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
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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!
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.
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