Using Aerobic Exercise to Improve Depressive Symptoms in Adults
Depression is among the most common mental disorder affecting more than 264 million people globally (World Health Organization [WHO], 2020). The disorder is characterized by severe symptoms that affect how people think, feel, and deal with daily activities, such as eating, sleeping, or working (National Institute of Mental Health [NIMH], 2018). Symptoms of depression that vary from mild to severe include loss of pleasure in activities once enjoyed, feeling sad, trouble sleeping, changes in appetite, loss of energy or increased fatigue, thoughts of death or suicide, and feeling worthless or guilty. For a person to be diagnosed with depression, an individual must experience the symptoms of the condition for at least two weeks (American Psychiatric Association [APA], 2020). Depression is the main cause of disability globally and a major contributor to increased disease burden worldwide (Friedrich, 2017). The burden of depression is increasing globally, leading to the realization of the World Health Assembly resolution adopted in May 2013. The focus of resolution is to support a comprehensive response to mental conditions at the country level (WHO, 2020).
Background and Significance
Depression is a growing public health problem (Friedrich, 2017). The disorder is among the most treatable of mental condition. Between 80% and 90% of people with the condition respond effectively to treatment (APA, 2020). The most common types of depression are major depression and persistent depressive disorder. Major depression is characterized by symptoms of the condition most of the day for at least two weeks, interfering person’s ability to eat, sleep, work, study, and enjoy life (NIMH, 2018). An episode of major depression can occur once in a person’s lifetime. However, some people experience several episodes. A persistent depressive disorder is characterized by symptoms of depression lasting for at least two years.
Depression is caused by a combination of biological, genetic, psychological, and environmental factors (NIMH, 2018). Depression occurs to people at any age. However, the condition is more common in adulthood. The condition also occurs in adolescents and children but presents with more prominent irritability. Depression in adults can co-occur with other severe medical illnesses, such as cancer, diabetes, Parkinson’s disease, and heart disease. Sometimes medications taken to manage the physical illnesses are associated with side effects leading to depression. As a result, healthcare professionals are required to develop a suitable treatment strategy to deal with complicated illnesses. The main risk factors for depression include personal or family history of depression, specific physical illnesses and medications, and main life changes, stress, or trauma (NIMH, 2018).
The condition is among the most common comorbidities of chronic medical diseases such as cardiovascular, cancer, metabolic, neurological, and inflammatory disorders (Gold et al., 2020). The prevalence of the condition in the patient groups is substantially higher compared to the general population. Depression accounts for a significant part of the psychosocial burden of the conditions. Many factors can lead to the incidence of comorbid depression, including converging biological pathways, social factors, shared genetic factors, health behaviors, and psychological factors (Gold et al., 2020).
Depression occurs as a result of a complex interaction of psychological, social, and biological factors (WHO, 2020). Persons who have experienced adverse life events, bereavement, (unemployment, and psychological trauma have a higher likelihood of developing depression. Depression can lead to dysfunction and more stress affecting the situation of people’s life. There is an interconnection between physical health and depression. For instance, depression can lead to cardiovascular disease (WHO, 2020).
Depression presents with the same symptoms in older adults as it does in younger populations. In contrast to younger patients, older adults with depression more commonly have several concurrent medical disorders and cognitive impairment. Depression occurring in older patients is often undetected or inadequately treated (Olfson et al., 2016). Diagnosis of depression among patients with a medical disorder is challenging because of symptomatic overlap. People with depression present in different settings and have various levels of depression severity, matching patients to suitable treatments (Olfson et al., 2016). A range of treatment approaches may be offered, including psychotherapy, monitoring, counseling, yoga, exercise, and pharmacological treatment (Kvam et al., 2016).
Prevention programs are effective in reducing depression (WHO, 2020). The use of effective community approaches to prevent depression includes school-based programs to improve a pattern of positive thinking in adolescents and children. It is essential for healthcare professionals to implement interventions for parents of children with depression to improve outcomes for their children (WHO, 2020). Among the strategies that people can apply to help in reducing the symptoms of depression include regular exercise to improves mood and promote positive feelings (APA, 2020; Ertekin et al., 2018). People should ensure that they get enough quality sleep, avoiding alcohol, and eating a healthy diet to help reduce symptoms of depression. People should try to deal with depression by doing things that they desire (NIMH, 2018). A person can help in dealing with large tasks and set priorities. Additionally, it is essential to discuss important decisions and avoid self-medication with drugs not prescribed by the healthcare professional.
Problem Statement
Depression can be managed through increased energy intake, changes in dietary quality, and engagement in physical activities. Societal preventive and medical management are currently being met. The continuous increase in the prevalence of the condition and projected upsurge in diabetes and other chronic conditions such as stroke over the next 20-30 years is expected to cause substantial strain on the resources and finances of the U.S. healthcare system. The condition is also associated with an increased cost burden to patients and their families (Ben-Nun, 2016).
