Exercise and Mental Health (Week 4)

Question 1

what are the key symptoms of ‘Major Depressive Disorder’ (MDD) ?

Answer 1

most days for at least 2 weeks

1) persistent sadness or low mood
2) marked as loss of interest or pleasure (anhedonia)

Question 2

there are more than 5 other associated symptoms of depression. give 3 examples

Answer 2

1) disturbed sleep (increased/decreased)
2) decreased/increased appetite and/or weight
3) fatigue or low energy
4) agitation or slowing of movements
5) poor concentration or indecisiveness
6) feelings of worthlessness or excessive/inappropriate guilt
7) suicidal thoughts or acts

Question 3

what is the prevalence of depression (diagnosed and non-diagnosed) in the uk ?

Answer 3

1 in 6 uk adults

Question 4

what situations tend to make it more common for people to suffer from MDD (3 points)

Answer 4

1) living alone
2) unemployed
3) poor physical health

Question 5

how much does the UK spend on mental illnesses a year ?

Answer 5

£70 - £100 billion (4.5% GDP)

Question 6

how much does depression treatment in the UK cost annually ?

Answer 6

£1.68 billion in health and social care

predicted to rise to £2.96 billion by 2026

Question 7

what was the study design the ‘Alameda County Study’ ? (3 points)

(Camacho et al., 1991)

Answer 7

1) longitudinal study
2) 1947 adults from Alameda County Study aged 50 - 94 at baseline
3) depression and PA was measured using an 8 point scale at baseline and at the 5 year follow up

Question 8

what was the main result of the ‘Alameda County Study’ (Camacho et al., 1991) ?

Answer 8

found that having a greater PA was protective of both prevalent and incidence depression over the 5 years

Question 9

state, and explain, 2 considerations when talking about the ‘Alameda County Study’ results (Camacho et al., 1991)

Answer 9

1) PA was self-reported
- we always question the accuracy of self-reported measures
- accelerometers weren’t widely used back then
- however, the large sample size should offset any variance caused by the self-reported measure

2) can we infer causality here ?
- no control group
- does not take into account other variables

Question 10

what was the purpose of the following study (2 points) ?

‘the association between past and current PA and depressive symptoms in young adults’ (Brunet et al., 2013) - longitudinal study

Answer 10

1) assess longitudinal associations of past MVPA and involvement in team sports with depressive symptoms in early adulthood (n = 1293)
2) assess the cross-sectional associations of current MVPA and involvement in team sports with depressive symptoms in young adulthood

Question 11

state, and explain, the 3 main results from the following study:

‘the association between past and current PA and depressive symptoms in young adults’ (Brunet et al., 2013) - longitudinal study

Answer 11

1) MVPA in childhood did NOT predict depressive symptoms in follow up

2) did find a cross sectional association at follow-up between MVPA and depressive symptoms
- no causality found
- could be because people with depression tend to be less active (Birkland et al., 2009)

3) however, when controlling for covarities, some of the associations disappeared
- done during point in life where lots of decisions are to be made

Question 12

state 3 evaluative points when talking about the following study:

‘the association between past and current PA and depressive symptoms in young adults’ (Brunet et al., 2013) - longitudinal study

Answer 12

• week associations found due to variances of what was considered depression symptoms (need homogeneity of definitions in future research)
• self-reported measures were used for PA
• focus is on quantity of PA and not on the quality of PA (should be considered in future research)

Question 13

what was the study design to the following study:

‘exercise cessation and mood changes’ (Berlin et al., 2006)

Answer 13

1) 40 regular exercisers
2) 2 week deprivation (n = 20)
3) control group (n = 20)

Question 14

what were the first results to the following study using the POMS:

‘exercise cessation and mood changes’ (Berlin et al., 2006)

Answer 14

1) exercise cessation group self-reported greater fatigue and less vigour at the end of week 1

2) cessation group self-reported more depressive symptoms at the end of week 2
- the loss in fitness was a predictor of depressive symptoms in this group

Question 15

what were the second results to the following study using the ‘Beck Depression Inventory’ (BDI):

‘exercise cessation and mood changes’ (Berlin et al., 2006)

Answer 15

1) week 1 saw a large drop in somatic scores in the intervention group
2) this then translated to a drop in cognitive-affective symptoms at the end of week 2
- results infer that physiological changes can play a key role in the onset of depressive symptoms

Question 16

what was the study design to the following experimental trial?

