Exercise training and depression in older adults
Introduction
Depression is a major health problem in this country. It is associated with significant impairment of function that may, at times, be worse than that of chronic medical disorders [31]. Depressive symptoms have been correlated with the presence of chronic disease [29], inability to work [7], increased mortality risk [28], [23], increased use of medical services [16], and decreased well being and lowered functioning [31]. Major depressive disorder (MDD) is the most prevalent of all psychiatric disorders [17], affecting up to 25% of women and 12% of men during their lifetimes.
MDD is typically diagnosed by psychiatric interview, in which the person must express sadness or a significant loss of interest in all or most things that were previously considered enjoyable for a minimum of two weeks, and at least an additional four (or three, if both dysphoric mood and loss of pleasure are present) of the following symptoms: significant weight loss or change in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, decreased concentration or indecisiveness, and recurrent thoughts of death or suicidal ideation. Although depression is underrecognized, several effective treatments exist, including antidepressant medications, and psychotherapy. Recently, evidence has suggested that exercise also may be an effective treatment for depression. The following review presents a brief summary of the evidence that exercise may reduce depression with a focus on older individuals. Limitations in the published research are discussed, along with suggestions for future research.
Section snippets
Epidemiological considerations
Data from epidemiological studies suggest an association between physical inactivity and higher levels of depressive symptoms [9], [13]. It also has been shown that reducing physical activity leads to increased symptoms of depression in older adults [19] and that depressive symptoms decrease when physical activity is resumed [13].
In addition to the correlational data showing a significant association between depression and physical activity, there is considerable evidence from intervention
Studies of exercise training in non-depressed older adults
Several studies have examined the effect of exercise training in older adults who do not meet criteria for MDD. In a sample of 101 healthy older adults randomized to four months of aerobic exercise, a yoga/flexibility control group, or wait list, assessment of scores from pre- to post-treatment revealed that depressive symptoms were reduced, especially in men [5]. In another study, 12 weeks of aerobic exercise did not have a beneficial effect on depressive symptoms in a community sample of 48
Studies of exercise training in older adults with clinical depression
In a study designed to assess the effects of exercise on total level as well as subtypes of depressive symptoms (i.e., somatic, psychological), a community sample of 30 older adults with “moderate” depression was randomized to one of three conditions: supervised exercise, social contact control, or wait list [25]. Participants in the exercise and social contact groups experienced a significant reduction in total and psychological depressive symptoms relative to wait list participants. Only
Studies of exercise training in medically ill older adults
The studies reviewed above were conducted with physically healthy participants. Due to the increased prevalence of comorbid medical illness in older adulthood, consideration of the relationship between exercise and mood in this population is especially important. Because an exercise component is typically part of cardiac and pulmonary rehabilitation programs, data collected during such programs provide an opportunity for assessing the effectiveness of exercise in reducing depressive symptoms in
Mechanisms
A number of potential mechanisms may be responsible for the reductions in depression associated with physical exercise [8]. For example, physiological mechanisms hypothesized include the central monoamine theory (i.e., exercise corrects dysregulation of the central monoamines believed to lead to depression), as well as consideration of the role of the hypothalamic–pituitary–adrenal (HPA) axis (i.e., some depressed individuals exhibit HPA hyperactivity in response to stress and exercise may
Conclusions and directions for future research
The purpose of the present review was to highlight studies of the effects of exercise on depression in older adults. In general, findings suggest that exercise has a positive effect on mood when compared to wait list, social contact controls, and even antidepressant medication.
Despite the favorable results of many of these studies, problems with research design such as small sample sizes, poor definition and assessment of depression, and insufficient follow-up of participants make definitive
Acknowledgement
The research was supported by grant MH49679-06A1 from the National Institute of Mental Health.
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