Adults with depression do not get the required treatment for the symptoms of the condition (Olfson et al., 2016). Approximately 49.5% of adults with a lifetime medical history of depression had never received treatment for the condition. There has been increased use of antidepressant prescriptions in the United States (US). It is essential to adopt other suitable treatment approaches for preventing and dealing with depression (Olfson et al., 2016).
The increased rate in the prescription of antidepressant drugs to help in the management of depression has greatly increased health spending (Hidalgo, 2019). More than half of the total cost of depression relates to direct costs, including expenditure on antidepressant drugs. The drugs are associated with undesirable effects, specifically among the older population. As a result, it would be necessary to test new therapeutic modalities such as aerobic exercise that help to prevent adverse effects and reduce health expenditure when managing the condition (Hidalgo, 2019).
There is increasing recognition that lifestyle behaviors such as exercise lead to an increased risk of developing depression. Exercises are associated with results in many health benefits, such as improving sleep, reducing cases of heart disease and diabetes (Harvard University, 2020; Rao et al., 2020). High-intensity exercise helps to release the body’s chemicals called endorphins that enable a person to feel good. Low-intensity exercise helps to release of proteins, neurotrophic enabling nerve cells to grow and create new connections to improve brain function making people to feel better. Exercise supports the growth of nerve cell in the hippocampus helping to relieve depression (Roeh et al., 2019; Harvard University, 2020).
Exercise could be a useful approach for reducing depressive symptoms, treating the condition, and improving quality of life (Brown et al., 2017; Schuch & Stubbs, 2019). Exercise has been proposed as a treatment approach for depression by clinicians and researchers. Exercise is connected to reduced levels of depressive symptoms. It is essential to conduct an investigation to ascertain the impact of aerobic exercise interventions among adults with clinical depression (Sadeghi et al., 2017). The findings would help in determining whether aerobic exercise has a significant impact on reducing depression (Askari et al., 2019).
Historical and Societal Perspective
Depression has a lengthy identifiable history as the most recognizable psychological disorder (Kastrup, 2020). The condition has affected human beings since the time of Ancient Greeks and Romans. Historical documents created by philosophers, healers, and writers helps to explain the long-standing existence of depression as a health problem. The history of the condition also helps to describe the continuous struggles people have experienced an effective approach to treat depression (Horwitz et al., 2016).
Depression was originally called “melancholia” with the earliest accounts of the condition registered in the second millennium B.C in ancient Mesopotamian texts (Kastrup, 2020). All mental conditions were considered to be as a result of demons possession. Mental conditions were treated by religious leaders. Physicians concentrate on treating physical injuries, but not mental illnesses such as depression (Horwitz et al., 2016). Ancient Romans and Greeks differed in their thinking in relation to causes of melancholia. Literature of the Ancient Romans and Greeks time indicated that mental illness was caused by demons or spirits. The Greek historian Herodotus, in the 400s B.C, wrote about a leader who was affected by evil spirits. Other ancient communities such as early Babylonian, Egyptian, and Chinese also viewed mental condition as a type of demonic possession. The communities used exorcism procedures, such as starvation, restraint, and beatings. The main aim of the approach was to drive demons out of the bodies of affected persons. In contrast, doctors in early Roman and Greek considered depression as both a psychological and biological disease. Massage, gymnastics, music, special diets, and baths were used as suitable approaches of treating depressive symptoms (Kastrup, 2020).
A Greek physician, Hippocrates, indicated that mental illnesses and personality traits were connected to imbalanced or balanced body fluids, humors (Horwitz et al., 2016). There the main types of humors included black bile, yellow bile, blood, and phlegm. The main classifications of mental illnesses according to Hippocrates included melancholia, phrenitis, and mania (Ustinova, 2017). Hippocrates indicated that melancholia was as a result of excess black bile in the spleen. Bloodletting, exercise, bathing, and dieting approaches were used treat depression. Contrary to Hippocrates’ view, Cicero maintained that melancholia resulted from grief, fear, and violent rage (Kastrup, 2020).
From the ancient Greece to the present Diagnostic and Statistical Manual of Mental Disorders (DSM), hopelessness, deep sadness, sorrow, despondency, dejection, despair, emptiness, and discouragement have been considered as the main features of depression (Horwitz et al., 2016; Pietikainen, 2020). Other related symptoms of the condition included fatigue, sleeplessness, irritability, fear of death, lack of interest, restlessness, negative ideas and social detachment. The development of the DSM-III in 1980 helped in recognizing intense sadness as the associated symptom of depression (Horwitz et al., 2016).
Increasing pluralism and globalization require psychiatrists to assess the effects of cultural factors on depressive conditions (Kastrup, 2020). Modern classification systems of depression should focus on culture- factors, operationalized, and methodical appraisals required to evaluate social aspects. The cultural formulation was introduced in In the DSM-IV to provide an operational method of the cultural outlook and enable patients to consider their cultural features in their descriptions. Prevailing systems of classification are criticized because they are considered to reflect Western perceptions and not the symptomatology of patients of from non-Western settings. Depression has a complex etiology with the healthcare professionals expected to distinguish culture-specific concerns.
