pp.140–147
* 1 2 3 Daley A (2002) Exercise therapy and mental health in clinical populations: is exercise therapy a worthwhile intervention? Advances in Psychiatric TreatmentD Vol. 8, pp. 262–270
* 1 2 Legrand F, Heuze JP (2007) Antidepressant Effects Associated with Different Exercise Conditions in Participants with Depression: A Pilot Study. Journal of Sport and Exercise Physiology. Vol. 29 Pp. 348-364
* ↑ Richardson CR, Faulkner G, McDevitt J, Skrinar GS, Hutchinson DS, Piette JD (2005) Integrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness. http://ps.psychiatryonline.org Vol. 56 (3)
* ↑ Meyer T, Broocks A (2000) Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Medicine. Vol. 30 (4). pp. 269-279