Original in pdf; 'Text only' version follows.
well wishes,
Kate

Issue 5
March 2006
This is the fifth issue of Active Inform; a bimonthly research based physical
activity newsletter
targeting practitioners in the field. Active Inform aims to increase access to
the evidence base
for physical activity promotion. It will provide a snapshot of the latest
physical activity research
news, key documents, models and other tools to assist you in your efforts to
promote physical
activity.

Feedback about this and future issues of Active Inform is welcome via email to
twhalen@...

Mental Health- The Case for Exercise in Prevention and Treatment
Mental health problems, including depression, are major threats to the health of
Australians. More
than 800,000 Australians experience depression each year. The 2004 Victorian
Population Health
Survey classified 3 % of Victorians over 18 as “high risk of psychological
distress” and a further 29.3%
as “middle risk of psychological distress.” It is predicted that almost one in
five adults will experience a
mental disorder at some time in their life.1 Major community awareness efforts
such as beyondblue are
working to raise awareness, reduce stigma and provide training and support for
patients, their carers,
policy makers and healthcare professionals. Much research supports physical
activity as both a
treatment for, and a tool to prevent, depression and similar mental health
concerns. In fact, physical
activity has been shown to be as effective as psychotherapy and medications in
alleviating symptoms
of depression.2 Public health campaigns across the country, and internationally,
are promoting
physical activity’s benefits as a result of the strong research evidence.

Research
The strongest evidence is in the area of the relationship between physical
activity (measured via
fitness level and/ or activity level) and depressive symptoms. A recent study
conducted at the Cooper
Institute concluded that “relative increases in maximal cardiorespiratory
fitness and habitual physical
activity are cross-sectionally associated with lower depressive sypmtomatology
and greater emotional
well- being.” Further, inactive women exhibited greater depressive symptom
severity than those
classified as insufficiently active and sufficiently active. Likewise, inactive
men exhibited greater
depressive symptom severity than those classified as insufficiently active and
sufficiently active. 3 A
cross-sectional analysis of 1536 adults performed in 1992, found those who
reported no physical
exercise were 3.15 times more likely to have severe to moderate depression.4
There is also much promising research in the effectiveness of exercise as an
intervention in the
management of depression. A 2002 meta-analysis published in the British Medical
Journal concluded:
when compared to no treatment, exercise reduced symptoms of depression and in
studies relating
exercise to cognitive therapy, the effect of exercise was similar.5 A
meta-analysis including 80 studies
indicated exercise reduces depression scores relative to comparison groups
across a wide range of
subjects, from normal adults to those with diagnosed clinical depression. When
research was limited
to the clinically depressed, similar effectiveness was shown. 6

Many different forms of physical activity have proven effective; including
resistance and cardiovascular
training with varying intensities, duration, frequencies and lengths of program.
In fact, Craft and
Landers6 found by analysing several varied studies, that “program
characteristics such as duration,
intensity, frequency and mode of exercise did not moderate the effect…only the
length of program was
a significant moderator, with programs 9 weeks or longer being associated with
larger reductions in
depression.” Resistance and cardiovascular programs of low to high intensity and
varied frequencies
all showed improvements for those with depressive symptoms.

Applications for Practitioners
What do these reports and those working in the field suggest for utilizing
physical activity as a
treatment and preventative tool for depression? There are a variety of resources
such as fact sheets
and notes for those wanting more information on how to best recommend physical
activity for those
with depression. The Go For Your Life website
(http://www.goforyourlife.vic.gov.au ) has a fact sheet,
as does beyondblue
(http://www.beyondblue.org.au/index.aspx?link_id=7.246&tmp=FileDownload&fid=328
). The Black
Dog Institute has a guide for GPs in prescribing Exercise (link) They highlight
6 considerations for this
population:
• Make realistic goals- start small. Focus on the frequency of exercise rather
than the duration
or intensity until the behaviour is well established.
• Consider lifestyle and previous experience of exercise.
• Consider depression type- some patients may need to wait until other
treatments alleviate
symptoms, but they may benefit from a short walk or stretch.
• Anticipate and make accommodations for barriers- additional skills may be
needed.
• Accentuate the positive- focus on the benefits and pick a pleasurable
activity. Encourage
patients to use self-monitoring techniques and set small achievable goals.
• Encourage social interaction- group activities and the stimulation of being
outdoors can
produce additional benefits.