Mental health professionals are challenged by decisions connected to culture-specific features of diagnosis, variability of symptoms, and validity of diagnostic entities. It is essential to assess the role of culture in clarifying variances in symptom manifestation. The information helps to explain interaction between culture and symptomatology of the condition when dealing with patients. Evaluating depressive conditions in persons from different cultural backgrounds is an essential routine for clinical work in mental health environments.
Incidence and Prevalence
Depression affects about 350 million people globally (Chiu et al., 2017). The risk for developing a major depression is between 12% and 16% with the condition being the second cause of disability. In 2017, the prevalence of episode of major depressive among adults aged 18 in the US was approximately17.3 million (NIMH, 2019). The number represented 7.1% of the total adults’ population in the US. The occurrence of major depressive episode was higher in female adults at 8.7% compared to males at 5.3% (NIMH, 2019). The prevalence was highest among persons aged between 18 and 25 years at 13.1%. Culture influences explanatory models, depressive symptomatology, societal response, and help-seeking behavior. Treatment approaches for depression is affected by culture (Kastrup, 2020). Depression is among the most common forms of mental condition in the US, with the condition affecting about 7.4% of adults suffering as of 2016 (Statista, 2020). The condition affected 4.84% of the U.S. population by the year 2017. According to the CDC (2020), one in every six adults will develop depression at least once in their lifetime. Depression affects approximately 16 million adults in the US every year. The condition affects people at any age, with many people experiencing depression, also experiencing other mental health disorders. There is about 9.4% of emergency department visits as a result of depression (CDC, 2020a). There are about 9.3% of physician office visits of people with depression in the US (CDC, 2020a).
There were 8.1% of American adults aged 20 and over with depression between 2013 and 2016 (CDC, 2018). The prevalence of depression among women was 10.4% that was almost twice that of men at 5.5%. Depression was higher among Hispanic, non-Hispanic whites, and non-Hispanic blacks compared to non-Hispanic Asian adults. The prevalence of depression reduced with the increase in family income levels. Approximately 80% of adults with depression indicated that they experienced at least some difficulty at home, with work, and in social activities as a result of depression. Among women and men, the prevalence of depression reduces with an increase in the levels of family income (CDC, 2018).
Healthcare Cost
The total cost of depression is calculated using emergency department visits, ambulatory care, and hospital visits (Mausbach et al., 2018). The calculation also involves the costs of worker absenteeism as a result of depression including expenditures of replacement workers, delay and loss in productivity, and costs in training replacement workers. The amount of money spent to treat and manage depressive disorders in the US, between1996–2013 was $71 billion. Depressive conditions were the sixth among the most costly health problems overall, behind injuries due to falls at $76.3 billion, hypertension at $83.9 billion, low neck and back pain at $87.6 billion, ischemic heart disease at $88.1 billion, and diabetes at $101.4 billion (Dieleman et al., 2016). There was increase in economic burden of major depressive disorders between 2005 and 2010 in the United States. The economic burden increased by 21.5% from $173.2 billion to $210.5 billion (Chow et al., 2019). The total burden of the condition in the US is estimated to be about $210.5 billion per year (APA, 2020a).
Introduction of PICOt Foundation.
The population, intervention, comparison group, and outcome (PICOT) is a suitable approach for summarizing research questions to help in exploring the impact of an intervention when dealing with a health condition (Lansing Community College Library, 2020). PICOT is an acronym representing the elements of the clinical question that include patient population (P), intervention (I), comparison (C), outcome (O), and time required to implement the intervention (T). PICOT is a suitable tool that helps to measure disease incidence (Melnyk, Overholt, 2015). The issue of interest in this project is the effectiveness of aerobic exercise in preventing and managing depression. The PICOT questions for this project is: (P) Does aerobic exercise among depressive adult (I) consisting of brisk walking three times a week (C) in comparison to a sedentary lifestyle, (O) improve depression outcomes (T) in three months?
Antidepressants are used as the first line of therapy for depression. The use of the approach has led to some patients being undertreated or over-treated. The approach is also associated with the increased cost burden of managing depression. Identification of a suitable treatment approach is necessary in helping the U.S government to save money allocated in managing the condition. As a result, it is essential to identify a suitable and affordable treatment approach for depression. The main aim of treatment of the disorder should be to deal with symptoms of depression. The treatment of the condition helps in reducing incidences of disability among people. Additionally, identifying a suitable treatment approach for depression helps in preventing the development of other chronic conditions such as diabetes, stroke, and cancer. It is essential to investigate the effectiveness of aerobic exercise among patients with depression to manage the condition. It is also necessary to determine the effectiveness of using aerobic brisk walking exercise to reduce the depressive symptoms to help in preventing absenteeism and lost productivity.
