Physical Exercise Reduce Symptoms Depression Health And Social Care Essay

Physical Exercise Reduce Symptoms unkept gear hygienicness And Social Cargon EssayThe aim of this endeavor go out be to discuss and apply selected tell apart link to nursing rule within a chosen field. prove based figure is an attempt used by clinicians to deliver the highest timberland c ar to meet the demand of patients and their families. By decision appraising and using the best point, wellness professionals be able to achieve optimum outcomes for both. (Melnyk Finout-Overholt 2005). However, an alternative view betokens that evidence exists to set forth and guide practice instead than dictate it. (McKenna et Al 1999). When clinicians apply an evidence based model, the best available evidence, modified by patient comp unitynt and preferences, is use to improve the quality of clinical judge ments. (McMaster clinical Epidemiology Group 1997)A recognised framework provide be used to identify a nous and then a taxonomical publications hunt club will be car ried out to assist in state this oral sex. A retroflex of this search will be provided and search parameters will be applied to gain the most relevant lit. After applying these parameters the search will be narrowed down to the quin most relevant pieces of look into. A shelve will be provided to show the key findings from each piece of literature, and mavin piece of inquiry will then be critiqued in erudition using a recognised framework.The question identified in this essay is Can animal(prenominal) mould or action at law abet to shrivel up the symptoms of depression in hoarer adults, compared to most other body-builds of sermon?Background and reflexion of QuestionThe question was devised using the PICO framework. This framework often is used to course of compositionulate clinical questions (Craig Smyth 2002), and it identifies and defines the essential comp peerlessnts of a good clinical question. PICO is an acronym for patient universe of interest, interve ntion, comparison intervention and outcome ( subject area impart for health and clinical excellence 2007). Patient cosmos of interest shall be former(a) persons diagnosed with depression, intervention shall be physical exploit or activity, the comparison intervention shall be other forms of intervention for depression and the outcome will be a decrement in the symptoms of depression. A well thought out and formulated question maximises the potential for finding relevant evidence for a patient population (Craig Smyth 2002) effect in onetime(a) adults refers to depressive syndromes defined in the American psychiatric Associations Diagnostic and Statistical Manual (DSM-IV) and in the International Classification of Diseases (ICD-10) that prepare in slew cured than period 65 long snip. In old age, the symptoms of depression often affect pot with chronic medical illnesses, cognitive impairment, or dis talent. (Alexopolous et al 2002). For a major depressive episode to be diagnosed, volt of the following symptoms must be present depressed mood, pocket-size interest, issue of pleasure in all or almost all activities, encumbrance loss or gain (more than 5% of bodyweight), insomnia or hypersomnia, psychomotor tumult or retardation, fatigue, feeling of worthlessness or inappropriate guilt, reduced ability to concentrate, recurrent thought of death or suicide.At least one of the symptoms must be either depressed mood or diminished interest or pleasure. The episode should last at least 2 weeks, lead to distress or situational impairment, and non be a field effect of substance use, a medical condition, or bereavement. (Depression like a shot 2010). Two of the symptoms detailed above must be present for a in evidential depressive episode to be diagnosed.Between one and quaternary percentage of the general elderly population has major depression, and kidskin depression has a prevalence of between four and thirteen percent (Blazer 2003). Twice as many women as men are affected. Both the prevalence (Palsson et al 2001) and the incidence (Teresi et al 2001) of major depression double after age 70-85 long time.Treatment for depression commonplacely involves a combination of anti tranquilizing drugs, talking therapies such as Cognitive Behaviour Therapy or interpersonal Therapy and self help. (NHS Choices 2010). A recent check cogitate that physical action computer platformmes can obtain confine a beneficial effect on depressive symptoms in ripened spate. Although not appropriate for all older people reading whitethorn improve mood in those undertaking it. (Blake et al 2009)Systematic Literature SearchA systematic recap of the literature was carried out using the CINAHL and PubMed databases and the search scathe depression physical cypher and old* were used. CINAHL was found to be particularly useful as it practical to specify the age separate required in the literature search. For the purposes of this search ag e 65+ was selected. PubMed is the public access version of Medline, a encyclopedic database which indexes thousands of journals in the medical sciences field. (TVU 2010a). The