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Outdoor Physical Activity Improved Mental Health Status of Adults With Clinical Depression

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While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it’s a serious condition that has an impact on both physical and mental health

One in six women and one in eight men will experience depression at some point in their lives. While the exact cause of depression isn't known, a number of things can be associated with its development. Generally, depression does not result from a single cause, but from a combination of biological factors (such as family history, serious medical illness or drug and alcohol use), early childhood experiences, personality factors, recent stressful life events and other personal factors.

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Most of the studies had significant positive findings in terms of reductions in depression or depressive symptoms, or increased remission from depression immediately after exercise intervention, when compared with controls. The few remaining studies identified non-significant trends towards positive outcomes or positive outcomes over the study period for both intervention and control groups. More than half the studies which measured medium-term outcomes demonstrated a positive effect of exercise on depression outcomes. Other studies found no medium-term effect or that positive effects varied according to exercise mode of intervention (e.g. aerobic/resistance). Most studies did not measure the long-term outcomes of intervention yet those that did showed positive outcomes, although longer term effects were found for aerobic exercise but not maintained for resistance exercise modalities. We therefore conclude that exercise interv ention exerts a clinically relevant effect on epressive symptoms in older people. 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.

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Depression is the most common psychiatric disorder and is thought to affect 121 million adults worldwide, and as such was rated as the fourth leading cause of disease burden in 2000 (Moussavi et al., 2007), projected to become the highest cause of disease burden by 2020. Antidepressant drugs are an effective and commonly used treatment for depression in primary care (Arroll et al., 2009), although almost half of those treated do not achieve full remission of their symptoms, and there remains a risk of residual symptoms, relapse/recurrence (Fava and Ruini, 2002). 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).

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Briefly, some conclusions can be drawn concerning frame conditions, which can make EX a promising intervention for mental disorders: studies that followed public health recommendations concerning the intensity and duration of their EX intervention were more likely to find significant clinical improvements. Patients' compliance during the EX program and continuation after program termination were found to be more relevant for treatment outcomes than actual fitness gains. Social support seems to be crucial for EX adherence and positive effects of EX, as may be time structure, therapeutic contact, and positive reinforcement

There is evidence that indoor/outdoor activity may have differential effects on mood states. 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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Martin C. K., Church T. S., Thompson A. M., Earnest C. P., Blair S. N. (2009). Exercise dose and quality of life: results of a randomized controlled trial.

McNeil J. K., LeBlanc E. M., Joyner M. (1991). The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol.

Moussavi S., Chatterji S., Verdes E., Tandon A., Patel V., Ustun B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys.

Nahas R., Sheikh O. (2011). Complementary and alternative medicine for the treatment of major depressive disorder. Can. Fam. Physician 57, 659–663

National Institute for Health and Clinical Excellence. (2009). Depression: the Treatment and Management of Depression in Adults (Update).

Pilu A., Sorba M., Hardoy M. C., Floris A. L., Mannu F. A., Seruis M. L., et al. (2007). Efficacy of physical activity in the adjunctive treatment of major depressive disorders: preliminary results.

Rethorst C. D., Wipfli B. M., Landers D. M. (2009). The antidepressive effects of exercise: a meta-analysis of randomized trials.

Rimer J., Dwan K., Lawlor D. A., Greig C. A., McMurdo M., Morley W., et al. (2012). Exercise for depression. Cochrane Database Syst. Rev. 7,

Sansone R. A., Sansone L. A. (2012). Antidepressant adherence: are patients taking their medications? Innov. Clin. Neurosci. 9, 41–46

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