Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias

Association between Changes in Depressive State and Cognitive Function

Dementia is defined as a severe form of cognitive impairment. Research concerning the two-way relationship between depression and cognitive impairment has been conducted; however, there has been little analysis of cognitive function following changes in depressive status. This study describes the association between changes in depressive state and cognitive function in a Korean geriatric population sample. Using the Korean Longitudinal Study of Aging (KLoSA) database, Mini-Mental State Examination (MMSE) scores and Center for Epidemiologic Studies Depression Scale (CESD-10) indexes were used for measuring cognitive function and depression, respectively. The survey population was divided into four case categories by change in depressive status: normal to normal (Group A), normal to depressive (Group B), depressive to normal (Group C), and depressive to depressive (Group D). Analysis of variance, multiple regression analysis, and subgroup analysis were used for statistical examination. In the multiple regression analysis between MMSE values and depressive status change groups, with Group A as the reference, β in all other groups was negative, and its absolute value was large in the order of D, B, and C in both men (B: −0.717, C: −0.416, D: −1.539) and women (B: −0.629, C: −0.430, D: −1.143). There were also significant results in the subgroup analysis in terms of age, working status, participation in social activities, regular physical activities, and number of chronic medical conditions. In conclusion, both cases—those suffering from depression and those having suffered from it before—experience cognitive impairment. The degree of cognitive function being impaired is greater in the case of depression-onset than that of depression-remission. Age, stimulating activities, and chronic conditions are also strongly relevant to cognitive decline accompanied by changes in depressive state.

The Effectiveness of Combining Visual Art Activities and Physical Exercise for Older Adults on Well-Being or Quality of Life and Mood: A Scoping Review

Visual art activities and physical exercise are both low-intensity and low-cost interventions. The present study aims to comprehensively describe published literature on the effectiveness of a combination of these interventions on well-being or quality of life (QoL) and mood of older adults. Embase, CINAHL, Ovid Medline (R), PsycINFO, and Web of Science databases were searched for studies published between 1990 and 2015 that evaluated interventions combining visual art therapy and exercise for people aged 50 years or older with at least one resultant well-being or QoL or mood outcome. We found 10 studies utilizing different combination programs and outcome measures, and most had small sample sizes. Seventy percent of the studies reported that combining both interventions was effective in improving well-being or QoL and mood in older adults. Future studies are, however, requisite to investigate whether in the respective population such a combination is more effective than either of the interventions alone.

Motives for physical activity in the adoption and maintenance of physical activity in middle-aged and old age outpatients with a mental disorder: A cross-sectional study from a low-income country

Within the trans-theoretical model (stages of change) and self-determination theory frameworks, we investigated motives for physical activity adoption and maintenance in middle-aged and old age people with a mental disorder from a low-income setting. Ninety Ugandan outpatients completed the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3) to assess exercise motives and the Patient-centred Assessment and Counselling for Exercise (PACE) to determine stage of change. The relationship between motives for physical activity and stage of change was investigated using MANOVA with post-hoc Scheffe tests. Higher amotivation levels were observed in the pre-action compared with action and maintenance stages, while except for external regulation, all regulation scores were significantly lower in the pre-action compared with action and maintenance stages. There were no significant differences in levels of motivational types between the action and maintenance stage. The study provides a platform for future research to investigate relationships between motivational factors and physical and mental health outcomes within physical activity interventions for middle-aged and old age people with a mental disorder.

Physical activity and sedentary levels among people living with epilepsy: A systematic review and meta-analysis

How physically active and sedentary people with epilepsy are is unclear. We conducted a meta-analysis to investigate physical activity and sedentary behavior levels compared with the general population in people with epilepsy across the lifespan. Embase, PubMed, PsycARTICLES, and CINAHL Plus were searched from inception until 1/3/2019. A random effects meta-analysis was conducted. Adults with epilepsy (mean age range = 30-47 years) were significantly less likely to comply with physical activity recommendations [odds ratio (OR) = 0.68; 95% confidence interval (CI) = 0.53-0.87; P < 0.001; N analyses = 10; n epilepsy = 1599; n controls = 137,800] and more likely to be inactive (as defined by individual study criteria) (OR = 1.57; 95% CI = 1.34-1.84; P < 0.001; N analyses = 6; n epilepsy = 6032; n controls = 928,184). Data in children (mean age range = 10-12 years) were limited (N = 4; n = 170) and inconsistent while there were no data available for middle-aged and old age (>65 years) people with epilepsy. Our data demonstrate that adults with epilepsy are less physically active than the general population. Public health campaigns specifically targeting the prevention of physical inactivity in adults with epilepsy are warranted. More research on physical activity and sedentary levels in children, adolescents, middle-aged, and old age but also adult people with epilepsy is needed before specific recommendations can be formulated.

Physical activity correlates across the lifespan in people with epilepsy: a systematic review

PURPOSE

Understanding barriers and facilitators of physical activity (PA) participation in people with epilepsy is an essential first step to enable development of targeted and effective interventions. This systematic review examined that PA correlates in people with epilepsy across the lifespan.

MATERIAL AND METHODS

Major electronic databases were searched from inception until 1 April 2019. Keywords included "physical activity" or "exercise" and "epilepsy".

RESULTS

Out of 31 correlates from 10 studies (n = 495, 5-72 years) no consistent (i.e., reported in four or more studies) correlates were identified. In children and adolescents, membership of a sports club was a facilitator for being physically active (confirmed in one study: 1/1), while lower maternal educational level was a barrier (1/1). In adults, the most reported barrier was the presence of depression (3/3), followed by trait anxiety (2/3), state anxiety (1/1), side effects of medication (1/1), and perceived stigma (1/1). No studies focusing on middle-aged and old age people with epilepsy were available.

CONCLUSIONS

The current review found that quantitative research about PA barriers and facilitators in people with epilepsy is still in its infancy, but PA participation is associated with a range of biological, social, and psychological factors which should be considered in rehabilitation programs.Implications for rehabilitationMany people living with epilepsy do not engage in physical activity on a regular basis.Children with epilepsy who are member of a sports club are more physically active.Depression, anxiety, and perceived stigma are important barriers for being active in adults with epilepsy.Side-effects of antiepilepstic drugs are a barrier for being active in adults with epilepsy.

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

OBJECTIVE

To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning.

DESIGN

Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017).

SETTING

Home/community.

PARTICIPANTS

People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety.

INTERVENTIONS

Non-pharmacological interventions targeted at depression/anxiety.

MEASUREMENTS

We extracted outcome data on depressive symptoms, quality of life, functioning, and service use. We used random effects meta-analysis to pool study data where possible. Two authors assessed the risk of bias using the Cochrane Risk of Bias tool.

RESULTS

We identified 14 eligible trials including 2099 randomized participants and two subgroup analyses. Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n = 5 trials, mean difference in Hamilton Depression Rating Scale score -4.94 [95% CI -7.90 to -1.98]) but not remission, with limited evidence for effects on functioning and quality of life. There was limited high-quality evidence for other intervention types. Collaborative care did not appear to affect depressive symptoms, functioning, or quality of life; and had mixed evidence for effects upon remission. No intervention consistently affected service use, but trials were limited by small sample sizes and short follow-up periods. No anxiety interventions were identified.