Cumulative Index to Nursing and Allied Health Literature Indexes virtually all English language journals from 1983 onwards. This database coers midwifery, nursing and related disciplines (TVU 2010b). Initially the searches indicated a vast array of literature hardly by applying a systematic review this was reduced. By using a transparent search strategy with Boolean techniques the number of documents was limited to thirty. These were then reviewed and fivesome articles were then selected which addressed the question of exercise as a form of treatment for older people diagnosed with depression. The search parameters were limited to studies written in the English language, the age and the subjects, and both sexes were to be include. Harvard (2007) suggests that by applying parameters such as these the most u p to date and relevant literature can be sourced. A full record of this search history is attached in appendage 1 and 2.A summary of the findings in the five pieces of search selected is detailed in the table overleaf. This table follows a structure recommended by Timmins McCabe (2005).Author and YearJournalType of StudyPurpose hearDesignData CollectionKey FindingsBlake et al 2009clinical replacementQualitativeTo assess ability of physical exercise in11 trials totalling 641 participantsVariedVaried1 Exercise not relevant2009 23 873-887systematictreating depression in older adultsto all in groupreview2 whitethorn improve mood3 make head course research neededto confirm medium tolong status set up andcost efficaciousnessMather et al 2002British Journal ofQuantitativeTo pay off whether exercise is effective86 participants split intoRCTclinical1 belittled improvementPsychiatry (2002)as an addition to anti depressants in step-downtwo groups hearingin symptoms after 10180411- 415depressive symptoms in older adultsweeks2 older people shouldbe encour elder to follow exercise classesBrenes et al 2007Aging psychic HealthQuantitativeTo see feasibility and efficacy of exercise and37 participants, 32 absoluteRCT unified1 Both exerciseJan 200711(1)61-68anti depressants compared with usualthe studyclinical interviewand medication weretreatments for older adults withobservedshown to be statisticallyminor depressionself reportingmore effective thancurrent treatment2 Exercise as well as aidedphysical functioningKerse et al 2010Annals of FamilyQuantitativeTo assess enduringness of home based193 participants, 187 completedRCTstructured1 exercise and lovingMedicine 8214-223 (2010)physical exercise plan in treating olderthe studyclinical interviewvisits showed similaradults with depressive symptoms compared cause in improvingto social visitsmood an quality of life2 More research is requiredBlumenthal et al recital of InternalQuantitativeto assess effectiveness of exercise156 participantsRCTstructured1 after 16 weeks1999Medicine 159(19) (1999)compared to antidepressants for treatmentclinical interviewexercise equally effectiveof major depression in olderas anti depressantsCritical AppraisalThe following appraisal was structured by using an approved and recognised framework for completing such tasks. (Polit et al. 2001)The article selected for censorious appraisal is effectuate of exercise on depressive symptoms in older adults with unwell antiphonary depressive disorder. (Mather et al. 2002). A copy of the article is attached as appendix 2.The aim of the study was to de depotine whether exercise is effective as an ancillary to antidepressant therapy in reducing depressive symptoms in older people. This was all the way defined. In the introduction the authors give tongue to that it is widely held that exercise is useful in depression, but that there were few studies on the potential effects that exercise may have as an addition to antid epressant therapies for older adults.The key finding of this study was that at ten weeks older people with poorly responsive depressive disorder showed a modest improvement in depressive symptoms and should therefore be encour venerable to see group exercise activities.The study conducted was a randomise controlled trial. Randomised controlled trials are the most rigorous way of determining whether a relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. (Sibbald Rowland 1998). Patients were randomly selected to attend either exercise classes or health fosterage talks for ten weeks. Assessments were machination and were conducted at baseline, ten and thirty four weeks. The primary outcome was mensurated with the 17 item Hamilton military rating get over for Depression (HRSD). HRSD is a multiple choice questionnaire used by clinicians to measure the severity of major depression in patients. (Hamilton 1960). The nature of both inte rventions is clearly described by the authors. All participants were outpatients recruited from primary care, psychiatric services and direct advertisement. 