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Exercise may improve depression management in some elderly patients

Adding exercise to antidepressant medication may increase likelihood of depression remission for certain elderly patients, such as those aged older than 75 years, according to research findings published in the Journal of the American Geriatrics Society. Researchers also reported liaison programs between primary care physicians (PCPs) and psychiatrists or other multi-disciplinary professionals may encourage PCPs to implement exercise interventions for depression in primary care.

“The process of dissemination involves the adaptation of any intervention to the specific characteristics of participants and to those of the recipient community agency and stakeholders. Implementation of interventions needs to take into account the high degree of clinical heterogeneity of [late-life major depression], the complex needs of the older population and their heterogeneous responses to exercise,” Stamatula Zanetidou, MD, of the department of mental health at the University of Genoa in Italy, and colleagues wrote. “Moreover, the attitude of health care providers can influence the choices of the type of treatments and other aspects of management.”

Researchers studied 120 patients from a previous study that had been put into one of three groups: antidepressants (AD) only, antidepressants plus low-intensity, non-progressive exercise involving instrumental exercises and mat work and anti-depressants plus high-intensity, progressive aerobic exercise involving the same exercises as the earlier group, but adding an exercise bike to the workout. All patients received increasing amounts of sertraline over 2 weeks up to a dose of 50 mg.

According to researchers, patients who completed exercises and took sertraline did better than those who only took the medication. Characteristics of patients more likely to achieve remission included age 75 and older (effect size 0.32), polypharmacy (effect size 0.35), greater aerobic capacity (effect size 0.48), displaying psychomotor slowing (effect size 0.49), and less-severe anxiety (effect size 0.30).

“The lack of substantial differences in the outcomes of the two protocols suggests that adding lower-intensity exercise to [antidepressants] might be sufficient to improve outcomes of [late-life major depression]. “Clinicians should also be aware that individuals’ choices of the type and intensity of exercise are associated with greater adherence to similar interventions,” Zanetidou and colleagues wrote.

Researchers also reported the 20 participating PCPs initially indicated a reluctance to recommend physical exercise to their patients who were depressed, citing lack of infrastructure (58%), judgment of insufficient efficacy and thinking individuals would not follow prescription because of habit (both 50%) and patients’ inadequate physical condition (33%). However, many of these mindsets changed after the study results were presented, with 80% reporting that they had prescribed exercise for their elderly patients to treat their depressive symptoms.

“Collaborative care models seem to be the most appropriate context in which to deliver similar exercise-based interventions; PCPs and psychiatrists ought to be involved in monitoring physical health, managing pharmacotherapy- and exercise-related adverse effects, and reinforcing motivation to exercise,” researchers wrote. “[Also], PCPs ultimately make the decision to refer a patient to such an intervention, so referral might depend on their opinions on depression, exercise, and other things.”  – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.