CONCLUSION

PST may reduce depressive symptoms post-intervention in older people with depression and functional impairments. Collaborative care appears to have few effects in this population. Future research needs to assess cost-effectiveness, long-term outcomes, and anxiety interventions for this population.

Compared to an active control condition, in persons with multiple sclerosis two different types of exercise training improved sleep and depression, but not fatigue, paresthesia, and intolerance of uncertainty

BACKGROUND

In persons with multiple sclerosis (MS), physical activity favorably impacts on psychological well-being. The aims of the present study were to investigate the influence of physical activity on depression, fatigue, sleep, paresthesia, and personality traits (intolerance of uncertainty), and to explore, if endurance training or coordinative training are superior to an active control condition.

METHODS

92 female individuals with MS (mean age: 37.36 years; mean EDSS: 2.43) took part in this intervention study. Participants were randomly assigned either to endurance training, coordinative training, or to an active control condition. At baseline, 4 weeks, and 8 weeks later at the end of the study, participants completed questionnaires on sleep, depression, fatigue, paresthesia and intolerance of uncertainty. Exercise training interventions took place three times/week for 45 min/session. Participants in the active control condition also met with the same duration and frequency.

RESULTS

Sleep complaints and symptoms of depression decreased over time, but more so in the exercising groups, compared to the active control group. No changes over time and between groups were observed for fatigue, paresthesia, and intolerance of uncertainty.

CONCLUSIONS

Both endurance and coordinative exercising had the potential to favorably impact on some aspects of cognitive-emotional processing, while also an active control condition appeared to have a positive impact.

Pilot randomized controlled trial of exercise training for older veterans with PTSD

Exercise training positively impacts mental health, yet remains untested in older adults with posttraumatic stress disorder (PTSD). We conducted a randomized controlled pilot trial to test the feasibility and acceptability of exercise training in older veterans with PTSD. Fifty-four veterans ≥ 60 years, with a DSM-V diagnosis of PTSD, were randomized to supervised exercise (n = 36) or wait-list (WL; n = 18). Primary outcomes included recruitment rates, attendance, satisfaction, and retention. Secondary outcomes included changes in PTSD symptoms, depression, health-related quality of life, and sleep quality; assessed at baseline and 12 weeks. There were no adverse events. Attrition was minimal (14%), and adherence to the exercise intervention was high (82%). Clinically significant improvements in PTSD and related conditions were observed following exercise (Cohen's d = 0.36-0.81). Exercise training is safe and acceptable in older adults with PTSD, may improve PTSD symptoms, and broadly impacts PTSD-related conditions. Future definitive trials are warranted.

Evidence available for patient-identified priorities in depression research: results of 11 rapid responses

OBJECTIVES

Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence.

DESIGN

Eleven rapid responses.

DATA SOURCES

Single electronic database (PubMed).

ELIGIBILITY CRITERIA

Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary.

RESULTS

For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0-179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects.

CONCLUSIONS

We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.

The Relationship between Dietary Vitamin K and Depressive Symptoms in Late Adulthood: A Cross-Sectional Analysis from a Large Cohort Study

Few studies assessed the associations between dietary vitamin K and depressive symptoms. We aimed to investigate the association between dietary vitamin K and depressive symptoms in a large cohort of North American People. In this cross-sectional analysis, 4,375 participants that were aged 45⁻79 years from the Osteoarthritis Initiative were included. Dietary vitamin K intake was collected through a semi-quantitative food frequency questionnaire and categorized in quartiles. Depressive symptoms were diagnosed using the 20-item Center for Epidemiologic Studies-Depression (CES-D) ≥ 16. To investigate the associations between vitamin K intake and depressive symptoms, logistic regression analysis were run, which adjusted for potential confounders. Overall, 437 (=10%) subjects had depressive symptoms. After adjusting for 11 confounders, people with the highest dietary vitamin K intake had lower odds of having depressive symptoms (OR = 0.58; 95%CI: 0.43⁻0.80). This effect was only present in people not taking vitamin D supplementation. In conclusion, higher dietary vitamin K intake was significantly associated with a lower presence of depressive symptoms, also after accounting for potential confounders. Future longitudinal research is required to explore the directionality of the association.

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

Physical activity (PA) may be therapeutic for people with severe mental illness (SMI) who generally have low PA and experience numerous life style-related medical complications. We conducted a meta-review of PA interventions and their impact on health outcomes for people with SMI, including schizophrenia-spectrum disorders, major depressive disorder (MDD) and bipolar disorder. We searched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI. We rated the quality of studies with the AMSTAR tool, grading the quality of evidence, and identifying gaps, future research needs and clinical practice recommendations. For MDD, consistent evidence indicated that PA can improve depressive symptoms versus control conditions, with effects comparable to those of antidepressants and psychotherapy. PA can also improve cardiorespiratory fitness and quality of life in people with MDD, although the impact on physical health outcomes was limited. There were no differences in adverse events versus control conditions. For MDD, larger effect sizes were seen when PA was delivered at moderate-vigorous intensity and supervised by an exercise specialist. For schizophrenia-spectrum disorders, evidence indicates that aerobic PA can reduce psychiatric symptoms, improves cognition and various subdomains, cardiorespiratory fitness, whilst evidence for the impact on anthropometric measures was inconsistent. There was a paucity of studies investigating PA in bipolar disorder, precluding any definitive recommendations. No cost effectiveness analyses in any SMI condition were identified. We make multiple recommendations to fill existing research gaps and increase the use of PA in routine clinical care aimed at improving psychiatric and medical outcomes.

Physical activity modifies the association between depression and cognitive function in older adults

OBJECTIVE

To examine the effects of gender and physical activity on the interplay between depression and cognitive function in late adulthood.

METHOD

Data on physical activity, depressive symptoms, two measures of cognitive function (the Animal Fluency Test (AFT) and the Digital Symbol Substitution Test (DSST)), and other demographic characteristics were extracted from 2604 adults aged ≥ 60 years participating in the National Health and Nutrition Examination Survey (2011-2014). Gender-specific multiple linear regressions examined the relationship between depressive symptoms and cognitive function in the overall sample and stratified by level of leisure-time physical activity.

RESULTS

Sample included 1327 women and 1277 men (mean age 69.0 years), Women with moderate to severe depressive symptoms had a 1.7 (95% CI: 0.5-2.9) point lower score on the AFT than those with none or minimal depressive symptoms. No such association was observed in men. In the stratified analyses, lower AFT test scores only persisted among women who were inactive. With respective to the DSST, lower test scores were observed in both men (-7.2, 95% CI: -13.1 to -1.3) and women (-6.4, 95% CI: -11.8 to -1.1) with moderate to severe depressive symptoms. In the stratified analyses, this association persisted in those who were insufficiently active, but attenuated to null among those engaged in sufficient physical activity.

