Exercise programme ‘fails to improve depression’

A major NHS study into whether exercise can improve depression has failed to show any clinical benefit at all from increasing activity levels, UK researchers claim.

In a randomised trial that raises questions over current treatment guidelines, a NHS health technology assessment failed to show any meaningful improvements after eight months of intensive support for 361 patients with depression in general practice.

The ‘Treating depression with physical activity' study looked at the effectiveness of employing a trained physical activity facilitator over eight months to encourage patients in Bristol and Exeter  to increase their exercise levels over three face-to-face and 10 telephone sessions, compared with usual care.

There was a significant increase in activity levels in the intervention group, compared with the usual care group, with an odds ratio of 2.27. The intervention group did score ‘very slightly' lower on the Beck Depression Inventory score at four months compared with the controls, with a non-significant difference of -0.54.

But there was no evidence of clinical benefit, reduced antidepressant use or improved quality of life in the intervention group and the physical activity intervention was more costly than usual care - costing an average of £220 per person. 

NICE guidance currently recommends physical activity programmes for people with persistent sub-threshold depressive symptoms or mild to moderate depression ‘which should be delivered in groups with support from a practitioner'.

But study author Professor Glyn Lewis, professor of psychiatric epidemiology at the University of Bristol said it was ‘unlikely' advising patients with depression to take exercise would improve their outcome.

He said: ‘We can be confident in concluding that our physical activity intervention does not benefit outcome in depressive illness when used as an adjunct to usual care and it is very unlikely to be a cost-effective intervention.'

Dr David Kessler, a GP in Bristol, and member of the NICE Guidelines Development Group for the management of depression in adults with a chronic physical health problem said the study demonstrated that perhaps exercise should not be seenas a treatment for depression.'

You could argue that exercise makes you feel better in the short term but does not necessarily help you address the patterns of thought and feeling that underlie depression'

‘However there is evidence that behavioural activation is effective in the treatment of depression, and it may be relevant to look at the role of exercise as part of a larger package of behavioural changes.'

Source: Health Technology Assessment 2012; 16: 1-164

http://www.ncbi.nlm.nih.gov/pubmed/22398106