‘exercise and treatment for MDD - maintenance of therapeutic benefit at 10 months’ (Blumenthal et al., 2000)

Answer 16

• 202 adults diagnosed with MDD assigned to 1/4 groups

1) supervised exercise in group setting
2) home-based exercise
3) antidepressant medication (Sertraline 50-200 mg/day)
4) placebo pill

• placebo pill controlled against expectancy effect of antidepressant medication
• home based exercise controlled against expectancy effect of group-based exercise

Question 17

wha were the remission results from all 4 groups in the following study:

‘exercise and treatment for MDD - maintenance of therapeutic benefit at 10 months’ (Blumenthal et al., 2000)

Answer 17

supervised group exercise = 45%
home-based exercise = 40%
antidepressant medication = 47%
placebo pill = 30%

Question 18

what do the remission results mean from the following study (3 points):

‘exercise and treatment for MDD - maintenance of therapeutic benefit at 10 months’ (Blumenthal et al., 2000)

Answer 18

1) not a huge difference in treatments as all work just use different mechanisms
- good because it is an attempt to find other methods of treatment other than medication

2) can infer that they all work as all interventions did significantly better than the placebo group

Question 19

what was the study design on the following ‘3-arm randomised control trial’ ?

‘relapse prevention’ (Blumenthal et al., 2000)

Answer 19

• 156 adult volunteers with MDD 6 months post completion of Blumenthal’s last study randomly assigned to a 4 month course of:

1) aerobic exercise
2) sertraline
3) combination of both

Question 20

what were the results from the following study:

‘relapse prevention’ (Blumenthal et al., 2000)

Answer 20

• the proportion of remitted participants were comparable across the 3 situations after the 4 month intervention
• after 10 months (6 months no treatment), remitted participants in the exercise group had lower relapse rates than the medication groups
• self-initiated exercise was associated with a reduced probability of depression in the diagnostic period

Question 21

why were relapse rates lower in just the exercise group in the following study (2 points)?

‘relapse prevention’ (Blumenthal et al., 2000)

Answer 21

• effects seen in exercise and not combination group as combination group did not know how to attribute changes in depressive symptoms
• also, combo group would have noticed when they came off the intervention, but the exercise group had exercise integrated into their lifestyle so would carry on as the ‘new normal’ for them

Question 22

what were the findings to the following ‘questionable’ systematic review:

‘using exercise to treat depression’ (Cooney et al., 2013)

Answer 22

• 35 RCTs compared exercise with control and found minimal effect
• 6 RCTs with even stricter control criteria (e.g. - blinded outcome assessment) found no effect
• 8 RCTs with a LT follow up found a very minimal effect

Question 23

state and explain 2 evaluative points on the following questionable systematic review:

‘using exercise to treat depression’ (Cooney et al., 2013)

Answer 23

1) different prescriptions of exercise –> which studies did what?
- group based, outdoors, low intensity…

2) review came under a lot of criticism (e.g. - Ekkekakis)
- studies used failed to have adequate control groups
- studies heterogeneity in defining exercise amongst studies

Question 24

state 3 facts about endorphins and depression

Answer 24

1) beta endorphins are released during exercise and have been shown to have a positive effect on depression (Craft & Perna., 2004)
2) endorphins are related to a positive mood and enhanced well-being (Craft & Perna., 2004)
3) remains unclear to whether elevations in plasma endorphins are directly linked to a reduction in depression (Craft & Perna., 2004)

Question 25

state 3 considerations you must be aware of when talking about endorphins and depression

Answer 25

1) blood plasma not always reflective on what’s going on psychologically
2) require people who suffer from depression to get blood from –> probably aren’t signing themselves up for these studies
3) very invasive - need to collect cerebral spinal fluid for a full picture on what’s going on in the brain

