Thank you Melanie- appreciate you've quite possibly being gettings lots of correspondence!
Melanie Chalder from Bristol University has kindly responded to an email I sent her yesterday with regard to the research on Exercise and depression in BBC News (Chalder et al 2012).
REF:
Chalder et al (2012) BMJ 2012; 344 doi: 10.1136/bmj.e2758 (Published 6 June 2012) available at http://www.bmj.com/content/344/bmj.e2758
Mike Feighan
Lecturer/Practioner in Occupational Therapy
Faculty of Health, Education and Society
Plymouth University
Peninsula Allied Health Centre
Derriford Road
Plymouth
Devon PL6 8BH
Tel: 01752 588823
[log in to unmask]
Mondays and Tuesdays only
‘High quality education for high quality care’
________________________________________
From: MJE Chalder [[log in to unmask]]
Sent: 07 June 2012 13:07
To: Mike Feighan
Subject: Re: FW: Depression and Exercise!
Dear Mike
Thank you for your e-mail and for your interest in our research.
I think you have picked up on a number of key points in our findings
which, unfortunately, are sometimes lost in the media coverage or when
read too quickly. Our paper does not suggest that exercise has no effect
on depression but considers the effect of introducing a physical activity
intervention into a package of GP care and comparing it to usual GP care.
In using an RCT design, we have to consider the 'average' effect observed
between the two treatment groups - and therefore some the detail around
individual experience is necessarily lost. We have produced a far fuller
report as part of our feedback to HTA funders and this details not only
the main trial outcomes but also qualitative work undertaken to illuminate
the trial findings and an cost-effectiveness evaluation. It's reference
is:
A pragmatic randomised controlled trial to evaluate the cost-effectiveness
of a physical activity intervention as a treatment for depression: the
treating depression with physical activity (TREAD) trial (Chalder) 164
pages, Volume 16, number 10
and I'm attaching a link to the online version
http://www.hta.ac.uk/fullmono/mon1610.pdf
Hopefully, this provides a more rounded picture of our work!
Best wishes
Melanie
Melanie Chalder
Research Fellow
Academic Unit of Psychiatry
School of Social & Community Medicine
Oakfield House
Oakfield Grove
Clifton
Bristol
BS8 2BN
Hi
You and your colleagues have certainly got the debate going! I thought I'd
copy you in- I meant to have copied you in to email response i gave to
[log in to unmask] anyhow.
Thanks
Mike Feighan
Lecturer/Practioner in Occupational Therapy
Faculty of Health, Education and Society
Plymouth University
Peninsula Allied Health Centre
Derriford Road
Plymouth
Devon PL6 8BH
Tel: 01752 588823
[log in to unmask]
Mondays and Tuesdays only
�igh quality education for high quality
care�________________________________________
From: Mike Feighan
Sent: 07 June 2012 07:40
To: Anne O'Donnell; [log in to unmask]
Cc: Lyn Westcott; Shaan Ellor
Subject: RE: Depression and Exercise!
I think that one of the paper's key findings was to avoid recommending
exercise as a means of reducing depressive symptoms, as the evidence does
not seem to support this. Perhaps this is as a response to Exercise
referral schemes in the UK, in which "prescribed exercises" (possibly
devoid of meaning) see refs below (Pavey et al and Williams et al), were
used without attention to the fact that exercise (which the published
paper Chalder et al 2012, acknowledges Exercise as being extremely
difficult to measure) were recommended in much the same way that taking a
pill would would alleviate symptoms. NICE (2006) critiqued exercise
referral schemes and the current paper has perhaps justifiably put a nail
in the coffin for such schemes. Intersetingly a number of authors (ie Fox
and Taylor) have been involved in the current research and also in Pavey
et al.
If one were to ensure meaning is maintained as Anne suggests, then
benefits are likely to occur. These however may be quite idiosyncratic, as
meaning is very individual. RCTs are poor at measuring heterogeneous data,
so qualitative types of methodologies are perhaps more powerful in
conveying value of exercise. In order for the current paper (Chalder et al
2012) to measure the effectiveness of exercise they my well have had to
have reduced the extraneous variables to show the effect. these very same
variables that may well bring meaning to the individual. If one were to be
controversial it might be suggested that the paper is stating the obvious:
Prescibed exercises (devoid of meaning) do not show an effect when taken
as an adjunct to treatment as normal for people with depression.
