L26 - Exercise & Psych Wellbeing 1: Depression

• Definitions of Health:

  • WHO: “Health is a state of complete physical, mental & social well-being & not merely the absence of disease or infirmity
  • Te Whare Tapa Whā - Health as physical (Taha tinana), spiritual (Taha wairua), family/social (Taha whanau), mental/emotional (Taha hinengaro), land, roots (Whenua) dimensions
  • If 1 dimension missing, the person is ‘unbalanced’ or ‘unwheel’
  • Each is necessary for the balance & strength of the whole
• Mental Health/Psych Well-being:

  • Mental health has no universal definition & Wellbeing is difficult to define
• Psychological activity & mental health:

  • Reduces depression
  • Elevates mood / +ve affect
  • Reduces -ve affect
  • Improves fatigue (less tired?)
  • Reduced anxiety & stress
  • Satisfaction with life
  • (independent - can function in life)
  • Improves self esteem
  • Improves cognitive functioning
• Psychological activity & mental health:

  • Research focus on single aspects nothing on all at once (psych wellbeing)
  • PA continuum:
  • Ability to treat (clinical)
  • Ability to prevent mental ill health from occurring
  • Can use it to promote positive psych wellbeing
• Research design issues - correlational research:

  • Shows association bw/ 2 variables measured at the same time
  • To look at relationships bw/ 2 variables
  • Limitations of correlation research:
  • But… chicken & egg scenario
  • Mental ill-health → inactivity?
  • Inactivity → mental ill-health?
  • What comes first, what causes what
• Research design issues - randomised controlled trials (RCT) - gold standard:

  • Medical, psychotherapy
  • Compare mental health change bw/ groups
  • See if alternative treatment has better outcome than exercise
• Research design issues - randomised controlled trials (RCT) - gold standard:

  • Acute Effects:
  • Immediate effect of a single bout of exercise
  • eg does one bout of exercise decrease anxiety?
  • Chronic Effects: (exercise intervention over weeks)
  • Effects of multiple exercise bouts
  • Accumulative effect of exercise
  • eg how frequently do we have to exercise to decrease depression
• Depression:

  • A transient mood state & a clinical syndrome or disorder
  • Once experience symptoms over a long period
• Depression:

  • Significant public health issue
  • NZ Prevalence adults - 19.95
  • NZ: 1 in 11 adults prescribed antidepressants every year
  • WHO: the 4th leading contributor to the global burden of disease
• Depression:

  • Treatment options
  • Medication (antidepressants)
  • Psychotherapy
  • Treats the cause of feeling depressed
  • PA?
  • Reduce severity
  • Prevention
  • Low cost + in control + lack of side effects
  • + medication doesn’t work for everyone (resistant - don’t respond)
• Research evidence on Depression:

  • Correlational studies
  • Suggest some relation, but don’t know cause & effect
  • Moderate inverse relationship
  • In graph
  • More PA the less likely they were to experience symptoms of depression
  • Least active → incidence of mood disorders
• Research evidence of Depression:

  • Prospective design
  • Predict change 11 yrs later
  • Limitations: a lot can happen in those 11 yrs
  • 34,000 “healthy” norwegians followed over 11 yrs
  • No mental health issues at baseline
  • Concluded: small amount of exercise protective against future incidence of depression
  • Biggest improvement to reduce likelihood of depression is exercise from 0 hrs to 1-2 hrs
  • Then flattens out up to 4 hrs a week (plateau - no more benefit) after 2 hrs
  • PA appears to be useful in the prevention of depressive symptoms
• Research evidence - exercise as a treatment:

  • Randomised controlled trials (RCT) show a medium effect of exercise for reducing depression
  • PA is an effective way to prevent/treat depression
  • what kind of exercise?
  • Concluded aerobic is as beneficial as resistance + doing both
  • Mode
  • Meeting aerobic PA guidelines → decrease depression after 12 weeks (meeting guidelines is enough)
  • Doing aerobic + muscle strengthening activities “likely” optimal - but evidence is cross-sectional
• Research evidence - exercise as a treatment:

  • More resistance less likely to experience depression (for any aerobically active level)
  • Even those most aerobically active
  • Greater than 4 doesn’t provide any additional effect (3 optimal)
• Research evidence:

  • Intensity
  • Moderate intensity recommended
  • Studies also shown benefits of light/vigorous
  • Light not as good, vigorous same as moderate
  • Not recommend vigorous straight away
  • Duration/Frequency
  • 3-5 times per week is advised
  • Compared 3 days to 5 days (same total amount = 150 mins)
  • So seems volume is more important than the frequency (depends on individual needs)
  • Most effective interventions are < 12 weeks
  • Better improvements while progressing within 12 weeks
  • Significant decrease in depressive symptoms picked up
  • Statistically significant at 12 weeks
• How does PA compare to other treatments:

  • Clinical outcomes
  • Exercise is as effective as other treatments
  • BUT…
  • Medication ‘works’ faster
  • Exercise takes time/longer; don’t get same speed of feeling it being reduced
  • Why might combine both meds & exercise at start, then go off meds
  • BUT…
  • Exercise group less likely to relapse (when exercise continued)
  • Back into symptoms of depression when finished in intervention
• How does PA compare to other treatments:

  • Exercise & Medication: Could look at both together as another group
  • Placebo - Given a sugar pill (think taking medication)
  • Exercise should be considered a valuable tool in depression treatment “toolbox”
  • Exercise get social support so that's what could be causing the change
  • Can compare by taking away social aspect
  • Found that it is predominantly PA that improved it but social aspect still valuable
  • Use counselling to look at cause along with exercise