1885 patients were screened with a view to recruitment, and 86 were selected at random for the study. To be include patients were required to have symptoms of depression, and to be older than fifty three years of age. In addition patients had to have been receiving antidepressant therapy for at least hexad weeks, without evidence of a sustained improvement in their condition. Patients were excluded if there was alcoholic drink or substance misuse, structured psychotherapy in place, or were already taking regular exercise. Patients with specific medical conditions preventing physical exercise were also excluded. Both groups were informed of the nature of the trial, and all patients gave written informed consent. The study was approved by a medical research ethics committee. at that place were two groups with 43 patients in each and were comparable in terms of age range and symptom presentation. There was til now a rotund preponderance of women in the exercise group. The authors suggest that this may have introduced a bias into the results, and suggest a control group could be introduced in the future without either intervention. The outcomes for both groups were measured in the same way by the proportion of participants achieving a greater than thirty percent lessening in HRSD score from baseline. The results are shown in a statistical formatting and are recorded in a table.There are cardinal four references in the report which support the evidence presented by the authors.The implications for the health service are that structured group exercise sessions can help to make a modest improvement in patients who are not responding to pharmacological treatment and that older people with depressive disorders should be encouraged to attend group exercise activities. It should be noted that one of the author s of the research is co-director of a company providing exercise classes for older people and whose profits support research into aging.Review of LiteratureThis review of literature will show how the five main studies and all available literature assist in answering the set question. The first part of this review will concentrate on the five main studies and the second part will contain evidence from a wide range of sources and relate this combined information to governing body policy and guidelines. There will also be evidence of how all the information relates back to practice.It is well acknowledged that depression is widespread (Osborn et al 2003) and is the most prevalent mental health problem for older people (Age Concern 2007) The condition affects one in five people over 65 and rises to two in five in those over 85 (Mental Health Foundation 2008). The use of exercise to combat depression is well supported due to its effects on enhancing mood, improving cognitive function an d reducing anxiety it is also less expensive than medication (Louch 2008). A literature review was conducted to examine whether exercise could be an effective form of treatment for older adults with depressive symptoms. member 1 (Blake, Mo, Malik and Thomas 2008) conducted a systematic review of eleven randomized control trials in order to establish whether physical activity interventions were successful in alleviating depressive symptoms in older people. Trials were included in the review when more than 80% of the participants were greater than lux years old. In nine of the eleven studies scam term positive outcomes were found, although the mode, colour and duration of the exercise program protested across the studies. The medium to long term effects of exercise as an intervention were less clear. This outcome is back up by Mead et al (2008) who concluded that exercise seems to improve depressive symptoms in people with a diagnosis of depression, but the effects are check over and not statistically significant.However a randomized controlled trial conducted by Blumenthal et al (1999) ( name 2) had reached different conclusions. One hundred and fifty six men and women aged over fifty were split into groups randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride) or combined exercise and medication. After xvi weeks of treatment the patients did not differ significantly statistically either on Hamilton Rating case for Depression or Beck Depression Inventory scores. The study concluded that antidepressant medication had the most rapid effect, but after sixteen weeks exercise was equally effective in reducing symptoms of major depressive disorder. hold 3 (Brenes et al 1999) conducted a pilot study designed as a randomized clinical trial to test the feasibility and efficacy of an exercise program and antidepressant treatment compared with usual care in improving emotional and physical functioning in older adults with minor depre ssion. A total of thirty seven participants aged over sixty five were randomized to treatment fourteen to exercise, eleven to sertraline and xii to usual care. Patients who standard either exercise or sertraline treatments demo improvement both in clinician led and self reported measures of depressive symptoms. Those participants who legitimate the usual package care experienced small or no improvement in mental state. There are some limitations to this study however. The sample size was small and thus the statistical power was weak. The diagnosis of minor depression was based on self