Question 26

what was the study design to the following study:

study on endorphins (Markoff et al., 1982)

Answer 26

• recruited 11 elite runners
• completed POMS
• got them to go for a run
• completed the POMS again
• took naloxone (competitive inhibitor of endorphins)
• completed the POMS for a 3rd time

Question 27

state, and explain, the results of the following study:

endorphins study (Markoff et al., 1982)

Answer 27

1) no difference in mood scores between the 2nd and 3rd POMS scores
- concludes that endorphins are not the only thing affecting mood, if they have any effect at all

2) not a lot of evidence that endorphins positively effect mood

Question 28

why was the study on endorphins done by (Markoff et al., 1982) considered a good one ?

Answer 28

because it controlled the physiological pathway by inhibiting the endorphin action so that he could infer causality or not

Question 29

state 5 key mechanisms of how exercise can help treat depression

Answer 29

1) endorphins
2) inflammation
3) distraction
4) self-esteem
5) social support

Question 30

what was the study design to the following study:

inflammation study (Euteneuer et al., 2017)

Answer 30

• patients who suffer from MDD randomly assigned to 1/3 groups

1) CBT and exercise
2) CBT control
3) wait list

Question 31

explain what was good about the inflammation study done by (Euteneuer et al., 2017) ?

Answer 31

people who would usually sign themselves up for an exercise benefit on psychology study are already pro-exercisers and not individuals who suffer from MDD. this study enrolled individuals who did suffer from MDD so they could get a better insight on the mechanisms within people who suffer

Question 32

what were the results from the inflammation study done by (Euteneuer et al., 2017)

Answer 32

• patients had higher levels of CRP, and higher neutrophil and monocyte counts in the blood
• had lower IL-10 levels
• both compared to control (people who did not suffer from depression)

Question 33

what are the considerations of the inflammation study done by (Euteneuer et al., 2017)

Answer 33

1) was IL-10 really the cause of a reduction in depressive symptoms ?
- to be able to infer causality, IL-10 would have had to of been controlled
- changes in IL-10 levels and reduction in depressive symptoms could have just happened concurrently and both are effects of exercise

Question 34

state 2 facts about how exercise can be used as a distraction tool to help treat depression (Craft & Perna., 2004)

Answer 34

1) better distraction compared to relaxation and social contact

2) better for managing depression than introspective activities (e.g. - journaling)
- have to focus on exercise but can easily get distracted from introspective tasks as no risk of external damage

Question 35

explain how exercise can boost self-efficacy and help treat depression (Craft & Perna., 2004)

Answer 35

1) exercise enhances SE through mastery experiences (SDT - competence)

2) however, most research is focused on using SE to regulate exercise behaviours, not depression
- the relationship between SE and exercise in the clinically depressed has had far less attention

Question 36

explain the study design to the following study:

self-esteem study (Legrand et al., 2014)

Answer 36

female residents of a low-income housing complex (n = 44) were randomised into a 7-week exercise training group or a wait list

Question 37

state, and explain, the 2 main results from the self-efficacy study done by (Legrand et al., 2014) ?

Answer 37

1) significant changes found in depression, self-esteem and self-worth
- observed changes in SE and self-worth between baseline and week 2
- the main decline in depressive symptoms did not occur until weeks 2 - 4

2) as changes came prior to the reductions in depressive symptoms, we can infer that an increase in SE can help in the treatment of depression

Question 38

explain the study design to the following study:

social support study (Hallgren et al., 2017)

Answer 38

• 946 adults living i Sweden randomised into 1/3 groups for 12 weeks

1) ICBT (internet CBT)
2) CBT
3) exercise

• looking for a change in depressive symptoms between groups

Question 39

what were the results from the social support study done by (Hallgren et al., 2017)

Answer 39

1) people who had access to social support reported greater reductions in depressive symptoms
- helps with anxiety symptoms as don’t have to meet in person
- keeps costs lower as no commuting costs

2) adds credibility to the need of social support when treating depression
- (STD - relatedness)
- (Maslow’s hierarchy of needs)

Question 40

state 4 common limitations in exercise and depression treatment research

Answer 40

1) human studies can be invasive (e.g. - involve lumbar punctures)
2) small, underpowered, and un-replicated studies
3) heterogeneity in defining depression
4) issue of causality with cross-sectional work

Question 41

according to (Glowacki et al., 2017), what are the two main barriers to PA engagement in the clinically depressed ?

