Exercise Interventions for Mental Health: A Quantitative and Qualitative Review

Clinical Psychology Science and Practice (Impact Factor: 2.92). 05/2006; 13(2):179 - 193. DOI: 10.1111/j.1468-2850.2006.00021.x


Associations between exercise and mental well-being have been documented repeatedly over the last two decades. More recently, there has been application of exercise interventions to clinical populations diagnosed with depression, anxiety, and eating disorders with evidence of substantial benefit. Nonetheless, attention to the efficacy of exercise interventions in clinical settings has been notably absent in the psychosocial treatment literature, as have been calls for the integration of these methods within the clinical practice of psychologists. In this article, we provide a quantitative and qualitative review of these efficacy studies in clinical samples and discuss the potential mechanism of action of exercise interventions, with attention to both biological and psychosocial processes. The meta-analysis of 11 treatment outcome studies of individuals with depression yielded a very large combined effect size for the advantage of exercise over control conditions: g = 1.39 (95% CI: .89–1.88), corresponding to a d = 1.42 (95% CI: .92–1.93). Based on these findings, we encourage clinicians to consider the role of adjunctive exercise interventions in their clinical practice and we discuss issues concerning this integration.

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Available from: Mark B Powers, Feb 21, 2014
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    • "The effectiveness of physical exercise in reducing depressive symptoms has received considerable attention in the past few years, with seven meta-analyses of randomized controlled trials (RCTs) published in the last decade (Stathopoulou et al., 2006; Mead et al., 2009; Rethorst et al., 2009; Krogh et al., 2011; Rimer et al., 2012; Cooney et al., 2013; Josefsson et al., 2014). Even though reviewed RCTs vary substantially in size, type of control group, methodological rigor, and type of exercise modality, these metaanalyses yielded an overall moderate-to-large effect size (from d ¼ À0.40 in Krogh et al. to d ¼ À1.39 in Stathopoulou et al.) indicating a significant reduction in depression for exercise treatment compared with non-active control condition. "
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    ABSTRACT: Background Physical exercise as adjunctive treatment for hospitalized patients with major depressive disorder (MDD) has been of increasing interest in the past few years. While preliminary findings are promising, these prior studies have been plagued by inclusion of participants at different stages of medication use at study entry. The present study evaluates the effects of a short (10-days) add-on endurance-training intervention in hospitalized MDD patients on antidepressant medication for less than two weeks. Method Thirty-five participants were randomly assigned to one of three study groups: aerobic exercise (n=14), placebo (stretching) exercise (n=11), or no intervention (control; n=10). The study outcome was the change in the Beck Depression Inventory (BDI-II) total score from baseline to the end of the study period. Results The intent-to-treat analysis showed significant improvements in BDI-II scores for both the aerobic and the stretching groups. However, comparing pre- to post-study depression changes in these two groups, we found a large effect size in favor of aerobic exercise (Cohen's d=-1.06). No significant change in depressive symptoms was found in the control group. Limitations The nature of the intervention (i.e., exercise) meant blinding participants to treatments was not possible. Precise information on medication dosage was not available, and the short duration of interventions and lack of follow-up assessment were all limitations. Conclusions Endurance-training can be a helpful adjunct treatment for hospitalized patients with severe affective disorders in the initial stages of pharmacotherapy.
    Full-text · Article · Nov 2015 · Journal of Affective Disorders
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    • "These models focus not only on individual trips, where time savings alone are important, but seek to better understand how time is allocated across all trips and activities, allowing the impact on wellbeing of various interrelated factors such as travel patterns, urban form, and time use to be examined concurrently (Abou-Zeid and Ben-Akiva, 2012; Bhat and Koppelman, 1999; Bowman and Ben-Akiva, 2001; McFadden et al., 1977; Pinjari et al., 2011; Sallis et al., 2004). Studies that examine the impact on wellbeing of active travel for recreational purposes, such as visiting friends (Hamer et al., 2009; Humphreys et al., 2013; Mutrie and Faulkner, 2004; Ravulaparthy et al., 2013; Teychenne et al., 2008), or as an intervention in clinical settings (Gusi et al., 2008; Stathopoulou et al., 2006), are more common than those that examine more routine active commuting. However, behaviour change in these non-work domains may be impractical for large numbers of working-aged people for whom the opportunity cost of physical activity outside of work hours is relatively high (House of Commons Health Committee, 2004; Martin et al., 2012; Popham and Mitchell, 2006). "
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    ABSTRACT: Objective To explore the relationship between active travel and psychological wellbeing. Method This study used data on 17,985 adult commuters in eighteen waves of the British Household Panel Survey (1991/2-2008/9). Fixed effects regression models were used to investigate how (i.) travel mode choice, (ii.) commuting time, and (iii.) switching to active travel impacted on overall psychological wellbeing and how (iv.) travel mode choice impacted on specific psychological symptoms included in the General Health Questionnaire (GHQ12). Results After accounting for changes in individual-level socioeconomic characteristics and potential confounding variables relating to work, residence and health, significant associations were observed between the 36-point GHQ12 wellbeing scale and (i.) active travel (0.185, 95% CI: 0.048-0.321) and public transport (0.195, 95% CI: 0.035-0.355) when compared to car travel, (ii.) time spent (per ten minute change) walking (0.083, 95% CI: 0.003-0.163) and driving (− 0.033, 95% CI: − 0.064 – -0.001), and (iii.) switching from car travel to active travel (0.479, 95% CI: 0.199-0.758). Active travel was also associated with reductions in the odds of experiencing two specific psychological symptoms when compared to car travel. Conclusion The positive psychological wellbeing effects identified in this study should be considered in cost-benefit assessments of interventions seeking to promote active travel.
    Full-text · Article · Dec 2014 · Preventive Medicine
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    • "Physical activity reduces the risk of many chronic diseases (Blair et al., 2001), including cardiovascular disease (Lee and Skerrett, 2001), depression and anxiety (Biddle et al., 2000; Stathopoulou et al., 2006), diabetes (Williams, 2007), musculoskeletal conditions (Oida et al., 2003), obesity (Foresight, 2007) and some cancers (Wolin et al., 2007). However, most adults do not achieve recommended levels of physical activity (Chief Medical Officer, 2004). "
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    ABSTRACT: Background and objectives: Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales. Design: Qualitative semi-structured group interviews. Setting: General practice premises. Methods: Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis. Results: Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smoking cessation. Professionals linked decisions on whether to advise physical activity to patients to their own physical activity levels and to subjective judgements of patient motivation. While some described ERS as a holistic alternative to medication, with potential social benefits, others expressed concerns regarding their limited reach and potential to exacerbate inequalities. Barriers to referral included geographic isolation and uncertainties about patient selection criteria, medico-legal responsibilities and a lack of feedback about patient progress. Conclusion: Clinicians' concerns about expertise, priority setting and time constraints should be addressed to enhance physical activity promotion in primary care. Further research is needed to fully understand decision making relating to provision of physical activity advice and use of ERS.
    Full-text · Article · Nov 2014 · Health Education Journal
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