CONCLUSIONS

Moderate-to-vigorous physical activity modifies the depression-cognition relationship and preserves cognition function. Engaging in sufficient (150 min/week) leisure-time physical activity at moderate-to-vigorous intensity may protect those with depressive symptoms from cognitive decline in older age.

Handgrip strength and depression among 34,129 adults aged 50 years and older in six low- and middle-income countries

INTRODUCTION

Handgrip strength is a simple and inexpensive marker of health and mortality risk. It presents an ideal risk-stratifying method for use in low and middle-income countries (LMICs). There are, however, no population-based studies investigating the associations between handgrip strength and depression in LMICs. We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six LMICs.

METHOD

Cross-sectional data on individuals aged ≥ 50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Depression was based on the Composite International Diagnostic Interview. Weak handgrip strength was defined as < 30 kg for men and < 20 kg for women using the average value of two handgrip measurements of the dominant hand. Multivariable logistic regression analysis was conducted.

RESULTS

The sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). The prevalence of weak handgrip strength and depression were 47.4% and 6.2%, respectively. Individuals with weak handgrip strength had a higher prevalence of depression than those without this condition (8.8% vs. 3.8%; p < 0.001). Across all countries, after adjustment for potential confounders, weak handgrip strength was associated with a 1.45 (95%CI = 1.12-1.88) times higher odds for depression, although some between-country differences were noted.

DISCUSSION

Weaker handgrip strength is associated with higher odds for depression in LMICs. Future research should seek to establish the predictive value of this inexpensive measure for clinical use. Furthermore, interventional studies should examine if muscular strength can be a target of resistance-training interventions to address depressive symptoms in low-resourced settings.

Effects of aquatic exercise on mental health, functional autonomy and oxidative stress in depressed elderly individuals: A randomized clinical trial

OBJECTIVES

The aim of this study was to investigate the effects of aquatic exercise on mental health, functional autonomy and oxidative stress parameters in depressed elderly individuals.

METHODS

Initially, ninety-two elderly individuals were included in the study and were allocated into the depression group (n=16) and nondepression group (n=14). Both groups engaged in the aquatic exercise program for 12 weeks, including two weekly sessions (45 min/session) at a low intensity (between 50% and 60% of maximal heart rate or Borg scale scores of 13 to 14) throughout the intervention. All outcomes were evaluated at baseline and 12 weeks later.

RESULTS

The patients were 63.5±8.8 years old. The following scores were decreased after training in the depressed group: depression (53%), anxiety (48%), and Timed Up & Go (33%). The following scores increased: Berg Balance Scale (9%) and flexibility (44%). Regarding the blood-based parameters, there were decreases in protein carbonylation (46%) and nitric oxide (60%) and increases in glutathione (170%) and superoxide dismutase (160%) in the depression group (p<0.005).

CONCLUSIONS

The aquatic exercise program reduces depression and anxiety, improves functional autonomy and decreases oxidative stress in depressed elderly individuals.

The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment

Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.

Is it possible for people with severe mental illness to sit less and move more? A systematic review of interventions to increase physical activity or reduce sedentary behaviour

Individuals with severe mental illness (SMI) (schizophrenia-spectrum, bipolar disorder and major depressive disorder) die 10-20 years prematurely due to physical disorders such as cardiovascular disease. Physical activity (PA) is effective in preventing and managing these conditions in the general population, however individuals with SMI engage in substantially less PA and more sedentary behaviour (SB) compared to healthy counterparts. Furthermore, the effectiveness of intervening to increase PA or reduce SB in SMI populations is unknown. Therefore, we systematically reviewed studies measuring changes in PA or SB following behavioural interventions in people with SMI. A systematic search of major databases was conducted from inception until 1/3/2018 for behavioural interventions reporting changes in PA or SB in people with SMI. From 3018 initial hits, 32 articles were eligible, including 16 controlled trials (CT's; Treatment n = 1025, Control n = 1162) and 16 uncontrolled trials (n = 655). Of 16 CTs, seven (47%) reported significant improvements in PA, although only one found changes with an objective measure. Of 16 uncontrolled trials, 3 (20%) found improvements in PA (one with objective measurement). No intervention study had a primary aim of changing SB, nor did any note changes in SB using an objective measure. In conclusion, there is inconsistent and low quality evidence to show that interventions can be effective in changing PA or SB in this population. Future robust randomized controlled trials, using objectively-measured PA/SB as the primary outcome, are required to determine which behavioural interventions are effective in improving the sedentary lifestyles associated with SMI. Systematic review registration- PROSPERO registration number CRD42017069399.

Prospective association between combined healthy lifestyles and risk of depressive symptoms in the French NutriNet-Santé cohort

BACKGROUND

Several modifiable lifestyle indicators, including diet, smoking, alcohol consumption, weight and physical activity have been associated with depression; however, their combined effect has been less studied. The aim of this study was to calculate a Healthy Lifestyle Index (HLI) composed of the 5 above-mentioned indicators and investigate its association with incident depressive symptoms.

METHODS

The study sample consisted of 25,837 participants from the NutriNet-Santé study, initially free of depressive symptoms. The HLI was computed by assigning 1 point to each lifestyle indicator namely healthy diet, healthy weight, moderate or high physical activity, never smoking and low alcohol consumption. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Hazard Ratios were estimated using Cox proportional hazards models and population attributable risks (PAR) were calculated.

RESULTS

A total of 2112 incident cases of depressive symptoms were identified over a mean follow-up of 5 years. After accounting for a wide range of potential confounders, a 1-point increase in the HLI was associated with a 10% (95% CI 6%; 13%) reduction in the risk of depressive symptoms. The estimated PAR representing the proportion of cases that are attributable to non-adherence to specific healthy lifestyle indicators were 8% for healthy diet, 5% for healthy weight, 5% for non-smoking and 14% for the non-adherence to a combination of healthy diet, healthy weight and non-smoking.

LIMITATIONS

Some unmeasured factors related to both depression and lifestyle indicators, such as family history of depressive disorder, stressful life events, and sleep disorders might have led to potential residual confounding.

CONCLUSIONS

Modifying unhealthy lifestyles, especially diet, weight and smoking, is a potential target of major interest in the prevention of depressive symptoms in adults.

A Cross Sectional Examination of the Relation Between Depression and Frequency of Leisure Time Physical Exercise among the Elderly in Jinan, China

Depression has become a major global public health problem. Many studies have shown the positive effects of physical exercise on depression. However, few studies have examined the relationship between frequency of leisure time physical exercise and depression without considering the time and intensity of exercise among middle-aged and elderly people of urban communities in northern China. We conducted a cross-sectional survey that included 1604 participants among urban residents aged 50 years or older in China to evaluate how the frequency of physical exercise was related to depression. Our study showed that the prevalence of depression in the urban community of Jinan is 16.52%. For physical exercise, the odds ratios (ORs) and 95% confidence intervals (CIs) for 1~2 times per week, 3~4 times per week and ≥5 times per week were 1.137 (0.661, 1.953), 0.516 (0.304, 0.875) and 0.548 (0.392, 0.768) respectively, with adjustment for age, gender, marital status, BMI, hypertension, previously diagnosed type 2 diabetes, triglyceride, total cholesterol, soy food intake, milk food intake, vegetable and fruit intake and meat intake. We concluded that physically exercising three times a week is associated with a low prevalence of depression.

