Is Exercise Useful in Treating Depression?
The publication of a new
study at BMJ on June 6 triggered many headlines showing that "exercise
does not help depression". However, reducing the specific and detailed
findings of this study to a media-friendly voice poses a risk of misleading
people, because the researchers did not set out to test the effects of exercise
on the depression.
. This article explains what
researchers do and what they find, while showing that some of the older
research in this area is experiencing increased scrutiny, and so there may be a
need for a new wave of rigorous and specific studies. Meanwhile, there are many
experts who support the idea that exercise can help patients with depression,
especially if they have or are at high risk of developing other conditions such
as obesity, cardiovascular disease, or diabetes, which are often the cause.
What
do researchers or scientists do ...?
The researchers wanted to
find out whether adding specific physical activity interventions received by
patients with depression through their general practitioner. In the UK, it
would significantly reduce their depressive symptoms.
The intervention, called
TREAD is based on theory, and provides trained facilitators who can provide
"support and encouragement that are individually designed to engage in
physical activity", the researchers wrote.
Such studies help health
care providers to make decisions about what services are offered through
primary services.
The researchers want to test
TREAD because although there is evidence to suggest that exercise is beneficial
for depressed people, most of it comes from a small, inaccurate study examining
programs that might not be practically carried out by the National Health
Service.
TREAD is designed to
"improve long-term adherence to physical activity", and the main
features encourage patients to choose their own activities and depend on their
individual needs and what they can do in their own environment. Patients receive
up to three face-to-face meetings with facilitators who are trained in
motivational interview techniques, and they themselves can also have up to 10
telephone calls.
In the BMJ study the
intervention lasts for 6 to 8 months with most of the facilitator's involvement
being in the first four.
Participants were 361 adult
patients aged 18-69 who were recently diagnosed with depression in several
different health centers in the UK. They themselves were randomly assigned to
one of two groups: one group received the usual care, and the other group
received the usual care plus TREAD.
The trial was attended by
participants for 12 months with steps taken at 4 months, 8 months and 12
months. For depressive symptoms, the key measure is Beck's depression inventory,
and participants can also be asked about their use
antidepressant.
The training data comes from
the diary that the participants completed about their own physical activity. A
number of participants can also wear an accelerometer, and this data confirms
that the diary is quite reliable and accurate.
Thus, the distinguishing
feature of this study is that all patients are free to do the prescribed
exercise but only a few are encouraged to do so.
Another distinguishing
feature is that this study does not compare the effectiveness of exercise
encouragement with other forms of treatment such as counseling and other
treatments, but in addition to this.
Current government
guidelines in the UK recommend that adults should do 150 minutes of moderate or
strong physical activity per week, so the researchers explain in detail that:
"The aspiration is for
the participants [in the TREAD group] to engage in moderate or excited
activities for 150 minutes a week in a fight of at least 10 minutes, but if it
seems unrealistic then the facilitator encourages any increase in physical
activity, whatever happens. in intensity. "
What
did they find?
The results showed that
patients in the TREAD intervention group fared no better than those who only
received usual care.
For example, there was no
evidence that participants offered physical activity interventions that
reported improved mood at a four-month follow-up point compared to those in
their own group..
