ReviewPhysical activity and likelihood of depression in adults: A review
Introduction
Depression affects more than 340 million people worldwide (Greden, 2001) and is the number one cause of non-fatal disease affliction in Australia (Mathers and Stevenson, 1999). Depression has become the leading cause of disability in the developed world (Lopez et al., 2006) and by 2020 it has been predicted to be the second leading cause of disability, next to cardiovascular disease in the developing world (Murray and Lopez, 1997). Clinical depression is characterized by the presence of various signs and symptoms which severely affect one's mood and daily functioning (Commonwealth Department of Health and Aged Care, 1999a). Non-clinical depressive symptoms are also very common in many populations (Commonwealth Department of Health and Aged Care, 1999a, US Department of Health and Human Services, 1999, The Centre for Economic Performance's Mental Health Policy Group, 2006). Typical management of depression has often involved treatment from clinical professionals such as general practitioners, psychiatrists and psychologists, and has included counselling and anti-depressant medication (CDHAC, 1999a). Recent research, however, has focused on the potential role of physical activity in the prevention and/or management of depression and depressive symptoms (Paluska and Schwenk, 2000).
A number of countries, including the UK, US and Australia, have developed health-related physical activity guidelines, which generally recommend that all adults accumulate at least 30 min of moderate-intensity physical activity on most, if not all days of the week (Commonwealth Department of Health and Aged Care, 1999b, American College of Sports Medicine, 2000, Chief Medical Officer's Report, 2004). These guidelines were developed to improve population health and to prevent diseases such as type 2 diabetes and coronary heart disease (Saxena et al., 2005). However, there has been relatively little systematic examination of the optimal dose of physical activity that is required to prevent depression.
Several reviews of the literature have focused on observational and intervention studies which have assessed the relationship between physical activity and depression (O'Neal et al., 2000, Brosse et al., 2002, Lotan et al., 2005, Penedo and Dahn, 2005, Saxena et al., 2005, Paluska and Schwenk, 2000, Lawlor and Hopker, 2001, Craft and Perna, 2004). These reviews generally draw a similar conclusion: that physical activity is positively associated with better mental health, with only one review suggesting that a strong conclusion could not be made due to methodological limitations of the studies examined (Lawlor and Hopker, 2001). However, past reviews have not intended to specifically examine the association between physical activity dose (i.e. frequency, duration, intensity), domain (i.e. domestic, leisure-time, work-related and transport-related physical activity), or setting (i.e. home-based or centre-based) and likelihood of depression. It is important to examine such components of physical activity and their relationship with depression in order to inform public health clinical recommendations regarding the specific amounts, contexts and settings of physical activity most likely to reduce the likelihood of depression.
This literature review will examine original research assessing the associations between physical activity and depression. A particular focus will be on identifying the optimal dose, domain and setting of physical activity most consistently associated with reduction in likelihood of depression.
Section snippets
Search strategy
A detailed search of electronic databases was performed for original research articles published post-1980. These databases included: MEDLINE (via Pub Med), Psychinfo, Science Direct and Expanded Academic. Authors' own bibliographic libraries were also searched. The following search terms were used to identify relevant articles: depression, mental health, physical activity, exercise, dose, intensity, duration, frequency, domain, leisure-time, occupation, domestic, transport, and adults.
Observational studies
Twenty-seven observational studies were identified (Table 1). Most of the studies comprised non-clinical community samples of adults (aged 10–89), predominately from the US. In general, self-report measures were used in order to assess depression and physical activity. The methods for assessing depression included well-validated measures such as the Centre for Epidemiologic Studies Depression Scale [CESD-S] (Radloff, 1977), the General Health Questionnaire [GHQ] (Goldberg, 1972), the Beck
Discussion
This literature review examined evidence of a relationship between physical activity and likelihood of depression. This review differs from previous published reviews as it examined the specific dose, domain and setting of physical activity associated with risk of depression. Nearly all of the observational studies in this review (25 out of 27) and the majority of the intervention studies (31 out of 40) reported an inverse relationship between physical activity and depression. A total of 20 out
Conclusion
This review has identified observational and intervention studies showing inverse associations between physical activity and the likelihood of depression in adults. It has provided some insights into the optimal dose (frequency, duration and intensity) of physical activity for reducing the risk of depression in adults. Despite inconsistencies between studies, findings suggest that even relatively low doses of physical activity may have a protective effect against the likelihood of depression.
Acknowledgments
Kylie Ball is supported by a National Health and Medical Research Council/National Heart Foundation of Australia Career Development Award. Jo Salmon is supported by a National Heart Foundation of Australia and sanofi-aventis Career Development Award.
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