Sedentary behaviors, physical activity, and changes in depression and psychological distress symptoms in older adults

BACKGROUND

Television (TV) viewing and computer use have been associated with higher risk of depression, but studies specifically assessing the impact of these and other types of sedentary behaviors (SBs) on the mental health of older adults are scarce and their results are inconclusive. Similarly, the association between specific types of recreational physical activity (rPA) and mental health in older adults is poorly understood.

METHODS

In 2012, information on SBs, rPA, and other health behaviors was collected with validated questionnaires from community-dwelling older adults participating in the Seniors-ENRICA cohort. In 2012 and 2015, symptoms of depression and mental distress were assessed using the GDS-10 and the General Health Questionnaire-12 (GHQ-12), respectively.

RESULTS

Time spent watching TV was prospectively associated with higher (worse) GDS-10 scores in women (β [95% confidence interval (CI)] comparing the second and third tertiles of TV viewing to the first: 0.21 [-0.04 to 0.46] and 0.37 [0.13-0.62], respectively; P-trend: < 0.01), but not in men (-0.11 [-0.35 to 0.13] and -0.18 [-0.44 to 0.08]; P-trend: 0.16). Women, but not men, who spent more time in other SBs, including reading, using the computer and commuting, showed a lower number of depressive symptoms (-0.19 [-0.44 to 0.06] and -0.34 [-0.60 to -0.08]; P-trend: 0.01) and lower (better) GHQ-12 scores (-0.33 [-0.67 to -0.00] and -0.35 [-0.69 to -0.00]; P-trend: 0.05) at follow-up. Both in men and women, higher levels of rPA, such as walking, practicing sports, and do-it-yourself activities, were associated with lower GDS-10 scores (-0.07 [-0.25 to 0.11] and -0.19 [-0.36 to -0.01]; P-trend: 0.04) and with lower GHQ-12 scores (-0.02 [-0.26 to 0.22] and -0.23 [-0.47 to -0.00]; P-trend: 0.06).

CONCLUSIONS

Older women who spent more time watching TV and less time in other SBs showed a higher number of depressive symptoms. Data suggest that increasing rPA may improve mental health in older adults, particularly among women.

Correlates of Physical Activity Among Middle-Aged and Older Adults With Hazardous Drinking Habits in Six Low- and Middle-Income Countries

We investigated physical activity (PA) correlates among middle-aged and older adults (aged ≥50 years) with hazardous drinking patterns in six low- and middle-income countries. Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Hazardous drinking was defined as consuming >7 (females) or >14 (males) standard drinks per week. Participants were dichotomized into low (i.e., not meeting 150 min of moderate PA/week) and moderate-high physically active groups. Associations between PA and a range of correlates were examined using multivariable logistic regressions. The prevalence of low PA in 1,835 hazardous drinkers (60.5 ± 13.1 years; 87.9% males) was 16.2% (95% confidence interval [13.9%, 18.9%]). Older age, living in an urban setting, being unemployed, depression, underweight, obesity, asthma, visual impairment, poor self-rated health, and higher levels of disability were identified as significant PA correlates. The current data provide important guidance for future interventions to assist older hazardous drinkers to engage in regular PA.

Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders

Substance use (e.g., alcohol, marijuana, opioids, cocaine., etc,) use often initiates during adolescence, a critical period of physiological and social development marked by an increase in risk-taking due, in part, to heightened motivation to obtain arousal from rewards. Substance use during adolescence has been associated with a greater risk of substance use disorders (SUD) in adulthood. Although use rates for most substances have remained relatively stable, the frequency of marijuana use and the perception that regular marijuana use is not harmful has increased in adolescents. Furthermore, the nonmedical use of opioids has increased, particularly in the South, Midwest, and rural low-income communities. Substance use in adolescence has been associated with adverse structural and functional brain changes and, may exacerbate the natural "imbalance" between frontal/regulatory and cortical-subcortical circuits, leading to further heightened impulsive and reward-driven behaviors. Exercise increases growth and brain-derived neurotrophic factors that stimulate endogenous dopaminergic systems that, in turn, enhance general plasticity, learning, and memory. Exercise may help to reinforce the "naïve" or underdeveloped connections between neurological reward and regulatory processes in adolescence from the "bottom up" and "offset" reward seeking from substances, while concomitantly improving cardiovascular health, as well as academic and social achievement. In this review, we provide an overview of the current state of substance use in adolescents and rationale for the utilization of exercise, particularly "assisted" exercise, which we have shown increases neural activity in cortical-subcortical regions and may modulate brain dopamine levels during adolescence, a unique window of heightened reward sensitivity and neural plasticity, for the prevention and adjunctive treatment of SUD.

Relationships between the neighborhood environment and depression in older adults: a systematic review and meta-analysis

ABSTRACTBackground:While depression is a growing public health issue, the percentage of individuals with depression receiving treatment is low. Physical and social attributes of the neighborhood may influence the level of depressive symptoms and the prevalence of depression in older adults.

METHODS

This review systematically examined the literature on neighborhood environmental correlates of depression in older adults. Findings were analyzed according to three depression outcomes: depressive symptoms, possible depression, and clinical depression. Based on their description in the article, environmental variables were assigned to one of 25 categories. The strength of evidence was statistically quantified using a meta-analytical approach with articles weighted for sample size and study quality. Findings were summarized by the number of positive, negative, and statistically non-significant associations by each combination of environmental attribute - depression outcome and by combining all depression outcomes.

RESULTS

Seventy-three articles met the selection criteria. For all depression outcomes combined, 12 of the 25 environmental attribute categories were considered to be sufficiently studied. Three of these, neighborhood socio-economic status, collective efficacy, and personal/crime-related safety were negatively associated with all depression outcomes combined. Moderating effects on associations were sparsely investigated, with 52 articles not examining any. Attributes of the physical neighborhood environment have been understudied.

CONCLUSION

This review provides support for the potential influence of some neighborhood attributes on population levels of depression. However, further research is needed to adequately examine physical attributes associated with depression and moderators of both social and physical neighborhood environment attribute - depression outcome associations.

