Hi all,
This is such a healthy discussion it's lightening my mood!
My first reaction to reading the news about this research was 'thank goodness'. This is one less stick to beat us depressives about with. It can feel that you are prescribed all this healthy living which over time, is reviewed and methods and ways are revised. Drink, but in moderation. Wine is good for the heart, alcohol is a depressant, the Mediterranean diet is good for you (wine included presumably), as some one has pointed out, but perhaps not the too fatty elements of that? The average person is rightly confused.
I can feel guilty enough about many aspects of my life when depressed so not feeling guilty about exercise is one less thing to beat myself with. In light depression I can try to pull myself out of it by any activity, usually keeping up with light work chores - emails and the like. A sense of purpose and achievement. I then reward myself with R&R. Walking out the back of where I live is also a good one. Takes a bit of energy to get up the hill but the view and connection to nature is the beneficial thing. So I agree that thing about meaning is very important. It's a chore and also a reward.
Motivation is very difficult when depressed and for me in severe depression I get psycho-motor retardation so it makes simple activity so much more difficult and then exercise isn't possible or if done, doesn't help. The recognition that psychiatric drugs also impair ones ability to take exercise is often forgotten and rightly pointed out as a key factor. So many people are prescribed chronic weight gaining meds, and then have the lecture about eating properly and taking exercise, when they are not helped with positive motivation, fighting a lost cause against the meds, and possibly doing themselves more harm by stressing the body that is Impaired by pharmacology. Feeling guilty about being overweight and needing to spend money to buy bigger clothes also weighs heavy!
I only seem to have so much energy. As obese and inactive I need to rectify that but when trying to keep on top of other things like work and not beating myself up for not doing other things and being kind to myself, I find I only have time and energy for so much anyway, and exercise falls by the wayside. It can be a vicious circle that many non-depressives find themselves in.
People do need to find what works for them and as part of a wider healthy lifestyle. Im still searching, but not agonising over it!
Tina Coldham
Mental Health User Consultant, Trainer & Researcher
M: 07710 714748
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On 7 Jun 2012, at 10:20, Konstantina Poursanidou <[log in to unmask]> wrote:
> Mike, many thanks for this really useful account and the references.
>
> From personal experience I can understand why exercise was not found to make a difference for people with severe depression in the RCT study (this is my understanding/ I need to read the full paper still). I guess these people were on fairly heavy medication and often anti-depressants (and the anti-psychotics that often go with them in severe depression cases) can make you very lethargic and lacking in energy, which means that people may not have been very keen to exercise in the first place. if people had severe depression, then the role of motivation is key and people with severe depression are very likely to lack motivation for exercise and motivation to do anything at all (depending on how pervasive the depression is; talking from personal experience here!!). I guess exercise may make a difference in cases of mild depression, but severe depression is a different kind of ordeal where exercise as an adjunct to treatment as normal would not necessarily have an impact.
>
> all this from a personal experience of very severe depression
>
> Dina
>
> Dr Dina Poursanidou
> Honorary Research Associate/User Researcher
> University of Manchester
> Centre for Women's Mental Health
> School of Community Based Medicine
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>
> ________________________________________
> From: Mental Health in Higher Education [[log in to unmask]] on behalf of Mike Feighan [[log in to unmask]]
> Sent: 07 June 2012 07:40
> To: [log in to unmask]
> 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
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> ________________________________________
> 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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