Summary
It is clear from both the academic research and field application that even
small amounts of exercise
for short periods of time can alleviate symptoms of depression and have lasting
health benefits. The
key messages are that physical activity has minimal side effects and numerous
benefits in terms of
reducing chronic disease risk, enhancing feelings of well being and increasing
functionality. It is
important to note that there are a number of psychological and pharmacological
treatments proven
effective. The key is to find a suitable treatment plan for each individual.
__________________________________________________________________________
1 The Victorian Population Health Survey, Department of Human Services, Victoria
2004.
2 Craft, L. and F. Perna (2004). "The benefits of exercise for the clinically
depressed." Prim Care Companion J Clin
Psychiatry 6(3): 104-111.
3 Galper, D., M. H. Trivedi, et al. (2006). "Inverse association between
physical inactivity and mental health in men and
women." Med Sci Sports Exerc 38(1): 173- 178
4 Dunn, A. L., M. H. Trivedi, et al. (2001). "Physical activity dose-response
effects on outcomes of depression and anxiety."
Med Sci Sports Exerc 33(6 Suppl): S587-97; discussion 609-10.
5 Lawlor, D. A. and S. W. Hopker (2001). "The effectiveness of exercise as an
intervention in the management of
depression: systematic review and meta-regression analysis of randomised
controlled trials." BMJ 322(7289): 763-7.
6 Craft, L. and D. Landers (1998). "The effect of exercise on clinical
depression and depression resulting from mental
illness; a meta-analysis." Jou Sport Exerc 20: 339-357.

Resources
Go For Your Life
Victoria’s “Go For Your Life” campaign website has information on depression and
exercise,
including an informative fact sheet. Access this resource by visiting:
http://www.goforyourlife.vic.gov.au/hav/articles.nsf/pages/Depression_and_exerci\
se?OpenDoc
ument
Exercises, Activities and Helpful Hints: Prescribing Exercise (January 2005).
A tool for clinicians for prescribing physical activity to patients. It includes
a fact sheet for GPs
and a patient information handout designed to assist the patient in recognizing
the benefits of
exercise and tracking progress.
http://www.blackdoginstitute.org.au/clinicians/clinicianaids/documents/HandoutPr\
escribingExe
rcise.pdf
Mental Illness and Keeping Well
Current issue of SANE Australia’s Research Bulletin: Mental Illness and Keeping
Well: People
affected by mental illness have serious concerns about their general health, and
often want to
improve it, but face significant access and cost barriers to doing so . . this
issue addresses these
concerns….
http://www.sane.org/images/assets/information/0601_INFO_RB2.pdf
Keeping Active
beyondblue’s website (www.beyondblue.org.au) has a number of helpful fact sheets
available
for download. Number 8, “Keeping Active,” addresses the benefits of regular
physical exercise
in helping relieve mental and muscular tension. Included are tips for increasing
daily activities
and ways to successfully plan activities.
http://www.beyondblue.org.au/index.aspx?link_id=7.246&tmp=FileDownload&fid=328
Blood Sweat and No Tears
The U.K. Mental Health Foundation recommends that GPs with access to exercise
referral
schemes should offer all patients presenting with mild or moderate depression
the opportunity
for referral to that scheme as part of their treatment plan. Their campaign
“Blood Sweat and No
Tears” promotes physical activity as an effective management tool for health.
The foundation’s
website contains a guide for GPs and other health practitioners and a separate
guide for
patients. Both are available at:
http://www.mentalhealth.org.uk/page.cfm?pageurl=mhaw.cfm
Youth Team Sports Involvement
A recent research study tested the notion that involvement in positive team
sports increases
levels of social acceptance and elevates body satisfaction to diminish risks for
depressive
symptoms in early adolescence. This study presents their findings and outlines
implications
for community and school-based sports programs.
Boone, E. and B. Leadbeater (2006). "Game On: diminishing risks for depressive
symptoms in early adolescence
through positive involvement in team sports." Journal of Research on Adolescence
16(1): 79-90.

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