Sprint interval training (SIT) substantially reduces depressive symptoms in major depressive disorder (MDD): A randomized controlled trial

Continuous aerobic exercise training (CAT) is considered a complementary treatment option in patients with major depressive disorder (MDD). Intermittent exercise training protocols, such as sprint interval training (SIT) have gained increasing popularity, but no studies on depressive symptoms following SIT in patients with MDD are available. Fifty-nine in-patients with MDD were randomly assigned to a SIT or CAT group. Medication was counterbalanced in both intervention arms. Both intervention groups received 3 weekly training sessions for 4-weeks (12 sessions in total). SIT comprised 25 bouts of 30 seconds at 80% of maximal power, whereas CAT consisted of 20 minutes of physical activity at 60% of maximal power. The training protocols were isocalorically designed. Maximal bicycle ergometer exercise testing yielded maximal and submaximal physical fitness parameters. The Beck-Depression-Inventory-II (BDI-II) was filled out by the patients before and after the intervention period. BDI-II scores substantially decreased in both groups with an effect size pointing towards a large effect (p < 0.001, η_p² = 0.70) while submaximal (0.07 < d < 0.89) and maximal (0.05 < d < 0.85) fitness variables improved in both groups. Short-term SIT leads to similar results as CAT in patients with MDD and can be regarded as a time-efficient and promising exercise-based treatment strategy.

Leisure time physical activity and future psychological distress: A thirteen year longitudinal population-based study

A number of cross-sectional studies have suggested that physical activity (PA) is negatively associated with psychological distress in adulthood. A paucity of regionally representative and longitudinal studies has considered this relationship. This study investigated the association between leisure time light and moderate-vigorous PA (MVPA) and psychological distress over 13 years in a regionally representative sample. A total of 4754 men (mean age: 47.2 years) and 5571 women from (mean age: 46.9 years) the Tromsø Study were followed for 13 years. Light PA and MVPA was captured at baseline and psychological distress was captured using the Hopkins Symptom Check List-10 scale. Ordinary least square and Poisson regression models were used, adjusting for multiple confounders to investigate the relationship between light PA/MVPA and psychological distress. In the fully-adjusted model, accounting sociodemographics, history of parental psychopathology, socioeconomic status, marital status, smoking, social support and risk factors, we found evidence that both light PA (β 0.11, 95% CI: 0.03, 0.19; p < 0.01) and MVPA (β 0.19, 95% CI: 0.12, 0.26; p < 0.001) confered protection against psychological distress at follow-up. Among men, a lower MVPA was associated with 14% (RR = 1.14, 95% CI: 1.01, 1.28) increased risk of clinically significant psychological distress; while among women, the risk was 15% (RR = 1.15, 95% CI: 1.06, 1.26; p < 0.001). In this regionally representative cohort, our study suggests that both higher levels of light PA and MVPA confer protection against future psychological distress. However, a key limitation of this study is that psychological distress at baseline was not controlled-for.

The relationship between different settings of medical service and incident frailty

BACKGROUND

Some studies have reported a potential association between usual source of health care and disability, but no one has explored the association with frailty, a state of early and potential reversible disability. We therefore aimed to explore the association between older persons' self-reported usual source of health care at baseline and the onset of frailty.

METHODS

Information regarding usual source of health care was captured through self-report and categorized as 1) private doctor's office, 2) public clinic, 3) Health Maintenance Organization (HMO), or 4) hospital clinic/emergency department (ED). Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of at least two of the following criteria: (i) weight loss ≥5% between baseline and any subsequent follow-up visit; (ii) inability to do five chair stands; and (iii) low energy level according to the SOF definition. Multivariable Cox's regression analyses, calculating hazard ratios (HRs) with 95% confidence intervals (CIs), were undertaken.

RESULTS

Of the 4292 participants (mean age: 61.3), 58.7% were female. During the 8-year follow-up, 348 subjects (8.1% of the baseline population) developed frailty. Cox's regression analysis, adjusting for 14 potential confounders showed that, compared to those using a private doctor's office, people using a public clinic for their care had a significantly higher risk of developing frailty (HR = 1.56; 95%CI: 1.07-2.70), similar to those using HMO (HR = 1.48; 95%CI: 1.03-2.24) and those using a hospital/ED (HR = 1.76; 95%CI: 1.03-3.02).

CONCLUSION

Participants receiving health care from sources other than private doctors are at increased risk of frailty, highlighting the need for screening for frailty in these health settings.

Dopamine-Related Genotypes and Physical Activity Change During an Intervention: The Lifestyle Interventions and Independence for Elders Study

OBJECTIVES

To determine whether intervention-induced physical activity (PA) changes in sedentary older adults differed according to dopamine-related genotype.

DESIGN

Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial (2010-13)).

SETTING

Multicenter study, 8 U.S.

LOCATIONS

PARTICIPANTS

Volunteer sample of sedentary adults aged 70 to 89 at risk of disability (N=1635).

INTERVENTIONS

Structured PA versus health education (HE) for an average of 2.6 years.

MEASUREMENTS

Single-nucleotide polymorphisms of dopamine-related genes (dopamine receptor (DR) D1, DRD2, DRD3, and catechol-O-methyltransferase (COMT)) were assessed. Average moderate to vigorous PA (MVPA) was calculated using accelerometry (min/d) at baseline and 6, 12, and 24 months. Between-arm MVPA differences according to genotype and genotype with square root-transformed MVPA separately according to arm were tested, stratified according to race, and adjusted for multiple comparisons.

RESULTS

White participants in the PA arm (n=513) had higher average square root transformed MVPA (4.91±1.91)than those in the HE arm (n=538) (4.51±1.82) (p=.001). Between-arm differences were greater for DRD2 Met/Met (high dopamine; HE: 4.76±1.80, PA: 5.53±1.60, p=.03) than Val/Val (low dopamine; HE: 4.58±1.92, PA: 4.81±1.83, p=.16); results were similar for COMT. In the PA arm, DRD2 Met/Met was associated with higher average MVPA (5.39±2.00) than Met/Val (4.46±2.51) (p=.01) and Val/Val (4.65±2.71) (p=.01). There were no associations for other genes. Associations were not significant in blacks but followed similar trends.

CONCLUSION

Higher dopamine signaling may support changes in PA during an intervention. The role of dopamine-related pathways in promoting PA participation and enhancing response to interventions in sedentary older adults should be studied.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01072500.

Home-Based Physical Activity Program Improves Depression and Anxiety in Older Adults

BACKGROUND

Late-life depression and anxiety among older adults is an important public health concern. This study examined the effect of a DVD-delivered exercise intervention on the secondary outcomes of depression and anxiety in older adults and the extent to which physical self-worth mediated the relationship between leisure-time physical activity and depression and anxiety.

METHODS

Older adults (N = 307) were randomized to a 6-month flexibility, toning, and balance DVD (FlexToBa™, FTB) or healthy aging DVD control. Self-reported physical activity and questionnaires were administered at baseline and postintervention. Statistical analyses were conducted in the total sample and in a subsample of participants with elevated levels of depression or anxiety.

RESULTS

FTB participants with elevated depression and anxiety symptoms at baseline had significantly greater reductions in depression and anxiety (d = 1.66 and 2.90) than the control condition (d = 0.77 and 0.73). The effect of physical activity on depression and anxiety was partially mediated by increases in physical self-worth in the total sample but not in those with elevated depression or anxiety.

