Exercise-Based Interventions for Mental Illness

Physical Activity as Part of Clinical Treatment

Brendon Stubbs,Simon Rosenbaum

• Publisher: Academic Press
• Year: 2018
• ISBN:
  9780128126066
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Exercise-Based Interventions for People with Mental Illness: A Clinical Guide to Physical Activity as Part of Treatment provides clinicians with detailed, practical strategies for developing, implementing and evaluating physical activity-based interventions for people with mental illness. The book covers exercise strategies specifically tailored for common mental illnesses, such as depression, schizophrenia, bipolar disorder, and more. Each chapter presents an overview of the basic psychopathology of each illness, a justification and rationale for using a physical activity intervention, an overview of the evidence base, and clear and concise instructions on practical implementation.

In addition, the book covers the use of mobile technology to increase physical activity in people with mental illness, discusses exercise programming for inpatients, and presents behavioral and psychological approaches to maximize exercise interventions. Final sections provide practical strategies to both implement and evaluate physical activity interventions.

• Covers interventions for anxiety, depression, eating disorders, alcohol use disorder, and more
• Provides the evidence base for exercise as an effective treatment for mental illness
• Demonstrates how to use mobile technology to increase physical activity in people with mental illness
• Features practical strategies for implementation and assessment
• Covers treatment approaches for patients of all ages

Chapter 1

Exercise for the Prevention and Treatment of Depression

Jacob Meyer¹, and Felipe Barreto Schuch^{2,3,4 1}Iowa State University, Ames, IA, United States ²Universidade La Salle, Canoas, Brazil ³Escola de Educação Física, Fisioterapia e Dança, Porto Alegre, Brazil ⁴Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

Abstract

Major depressive disorder (MDD) is a chronic condition and a worldwide public health problem. Higher levels of physical activity are linked to fewer depressive symptoms and to a decreased risk of developing MDD. Numerous studies have supported the notion that exercise has significant antidepressant effects in people with MDD and can also be used as a strategy to acutely manage depressive symptoms. Following general guidelines for aerobic exercise (150 min of moderate-to-vigorous physical activity/week) appears effective in treating mild to moderate depression. Exercise influences many systems associated with depression (e.g., neurotrophic factors, hypothalamic-pituitary-adrenal axis, and so on) and may improve depressive symptoms through a combination of mechanisms. People with MDD often experience unique barriers to initiating or maintaining an exercise program and, therefore strategies sensitive to depression that focus on increasing adherence should be used.

Keywords

Depression; Exercise; Physical activity; Symptom management; Treatment

Outline

1. Introduction
2. Relationship Between Physical Activity and Depression
   1. Physical Activity and the Prevalence of Depression
   2. Physical Activity and the Incidence of Depression
3. Exercise as a Treatment for MDD
   1. Evidence From Meta-Analyses
   2. Exercise for Symptom Management
   3. Exercise Training for Depression: Historical Development and Potential Prescriptions
   4. Potential Mechanisms
   5. Barriers/Facilitators
4. Summary and Future Directions
5. References

Introduction

Major depressive disorder (MDD) is a highly prevalent condition (lifetime prevalence of about 16% in Brazil and 19% in the United States; Andrade et al., 2003) with a strong social impact and is one of the leading medical conditions contributing to the global burden of disease. Estimates suggest that MDD accounted for 8.2% of the global years lived with disability in 2010 (Ferrari et al., 2013).

The primary symptoms of MDD include low mood and lack of interest/motivation in activities that used to be pleasant, along with fatigue, impairments in appetite, sleep, and cognition, and suicidal ideation with or without a plan or a suicide attempt (American Psychiatric Association, 2013) for a minimum period of 2 weeks. In addition, these symptoms result in a clinically significant impairment in social, occupational, or other areas of functioning and are not related to physiological effects of a substance or another medical condition (American Psychiatric Association, 2013).

