Physical Exercise Reduce Symptoms Depression Health And Social Care Essay

Physical deterrent example Reduce Symptoms starting Health And Social C be EssayThe aim of this essay will be to discuss and apply selected evidence related to nurse practice within a chosen field. Evidence based practice is an approach utilise by clinicians to deliver the highest quality care to meet the needs of patients and their families. By finding appraising and victimisation the best evidence, health professionals are able to achieve optimal knocked out(p)comes for all. (Melnyk Finout-Overholt 2005). However, an alternative view counsels that evidence exists to inform and guide practice rather than dictate it. (McKenna et Al 1999). When clinicians apply an evidence based model, the best uncommitted evidence, special by patient circumstances and preferences, is applied to improve the quality of clinical judge workforcets. (McMaster Clinical Epidemiology stem 1997)A recognised framework will be utilise to identify a question and then a organized literature search will be carried out to assist in answering this question. A copy of this search will be provided and search parameters will be applied to sort out the most applicable literature. After applying these parameters the search will be narrowed down to the five most relevant slices of research. A table will be provided to show the key findings from each piece of literature, and one piece of research will then be critiqued in depth using a recognised framework.The question identified in this essay is Can bodily do or military action help to reduce the symptoms of first in fourth-year adults, compared to other forms of intervention?Background and Formulation of QuestionThe question was devised using the PICO framework. This framework often is used to formulate clinical questions (Craig Smyth 2002), and it identifies and defines the essential components of a good clinical question. PICO is an acronym for patient population of interest, incumbrance, comparison intervention and ou tcome (National demonstrate for Health and Clinical rectitude 2007). Patient population of interest shall be erstwhile(a) persons diagnosed with low, intervention shall be physical movement or activity, the comparison intervention shall be other forms of intercession for depression and the outcome will be a reduction in the symptoms of depression. A well thought out and theorise question maximises the potential for finding relevant evidence for a patient population (Craig Smyth 2002) clinical depression in older adults refers to depressive syndromes defined in the American psychiatrical Associations Diagnostic and Statistical Manual (DSM-IV) and in the International Classification of Diseases (ICD-10) that arise in mint older than age 65 geezerhood. In old age, the symptoms of depression often affect flock with chronic medical illnesses, cognitive impairment, or disability. (Alexopolous et al 2002). For a major depressive episode to be diagnosed, five of the fol depleted ing symptoms essential be present depressed mood, diminished interest, loss of pleasure in all or almost all activities, weight loss or gain (more than 5% of bodyweight), insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feeling of worth littleness or in appropriate guilt, reduced ability to concentrate, recurrent thought of death or suicide.At least one of the symptoms must be either depressed mood or diminished interest or pleasure. The episode should last at least 2 weeks, lead to distress or functional impairment, and not be a direct effect of substance use, a medical condition, or bereavement. (Depression Today 2010). Two of the symptoms detailed to a higher place must be present for a insignificant depressive episode to be diagnosed.Between one and four share of the general elderly population has major depression, and minor depression has a prevalence of between four and thirteen percent (Blazer 2003). Twice as many another(prenominal) women as men a re affected. Both the prevalence (Palsson et al 2001) and the incidence (Teresi et al 2001) of major depression double after age 70-85 years.Treatment for depression usually involves a combination of anti depressant drugs, talking therapies such as Cognitive Behaviour Therapy or Interpersonal Therapy and self help. (NHS Choices 2010). A late(a) look into concluded that physical fare programmes can obtain devour a beneficial effect on depressive symptoms in older people. Although not appropriate for all older people exercise may improve mood in those undertaking it. (Blake et al 2009)Systematic Literature chaseA systematic review of the literature was carried out using the CINAHL and PubMed databases and the search terms depression physical exercise and old* were used. CINAHL was found to be inciteicularly useful as it possible to specify the age group required in the literature search. For the purposes of this search age 65+ was selected. PubMed is the public access version of Medline, a super database which indexes thousands of journals in the medical sciences field. (TVU 2010a). The Cumulative Index to Nursing and Allied Health Literature Indexes virtually all English language journals from 1983 onwards. This database covers midwifery, nursing and related disciplines (TVU 2010b). ab initio the searches indicated a vast array of literature yet by applying a systematic review this was reduced. By using a logical search scheme with Boolean techniques the number of documents was limited to thirty. These were then reviewed and five articles were then selected which addressed the question of exercise as a form of intervention for older people diagnosed with depression. The search parameters were limited to studies written in the English language, the age and the subjects, and both sexes were to be included. Harvard (2007) suggests that by applying parameters such as these the most up to date and relevant literature can be sourced. A full record of this s earch history is attached in appendix 1 and 2.A summary of the findings in the five pieces of research selected is detailed in the table overleaf. This table follows a structure recommended by Timmins McCabe (2005).Author and YearJournalType of Study projectSampleDesignData CollectionKey FindingsBlake et al 2009Clinical RehabilitationQualitativeTo assess efficacy of physical exercise in11 tribulations totalling 641 participantsVariedVaried1 Exercise not relevant2009 23 873-887systematictreating depression in older adultsto all in groupreview2 May improve