Effect of exercise on depression severity in older people: Systematic review and meta-analysis of randomised controlled trials

Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK. .
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 09/2012; 201(30):180-5. DOI: 10.1192/bjp.bp.111.095174
Source: PubMed


The prevelance of depression in older people is high, treatment is inadequate, it creates a substantial burden and is a public health priority for which exercise has been proposed as a therapeutic strategy.
To estimate the effect of exercise on depressive symptoms among older people, and assess whether treatment effect varies depending on the depression criteria used to determine participant eligibility.
Systematic review and meta-analysis of randomised controlled trials of exercise for depression in older people.
Nine trials met the inclusion criteria and seven were meta-analysed. Exercise was associated with significantly lower depression severity (standardised mean difference (SMD) = -0.34, 95% CI -0.52 to -0.17), irrespective of whether participant eligibility was determined by clinical diagnosis (SMD = -0.38, 95% CI -0.67 to -0.10) or symptom checklist (SMD = -0.34, 95% CI -0.62 to -0.06). Results remained significant in sensitivity analyses.
Our findings suggest that, for older people who present with clinically meaningful symptoms of depression, prescribing structured exercise tailored to individual ability will reduce depression severity.

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Available from: Nicky Atherton, Jan 30, 2015
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    • "International Scholarly Research Notices and special tools; these approaches are not applied as routine care extensively [8]. Exercise and physical activity, as a nonpharmacological care, are suggested to treat or help to cure major depression [11] [12] [13], but there are few studies and paradoxical results related to the effect of exercise on depression in hemodialysis patients [14] [15] [16]. "
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    ABSTRACT: Background and Aim. Depression is the most common psychological disorder in hemodialysis patients which decreases their quality of life and increases the mortality. This study was conducted to assess the effect of regular exercise on depression in hemodialysis patients. Methods. In a randomized clinical trial, 51 hemodialysis patients were allocated in two groups. Beck Depression Inventory (BDI) scale was used to assessing depression rate in participants. Designed program was educated using poster and face-to-face methods for case group. Intervention was carried out three times a week for ten weeks. At the beginning and the end of the study, depression rate of the subjects was assessed. Data was analyzed by SPSS16 software and descriptive and inferential statistics. Findings. According to the results of this study, there were no differences between case and control groups in depression rate at the beginning of the study, but there was significant difference after intervention . In the beginning of the study, the mean and SD of depression in case group were and reduced to at the end . Conclusion. The regular exercise program could reduce the depression in hemodialysis patients; therefore it is suggested for training this program for hemodialysis patients. This trial is registered with Iranian Registry of Clinical Trial (IRCT) number IRCT201205159763N1.
    International Scholarly Research Notices 01/2015; 2015:1-6. DOI:10.1155/2015/182030
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    • "The review findings also indicated ICMT improved depression scores in people both with and without sub-syndromal depression. Depressive symptoms have been consistently associated with falls in older people [74], and exercise is considered an effective strategy for reducing depressive symptoms [75]. However, whether this is due to physiologic, psychological or cognitive factors remains unclear [76]. "
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    ABSTRACT: It is well-known physical exercise programs can reduce falls in older people. Recently, several studies have evaluated interactive cognitive-motor training that combines cognitive and gross motor physical exercise components. The aim of this systematic review was to determine the effects of these interactive cognitive-motor interventions on fall risk in older people. Studies were identified with searches of the PubMed, EMBASE, and Cochrane CENTRAL databases from their inception up to 31 December 2013. Criteria for inclusion were a) at least one treatment arm that contained an interactive cognitive-motor intervention component; b) a minimum age of 60 or a mean age of 65 years; c) reported falls or at least one physical, psychological or cognitive fall risk factor as an outcome measure; d) published in Dutch, English or German. Single case studies and robot-assisted training interventions were excluded. Due to the diversity of populations included, outcome measures and heterogeneity in study designs, no meta-analyses were conducted. Thirty-seven studies fulfilled the inclusion criteria. Reporting and methodological quality were often poor and sample sizes were mostly small. One pilot study found balance board training reduced falls and most studies reported training improved physical (e.g. balance and strength) and cognitive (e.g. attention, executive function) measures. Inconsistent results were found for psychological measures related to falls-efficacy. Very few between-group differences were evident when interactive cognitive-motor interventions were compared to traditional training programs. The review findings provide preliminary evidence that interactive cognitive-motor interventions can improve physical and cognitive fall risk factors in older people, but that the effect of such interventions on falls has not been definitively demonstrated. Interactive cognitive-motor interventions appear to be of equivalent efficacy in ameliorating fall risk as traditional training programs. However, as most studies have methodological limitations, larger, high-quality trials are needed.
    BMC Geriatrics 09/2014; 14(1):107. DOI:10.1186/1471-2318-14-107 · 1.68 Impact Factor
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    • "Eligible subjects who gave informed consent were offered three months of watchful waiting, and consequently invited for an intake session when depressive symptoms persisted (Figure 1). The stepped care programme consisted of preference-led, evidence-based interventions administered in three steps, if necessary: step 1: choice of 1a) a guided self-help course based on Lewinsohn’s ‘Coping with Depression Course’ [18] or 1b) an exercise programme [19] delivered in groups of four to six participants three times a week; step 2: choice of 2a) life review (a structured reminiscence intervention aimed at reducing late life depressive symptoms) [20] or 2b) Problem Solving Treatment (PST; structured skills enhancing behavioural intervention based on the assumption that problems in daily life cause and maintain depressive symptoms [21]); and step 3: referral to a GP to discuss further treatment options. Nurses were provided with instructions on how to refer older people with feelings of loneliness to social services, if desirable. "
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    ABSTRACT: Background Depressive symptoms are highly prevalent in old age, but they remain mostly untreated. Several clinical trials have shown promising results in preventing or reducing depressive symptoms. However, it is not clear how robust these effects are in the real world of day-to-day care. Therefore, we have implemented the `Lust for Life¿ programme, which significantly reduced depressive symptoms in community-dwelling older adults in the first three months after implementation. This mixed-methods study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation.MethodsA total of 263 persons of 65 years and older with depressive symptoms were recruited from 18 general practices and home care organizations in the Netherlands. We used qualitative data (in-depth interviews and focus group discussions with participants with depressive symptoms and healthcare professionals) as well as quantitative data (longitudinal data on the severity of depressive symptoms) to explore hindering and facilitating factors to the implementation of the `Lust for Life¿ programme.ResultsThe uptake of the routine screening was poor and imposed significant burdens on participants and healthcare professionals, and drop-out rates were high. Participants¿ perceived mental problems and need for care played a key role in their decision to participate in the programme and to step up to consequent interventions. Older people preferred interventions that focused on interpersonal contact. The programme was only effective when delivered by mental healthcare nurses, compared to home care nurses with limited experience in providing mental healthcare.Conclusions The intervention programme was effective in reducing depressive symptoms, and valuable lessons can be learned from this implementation trial. Given the low uptake and high investment, we advise against routine screening for depressive symptoms in general healthcare. Further, agreement between the participant and healthcare professional on perceived need for care and intervention is vital. Rather than providing a stepped care intervention programme, we showed that offering only one single preference-led intervention is effective. Lastly, since the provision of the interventions seems to ask for specific skills and experiences, it might require mental healthcare nurses to offer the programme.Trial registrationDutch trial register NTR2241.
    Implementation Science 08/2014; 9(1):107. DOI:10.1186/s13012-014-0107-y · 4.12 Impact Factor
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