Depression and Physical Activity in Older Adults
Amy Blackburn, MSG
Depression can affect up to 25% of the elderly population. Depression is characterized by social withdrawal, loss of interest in activities, weight loss or gain, difficulty sleeping, low energy, and a state of hopelessness. This disorder, along with the use of excessive medications and additional chronic disorders, decrease quality of life for older adults. Depressed people are more likely than nondepressed people to be physically inactive and have unhealthy eating habits. Older depressed people also have more physical disability than those who are not depressed. Significant impairments in functioning (which often lead to disability with older adults) are associated with depression. Studies have shown a correlation between physical activity and significantly fewer depressive symptoms, even in people diagnosed with Major Depressive Disorder (MDD). The relationships between depression, disability, and physical activity have shown a major breakthrough in research.
- Major Depressive Episode: a period of at least two weeks during which there is either depressed mood or the loss of interest in pleasure in nearly all activities; symptoms must persist for most of the day, nearly every day; a symptom must either be newly present or must have clearly worsened compared with the person’s previous status; there must be either clinically significant distress or some interference in social, occupational, or other important areas of functioning (DSM IV).
- Major Depressive Disorder: one or more Major Depressive Episodes (MDE) without a history of Manic, Mixed, or Hypomanic Episodes; an episode is considered to have ended when the full criteria for MDE have not been met for at least two consecutive months; during the two month period, there is complete resolution of symptoms or the presence of depressive symptoms (DSM IV).
Studies have shown that 20%-60% of patients in primary care stop taking antidepressants within three weeks of the drugs being prescribed. Since the government started restricting use of excessive medications in skilled nursing facilities because of side effects, statistical and clinical decreases in symptoms have been reported with the use of behavioral interventions. When older adults living alone at home inadequately manage antidepressant medication, it is more vital for them to manage those symptoms in other ways. The implications of physical activity having an effect on depression in older adults could be monumental.
Physical Activity Interventions and Cognitive Therapy Groups
Studies have shown that reduction in depression symptoms were similar in physical activity interventions and cognitive therapy groups. Program-specific physical activity, such as strength training and aerobic exercise developed by professionals, was particularly comparable to benefits of cognitive group therapy. People who participated in exercise programs were statistically less depressed than those who did not participate.
Possible Explanations of Effects of Physical Activity on Depression
Effects of physical activity on depression could be due to psychosocial factors, such as learning a new skill or socializing; such as what is found in assisted living. Depressed people are significantly less active, more likely to be unmarried, and have fewer close friends and relatives. In addition, health behaviors such as smoking, abstaining from excessive alcohol, being sedentary, and extremely high/low body mass index (BMI) increase risk for disability and need for assistance with activities of daily living (ADLs). In contrast, having more close friends and relatives significantly reduced the risk for disability. Studies have shown that depression alone increases the risk of ADL disability and mobility disability by up to 67% and 73% respectively.
Physical activity is positively associated with general well-being and psychological well-being in all age and gender groups. Positive mental health may be enhanced or maintained through physical activity (especially in social settings with older adults); or at least stop them from escalating to levels of clinical significance. Studies have shown this particular relationship to be stronger in women than men. Professionally programmed exercise in social settings may enhance well-being by providing a personal sense of mastery over one aspect of his or her life; it also may provide distraction from daily stress; or provide opportunities to receive extrinsic and intrinsic reinforcement such as socialization and physical changes. Tranquilizing psychological effects of regular physical activity and exercise occur from the release of endorphins, increasing a euphoria that could last for several hours, reducing symptoms of depression at least for the short term.
With the strong relationship between depression and disability, physical activity may be effective in maintaining functional ability and promoting an enhanced sense of well being in older adults. In addition to the long-term effects, physical activity has beneficial short-term effects on depression. While antidepressant medication is recommended for those diagnosed with MDD, the additional benefits of physical activity provide sound reason to include it as a part of the care plan. If an elderly loved one is depressed at home, a social environment such as assisted living homes with professionally developed programs will most likely enhance quality of life.