mood3 further research neededto establish moderate to grand term effects andcost specialtyMather et al 2002British Journal ofQuantitativeTo determine whether exercise is effective86 participants split intoRCTclinical1 Modest improvementPsychiatry (2002)as an addition to anti depressants in lessentwo groupsinterviewin symptoms after 10180411-415depressive symptoms in older adultsweeks2 older people shouldbe encour develop to fal l exercise classesBrenes et al 2007Aging Mental HealthQuantitativeTo test feasibility and efficacy of exercise and37 participants, 32 completedRCTstructured1 Both exerciseJan 200711(1)61-68anti depressants compared with usualthe field of operationclinical interviewand medicine weretreatments for older adults withobservedshown to be statisticallyminor depressionself reportingmore effective thancurrent treatment2 Exercise also aidedphysical functioningKerse et al 2010Annals of FamilyQuantitativeTo assess effectiveness of home based193 participants, 187 completedRCTstructured1 exercise and social medication 8214-223 (2010)physical exercise plan in treating olderthe studyclinical interviewvisits showed similaradults with depressive symptoms comparedeffects in improvingto social visitsmood an quality of life2 More research is requiredBlumenthal et alArchives of InternalQuantitativeto assess effectiveness of exercise156 participantsRCTstructured1 after 16 weeks1999 practice of medicine 159(19) (1999)compared to antidepressants for treatmentclinical interviewexercise equally effectiveof major depression in olderas anti depressantsCritical AppraisalThe following appraisal was structured by using an approved and recognised framework for completing such tasks. (Polit et al. 2001)The article selected for critical appraisal is Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. (Mather et al. 2002). A copy of the article is attached as appendix 2.The aim of the study was to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. This was clearly defined. In the introduction the authors stated that it is widely held that exercise is useful in depression, but that there were few studies on the potential effects that exercise may have as an addition to antidepressant therapies for older adults.The key finding of this study was that at ten weeks older people with poorly responsive depressive disorder showed a modest improvement in depressive symptoms and should therefore be encouraged to attend group exercise activities.The study conducted was a randomized cookled trial. Randomised controlled trials are the most rigorous way of determining whether a relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. (Sibbald Rowland 1998). Patients were randomly selected to attend either exercise classes or health education talks for ten weeks. Assessments were blind and were conducted at baseline, ten and thirty four weeks. The primary outcome was measured with the 17 item Hamilton rank Scale for Depression (HRSD). HRSD is a multiple choice questionnaire used by clinicians to measure the severity of major depression in patients. (Hamilton 1960). The nature of both interventions is clearly described by the authors. All participants were outpatients recruited from primary care, psychiatric g o and direct advertisement. 1885 patients were screened with a view to recruitment, and 86 were selected at random for the study. To be included patients were required to have symptoms of depression, and to be older than fifty three years of age. In addition patients had to have been receiving antidepressant therapy for at least six weeks, without evidence of a sustained improvement in their condition. Patients were excluded if there was alcohol or substance misuse, structured psychotherapy in place, or were already taking regular exercise. Patients with specific medical conditions preventing physical exercise were also excluded. Both groups were assured of the nature of the trial, and all patients gave written informed consent. The study was approved by a medical research ethics committee.thither were two groups with 43 patients in each and were comparable in terms of age range and symptom presentation. There was however a heavy preponderance of women in the exercise group. The au thors suggest that this may have introduced a bias into the results, and suggest a control group could be introduced in the future without either intervention. The outcomes for both groups were measured in the same way by the proportion of participants achieving a greater than thirty percent reduction in HRSD score from baseline. The results are shown in a statistical format and are recorded in a table.There are twenty four references in the report which support the evidence presented by the authors.The implications for the health service are that structured group exercise sessions can help to make a modest improvement in patients who are not responding to pharmacological treatment and that older people with depressive disorders should be encouraged to attend group exercise activities. It should be noted that one of the authors of the research is co-director of a company providing exercise classes for older people and whose profits support research into aging. polish of LiteratureTh is review of literature will show how the five main studies and all available literature assist in answering the discipline question. The first part of this review will concentrate on the five main studies and the second part will contain evidence from a wide range of sources and relate this combined information to government policy and guidelines. There will also be evidence of how all the information relates back to practice.It is well acknowledged that depression is widespread (Osborn et al 2003) and is the most prevalent mental health problem for older people (Age Concern 2007) The condition affects one in five people over 65 and rises to two in five in those over 85 (Mental Health Foundation 2008). The use of exercise to combat depression is well supported due to its effects on enhancing mood, improving cognitive function and reducing anxiety it is also less expensive than medication (Louch 2008). A literature review was conducted to examine whether exercise could be an effect ive form of treatment for older adults with depressive symptoms.Article 1 (Blake, Mo, Malik and Thomas 2008) conducted a systematic review of eleven randomized control trials in order to establish whether physical activity interventions were self-made in alleviating depressive symptoms in older people. Trials were