Exercise as it relates to Disease/The effect of physical exercise on adolescent women with depression

This page is an analysis and critique of the article "Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms" by Chanudda Nabkasorn, Nobuyuki Miyai, Anek Sootmongkol, Suwanna Junprasert, Hiroichi Yamamoto, Mikio Arita and Kazuhisa Miyashita (2005).

What is the background to this research?
Depression is a disease that is increasing at an alarming rate and could find its self being a bigger burden than diseases such as ischaemic heart disease, cerebrovascular disease or tuberculosis. Over recent years it has been found that the disease has become more and more evident within adolescent females worldwide. Depression can contribute to outcomes that can negative have an impact on the suffering individual such as; to substance abuse, increases levels of neuroticism, academic underachievement and depressive episodes. Although this disease is treatable, if it becomes associated with maladjustment in an unstable person it can lead to potential suicide)

Where is the research from?
The following article was written by the following; Chanudda Nabkasorn Nobuyuki Miyai Anek Sootmongkol Suwanna JunprasertHiroichi Yamamoto Mikio Arita Kazuhisa Miyashita. All of the contributing researchers/authors of this article have been involved in other studies within the discipline of health science and have been published within well-known journals leading us to believe this article is a reputable source. (add something about the European journal of public health)

What kind of research was this?
The design of the study was a randomised control trial of female volunteers with depressive symptoms. Opting for a randomised control trial allows for three main advantages within a study, it helps try and remove the bias, more likely to be done blinded, and also helps in making the process of statistical analysis easier.

What did the research involve?
266 female volunteers, aged 18-20, participated in a screening examination for depressive symptoms. This was done by using the Centre for Epidemiological Studies Depression (CES-D) rating scale. The commonly used cut-off score of 16, cases of depressive state, was found in 114 of 266 participants. However, subjects were excluded if they had ever taken antidepressant medication, had symptoms of illness that limited physical activity and had engaged in regular physical activity in the prior 6 months. After strict assessment, 62 participants presented a mild/moderate level of depressive symptoms and had no reason to be excluded from the study.

The participants were randomly divided into two groups, one of 28 and one of 31, and assigned to a 16 week, two-way crossover trial. In the first phase, group A (n28) started an 8-week physical activity program and group B (n31) continued their usual daily routines and were used as non-exercising controls. Subjects then crossed over to the alternate condition for an additional 8-week period. The major physical exercise used throughout this study was group jogging. The participants were encouraged to join the exercise class, a 50 min session for 5 days a week for 8 weeks. The exercise class was not strictly supervised and each participant jogged at her own speed, however, each session had a physical fitness instructor who assisted and ensured proper intensity (heart rate of less than 50% max heart rate) of exercise was maintained.

What were the basic results?
Of the 59 participants who joined the trial, five did not complete the training program, a further three dropped out, and two attended less than three sessions per week, as well as five subjects who could not maintain their usual level of physical activity in their non exercising period were also excluded from the study.

Data analysis was performed on the remaining 49 participants with Group A (n21) and Group B (n28). The average ages of Group A were 18.7 ± 0.2 and the average ages of Group B were 18.8 ± 0.1 years, respectively. The baseline comparison of the groups revealed no large differences of CES-D depressive score (group A, 20.1 ± 0.9; group B, 18.8 ± 0.7). Throughout the duration of the study (40 exercise sessions), the participants of Group A exercised an average of 31.3 ± 0.6 sessions, and those of Group B, 29.5 ± 0.7 sessions.

After sessions of exercise concluded, the CES-D total depressive score showed a significant decrease whereas there was no effect observed on those completing the usual daily activities. Another result to note was that twenty-four hour excretions of cortisol and epinephrine in urine were reduced due to the physical activity. The training group resulted in increases oxygen uptake as well as lung capacity and a considerably reduced resting heart rate.

What conclusions can we take from this research?
In conclusion, depression is an illness that is present throughout the general population, especially among adolescent females. The results have established that group based physical exercise can improve not only the physiological fitness levels but also the depressive state and stress conditions. Therefore, from this study it can be understood that regular physical exercise is concluded to have a wide variety of benefits to psychological health and wellbeing in adolescent females with depressive symptoms. Nevertheless, this study was done with adolescent females, who showed non clinical, mild/moderate levels of depression and so can be assumed that the results attained from this research may not be possibly transferrable to other populations of different ages, depression severity and social and cultural contexts.

Practical Advice
Consistent exercise regimes for patients suffering from mild to sever depression can be an effective treatment as itself and can function as both short and long term fixes. However, exercise alongside other treatments such as therapy and a support system, can be beneficial for improving an individuals well being, mental stability, improved motivation and a general better outlook on day to day life.

Further Resources
Understanding Depression isn't just a low mood - https://www.beyondblue.org.au/the-facts/depression

Help lines and websites - https://www.beyondblue.org.au/get-support/national-help-lines-and-websites