Therapeutic Intervention by Physical Exercises in Depression

1. 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 Bachelor Degree in Physical Therapy 2008

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

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

4. Introduction

5. 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

6. 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

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

8. 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

9. 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

10. Limbic System Depression Prefrontal Cortex

11. Definition of 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

12. 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

13. 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

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

15. Methodology

16. 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

17. 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

18. Physiological Effects of Physical Exercise on Depression

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

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

21. 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.

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

23. Literature Review

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

25. 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

26. 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

27. 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

29. Results

30. 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

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

32. Discussion

33. 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

34. Conclusion

35. 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

36. Acknowledgments

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

38. Thank You For Your Attention