Answer 41

1) lacking knowledge, SE, and time (all key determinants of PA)
2) specific depressive factors (e.g. - low mood, energy)

Question 42

what 3 things did (Morres et al., 2014) state about promoting exercise ? (3 points)

Answer 42

• PA interventions show lowest uptake and completion (motivation, lack of interest, fatigue)
• interventions should support autonomy, competence, and relatedness (SDT theory?)
• combine interventions with therapy to find the source of depression within the individual

Question 43

what is the second questionable RCT we will look at ?

Answer 43

the ‘TREAD UK’ trial

Chalder et al., 2012

Question 44

what was the study design to ‘TREAD UK’ (Chalder et al., 2012) ?

Answer 44

• 361 primary care patients with new onset of depression randomly selected into 1/2 groups:

1) usual care (antidepressants, referral)
2) usual care + exercise counselling

• 3 face-to-face sessions and 10 phone calls with trained physical activity facilitator for 8 months
• symptoms of depression assessed every month and for 4 months post-intervention

Question 45

explain the results to ‘TREAD UK’ (Chalder et al., 2012)

Answer 45

1) no difference between the intervention and usual care group
- however, participants allocated to intervention group reported more PA during follow-up period

2) both groups reduced depressive symptoms by approx. 50%
- good because it further showed that exercise can be an effective treatment as it did just as well

Question 46

state, and explain, the 2 major issues with ‘TREAD UK’ (Chalder et al., 2012)

Answer 46

1) had usual care in both study arms
- poor design, competing mechanisms going on at once (‘contamination effect’ of the results)

2) self-reported measures (not everyone had access to accelerometers in the study)
- e.g. - social desirable biases; forget how much activity they have done

Question 47

what was the study design to ‘eMOTION’ (Lambert et al., 2018)

Answer 47

1) pilot randomised control trial (lacked funding for RCT)
2) 62 participants with elevated depressive symptoms randomised into 2 groups

• ‘web-based behaviour change’ intervention
• a wait list group

3) also focused on non physical activity activities

Question 48

why, in the ‘eMOTION’ study (Lambert et al., 2018) did they move away from an exercise focus?

Answer 48

helped to get volunteers who weren’t already in such high favour of exercise and its benefits

Question 49

state, and explain, the 2 main results from ‘eMOTION’ (Lambert et al., 2018) ?

Answer 49

1) lead to a reduction in depressive symptoms in the intervention group
- social support, even via online, can have positive effects on the reduction of depressive symptoms (Maslow’s hierarchy of needs)

2) at baseline, people WERE doing low levels of activity
- gives evidence to the field of exercise and MDD research that you can recruit less active participants

Question 50

explain the study design of ‘ecoachER’ (Lambert., in prep)

Answer 50

• 450 adults with serious physiological health conditions (pre-covid) referred to an online exercise referral scheme (ERS)
• depression and anxiety measured using ‘hospital anxiety and depression scale’ (HADS)
• PA measured using GENEActive at baseline, 4 and 12 months
• offline intervention group (same measures at same intervals)

Question 51

why did ‘ecoachER’ (Lambert., in prep) make his intervention online ?

Answer 51

a lot of individuals drop out of exercise referral schemes for many reasons (social anxiety, lack of time, lack of money). Lambert wanted to assess whether an online intervention would prevent those large drop out rates

Question 52

state, and explain, 3 main results from ‘ecoachER’ (Lambert., in prep)

Answer 52

1) found no difference in PA between intervention and control group

2) found a reduction in depression and anxiety symptoms in the online intervention group
- found adding online support to exercise referral schemes helps with MDD treatment

3) reliable –> large sample size and participants with a range of health conditions