Outdoor Physical Activity Improved Mental Health Status of Adults With Clinical Depression
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Direct comparison between studies is difficult since studies varied greatly in sample characteristics, nature of control comparison group (e.g. group attendance versus usual care), mode of intervention, intensity and duration of exercise, outcome measures used and length of follow-up. Although evidence from well-designed research studies is clearly limited, the findings do suggest that both aerobic exercise and resistance training programmes may be beneficial in improving mood in older people with depression. There are several limitations of the present review that should be noted. Comparable with most systematic reviews, there remains a possibility that some articles may have been overlooked, particularly for studies examining exercise interventions without explicitly addressing older adults with depression or depressive symptoms in their abstract or title.
In those patients who do demonstrate improvements in depressive symptoms with antidepressant therapies, a time-lag in the onset of therapeutic effects is frequently reported. Antidepressant drugs are associated with adverse side effects (Agency for Health Research and Quality (AHRQ), 2012) and an increased risk of cardiovascular disease, particularly in those with pre-existing cardiovascular conditions or major cardiovascular risk factors (Waring, 2012). Furthermore, adherence to antidepressant medications is often poor and patients often prematurely discontinue their antidepressant therapy; it has been suggested that approximately 50% of psychiatric patients and 50% of primary care patients are non-adherent when assessed 6-months after the initiation of treatment (Sansone and Sansone, 2012). Psychological treatments for depression have been recommended in the UK National Institute for Health and Clinical Excellence (NICE) guidelines (NICE, 2009) and are becoming more commonplace for helping to reduce symptoms in depressed adults (Ambresin et al., 2012; Brakemeier and Frase, 2012), with even brief psychosocial interventions showing promise for improving adherence to depression medication treatment in primary care settings (Sirey et al., 2010).
Professional supervision and training management should be provided, especially in the beginning, and PA and EX should be integrated into psychotherapy (e.g., using training and mood diaries).
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