An Active Mind - Aerobic Exercise and Depression for Health Professionals

Background
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 it works
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

 * 1) 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? 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.
 * At Home
 * At the Gym
 * In a Group
 * By themselves

Important Considerations
Decreased participation rates may be observed in depressed individuals due to symptoms of their disease. Some common symptoms of depression include:


 * 1) Fatigue
 * 2) Lack of energy
 * 3) Hopelessness
 * 4) 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/Information Sources
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