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teaching:exercise-prescription [on April 30, 2020]
teaching:exercise-prescription [on February 27, 2024] (current)
psychdb [Depression]
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 ===== Primer ===== ===== Primer =====
-==== Exercise ​and Psychiatric Disorders ==== +**Exercise** is structured physical activity ​with the goal of maintaining or improving physical fitness or healthExercise ​is a highly ​effective, ​but often under-utilized treatment ​in the management ​of psychiatric disorders.
-Antidepressants alone do not adequately treat many patients ​with depressionCombining 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|SidhuKanwaldeep 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, ​affectiveeating, 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 largesignificant improvements in patient-rated sleep quality).[([[https://​www.sciencedirect.com/​science/​article/​pii/​S0022395618308525|LedermanO.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.]])][([[https://​www.bmj.com/​content/​384/​bmj.q320|Bellón,​ J. Á. (2024). Exercise for the treatment of depression. bmj, 384.]])] 
 +==== 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 ===== ===== Resources =====
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 == Articles == == 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]]
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