Download Physiological Effects of Physical Exercise on Depression (Cont.)

Therapeutic Intervention by
Physical Exercises in
Depression
By
Afnan Mohammad Al Khateeb
Mashael Ghazi Al Sobhi
Rehab Abdurrahman Al Harbi
Supervised by
Ms. Isabelle Devreux
A dissertation submitted in partial
fulfillment for the
Bachelor Degree in Physical Therapy
2008
Contents
• Introduction
• Depression
• Methodology
• Physiological Effects of Physical Exercise on
Depression
Contents (Cont.)
• Literature Review
• Physical Therapist Treatment Approach
• Results
• Discussion
• Conclusion
• Acknowledgments
Introduction
Introduction
- The World Health Organization predicts that by
2020 depression will create the greatest burden of
disease in european countries (USDHHS, 1999).
- The link between ‘healthy mind and body is not new’
Hippocrates the Greek philosopher recommended
exercise as treatment of mental illnesses.
1
Aim of the Study
- The aim of this research is to review the
recent literature related to the study of the
effects of physical exercise on depression.
2
Hypothesis
- Physical exercise can reduce symptoms of
depression and has effective therapeutic
effects.
3
Delimitations
- The initial study is based on a literature review of all
related articles concerning physical therapy and
depression since 1990.
- The secondary delimitation the study is restricted to a
cross sectional screening of the depression in a female
student population.
4
Limitations of the Study
• The study did not include patients referred by the
psychologist or psychiatric department.
• Mental or hormonal disturbances could occur
during the assessment or additional stressful events.
• The study is limited to the short term time frame.
5
Limbic System
Prefrontal
Cortex
Depression
Definition of Depression
Clinical depression is a psychiatric disorder,
characterized by a pervasive low mood, loss of
interest in usual activities and diminished ability
to experience pleasure.
-
6
Symptoms of Depression
- Persistent sadness.
- Insomnia.
- Feelings of worthlessness and helplessness.
- Thoughts of death or suicide.
- Loss of interest or pleasure in hobbies and activities.
- Withdrawal from social situations, family and friends.
7
Causes of Depression
- Genetic Causes:
Scientists have not been able to identify a "depression" gene.
- Neurochemical Causes:
Neurochemical influences of neurotransmitters focus on serotonin and
norepinephrine.
- The Psychodynamic Causes:
Therapists believe the root of all depression lies in the loss of something
loved, whether it be a person or an object.
- Life Experiences Causes:
Such as divorce, financial difficulties and the death of a child or other
family member.
8
Assessment for Depression
- Beck Depression Inventory Scale.
-Zung Self-Rating Depression Scale.
-Hamilton Rating Scale for Depression.
9
Methodology
Methodology
1- Literature review
We reviewed many articles, journals and electronic
libraries about our research.
2- Screening study
a- Subjects
A total of 100 female volunteers, aged between 18 to
22 years, medical students from the King Abdul Aziz
University (KAAU), single and free from diseases.
10
Methodology (Cont.)
b- Tools
The Beck Depression Inventory was utilized as
screening assessment tool for depression.
c- Method
The questionnaires were randomly distributed to 100
female students of the college of medical
technology and collected during the same session.
11
Physiological Effects of Physical
Exercise on Depression
Physiological Effects of Physical
Exercise on Depression (Cont.)
Serotonin (5-HT)
Sex
Appetite
Aggression
Depressed
Mood
Norepinephrine (NE)
Anxiety
Concentration
Vague aches
and pain
Interest
Irritability
Thought
process
Motivation
12
How Exercise Increase the Mood
Stabilizers?
1- Sympathetic nervous
system is activated.
2- With more strenuous
exercise circulating
epinephrine and
norepinephrine released
from the adrenal medulla.
(Prentice, 2005)
13
The Mental Effects by Norepinephrine
and Serotonin
Concentration of
norepinephrine
neurotransmitters
and serotonin in the
neurons will
increase during
exercise and the
depressed patient’s
mood could
improve.
Supporting Theories of the Exercise
Effects on Depression
There are many theories:
1- Acidosis → ↑ endorphins release.
2- ↑ Circulation →↑↑ endorphins.
15
Literature Review
Comparative Table of Studies and their
Results on Exercise and Depression.
Author
Craft,
1997
Type of Exercise
Program
Aerobic exercise
program < 9 Ws.
Babyak, 30 mints. of speed
Hermana, walking 3\ w.
2000.
Results
- Exercises produce larger
antidepressant effects.
- Effective as drug therapy in
relieving the symptoms of
depression.
Dr.
Dimeo,
2001.
Walking
- Exercise caused a clinically
on a treadmill for 30 significant drop of
depression symptoms.
min. / day for 10
days.
Trivvedi,
2005.
Running
30-min. 3-5
time/week
- Depressive symptoms were
reduced almost 50 %.
Literature Review
 No definitive exercise recommendation for all
elements of mental health promotion.

