On ‘prescribing’ exercise for patients with depression
Though exercise helps in managing the symptoms of mild to moderate depression, even in non-depressed adults fewer than half are still following an exercise program after six months.
What are some factors that help increased physical activity become a habit?
A 2011 UK study of depressed patients and their views of exercise showed that physical activity is accepted by patients as a credible management tool for depression and the positive effects of antidepressant medication helped both with starting and continuing to improve fitness. They said exercise gave them a sense of purpose and distracted them from negative thoughts.
Interestingly, patients who saw their depression as more ‘biological’ felt that activity that ‘raised the heartbeat’ was best; those who believed their depression was more to do with their situation preferred less aerobic activities such as walking.
Planting and nurturing an exercise habit involved:
- Determining which of the benefits of exercise was most salient to the individual and tailoring suggestions to these
- Helping the patient set realistic goals and first steps
- Avoiding a focus on barriers to exercise
- Discussing back-up strategies and how to get back on track, to enable the patient to deal with relapse
- Adding in external accountability and encouragement – one study reported increased success when patients were helped to connect with their chosen fitness centre/activity
- Ensuring some follow-up – one study included a brief follow-up phone call
- Scheduling further visits to solve any problems around barriers, to reinforce progress and to modify goals as needed.
Handouts from Black Dog Institute Psychological Toolkit that might be useful:
- Goal Setting
- Building Motivation for exercise
- Exercise Planning Tips
- Exercise Planning
- Exercise – Overcoming Obstacles
- Recording Exercise 2
References
- Cochrane Review: Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M & Mead GE, Exercise for depression: Updated, Cochrane Summaries, published online, September 12, 2013.
- Searle A, Calnan M, Lewis G, Campbell J, Taylor A & Turner K, Patients’ views of physical activity as treatment for depression: A qualitative study, British Journal of General Practice, April 2011, pp. 149-156.
The PTSD Program for people with Post Traumatic Stress Disorder.
Do you know anyone who has difficulty motivating themselves to exercise? I think we all know people who get too depressed to exercise or too anxious to leave the house. But there are other people who, despite a lack of “diagnosis”, find exercise hugely difficult to contemplate.
As someone who has practiced medicine for almost four decades I have had the opportunity to observe firsthand the upsurge in the use of opioid pain killers in non-cancer pain.