Exercise still brings about a number of positive changes for people-
particularly physiological ones, in impact studies (Hughes et al 2009 and
Oja et al 2011) the benefits have been well documented. The individual
idiosyncratic nature of exercise and peoples response to it, possibly
necessitates methodologies that really capture what exercise means for
people (Whitaker 2005 and Priest 2007). Exercise still justifies being
recommended but amongst a number of other meaningful activities, not all
need to bring about physiological changes as the health benefits may occur
in the absence of physical exercise- so long as meaning is taken into
account (Clark et al 2011)
Clark, F., Jackson, J., Carlson, M., Chou, C.P., Cherry, B.J.,
Jordan-Marsh, M.A., Knight, B.G., Mandel, D., Blanchard, J., Granger,
D.A., Wilcox, R.R., Lai, M.Y., White, B., Hay, J., Lam, C., Marterella, A.
and Azen, S.P. (2011) Effectiveness of a lifestyle intervention in
promoting the well-being of independently living older people: results of
the Well Elderly 2 Randomised Controlled Trial. Journal of Epidemiology
and Community Health. Available at
http://www.ncbi.nlm.nih.gov/pubmed/21636614. Accessed on 15.05.2012
Hughes, S.L., Seymour, R.B., Campbell, R.T., Whitelaw, N. and Bazzarre, T.
(2009) Best-Practice Physical Activity Programs for Older Adults: Findings
From the National Impact Study. American Journal of Public Health
February. 99(2), 362-367
NICE (2006) Public Health Collaborating Centre for Physical Activity: A
rapid review of the effectiveness of exercise referral schemes to promote
physical activity in adults. London. National Institute for Health and
Clinical Excellence
Oja, P.,Titze, S., Bauman, A., de Geus, B., Krenn, P., Reger-Nash, B. and
Kohlberger, T. (2011) Health benefits of cycling: a systematic review.
Scandinavian Journal of Medicine and science in Sports. 21(4), 496-509
Pavey, T.G., Anokye, N., Taylor, A.H., Trueman, P., Moxham, T., Fox, K.R.,
Hillsdon, M., Green, C., Campbell, J.L., Foster, C., Mutrie, N., Searle,
J. and Taylor, R.S. (2011) The clinical effectiveness and
cost-effectiveness of exercise referral schemes: a systematic review and
economic evaluation. Health Technology Assessment.15(44),1-254. Summary
version available at
http://www.bmj.com/highwire/filestream/533981/field_highwire_article_pdf/0.pdf
accessed 17.05.2012
Priest, P. (2007) The healing balm effect: using a walking group to feel
better. Journal of Health Psychology. 12(1), 36-52
Whitaker. E.D. (2005) The bicycle makes the eyes smile: exercise, aging,
and psychophysical well-being in older Italian cyclists. Medical
Anthropology. 24(1),1-43
Williams, N., Hendry, M., France, B., Lewis, R. and Wilkinson, C. (2007)
Effectiveness of exercise-referral schemes to promote physical activity in
adults: systematic review. British Journal of General Practitioners. 57,
979-986
Mike Feighan
Lecturer/Practioner in Occupational Therapy
Faculty of Health, Education and Society
Plymouth University
Peninsula Allied Health Centre
Derriford Road
Plymouth
Devon PL6 8BH
Tel: 01752 588823
[log in to unmask]
Mondays and Tuesdays only
�igh quality education for high quality
care�________________________________________
From: Mental Health in Higher Education [[log in to unmask]] On Behalf Of
Anne O'Donnell [[log in to unmask]]
Sent: 06 June 2012 14:46
To: [log in to unmask]
Subject: Re: Depression and Exercise!
Hi Dominic
Thanks for forwaring Anne Haase's email. The way the media reports on
research like this, often just pulling stuff out of a press release rather
than reading the papers, is a real worry.
Like you, I have found exercise beneficial in my own recovery. But I had
to figure it out for myself - the advice I got from various doctors has
not been helpful at all as it was very simplistic and focused on weight
loss above all else.
As Anne says
Although there was no effect on reducing depressive symptoms, we did show
a
increase in physical activity which was maintained - an uncommon finding.
The facilitators worked with patients to promote increase and uptake in
ANY
form of activity - whatever the patient believed they could successfully
achieve. Our facilitation was based on self-determination theory
promoting
development of confidence in engaging in activity, supporting and
promoting
the patients' preferences and own choices (autonomy) and development of
relatedness (social networks, support etc).
I've found my own way to sustainable and enjoyable exerise - walking over
10,000 steps a day and swimming three times a week in the sea. Through the
swimming, I have met many people - it is better swimming with others for
safety. The fun and challenge and low pressure social contact have been
great.
Like the people in this research, I still have symptoms, such as anxiety,
paranoia, and lethargy. And I am just as fat/obese as ever. But life is a
lot better and recovery is, or should be, about living a good life, in the
absence or presence of symptoms.
Anne
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