diagnosis rather than clinical interview. It was also not stated in the report what the usual care was. There were however significant trends to suggest that sertraline and exercise could be used as treatments for mild depression in older adults, and that a more in depth study should be undertaken.Article 4 (Kerse et al 2010) published a study comparing the effects of a home based exercise program with regular social contact in improving function, quality of life and mood in older people with depressive symptoms. A randomized controlled trial was conducted in which one hundred and ninety three people aged over 70 five with depressive symptoms received either an individualized physical activity program or social visits delivered over six months. The social visits were of the same time span as the exercise program. Outcome measures were obtained at three, six and cardinal months. Both physical and mental well being was measured using a variety of techniques including a short function test, and the Nottingham Extended Activities of mundane Living Scale (Nouri Lincoln 1987). It was concluded that a structured activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. There was however no control group being measured that was receiving usual care.Article 5 (Mather et al 2002) set out to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. A randomized controlled trial was conducted in which eighty six participants aged between fifty three and ninety one already receiving anti depressant therapy were given either exercise classes or health information talks over a ten week period. Assessments were made blind at baseline, ten and thirty four weeks using the Hamilton Rating Scale for Depression as the primary outcome. At ten weeks a significantly higher proportion of the exercise group (55% compared with 33%) experienced a greater than 30% decline in depression. In an article in The British Journal of Psychiatry in 2002, Jagadheesan et al critiqued this study and stated that it could have been more meaningful if a control group had been added which received no additional treatment other than continuing antidepressants. (Jagadheesan et al 2002).The mass of research above suggests that physical exercise reduce s depression and depressive symptoms in the short term in older adults, but additional well controlled studies are required to determine the long term efficacy. A systematic review carried out by Sjosten Kivela supports these findings (Sjosten Kivela 2002). Direct comparisons between studies is difficult as they differ greatly in characteristics, nature of control comparison group, age of the participants, eccentric person and intensity of exercise and outcome measures used to follow up.National Institute for Clinical Excellence guidelines are set out to assist clinicians and patients in fashioning decisions about appropriate treatment for specific conditions. The guidelines for depression suggest that for particularly for patients with mild or moderatedepressive disorders, structured and supervised exercise can be an effective intervention that has a clinically significant impact on depressive symptoms. There is also evidence to suggest that individuals with low mood may also b enefit from structured and supervised exercise. (NICE 2005). goalPhysical exercise is clinically beneficial in the short term for treatment of depressive symptoms in older people. Exercise, although not appropriate for all older persons with depression, may improve mood in this group. Evidence of the cost effectiveness of providing exercise interventions would be beneficial in helping decision making regarding service use and delivery. More well designed research studies are needed to examine the medium and long term benefits of exercise as a treatment for depressive symptoms in older adults, and to examine the types and duration of interventions that have the most positive effect.Word Count 3008ReferencesAge Concern (2007) Mental Health service Letting Down Older People. On Line procurable at http//www.ageuk.org.uk/ Accessed 12 May 2010 capital of the United Kingdom Age Concern.Alexopoulos, G.S., Buckwalter, K., Olin, J., Martinez, R., Wainscott, C., Krishnan, K.R. (2002) Comorbid ity of late-life depression an opportunity for research in mechanisms and treatment. Biol Psychiatry 2002 52543-58.Blake, H., Mo, P., Malik, S., Thomas, S. 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Int J Geriatr Psychiatry. 2006 May 21(5)410-8Teresi, J., Abrams, R., Holmes, D., Ramirez, M., Eimicke, J. (2001) Prevalence of de pression and depression course credit in nursing homes. Soc Psychiatry Psychiatr Epidemiol 2001 36 613-29.Thames Valley University (2010a) Library service Databases A-Z Online Available at http//lrs.tvu.ac.uk/eresources/atozlist.jsp?id= Accessed 2nd May 2010Thames Valley University (2010b) Library Services Databases A-Z Online Available at http//lrs.tvu.ac.uk/eresources/atozlist.jsp?id= Accessed 2nd May 2010Timmins, F. McCabe, C. (2005) How to conduct an effective literature search Nursing Standard November 23 vol 20 no 11Appendix 1Copies of Search Strategies