Exercise as a Recreational Therapy Treatment for Depression

1. Exercise as a Recreational Therapy Treatment for Depression Tim Passmore, Ed.D., CTRS West Virginia Therapeutic Association Annual Conference Oklahoma State University

2. 8 Global Reasons Increased Demand for Outcomes • Eliminate poor/unnecessary practice • Negotiations between providers & payers • Accountability • Mean for evaluation of ill (chronically) • Empower consumers • Evaluate new service/intervention • Priority setting & resource allocation • Set, monitor & improve standards • (United Kingdom Clearing House on Health Outcomes, 1997)

3. The Term Recreation • Recreational Therapy/Therapeutic Recreation • Often not given similar consideration as • Other allied health profession • Because of the term recreation • Regulations • Specifically state – don’t not pay or cover • Recreation • Diversion • Maintenance • Comfort

4. Inpatient Psychiatric Treatment Facilities • Section 20.1.2 – Services Expected to Improve the Condition or for Purpose of Diagnosis, A3-3102.1.A.2, HO-212.1A2 of the Medicare Benefit Policy Manual Chapter 2 • Adjunctive Therapies – Prior to July 2006 • Recreational Therapy • Occupational Therapy • Milieu Therapy • Specific Wording of RT & OT • Replaced with term Therapeutic Activities

5. Inpatient Psychiatric Treatment Facilities • “If the only activities prescribed for the patient are primarily diversional in nature, (i.e. to provide some social or recreational outlet for the patient), it will not be regarded as treatment to improve patients’ conditions.”

6. Inpatient Psychiatric Treatment Facilities • Adjunctive Therapies (Recreational Therapy/Activity Therapy) • Expected to improve • Psychiatric condition • Assist with diagnosis • Required to Provide Active Treatment • Recreational Therapy interventions • Specific interventions intended to improve psychiatric condition • Assist with diagnosis

7. Inpatient Psychiatric Treatment Facilities • Therapeutic Recreation – must follow • Physician’s Orders • Assessment • Goals & Objectives • Treatment Plan • Delivery of Services or Interventions • Documentation of Provision of Services/Interventions • Reevaluation • Discharge Recommendations & Summary

8. Outcomes Terminology • Effectiveness • Effectiveness Research • Efficacy • Evidence-based Practice • Clinical Importance

9. Effectiveness/Effectiveness Research • Effectiveness • How interventions work in typical clinical practice • Effectiveness Research • Compares practice or interventions

10. Efficacy • Efficacy • Performance of intervention • Controlled study

11. Evidence Based Practice • Evidence Based Practice • Based on best available scientific • Evidence • Knowledge

12. Clinical Importance • Important difference in patient • Outcomes • Health Status • Different from statistical significance

13. Outcomes Characteristics • Desired outcomes identified • Based on setting • Client need • Measurable • Distance • Time tolerated • ROM • Number of Coping Mechanisms • Number of Positive Self Comments • Etc…

14. Evidence Based Research • 1970’s Early Research – Exercise & Depression • Reported positive outcomes of exercise & depression levels • 1980’s – Researchers – Compared Exercise & a Combination of Exercise & Psychotherapy • Combination – greater effect on lowering levels of depression

15. Evidence Based Research • 1980’s Research • Compared counseling & aerobic exercise • Aerobic exercise had greater effect on depression levels • Later Studies • Compared exercise & exercise in combination with pharmacotherapy & pharmacotherapy alone • Exercise alone was found to be as effective as combination or pharmacotherapy alone

16. Evidence Based ResearchCurrent Studies – Last 10 Years • Support earlier studies • Individuals who exercise after diagnosis of depression • Report decreasing levels of depression • Maintains lower levels of depression • Studies Comparing pharmacotherapy with exercise • Indicate exercise elicits similar outcomes as medication

17. Diagnosis • Depression • Dysthymia • Persistent depression that has symptoms such as fatigue, low self-esteem, insomnia, and appetite disturbances but is not severe enough to amount to a psychosis

18. InterventionExercise • Aerobic Type • Treadmill • Stationary bike • 10 minute warm-up • 45 minutes • 60% to 70% of Target Heart Rate • Goal of aerobic type

19. InterventionExercise • Resistive • Free Weights • Exercise Machines • Exercise Bands • Weight appropriate • 3 sets • Weight appropriate for prescribed repetitions • 10 repetitions each set

20. Exercise Routines • 2 types • Aerobic type • Combined aerobic type & resistive • 3 X’s per week • 10 to 15 minute warm-up period • 45 minutes

21. Discharge Recommendations • Continue Exercise Routine • Locate post discharge facility to exercise • Commercial • Senior Citizen Center • Community Center • Exercise Facility • Exercise in the community/at home • Not recommended – due to • Isolation • Reasons causing diagnosis

22. Data & Analysis • 21 patients • 11 assigned to combined exercise group • 10 assigned to aerobic type exercise group • Completed Beck Depression Inventory at • Admission • Discharge • 6 week post discharge • 12 week post discharge

23. Instrument Beck Depression Inventory • Scale • Measures reported levels of depression • 0 to 63 • See next slide

24. Instrument Beck Depression Inventory • Below 4  = Possible denial of depression • Faking • Below usual scores • 05 - 09   Considered normal • 10 - 18   Mild to Moderate depression • 19 - 29   Moderate to Severe depression • 30 - 63   Severe Depression • Over 40  Significantly above severe depression • Suggests possible exaggeration of depression • Possibly characteristic of borderline personality disorders. Significant levels of depression are still possible (Groth-Marnat, 1990).

25. Results

26. ResultsAdmission • 90% of the 11 Combined Subjects • Scored in range of clinical depression • 100% of the 10 Aerobic Subjects • Scored in the ranges of clinical depression

27. ResultsDischarge • 80% of Combined Group • No presences of depression • Two had scores of 17 • Had decreases in depression scores of 31 points & 19 points • 100% of Aerobic Group • No presences of depression

28. Results 6 Week Post Discharge • Between groups • No significant difference • In adherence • In depression scores • Both Groups • Significant difference – between those who continued & those who did not

29. Results12 Week Post Discharge • Between Groups • No significant difference • In adherence • In depression scores • Both Groups • Significant difference – between those who continued & those who did not

30. Contact InformationParticipate in Research Tim Passmore, Ed.D., CTRS Assistant Professor School of Applied Health & Educational Psychology - Leisure Studies Program Oklahoma State University (405) 744-1811 tim.passmore@okstate.edu