CONCLUSION

A home-based physical activity intervention may be a viable treatment for reducing depression and anxiety in older adults with elevated baseline scores.

Physical exercise for late-life depression: Effects on symptom dimensions and time course

BACKGROUND

Physical exercise is increasingly recognized as a treatment for major depression, even among older patients. However, it is still unknown which depressive symptoms exercise affects most, (e.g. somatic vs. affective) and the timing of its effects. Thus, the aim of this study was to examine the changes of depressive symptoms after treatment with exercise.

METHODS

We analyzed data from the SEEDS study, a trial comparing the antidepressant effectiveness of sertraline (S) and sertraline plus exercise (S+EX). Exercise was delivered thrice weekly in small groups and monitored by heart rate meters. Patients with late life depression (n=121) were assessed at baseline, 4, 8, 12 and 24 weeks with the Hamilton Depression Scale. Scores of affective, vegetative, anxiety and agitation/insight factors were analyzed using Multilevel Growth Curve Models and sensitivity analyses (multiple imputation).

RESULTS

Compared with the S group, patients in the S+EX group displayed significantly greater improvements of the affective symptom dimension (total effect size = 0.79) with largest changes in the first 4 weeks and last 12 weeks. Improvements were mainly driven by depressed mood and psychomotor retardation.

LIMITATIONS

Sample size; lack of an exercise only treatment arm CONCLUSIONS: Adding exercise to antidepressant drug treatment may offer significant advantages over affective symptoms of depression, rather than somatic symptoms or other dimensions of depression. Compared with standard antidepressant treatment, clinical advantages should be expected both at an early (first 4 weeks) and later stage (after 12 weeks).

The association between physical activity and depression among individuals residing in Brazil

PURPOSE

There is very limited literature investigating the association between physical activity (PA) and depression in South American countries such as Brazil. The purpose of the current study was to evaluate the prevalence of depression and its association with PA in a very large, representative sample of young adults (ages 18-39 years) (YA), middle-aged adults (ages 40-59 years) (MAA) and older adults (ages ≥ 60 years) (OA) residing in Brazil.

METHODS

The sample for this cross-sectional study was based on the Brazilian National Health Survey conducted in 2013. The Personal Health Questionnaire depression scale (PHQ-8) was applied to measure current (past 2 weeks) depression as the outcome of interest, and the exposure was self-reported PA for leisure. Multivariable weighted logistic regression models were conducted to investigate the association between PA and depression while adjusting for socio-demographic characteristics and number of health comorbidities among YA, MAA and OA.

RESULTS

The final study sample size was 59,399 (33,480 females; 25,919 males). After adjusting for the covariates of interest, the lack of PA for leisure was associated with a significant increase in depression only among males (YA: OR 1.45, 95% CI 1.02-2.06; MAA: OR 2.38, 95% CI 1.40-4.03; OA: OR 5.35, 95% CI 2.14-13.37). There was no significant association between PA for leisure and depression among females of all age groups.

CONCLUSIONS

Although PA for leisure is not associated with depression among Brazilian females, the obtained results suggest that this association is significant among Brazilian males, who may be able to benefit from PA for leisure to reduce their symptoms of depression.

Medications & Polypharmacy Influence on Recurrent Fallers in Community: a Systematic Review

The purpose of this systematic review is to summarize information about the impact different classes of medications and polypharmacy have on recurrent falls, defined as two or more falls in a 12-month period, in community-dwelling older adults. After adjustment for confounders such as age, gender, weight or depression symptoms, the reviewed studies suggested that older adults who use antidepressants, sedatives or hypnotics and anti-epileptics were more likely to experience recurrent falls than non-users. Polypharmacy (use of four or more prescription medications daily) caused 1.5-2 times higher possibility of recurrent falls in older adults. As a high-risk group, recurrent fallers require meaningful intervention. Medications are believed to be a modifiable risk factor in falls prevention; hence, special consideration should be taken to balance the benefit and harm in initiating, continuing or increasing certain classes of medications in elderly recurrent fallers.

Psychological effects of exercise on community-dwelling older adults

Background

In recent years, there have been an increasing number of older adults who suffer from mental disorders globally.

Objective

The objective of this study was to examine the effect of an intervention that consisted of an exercise program to improve the mental health of community-dwelling older adults.

Participants and methods

The recruited participants of this study were community-dwelling older adults aged ≥60 years who participated in a comprehensive health promotion program in Kakogawa, Japan. Participants in the intervention group received an exercise program that was developed for older adults using Thera-Band. To measure participants’ mental health status, a Japanese version of the short form of the Profile of Mood States (POMS-SF) was used. Stress markers were measured, such as salivary cortisol, alpha-amylase, and sIgA levels. All participants provided salivary samples and completed psychological questionnaires at baseline and 6-month follow-up.

Results

No significant differences were observed between the intervention and control groups with respect to POMS-SF score and salivary biomarker profile at baseline. After the intervention, the intervention group showed a significant decrease in the POMS-SF “fatigue” score and cortisol level. No significant changes were observed in the control group.

Conclusion

Simultaneous changes in feelings of fatigue and cortisol levels were observed among subjects who had received the intervention of regular exercise. Further research is needed to investigate the effectiveness of exercise intervention in improving mental health among older adults.

Physical activity correlates in people with mild cognitive impairment: findings from six low- and middle-income countries

OBJECTIVES

Despite promising research showing that physical activity (PA) might improve cognitive functioning in people with mild cognitive impairment (MCI), people with MCI are less physically active compared with the general population. Therefore, the aim of this study was to assess PA correlates among community-dwelling older people with MCI in six low- and middle-income countries.

DESIGN

Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analysed.

METHODS

PA level was assessed by the Global Physical Activity Questionnaire. 4854 participants with MCI (mean age 64.4 years; 55.1% females) were grouped into those who do and do not (low PA) meet the 150 min of moderate-to-vigorous PA per week recommendation. Associations between PA and the correlates were examined using multivariable logistic regressions.

RESULTS

The prevalence of low PA was 27.4% (95% confidence interval = 25.0-30.0). In the multivariable analysis, older age and unemployment were the only sociodemographic correlates of low PA. The significant positive correlates of low PA in other domains included depression, being underweight, obesity, asthma, chronic lung disease, hearing problems, visual impairment, slow gait, weak grip strength, poor self-rated health, and lower levels of social cohesion.

CONCLUSIONS

The current data illustrate that a number of sociodemographic and health factors are associated with PA levels among older people with MCI. The promotion of social cohesion may increase the efficacy of public health initiatives while from a health care perspective, somatic co-morbidities, muscle strength and slow gait need to be considered when activating those at risk for dementia.

Correlates of physical activity among depressed older people in six low-income and middle-income countries: A community-based cross-sectional study

OBJECTIVE

Despite the benefits of physical activity (PA) in older people with depression, many do not comply with the International PA guidelines. Thus, we investigated what factors influence PA participation among 915 community-dwelling older adults (aged ≥65 years) with depression in 6 low-income and middle-income countries (LMICs).

