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Physical activity supports patient’s recovery from severe major depression

The influence of the practice of physical activity in combination with hospital treatment reduced symptoms of depression and improved patients' quality of life
Physical activity supports patient’s recovery from severe major depression

Researcher analysed the effects of aerobic physical activity practice on symptoms of depression - Photo: Ramon Moser

Author: Carolina Golenia

Graduated in Physical Education, Professor Felipe Barreto Schuch, in his Doctoral Thesis – defended at UFRGS Postgraduate Program in Medical Sciences – analysed the effects of physical activity practice in hospitalized patients with severe depression. With the aim of complementing the treatment of these patients, the study was led by Professor Marcelo Fleck with the  assistance of a team of researchers, and conducted in the psychiatric ward of Hospital de Clínicas de Porto Alegre (HCPA).

The supervision of the practice of aerobic physical activities was conducted by Schuch, and performed in a room that contained gym equipment - such as treadmill, elliptical, and bicycle. The study was carried out with 50 patients aged between 18 and 60 years old, 25 of whom did the usual treatment and physical exercises three times a week, and the remaining 25 did only the usual treatment. The division of groups occurred randomly, and physical activities were performed individually. The methodology, which started with stretching exercises and a four minute warm-up on the treadmill at 5km/h, allowed patients to choose the intensity and time of their training instead of being the same period of time for all of them. Additionally, they had the option to listen to the music of their choice during the activities.

The patients were advised by the team of researchers about the use of the equipment and on how to achieve the recommended dose of 16.5 kcal/kg per week in relation to the weight of each patient. A good example is when a participant weighing 70 kg should achieve the equivalent of 1,120 kcal per week. The data collection for this study began in 2008 and finished in the middle of 2013. According to the researcher “even though these patients have severe depression and are on other treatments, these exercises reduced depression symptoms and significantly improved quality of life, mainly in two domains (physical and psychological) as compared to those who did not practice exercises”.

Marcelo Fleck adds that “Hospitalization is an indicator of something very serious. Nowadays  psychiatry is usually done on an outpatient basis; people are treated in public health centers, in consulting rooms, places in which hospitalization is not required. The very fact of being hospitalized shows a profile of a particularly severe patient.”  Professor Fleck also points out that patients accepted and tolerated well the exercises, “seizing the time they were hospitalized to make an intervention, which showed an increase in benefits for these patients”.

Before starting the activities, the patients were examined, and those who had some heart condition did not participate. Thus, the method was considered safe, and the intervention beneficial, bringing only advantages for the recovery of those who suffer with the disease. Even associated with drug treatments, there were no major complications.

Schuch says that “Many of the patients expressed feelings such as ‘I am in the hospital, I am bad, I need to get better, so I am going to do whatever I can do to feel better”. Additionally, he and Fleck observe that some patients did not like exercising, but they accepted the possibility of improving. Once realizing this improvement, they continued to exercise, and some of the patients even began to enjoy it.

"Depression is a very difficult disease to be treated, and believing that a single treatment will solve all the problems is very ambitious. Our study helps consolidate the information that exercise can be used as an alternative treatment for depression, even in severe cases. Not only did these patients improve their depression, but they also felt better in a more general aspect of their lives”, he concludes.

One of the greatest difficulty found during the research was in relation to logistics. The team needed to add a new activity to hospitalization. Nevertheless, as hospitals already have well-established routines, it is difficult to fit other activities into patients’ schedule. However, Hospital de Clínicas is a renowned research institution, which was advantageous to the team. Additionally, as Flecks points out, “the advantage of hospitalization is that we have a well-structured environment in which the patient is already there, and we can arrive whenever we want to organize and participate directly in the intervention."

Schuch and Fleck are developing a new project, and both intend to continue studying depression, focusing on outpatients from an unconventional physical activity format which adapts to patients’ daily routine, such as walking and climbing stairs. “With outpatient it is more difficult because making a person leave the house and come to the hospital to do a physical activity is more complicated," Fleck concludes. In future research, patients will use pedometers in order to measure the number of walking steps per day and they will also have a goal to  meet, which will be gradually  increased according to individual progress.



Title: Exercício físico e depressão: efeitos em desfechos clínicos e em biomarcadores

Author: Felipe Barreto Schuch

Advisor: Marcelo Pio de Almeida Fleck

Department: Programa de Pós-Graduação em Ciências Médicas: Psiquiatria

Scientific Paper: Schuch, F. B. et al. Exercise and severe major depression: Effect on symptom severity and quality of life at discharge in an inpatient cohort. Journal of Psychiatric Research, v. 61, 2015

Translated by Rafaela S. Silva under the supervision and revision of Professor Márcia Moura da Silva (UFRGS)


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