included in the review when more than 80% of the participants were greater than sixty years old. In nine of the eleven studies small term positive outcomes were found, although the mode, intensity and duration of the exercise program differed across the studies. The medium to long term effects of exercise as an intervention were less clear. This outcome is backed up by Mead et al (2008) who concluded that exercise seems to improve depressive symptoms in people with a diagnosis of depression, but the effects are moderate and not statistically significant.However a randomized controlled trial conducted by Blumenthal et al (1999) (Article 2) had reached different conclusion s. One hundred and fifty six men and women aged over fifty were split into groups randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride) or combined exercise and medication. After sixteen weeks of treatment the patients did not differ significantly statistically either on Hamilton Rating Scale for Depression or Beck Depression Inventory scores. The study concluded that antidepressant medication had the most rapid effect, but after sixteen weeks exercise was equally effective in reducing symptoms of major depressive disorder.Article 3 (Brenes et al 1999) conducted a pilot study designed as a randomized clinical trial to test the feasibility and efficacy of an exercise program and antidepressant treatment compared with usual care in improving emotional and physical functioning in older adults with minor depression. A total of thirty seven participants aged over sixty five were randomized to treatment fourteen to exercise, eleven to sertraline and twelve to usual care. Patients who received either exercise or sertraline treatments demonstrated improvement both in clinician led and self reported measures of depressive symptoms. Those participants who received the usual package care experienced small or no improvement in mental state. There are some limitations to this study however. The take size was small and thus the statistical power was weak. The diagnosis of minor depression was based on self diagnosis rather than clinical interview. It was also not stated in the report what the usual care was. There were however significant trends to suggest that sertraline and exercise could be used as treatments for mild depression in older adults, and that a more in depth study should be undertaken.Article 4 (Kerse et al 2010) published a study comparing the effects of a home based exercise program with regular social contact in improving function, quality of life and mood in older people with depressive symptoms. A randomized controlled tr ial was conducted in which one hundred and ninety three people aged over seventy five with depressive symptoms received either an individualized physical activity program or social visits delivered over six months. The social visits were of the same time span as the exercise program. Outcome measures were obtained at three, six and twelve months. Both physical and mental well being was measured using a variety of techniques including a short function test, and the Nottingham Extended Activities of Daily support Scale (Nouri Lincoln 1987). It was concluded that a structured activity program improved mood and quality of life for older people with depressive symptoms as more than as the effect of social visits. There was however no control group being measured that was receiving usual care.Article 5 (Mather et al 2002) set out to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. A randomized controlled tr ial was conducted in which eighty six participants aged between fifty three and ninety one already receiving anti depressant therapy were given either exercise classes or health education talks over a ten week period. Assessments were made blind at baseline, ten and thirty four weeks using the Hamilton Rating Scale for Depression as the primary outcome. At ten weeks a significantly higher proportion of the exercise group (55% compared with 33%) experienced a greater than 30% decline in depression. In an article in The British Journal of Psychiatry in 2002, Jagadheesan et al critiqued this study and stated that it could have been more meaningful if a control group had been added which received no additional treatment other than continuing antidepressants. (Jagadheesan et al 2002).The majority of research above suggests that physical exercise reduces depression and depressive symptoms in the short term in older adults, but additional well controlled studies are required to determine t he long term efficacy. A systematic review carried out by Sjosten Kivela supports these findings (Sjosten Kivela 2002). Direct comparisons between studies is difficult as they differ greatly in characteristics, nature of control comparison group, age of the participants, type and intensity of exercise and outcome measures used to follow up.National Institute for Clinical Excellence guidelines are set out to assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The guidelines for depression suggest that for particularly for patients with mild or moderatedepressive disorders, structured and administrate exercise can be an effective intervention that has a clinically significant impact on depressive symptoms. There is also evidence to suggest that individuals with low mood may also benefit from structured and supervised exercise. (NICE 2005).ConclusionPhysical exercise is clinically beneficial in the short term for treatment of depre ssive symptoms in older people. Exercise, although not appropriate for all older persons with depression, may improve mood in this group. Evidence of the cost effectiveness of providing exercise interventions would be beneficial in helping decision making regarding service use and delivery. More well designed research studies are needed to examine the medium and long term benefits of exercise as a treatment for depressive symptoms in older adults, and to examine the types and duration of interventions that have the most positive effect.Word find out 3008ReferencesAge Concern (2007) Mental Health Services Letting Down Older People. On Line Available at http//www.ageuk.org.uk/ Accessed 12 May 2010 London Age Concern.Alexopoulos, G.S., Buckwalter, K., Olin, J., Martinez, R., Wainscott, C., Krishnan, K.R. (2002) Comorbidity of late-life depression an opportunity for research in mechanisms and treatment. Biol Psychiatry 2002 52543-58.Blake, H., Mo, P., Malik, S., Thomas, S. 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