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Fair warning: I didn't read the study or anything at all other than the thread.
Well, you could make them drink, by enrolling them in aerobics classes as a baseline requirement of being in the study, and then taking attendance. Call it part of the treatment regime... whatever. You could also track actual activity of the attendees by issuing them heart rate monitors that keep logs, and instructing them to wear it whenever they are doing things that feel intense or possibly had prescribed conditions like walking more than 5 minutes, more intense than walking, or anything raising HR more than a certain amount for more than a 2 minutes. The data could be readily sucked into the computer for analysis from the HRMs.
But they didn't do any of that because they didn't want to. Basically they were checking the effect of a minimal-effort / no-cost intervention. It really does sound psych-like of them to suggest that people do something without making sure by any reasonable means that they actually do. Then again, it's kind of what it's come to in modern medicine that they aren't actually trying to help you as an individual all that much
Great reading and analysis DG and WK!
Edited by: GRACEFULIFE at: 12/11/2012 (17:25)
'My final point is simply: "You can lead a horse to water but you can't make them drink."'
Succinct and simple synopsis of the paper- well said!
If there were slave-drivers exerting force to make groups of depressed people more physically "active", that wouldn't help depression either. It would make the feelings of isolation, hopelessness, and helplessness worse, I'm guessing.
However, if you couple physical activity with accomplishment, increased health and ability, and other positives, I think it directly affects depression. Even just the act of taking action - leaving the house or moving your body has got to have a positive effect on your mood if it helps you break from the downward spiral of the doom thoughts.
That's not really what this study is about. The information regarding how the physical activity increased or didn't was limited - this was more about how the intervention offered to the subjects may or may not have changed their depression. (Definitely a topic that someone in charge of administering such care would need to know more about.)
"Adults presenting with depressing in primary care and receiving the TREAD (TREAtment of Depression with physical activity) intervention in addition to usual care reported increased physical activity compared with those receiving usual care alone, although there was no evidence to suggest that the intervention brought about any improvement in symptoms of depression or reduction in antidepressant use at the four month follow-up point. "
My final point is simply: "You can lead a horse to water but you can't make them drink."
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This study was definitely flawed and the interpretation by the media compounded these problems.
To be fair to the authors the headline 'physical activity does not improve depression' was not the conclusion drawn by them and it was not what they set out to study. Their conclusion was that the the PROVISION of 'facilitated physical activity' , which from my reading of it means encouraging physical activity (or 'motivational interviewing'), did not improve mood. This study essentially set out to establish whether encouraging people to exercise had an impact on depression - it did not address whether EXERCISE ITSELF had an impact. As it turns out the 'usual care' group also increased their physical activity so a comparison of the two groups was complicated.
As is often the case - the devil is in the details! It would be wrong to say that physical activity does not improve symptoms of depression based on this study because 1. that is not what they examined and 2. that is not the conclusion they came to.
The quote below from one of the comments in the BMJ describes the problems with the study:
'Many of the criticisms of previous studies that are discussed in the introduction, apply equally to the reported study. Although a relatively large study, some of the protocol decisions potentially contaminate the reported results, such as the fact that the 'usual care' group were still able to receive 'exercise by prescription', which if provided would dilute the between group differences based on exercise use. The intervention itself provided no direct exercise activity, but used 'motivational interviewing' to encourage participants to engage in physical activity. There was no direct measurement of activity undertaken, either by direct observation or by patient diary data, and therefore the reliability of data is open to interpretation. The use of a 7 day recall diary with 10 minute intervals is open to significant levels of recall bias. The reported results appear to be based more on the effect of contact with the activity coordinator, rather than effects from exercise/physical activity itself. In this way, the study does not in our view meet the requirements from a recent Cochrane review on this subject (2) as a 'methodologically robust trial'.'
Edited by: DONEGIRL at: 9/12/2012 (13:39)
I think there are a lot of individual differences because there are lots of different reasons for depression. In many cases exercise may help just as much or more than antidepressants, in some cases not. I agree that depression is very hard to quantify and the duration is hard to measure.
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Me personally? Exercise helps with depression.
Debra Sue ~
This is very subjective. How do you measure depression?
Also I couldn't find where physical activity was clearly described, other than 150 minutes a week in at least 10-minute increments; and again self-reported.
These studies are always so lopsided. And ya, maybe just increasing activity won't do the trick.
No study to cite here, but I wouln't dis exercise for that purpose just yet.
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Conclusions: The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone.
I'll admit, this surprised me a bit.
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