Therapeutic Intervention by Physical Exercises in

Depression By

Afnan Mohammad Al Khateeb

Mashael Ghazi Al Sobhi

Rehab Abdurrahman Al Harbi

Supervised by

Ms. Isabelle DevreuxA dissertation submitted in

partial fulfillment for the

Bachelor Degree in Physical Therapy

2008

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

Hypothesis

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

3

- 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.

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Delimitations

• 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

Limitations of the Study

Limbic System

Prefrontal Cortex

Depression

-Clinical depression is a psychiatric disorder, characterized by a pervasive low mood, loss of

interest in usual activities and diminished ability to experience pleasure .

6

Definition 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

Symptoms 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.

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Causes of Depression

- Beck Depression Inventory Scale.

-Zung Self-Rating Depression Scale.

-Hamilton Rating Scale for Depression.

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Assessment for Depression

Methodology

1- Literature review We reviewed many articles, journals and electronic

libraries about our research.

2- Screening study

a- SubjectsA 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.

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Methodology

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.

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Physiological Effects of Physical Exercise on Depression

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Physiological Effects of Physical Exercise on Depression (Cont.)

Sex

Appetite

Aggression

Serotonin (5-HT) Depressed Mood

Anxiety

Vague aches and pain

Irritability

Thought process

Concentration

Interest

Motivation

Norepinephrine (NE)

1- Sympathetic nervous system is activated.

How Exercise Increase the Mood Stabilizers?

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2- With more strenuous exercise circulating

epinephrine and norepinephrine released

from the adrenal medulla. (Prentice, 2005)

The Mental Effects by Norepinephrineand Serotonin

Concentration of norepinephrine

neurotransmitters and serotonin in the

neurons will increase during exercise and the

depressed patient’s mood could

improve.

There are many theories:

1- Acidosis → ↑ endorphins release.

2- ↑ Circulation →↑↑ endorphins.

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Supporting Theories of the Exercise Effects on Depression

Literature Review

Comparative Table of Studies and their Results on Exercise and Depression.

Author Type of Exercise Program

Results

Craft, 1997

Aerobic exercise program < 9 Ws.

- Exercises produce larger antidepressant effects.

Dr. Dimeo,2001.

Walking on a treadmill for 30 min. / day for 10 days.

- Exercise caused a clinically significant drop ofdepression symptoms.

Babyak,Hermana,2000.

30 mints. of speed walking 3\ w.

- Effective as drug therapy in relieving the symptoms of depression.

Trivvedi, 2005.

Running30-min. 3-5 time/week 

- Depressive symptoms were reduced almost 50 %.

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).

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Literature Review

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.

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• 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.

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Protocol of Treatment by Physical Exercises for Depression

Exercise Protocol for the Treatment of Mild to Moderate Depression.

Sessions Warm up Walking Cycling Running Weight lifting Cool down

1st session 5 minutes 15 minutes 5 minutes ـــــــــــــــــــــ ـــــــــــــــــــــ 5 minutes

2nd session 5 minutes 15 minutes 5 minutes ـــــــــــــــــــــ ـــــــــــــــــــــ 5 minutes

3rd session 5 minutes 10 minutes 10minutes ـــــــــــــــــــــ ـــــــــــــــــــــ 5 minutes

4th session 5 minutes 10 minutes 10 minutes ـــــــــــــــــــــ ـــــــــــــــــــــ 5 minutes

5th session 5 minutes 13minutes 5 minutes 2 minutes ـــــــــــــــــــــ 5 minutes

6th session 5 minutes 13minutes 5 minutes 2 minutes ـــــــــــــــــــــ 5 minutes

7th session 5 minutes 10 minutes 5 minutes 5 minutes ـــــــــــــــــــــ 5 minutes

8th session 5 minutes 10 minutes 5 minutes 5 minutes ـــــــــــــــــــــ 5 minutes

9th session 5 minutes 10 minutes 5 minutes 2 minutes 3 minutes 5 minutes

10thsession 5 minutes 10 minutes 5 minutes 2 minutes 3minutes 5 minutes

11thsession 5 minutes 10minutes ـــــــــــــــــــــ 5 minutes 5 minutes 5 minutes

12thsession 5 minutes 10 minutes ـــــــــــــــــــــ 5 minutes 5 minutes 5 minutes

Results

Results of the Screening Study

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0

10

20

30

40

50

60

70

80

90

1

Freq

uancy.

Level of depression.

Figure 1.percentage of depressed studen

Normal

Mild

Moderate

Severe

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

There is inverse relationship between severity of depression and physical activity of the students.

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0

10

20

30

40

50

60

70

Physical activity

Normal Mild Moderate

Level of depression

Figure 3.Corelation between severity o f depression and physical activity of students.

Regular

Irregular

Non-exercised

Results of the Screening Study

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.

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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.

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Conclusion

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