Therapeutic Intervention by Physical Exercises in Depression By

Therapeutic Intervention by Physical Exercises in Depression By Afnan Mohammad Al Khateeb Mashael Ghazi Al Sobhi Rehab Abdurrahman Al Harbi Supervised by Ms. Isabelle Devreux A dissertation submitted in partial fulfillment for the

Contents • Introduction • Depression • Methodology • Physiological Effects of Physical Exercise on Depression

Contents (Cont. ) • Literature Review • Physical Therapist Treatment Approach • Results • Discussion • Conclusion • Acknowledgments

Introduction

Introduction - The World Health Organization predicts that by 2020 depression will create the greatest burden of disease in european countries (USDHHS, 1999). - The link between ‘healthy mind and body is not new’ Hippocrates the Greek philosopher recommended exercise as treatment of mental illnesses. 1

Aim of the Study - The aim of this research is to review the recent literature related to the study of the effects of physical exercise on depression. 2

Hypothesis - Physical exercise can reduce symptoms of depression and has effective therapeutic effects. 3

Delimitations - The initial study is based on a literature review of all related articles concerning physical therapy and depression since 1990. - The secondary delimitation the study is restricted to a cross sectional screening of the depression in a female student population. 4

Limitations of the Study • The study did not include patients referred by the psychologist or psychiatric department. • Mental or hormonal disturbances could occur during the assessment or additional stressful events. • The study is limited to the short term time frame. 5

Limbic System Depression Prefrontal Cortex

Definition of Depression is a psychiatric disorder, characterized by a pervasive low mood, loss of interest in usual activities and diminished ability to experience pleasure. - Clinical depression 6

Symptoms of Depression - Persistent sadness. - Insomnia. - Feelings of worthlessness and helplessness. - Thoughts of death or suicide. - Loss of interest or pleasure in hobbies and activities. - Withdrawal from social situations, family and friends. 7

Causes of Depression - Genetic Causes: Scientists have not been able to identify a "depression" gene. - Neurochemical Causes: Neurochemical influences of neurotransmitters focus on serotonin and norepinephrine. - The Psychodynamic Causes: Therapists believe the root of all depression lies in the loss of something loved, whether it be a person or an object. - Life Experiences Causes: Such as divorce, financial difficulties and the death of a child or other family member. 8

Assessment for Depression - Beck Depression Inventory Scale. -Zung Self-Rating Depression Scale. -Hamilton Rating Scale for Depression. 9

Methodology

Methodology 1 - Literature review We reviewed many articles, journals and electronic libraries about our research. 2 - Screening study a- Subjects A total of 100 female volunteers, aged between 18 to 22 years, medical students from the King Abdul Aziz University (KAAU), single and free from diseases. 10

Methodology (Cont. ) b- Tools The Beck Depression Inventory was utilized as screening assessment tool for depression. c- Method The questionnaires were randomly distributed to 100 female students of the college of medical technology and collected during the same session. 11

Physiological Effects of Physical Exercise on Depression

Physiological Effects of Physical Exercise on Depression (Cont. ) Serotonin (5 -HT) Sex Appetite Aggression Depressed Mood Norepinephrine (NE) Anxiety Concentration Vague aches and pain Interest Irritability Thought process Motivation 12

How Exercise Increase the Mood Stabilizers? 1 - Sympathetic nervous system is activated. 2 - With more strenuous exercise circulating epinephrine and norepinephrine released from the adrenal medulla. (Prentice, 2005) 13

The Mental Effects by Norepinephrine and Serotonin Concentration of norepinephrine neurotransmitters and serotonin in the neurons will increase during exercise and the depressed patient’s mood could improve.

Supporting Theories of the Exercise Effects on Depression There are many theories: 1 - Acidosis → ↑ endorphins release. 2 - ↑ Circulation →↑↑ endorphins. 15

Literature Review

Comparative Table of Studies and their Results on Exercise and Depression. Author Craft, 1997 Type of Exercise Results Program Aerobic exercise - Exercises produce larger program > 9 Ws. antidepressant effects. Babyak, 30 mints. of speed - Effective as drug therapy in Hermana, walking 3 w. relieving the symptoms of 2000. depression. Dr. Dimeo, 2001. Walking - Exercise caused a clinically on a treadmill for 30 significant drop of min. / day for 10 depression symptoms. days. Trivvedi, Running 2005. 30 -min. 3 -5 time/week - Depressive symptoms were reduced almost 50 %.

Literature Review § No definitive exercise recommendation for all elements of mental health promotion. § No definitive formula of frequency, intensity and duration. § 30 minutes or more of moderate exercise is recommended. § Vigorous exercises are effective in treating depression (Fox, 1999). 17

Physical Therapist Treatment Approach - Use silence and active listening when interacting with the depressed patient. - Simple, direct sentence should be used. - Avoid asking the depressed patient many questions. - Extra work should not always be requested. - The depressed patient needs care and attention to recover faster. 18

Protocol of Treatment by Physical Exercises for Depression • Assessment of depression level by the Beck Depression Inventory Scale. • History taking. • Screening for contraindications. • Manual muscle testing. • Assessment and monitoring of the exercise within the target heart rate. 19

Exercise Protocol for the Treatment of Mild to Moderate Depression. Sessions Warm up Walking Cycling Running Weight lifting Cool down 1 st session 5 minutes 15 minutes ـــــــــــــــــــــ 5 minutes 2 nd session 5 minutes 15 minutes ـــــــــــــــــــــ 5 minutes 3 rd session 5 minutes 10 minutes ـــــــــــــــــــــ 5 minutes 4 th session 5 minutes 10 minutes ـــــــــــــــــــــ 5 minutes 5 th session 5 minutes 13 minutes 5 minutes 2 minutes ـــــــــــ 5 minutes 6 th session 5 minutes 13 minutes 5 minutes 2 minutes ـــــــــــ 5 minutes 7 th session 5 minutes 10 minutes 5 minutes ـــــــــــ 5 minutes 8 th session 5 minutes 10 minutes 5 minutes ـــــــــــ 5 minutes 9 th session 5 minutes 10 minutes 5 minutes 2 minutes 3 minutes 5 minutes 10 thsession 5 minutes 10 minutes 5 minutes 2 minutes 3 minutes 5 minutes 11 thsession 5 minutes 10 minutes ـــــــــــ 5 minutes 12 thsession 5 minutes 10 minutes ـــــــــــ 5 minutes

Results

Results of the Screening Study The result of the Beck Depression Inventory (BDI) scale that was distributed to 100 female students. All students responded to the questionnaire. 21

Results of the Screening Study There is inverse relationship between severity of depression and physical activity of the students. 22

Discussion

Discussion - Physical exercise is effective in reducing depressive symptoms. All the previous studies reported good results. - Through the cross sectional screening assessment of the student population in our university we found a 16 % present the symptoms of depression at the time of the screening. - All 16 % of students associated to a sedentary life style. 24

Conclusion

Conclusion - We clearly outlined several mechanisms supporting the effects of physical exercise on depression - We resumed the guidelines, precautions and the protocol of management in physical therapy. - There is a high correlation between depression and limited physical activity. - The importance of physical exercises in prevention and treatment of depression. 25

Acknowledgments

Acknowledgments Thanks for: • Ms. Isabelle Devreux • Dr. Sausan Raheem. • Dr. Dua'a Khalifa. • Dr. Khaled Mamdooh. • Dr. Mohammed Sayim Aldahr.

Thank You For Your Attention