Exercise as it relates to Disease/How physical activity affects the symptoms of depression in young adults

This is a critique of the research paper Physical Activity and Depression Symptom Profiles in Young Men and Women with Major Depression, published by Psychosomatic Medicine, 2013.

What is the background to this research?
Lowered mood, loss of interest, rapid weight loss/gain, disturbances in sleep, sense of worthlessness, difficulty in concentration, or thoughts of suicide are all major symptoms of major depression. In Australia, 15% of people over the age of 16 have experienced depression in their lifetime. Major depression affects one in six females and one in eight males, and depression is expected to become the single largest healthcare burden by 2030.

There are many ways to treat major depression via pharmacological, psychological, and lifestyle changes. There is no perfect cure for depression, as a mix of pharmacological and psychological interventions was found to be only effective for 30% of patients. Lifestyle changes such as physical activity used in conjunction with these other treatments, can be used as symptom management for depression.

This study explores how young adults with major depression and who are also physically active differ from those who are not physically active. Physical activity has been shown to help with sleep problems, concentration difficulties, negative self-worth, and improve overall mood. The research found that withdrawing or decreasing physical activity levels has been found to worsen sleep patterns, increase fatigue and overall depressed mood.

Where is the research from?
The authors of this research paper are Charlotte Mckercher University of Tasmania, George Patton University of Melbourne, and Michael Schmidt University of Georgia. All three authors have published several research articles covering mental health, adolescents and young adults, and physical activity.

The authors state that they were funded by the National Health and Medical Research Council, the National Heart Foundation, the Tasmanian Community Fund, and Veolia Environmental Services, and report no conflict of interest.

What kind of research was this?
The research was an observational cohort study completed in 1985, with a follow up 20 years later. A cohort study follows a group over a large period of time and are useful when investigating risk factors yet are time consuming and can have large dropout rates. To reduce any potential bias in cohort studies due to dropout rates, ensure that the dropout rate does not exceed 20% of the original sample. In this study, 61% of the original sample re-enrolled and provided follow up data.

What did the research involve?
This study was conducted in Australia in 2012. The research is a follow up of participants who participated in the 1985 Australian Schools Health and Fitness Survey.

As this was a follow up study, 81% of the original participants were traced and 61% enrolled to provide follow up data. Of these participants, 2410 attended a study clinic, and 2070 self-reported their physical activity and major depression levels. A further 75 were excluded due to pregnancy, leaving 1995 participants eligible for analysis. Of the clinic attendees, 84.3% completed a seven-day pedometer diary.

All participants completed the Internal Physical Activity Questionnaire (IPAQ) as well as the Composite International Diagnostic Interview (CIDI). Between those who did and did not provide a pedometer diary, there were no significant differences at their baseline of the depressed mood and physical activity levels.

As questionnaires were used to determine physical activity and depressive symptoms, the results gained might not be entirely accurate. However, the IPAQ and CIDI have been shown to improve standardisation and have acceptable measurement reliability.

Numerous studies have investigated how physical activity affects major depression and other mental health disorders. A study by Legrand et Al. found that among hospitalised patients with major depression, that 10 days of endurance training and antidepressant medication can be a helpful adjunct treatment while in the initial stages of pharmacotherapy.

What were the basic results?
Overall, this study found that adults with major depression that are physically active differ in their symptom profile from those who are physically inactive. Those who were physically active were shown to have an improvement in depressed mood, vacillating thoughts, appetite changes, and thoughts of suicide.

Among the participants, 5.5% of men and 11.6% of women had major depression. Physically active men with major depression were significantly less likely to experience insomnia and fatigue, and physically active women with major depression were significantly less likely to experience hypersomnia and suicidal thoughts. According to the authors, young adults with major depression who are physically active appear to have differing depressive symptoms from those who are not physically active.

The authors thought their analysis of physical activity and major depression characteristics did not fully account for other documented associations in other literature, yet they found a strong correlation between physical activity and the decreased suicidal thoughts in both men and women. The authors also found a strong correlation that increased physical activity was inversely related to young women having a suicide plan, in contrast to previous research which found that there was a positive association with moderate levels of physical activity and suicide plans in young women.

What conclusions can we take from this research?
Based on the evidence presented in this article, physical activity does have an impact on depressive symptoms in young adults. The evidence from this study also shows how physical activity can have a particular benefit in reducing sleep disturbances and thoughts of suicide.

These results match with other studies that also show how physical activity can aid in the treatment of major depression. Legrand et Al. shows how physical activity helps with major depression in conjunction with antidepressants. Even though multiple studies have proven the benefit of physical activity, many studies are unable to provide information on the most efficient type and the optimal amount of physical activity. Further research is required to find the ideal amount and type of physical activity to aid with major depression.

Practical advice.
Physical activity is inexpensive, improves general health and well being, and can decrease depressive symptoms. Even though the ideal type or amount of physical activity is still unknown, this research article and others have proven the effects of physical activity on depressive symptoms. A general practitioner should be consulted prior to the beginning of a program, to ensure that there are no underlying health conditions that could affect physical activity.

If you or someone you know is living with major depression, there are multiple different ways to get help. A GP is a great part as they can begin a treatment plan or point you in the right direction. The websites below have plenty of helpful information to help you get started, but for more urgent help you can call Lifeline on 13 11 14.

Further information/resources:
https://www.blackdoginstitute.org.au/

https://www.beyondblue.org.au/

https://www.lifeline.org.au/

Lifeline number: 13 11 14