No definitive formula of frequency, intensity and
duration.

30 minutes or more of moderate exercise is
recommended.
 Vigorous exercises are effective
in treating depression (Fox,1999).
17
Physical Therapist Treatment
Approach
- Use silence and active listening when interacting
with the depressed patient.
- Simple, direct sentence should be used.
- Avoid asking
questions.
the
depressed
patient
many
- Extra work should not always be requested.
- The depressed patient needs care and attention to
recover faster.
18
Protocol of Treatment by Physical
Exercises for Depression
• Assessment of depression level by the Beck
Depression Inventory Scale.
• History taking.
• Screening for contraindications.
• Manual muscle testing.
• Assessment and monitoring of the exercise within the
target heart rate.
19
Exercise Protocol for the Treatment of Mild to Moderate Depression.
Sessions
Warm up
Walking
Cycling
Running
Weight lifting
Cool down
1st session
5 minutes
15 minutes
5 minutes
‫ـــــــــــــــــــــ‬
‫ـــــــــــــــــــــ‬
5 minutes
2nd session
5 minutes
15 minutes
5 minutes
‫ـــــــــــــــــــــ‬
‫ـــــــــــــــــــــ‬
5 minutes
3rd session
5 minutes
10 minutes
10minutes
‫ـــــــــــــــــــــ‬
‫ـــــــــــــــــــــ‬
5 minutes
4th session
5 minutes
10 minutes
10 minutes
‫ـــــــــــــــــــــ‬
‫ـــــــــــــــــــــ‬
5 minutes
5th session
5 minutes
13minutes
5 minutes
2 minutes
‫ـــــــــــــــــــــ‬
5 minutes
6th session
5 minutes
13minutes
5 minutes
2 minutes
‫ـــــــــــــــــــــ‬
5 minutes
7th session
5 minutes
10 minutes
5 minutes
5 minutes
‫ـــــــــــــــــــــ‬
5 minutes
8th session
5 minutes
10 minutes
5 minutes
5 minutes
‫ـــــــــــــــــــــ‬
5 minutes
9th session
5 minutes
10 minutes
5 minutes
2 minutes
3 minutes
5 minutes
10thsession
5 minutes
10 minutes
5 minutes
2 minutes
3minutes
5 minutes
11thsession
5 minutes
10minutes
‫ـــــــــــــــــــــ‬
5 minutes
5 minutes
5 minutes
12thsession
5 minutes
10 minutes
‫ـــــــــــــــــــــ‬
5 minutes
5 minutes
5 minutes
Results
Results of the Screening Study
The result of the Beck Depression Inventory (BDI) scale
that was distributed to 100 female students.
All students responded to the questionnaire.
90
80
60
Mi l d
Mo d erate
50
Severe
40
30
Frequancy.
70
No rmal
20
10
0
1
Level o f d ep ressi on.
Fig ure 1.p ercentag e o f d ep ressed stud en
21
Results of the Screening Study
There is inverse relationship between severity of depression
and physical activity of the students.
70
60
50
40
Regular
Physical activity
30
Irregular
20
10
Non-exercised
0
Normal
Mild
Moderate
Level of depression
Figure 3.Corelation between severity o f depression
and physical activity of students.
22
Discussion
Discussion
- Physical exercise is effective in reducing
depressive symptoms. All the previous studies
reported good results.
- Through the cross sectional screening assessment
of the student population in our university we found
a 16 % present the symptoms of depression at the
time of the screening.
- All 16 % of students associated to a sedentary life
style.
24
Conclusion
Conclusion
- We clearly outlined several mechanisms supporting
the effects of physical exercise on depression
- We resumed the guidelines, precautions and the
protocol of management in physical therapy.
- There is a high correlation between depression and
limited physical activity.
- The importance of physical exercises in prevention
and treatment of depression.
25
Acknowledgments
Acknowledgments
Thanks for:
• Ms. Isabelle Devreux
• Dr.Sausan Raheem.
• Dr.Dua'a Khalifa.
• Dr. Khaled Mamdooh.
• Dr. Mohammed Sayim Aldahr.
Thank You For
Your
Attention