METHODS

Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. The sample was restricted to those with DSM-IV depression or receiving depression treatment in the last 12 months. PA was assessed by the Global Physical Activity Questionnaire. Participants were dichotomized into low (ie, not meeting 150 minutes of moderate PA per week) and moderate-to-high physically active groups. Associations between PA and a range of correlates were examined using multivariable logistic regressions.

RESULTS

The prevalence of low PA was 40.4% (95%CI = 34.8%-46.1%). After adjusting for age, sex, and country, larger household size and unemployment were significant sociodemographic correlates of low PA. Former smoking (vs never), anxiety, mild cognitive impairment (MCI), lower body mass index, bodily pain, asthma, chronic back pain, chronic obstructive pulmonary disease, hearing problems, stroke, slow gait, poor self-rated health, higher levels of disability, and lower levels of social cohesion were identified as significant negative correlates of PA.

CONCLUSIONS

The current data provide guidance for future interventions across LMICs to assist older people with depression engage in regular PA. The promotion of social cohesion may increase the efficacy of future public health initiatives, while from a clinical perspective, somatic co-morbidities, MCI, pain, and slow gait need to be considered.

Correlates of low physical activity across 46 low- and middle-income countries: A cross-sectional analysis of community-based data

Physical inactivity accounts for 5.5% of all avoidable global deaths. However, a paucity of multinational studies, particularly in low- and middle-income countries (LMICs), has investigated correlates of physical activity (PA). Thus, we assessed the correlates of PA using cross-sectional, community-based data of the World Health Survey including 46 LMICs. PA was assessed by the International Physical Activity Questionnaire (IPAQ) and participants were dichotomized into those who do (≥150min moderate-vigorous PA per week) and do not (<150min=low PA) comply with the World Health Organization (WHO) PA recommendations. Multivariable logistic regression was used to assess the PA correlates. The prevalence of low PA in 206,356 persons (mean age 38.4years; 49.6% males) was 29.2% (95%CI=28.3%-30.0%). In the overall sample, female sex, not married/cohabiting, high education and wealth, unemployment, and urban setting were significant sociodemographic correlates of low PA. In terms of other correlates, inadequate fruit and vegetable intake, subsyndromal depression, worse sleep/energy and cognition, visual impairment, hearing problems and asthma were associated with not meeting the WHO recommendations. There were some variations in the correlates depending on age and sex. Interventions should be developed that operate at multiple levels of influence and take into account age- and gender-related PA patterns in order to assist people in LMICs to comply with the WHO PA recommendations. Researchers, funding bodies, practitioners and policymakers in education, mental and physical health, and urban planning have a critical role to play.

Alzheimer's Disease: A Journey from Amyloid Peptides and Oxidative Stress, to Biomarker Technologies and Disease Prevention Strategies-Gains from AIBL and DIAN Cohort Studies

Worldwide there are over 46 million people living with dementia, and this number is expected to double every 20 years reaching about 131 million by 2050. The cost to the community and government health systems, as well as the stress on families and carers is incalculable. Over three decades of research into this disease have been undertaken by several research groups in Australia, including work by our original research group in Western Australia which was involved in the discovery and sequencing of the amyloid-β peptide (also known as Aβ or A4 peptide) extracted from cerebral amyloid plaques. This review discusses the journey from the discovery of the Aβ peptide in Alzheimer's disease (AD) brain to the establishment of pre-clinical AD using PET amyloid tracers, a method now serving as the gold standard for developing peripheral diagnostic approaches in the blood and the eye. The latter developments for early diagnosis have been largely achieved through the establishment of the Australian Imaging Biomarker and Lifestyle research group that has followed 1,100 Australians for 11 years. AIBL has also been instrumental in providing insight into the role of the major genetic risk factor apolipoprotein E ɛ4, as well as better understanding the role of lifestyle factors particularly diet, physical activity and sleep to cognitive decline and the accumulation of cerebral Aβ.

Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes

Major depression shortens life while the effectiveness of frontline treatments remains modest. Exercise has been shown to be effective both in reducing mortality and in treating symptoms of major depression, but it is still underutilized in clinical practice, possibly due to prevalent misperceptions. For instance, a common misperception is that exercise is beneficial for depression mostly because of its positive effects on the body ("from the neck down"), whereas its effectiveness in treating core features of depression ("from the neck up") is underappreciated. Other long-held misperceptions are that patients suffering from depression will not engage in exercise even if physicians prescribe it, and that only vigorous exercise is effective. Lastly, a false assumption is that exercise may be more harmful than beneficial in old age, and therefore should only be recommended to younger patients. This narrative review summarizes relevant literature to address the aforementioned misperceptions and to provide practical recommendations for prescribing exercise to individuals with major depression.

Immune-based strategies for mood disorders: facts and challenges

INTRODUCTION

Inflammation seems to play a role in the pathophysiology of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). In the last years several studies have shown increased levels of inflammatory and/or immune markers in patients with mood disorders. Accordingly, the immune system has become a target of interest for the development of biomarkers and therapeutics for mood disorders. Areas covered: Here, we review the evidence showing low-grade inflammation in mood disorders and the studies evaluating immune-based strategies for the treatment of these conditions. Expert commentary: Clinical trials with non-steroidal anti-inflammatory drugs, polyunsaturated acids, N-acetylcysteine, anti-cytokines, physical activity and probiotics have provided promising results in terms of antidepressant efficacy in patients with MDD and BD. Regarding stem cells, only studies with animal models have been performed so far with interesting pre-clinical results. Due to the preliminary nature of the results, most of the clinical studies need to be replicated and/or confirmed in larger clinical settings, embracing the highly heterogeneous pathophysiology of mood disorders.

Detached mindfulness reduced both depression and anxiety in elderly women with major depressive disorders

We investigated the influence of detached mindfulness (DM) in treating symptoms of depression and anxiety among elderly women. Thirty-four elderly females (mean age: 69.23 years) suffering from moderate major depressive disorders (MDD) and treated with a standard medication (citalopram) at therapeutic doses were randomly assigned either to an intervention condition (DM; group treatment, twice weekly) or to a control condition (with leisure activities, twice weekly). At baseline (BL), four weeks later at study completion (SC), and four weeks after that at follow-up (FU), participants completed ratings for symptoms of depression and anxiety; experts blind to patients' group assignments rated patients' symptoms of depression. Symptoms of depression (self and experts' ratings) and anxiety declined significantly over time in the DM, but not in the control condition. Effects remained stable at FU. The pattern of results suggests that, compared to a control condition, a specific psychotherapeutic intervention such as DM can have a beneficial effect in elderly female patients with MDD.

Relationship between depression and frailty in older adults: A systematic review and meta-analysis

AIM

Depression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty.

METHODS

Two authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders.

