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Last edited on February 27, 2024

This shows you the differences between two versions of the page.

--- teaching:exercise-prescription [on April 30, 2020]
+++ teaching:exercise-prescription [on January 2, 2024]
psychdb [Mild Cognitive Impairment]
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 ===== Primer =====
-==== Exercise and Psychiatric Disorders ====
+**Exercise** is structured physical activity with the goal of maintaining or improving physical fitness or health. Exercise is a highly effective, but often under-utilized treatment in the management of psychiatric disorders.
-Antidepressants alone do not adequately treat many patients with depression. Combining antidepressants with lifestyle changes, such as exercise is supported by well-designed studies.[([[http://www.mdedge.com/currentpsychiatry/article/63598/exercise-prescription-practical-effective-therapy-depression|Sidhu, Kanwaldeep S., Pankhuree Vandana, and Richard Balon. "Exercise prescription: A practical, effective therapy for depression." Current Psychiatry 8.6 (2009): 38. APA]])] For patients with major depression, substance use disorders, post-traumatic stress disorder, and generalized anxiety disorder, exercise interventions were associated with large, significant improvements in patient-rated sleep quality.[([[https://www.sciencedirect.com/science/article/pii/S0022395618308525|Lederman, O., Ward, P. B., Firth, J., Maloney, C., Carney, R., Vancampfort, D., ... & Rosenbaum, S. (2018). Does exercise improve sleep quality in individuals with mental illness? A systematic review and meta-analysis. Journal of Psychiatric Research.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/29800984|Gordon, B. R., McDowell, C. P., Hallgren, M., Meyer, J. D., Lyons, M., & Herring, M. P. (2018). Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA psychiatry, 75(6), 566-576.]])]
-== Exercise Prescription ==
+===== Mechanism of Action =====
-Physical activity should be prescribed for all patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Scheduled physical activity can induce improvements in physical, subjective and disorder-specific clinical outcomes.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567313/|Zschucke E, Gaudlitz K, Ströhle A. Exercise and Physical Activity in Mental Disorders: Clinical and Experimental Evidence. Journal of Preventive Medicine and Public Health. 2013;46(Suppl 1):S12-S21.]])]
+  * Exercise is thought to improve depression symptoms via reduction in cortisol levels, increased turnover of neurotransmitters, release of endorphins, and neurotrophic factors like brain-derived neurotrophic factor.
+===== Indications =====
+  * Exercise is not a disorder/disease specific treatment. Various studies have supported its use in:
+    * [[addictions:home|Substance use disorders]], [[trauma-and-stressors:ptsd|posttraumatic stress disorder]], and [[anxiety:gad|generalized anxiety disorder]] (leads to large, significant improvements in patient-rated sleep quality).[([[https://www.sciencedirect.com/science/article/pii/S0022395618308525|Lederman, O., Ward, P. B., Firth, J., Maloney, C., Carney, R., Vancampfort, D., ... & Rosenbaum, S. (2018). Does exercise improve sleep quality in individuals with mental illness? A systematic review and meta-analysis. Journal of Psychiatric Research.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/29800984|Gordon, B. R., McDowell, C. P., Hallgren, M., Meyer, J. D., Lyons, M., & Herring, M. P. (2018). Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA psychiatry, 75(6), 566-576.]])]
+    * [[eating-disorders:home|Eating disorders]], [[psychosis:schizophrenia-scz|schizophrenia]], and [[geri:dementia:home|dementia]]/[[cl:3-mild-neurocog-disorder|mild cognitive impairment]].[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567313/|Zschucke E, Gaudlitz K, Ströhle A. Exercise and Physical Activity in Mental Disorders: Clinical and Experimental Evidence. Journal of Preventive Medicine and Public Health. 2013;46(Suppl 1):S12-S21.]])]
+  * Scheduled physical activity can induce improvements in physical, subjective and disorder-specific clinical outcomes.
+==== Depression ====
+  * [[meds:antidepressants:home|Antidepressants]] alone do not adequately treat many patients with depression. Combining antidepressants with lifestyle changes, such as exercise is supported by well-designed studies.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994794/|Ravindran, A. V., Balneaves, L. G., Faulkner, G., Ortiz, A., McIntosh, D., Morehouse, R. L., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 5. Complementary and alternative medicine treatments. The Canadian Journal of Psychiatry, 61(9), 576-587.]])][([[http://www.mdedge.com/currentpsychiatry/article/63598/exercise-prescription-practical-effective-therapy-depression|Sidhu, Kanwaldeep S., Pankhuree Vandana, and Richard Balon. "Exercise prescription: A practical, effective therapy for depression." Current Psychiatry 8.6 (2009): 38. APA]])][([[https://www.sciencedirect.com/science/article/pii/S0165032723002239|Verhoeven, J. E., Han, L. K., Lever-van Milligen, B. A., Hu, M. X., Révész, D., Hoogendoorn, A. W., ... & Penninx, B. W. (2023). Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. Journal of Affective Disorders, 329, 19-29.]])]
+==== ADHD ====
+  * Animal studies indicates that exercise enhances brain development and overall behavioural functioning.
+  * Studies in children with [[child:adhd|attention-deficit/hyperactivity disorder]] suggest that both short-term (≥20 minutes) and long-term (≥5 weeks) of moderate-to-vigorous physical activity can improve ADHD symptoms and neuropsychological functioning.[([[https://pubmed.ncbi.nlm.nih.gov/25220093/|Halperin, J. M., Berwid, O. G., & O’Neill, S. (2014). Healthy body, healthy mind?: the effectiveness of physical activity to treat ADHD in children. Child and Adolescent Psychiatric Clinics, 23(4), 899-936.]])]
+==== Mild Cognitive Impairment ====
+  * Exercise at least twice weekly of moderate intensity may provide benefits in cognition for individuals with [[cl:3-mild-neurocog-disorder|mild cognitive impairment]].[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772157/|Petersen, R. C., Lopez, O., Armstrong, M. J., Getchius, T. S., Ganguli, M., Gloss, D., ... & Rae-Grant, A. (2018). Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 90(3), 126-135.]])]
+===== Effectiveness =====
+  * In general, exercise is well tolerated, with adverse events rarely reported.
+  * Both cardiovascular (aerobic) and resistance (anaerobic) exercise reduce depressive symptoms, with no superiority of one over the other.
+  * Population studies show that participation in physical activity may prevent the onset of depression.[([[https://pubmed.ncbi.nlm.nih.gov/24139780/|Mammen, G., & Faulkner, G. (2013). Physical activity and the prevention of depression: a systematic review of prospective studies. American journal of preventive medicine, 45(5), 649-657.]])]
+===== Treatment =====
+  * Recommendations for total exercise time vary according to different studies.
+  * In the depression literature, at least ''30'' minutes of supervised, moderate-intensity exercise at least ''3'' times weekly for at least ''9'' weeks is recommended.
+  * As with any physical interventions, the participant's physical fitness needs to be taken into account as well.
 ===== Resources =====
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 == Articles ==
+  * [[https://www.theguardian.com/lifeandstyle/2019/jul/28/its-a-superpower-how-walking-makes-us-healthier-happier-and-brainier|The Guardian: ‘It’s a superpower’: how walking makes us healthier, happier and brainier]]
 </WRAP>
 <WRAP quarter column>