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Author(s): Caroline Richardson, M.D., 2009License: Unless otherwise noted, this material is made available under the terms...
Citation Key                          for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Ada...
Treating Depression with    Physical Activity    Caroline R. Richardson, MD   Department of Family Medicine  VA Health Ser...
Blumenthal et al                        exercise vs. medication156 men and womenOver 50 years oldMajor depressive disorder...
The Exercise Intervention    3 supervised exercise sessions /     week    10 minute warm up    30 minutes walking or jo...
Blumenthal’s ResultsBlumenthal et al Archives of Internal Medicine 1999:159:2349-2356.
Blumenthal’s Conclusion    Exercise is as good as Zoloft in the     treatment of Depression.
Correct Conclusion    Among highly motivated but     depressed individuals, those who can     successfully participate in...
Meta-Analysis    14 Randomized Controlled Trials    All but two studies showed an     independent, statistically and cli...
100’s of Observational Studies    People who are not depressed now     but are physically active now are less     likely ...
One more point.    We know that it is hard to start an     exercise program and harder to stick     with it.    How many...
How Can You Help Depressed      Patients Become More Active    Recommend exercise and say that there     are some clinica...
PEDOMETERS    Count Daily Steps and record on a     calendar    Bring in Calendar to review after one week    Obese pat...
Watch out for Biases    Who do we think will not or should     not exercise     •  Poor patients     •  Sick patients    ...
More Reasons for Depressed          Patients to Exercise    Medications for Depression cause     weight gain, diabetes  ...
Additional Source Information                            for more information see: http://open.umich.edu/wiki/CitationPoli...
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10.28.08(a-1): Treating Depression with Physical Activity

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Transcript of "10.28.08(a-1): Treating Depression with Physical Activity"

  1. 1. Author(s): Caroline Richardson, M.D., 2009License: Unless otherwise noted, this material is made available under the terms ofthe Creative Commons Attribution–Noncommercial–Share Alike 3.0 License:http://creativecommons.org/licenses/by-nc-sa/3.0/We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use,share, and adapt it. The citation key on the following slide provides information about how you may share and adapt thismaterial.Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions,corrections, or clarification regarding the use of content.For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use.Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or areplacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to yourphysician if you have questions about your medical condition.Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
  2. 2. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation LicenseMake Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  3. 3. Treating Depression with Physical Activity Caroline R. Richardson, MD Department of Family Medicine VA Health Services Research and Development Center
  4. 4. Blumenthal et al exercise vs. medication156 men and womenOver 50 years oldMajor depressive disorder by clinical interview, BDI, HAM-DRandomized to – aerobic exercise (n=53), - Zoloft ( n = 48) or - aerobic exercise + Zoloft (n=55)For 16 weeksSource: Blumenthal et al 1999 Archives of Internal Medicine
  5. 5. The Exercise Intervention  3 supervised exercise sessions / week  10 minute warm up  30 minutes walking or jogging at 70 to 85% of heart rate reserve.  5 minute cool down  16 weeks
  6. 6. Blumenthal’s ResultsBlumenthal et al Archives of Internal Medicine 1999:159:2349-2356.
  7. 7. Blumenthal’s Conclusion  Exercise is as good as Zoloft in the treatment of Depression.
  8. 8. Correct Conclusion  Among highly motivated but depressed individuals, those who can successfully participate in a structured exercise program will probably significantly decrease their depressive symptoms.
  9. 9. Meta-Analysis  14 Randomized Controlled Trials  All but two studies showed an independent, statistically and clinically significant improvement in depressive symptoms.  Effect Size -1.1 (95% CI -1.5 to -0.7)  Comparing Exercise to No treatment ControlSource: Lawlor, DA BMJ March 2001.
  10. 10. 100’s of Observational Studies  People who are not depressed now but are physically active now are less likely to be depressed in the future.  Physical Activity reduces depression relapse  College students who were physically active are less likely to become depressed later
  11. 11. One more point.  We know that it is hard to start an exercise program and harder to stick with it.  How many of our depressed patients successfully initiate and maintain a medication program? 20% to 60% stop taking med in 1st week.
  12. 12. How Can You Help Depressed Patients Become More Active  Recommend exercise and say that there are some clinical trials showing exercise reduces depression symptoms.  Write out an exercise prescription along with the anti-depressant script  Discuss types of exercise, Ways of fitting in exercise, How to get started
  13. 13. PEDOMETERS  Count Daily Steps and record on a calendar  Bring in Calendar to review after one week  Obese patients may not get accurate step counts  Caution with 10,000 steps a day target!  Wear the pedometer all day every day  Digi-walker SW200 ($20.00)
  14. 14. Watch out for Biases  Who do we think will not or should not exercise •  Poor patients •  Sick patients •  Minority Groups •  Older patients •  Depressed Patients
  15. 15. More Reasons for Depressed Patients to Exercise  Medications for Depression cause weight gain, diabetes  Number 1 cause of death in depressed patients is still heart disease.  Diabetes is about 2 x as prevalent in depressed patients as it is among non-depressed patients.
  16. 16. Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicySlide 4: Blumenthal et al 1999 Archives of Internal MedicineSlide 6: Blumenthal et al Archives of Internal Medicine 1999:159:2349-2356
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