RESULTS

From 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07-47.10, I²=94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66-7.35, k=11), also after adjusting for potential confounders (OR=2.64; 95%CI: 1.59-4.37, I²=55%, k=4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00-55.30, I²=97%). People with depression were at increased odds of having frailty (OR=4.07, 95%CI 1.93-8.55, k=8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95-7.08, I²=98%, k=4), whilst in two studies frailty increased the risk of incident depression with an OR=1.90 (95%CI 1.55-2.32, I²=0%).

CONCLUSION

This meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.

Multiple Sclerosis: Associations Between Physical Disability and Depression Are Not Mediated by Self-Reported Physical Activity

This study investigated the interrelatedness of physical disability, physical activity, and depression among patients with multiple sclerosis (MS). We hypothesized that self-reported physical activity would mediate the effect of disability on depressive symptoms. Twenty-seven patients with MS (mean age: 49 years; 44.5% females) completed self-rating scales covering sociodemographic variables, intake of antidepressants, physical activity, and symptoms of depression; disability was measured by the Expanded Disability Status Scale. We found a higher level of disability to be significantly associated with more symptoms of depression. While higher reported physical activity was descriptively associated with lower depression scores and unrelated to Expanded Disability Status Scale, physical activity levels did not mediate the effect of disability on depressive symptoms.

Reduced muscle mass in middle-aged depressed patients is associated with male gender and chronicity

OBJECTIVE

Reduced muscle mass is a characteristic finding in sarcopenia, the central element of physical frailty syndrome, and a major cause of physical function decay, morbidity and mortality in the elderly. Studies so far demonstrated reduced muscle mass in depressed patients with an average age over 60years. An open question is whether muscle mass reduction is already observed earlier. Therefore, muscle mass was assessed in middle-aged male and female depressive patients, and the findings were related to indicators of hypothalamus-pituitary adrenal axis activation, lifestyle factors, endocrine and immune measures.

METHODS

Sixty-seven depressed patients (mean age 38.6y; 58.2% female) and 26 healthy volunteers (mean age 40.5y; 61.5% female) were included. Muscle mass, adrenal gland volume, and intra-abdominal adipose tissue were assessed by magnetic resonance tomography. Laboratory parameters included fasting cortisol, pro-inflammatory cytokines, factors constituting the metabolic syndrome, and relative insulin resistance according to the homeostasis model assessment (HOMA-IR).

RESULTS

We found significant effects of depression (F=4.2; P=0.043) and gender (F=182; P<0.001) on muscle mass. Muscle mass was reduced in depressed men compared to healthy men (F=3.4; P=0.044), particularly in those with chronic depression. In contrast, no such association was observed in depressed females. Adrenal gland volume and intra-abdominal fat was increased in depressed men and women, although not significantly. Correlations were observed for muscle mass with the amount of self-reported exercise and depression severity, and for depression severity with self-reported exercise. Further findings comprised lower self-reported activity and higher cortisol concentrations in depressed male and female compared to healthy probands.

CONCLUSIONS

Muscle mass is reduced in middle-aged depressed men, particularly those with chronic disease course. This association is not observed in depressed females, possibly pointing to the role of female sex steroids in maintaining muscle mass. The increase of adrenal gland volume in depressed patients may point to the role of a dysregulated hypothalamus-pituitary-adrenal system. The inverse association of exercise with muscle mass demonstrates the importance of physical activity. Looking at the long term consequences of reduced muscle mass, interventions to preserve and rebuild muscle mass in depression - such as structured exercise interventions - should be recommended.

SIGNIFICANT OUTCOMES

Muscle mass is decreased in male patients with major depressive disorder, particular those with chronic disease course. This difference was not observed in female depressed patients. The extent of muscle mass reduction is correlated to depression severity and inversely to physical activity, pointing to the role of depression associated inactivity. Low muscle mass is a risk factor for physical frailty, therefore interventions aiming at improving physical fitness may be recommended.

LIMITATIONS

Sex steroids were not assessed in the study groups.

Reducing depressive symptoms after the Great East Japan Earthquake in older survivors through group exercise participation and regular walking: a prospective observational study

OBJECTIVES

Survivors of the 2011 Great East Japan Earthquake have an increased risk of depressive symptoms. We sought to examine whether participation in group exercise and regular walking could mitigate the worsening of depressive symptoms among older survivors.

DESIGN

Prospective observational study.

SETTING

Our baseline survey was conducted in August 2010, ∼7 months prior to the Great East Japan Earthquake and tsunami, among people aged 65 or older residing in Iwanuma City, Japan, which suffered significant damage in the disaster. A 3-year follow-up survey was conducted in 2013.

PARTICIPANTS

3567 older survivors responded to the questionnaires predisaster and postdisaster.

PRIMARY OUTCOME MEASURES

Change in depressive symptoms was assessed using the 15-item Geriatric Depression Scale (GDS).

RESULTS

From predisaster to postdisaster, the mean change in GDS score increased by 0.1 point (95% CI -0.003 to 0.207). During the same interval, the frequency of group exercise participation and daily walking time also increased by 1.9 days/year and 1.3 min/day, respectively. After adjusting for all covariates, including personal experiences of disaster, we found that increases in the frequency of group exercise participation (B=-0.139, β=-0.049, p=0.003) and daily walking time (B=-0.087, β=-0.034, p=0.054) were associated with lower GDS scores. Interactions between housing damage and changes in group exercise participation (B=0.103, β=0.034, p=0.063) and changes in walking habit (B=0.095, β=0.033, p=0.070) were marginally significant, meaning that the protective effects tended to be attenuated among survivors reporting more extensive housing damage.

CONCLUSIONS

Participation in group exercises or regular walking may mitigate the worsening of depressive symptoms among older survivors who have experienced natural disaster.

Meta-evaluation of meta-analysis: ten appraisal questions for biologists

Meta-analysis is a statistical procedure for analyzing the combined data from different studies, and can be a major source of concise up-to-date information. The overall conclusions of a meta-analysis, however, depend heavily on the quality of the meta-analytic process, and an appropriate evaluation of the quality of meta-analysis (meta-evaluation) can be challenging. We outline ten questions biologists can ask to critically appraise a meta-analysis. These questions could also act as simple and accessible guidelines for the authors of meta-analyses. We focus on meta-analyses using non-human species, which we term 'biological' meta-analysis. Our ten questions are aimed at enabling a biologist to evaluate whether a biological meta-analysis embodies 'mega-enlightenment', a 'mega-mistake', or something in between.

The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline

Currently, there are no effective pharmaceutical treatments to reduce cognitive decline or prevent dementia. At the same time, the global population is aging, and rates of dementia and mild cognitive impairment (MCI) are on the rise. As such, there is an increasing interest in complementary and alternative interventions to treat or reduce the risk of cognitive decline. Depression is one potentially modifiable risk factor for cognitive decline and dementia. Notably, exercise and yoga are two interventions known to both reduce symptoms of depression and improve cognitive function. The current review discusses the efficacy of exercise and yoga to ameliorate depression and thereby reduce the risk of cognitive decline and potentially prevent dementia. Potential mechanisms of change, treatment implications, and future directions are discussed.