The two main strategies for treating depression proposed by most guidelines are pharmacological antidepressants and psychotherapies (Malhi et al., 2015; National Collaborating Centre for Mental Health (UK), 2010). Although helpful, antidepressant medication and/or psychotherapy do not work for all people. For example, the STAR∗D study (Sinyor et al., 2010), the largest open trial evaluating the effects of pharmacological antidepressants, psychotherapies, or the combination of both, revealed that the response rate following the first pharmacological attempt was less than 50%. This suggests that about half of patients did not experience significant symptom improvements after the first treatment. Interestingly the response rate dropped following each subsequent strategy adopted (switching to or combining with a second medication).

MDD is associated with poor cardiovascular and metabolic outcomes. Approximately 30% of people with MDD also have metabolic syndrome, which is 54% greater than people without MDD (Vancampfort et al., 2014; Vancampfort et al., 2016). Similarly the rate of type II diabetes mellitus in people with MDD is about 8%; again, this represents a roughly 50% higher rate than people without MDD (Vancampfort et al., 2014, 2016).

In sum, (1) depression is a highly prevalent condition that is associated with a high burden to society; (2) current treatments may not work for all people with MDD and may not address the poor physical health of this population. Therefore strategies that (1) help to decrease the incidence and prevalence of MDD and/or (2) effectively treat (or augment treatment of) the primary and secondary symptoms (e.g., poor physical health) of MDD are required.

Exercise training is one intervention that may act on these two fronts, simultaneously decreasing the risk of depressive episodes in people free from depression and reducing depressive symptoms in people with depression. In this chapter, we aim to discuss (1) the relationship between physical activity and depression prevalence and incidence; (2) evidence from meta-analyses and systematic reviews on the effects of exercise in reducing depressive symptoms; (3) how exercise can be used to manage depressive symptoms; (4) exercise prescription guidelines for people with depression; (5) mechanisms involved in the effects of exercise on depressive symptoms; and (6) barriers and facilitators to exercise among people with depression.

Relationship Between Physical Activity and Depression

Substantial evidence supports the notion that physical activity and depression are closely related. This relationship has been primarily assessed through answering two questions. First, is physical activity related to the prevalence of depression? Stated another way, is physical activity participation associated with the likelihood of current depression? Second, is physical activity related to the incidence of depression—that is, does physical activity participation predict future development of depression? If either prevalence or incidence of depression is related to physical activity participation or exercise, this would provide initial evidence to pursue experiments to improve current or prevent future depression through manipulating exercise behavior.

Physical Activity and the Prevalence of Depression

Cross-sectional studies revealed a clear relationship between greater amounts of physical activity and reduced current depressive symptoms in people without a diagnosis of depression. Two large epidemiological studies that assessed both physical activity and depressive symptoms were the National Health and Nutrition Examination Survey (NHANES; Farmer et al., 1988) and the National Comorbidity Survey (Goodwin, 2003; Camacho et al., 1991). From an early wave of NHANES (1982–84; 1900 healthy adults), Farmer et al. (1988) found that greater depressive symptoms were associated with little or no self-reported physical activity across gender and race. From the National Comorbidity Survey (1990–92; 5877 people aged 15–54 years), Goodwin found that regularly active adults had a 25%–38% reduced risk of having current major depression than adults who were not regularly active. Additionally, there appeared to be a dose-response relationship between self-reported physical activity and depression with a lower risk of depression in the regularly active (8.2%) compared with the occasionally active (11.6%), the rarely active (15.6%), and the never active (16.8%).

Even in patients with depression, more physical activity is significantly related to lower depression severity (Harris et al., 2006). In a 424-person cohort of depressed adults, Harris et al. found that greater physical activity was related to lower levels of concurrent depressive symptoms. This suggests that even in patients suffering from depression, those who engage in a more active lifestyle may have lower symptom burden even in the face of current clinical illness. These findings extend the previously found association between exercise and depressive symptoms in the general population to those who are clinically depressed.

Physical Activity and the Incidence of Depression

Substantial evidence exists demonstrating that current physical activity or a higher level of cardiovascular fitness is protective against the development of depression (i.e., incidence; Strawbridge et al., 2002; Schuch et al., 2016a). Data from the Alameda County study show that people who are active are less likely to develop clinical depression over 5 years (Strawbridge et al., 2002). Farmer et al. also showed from NHANES that physical activity was an independent predictor of depressive symptoms ...