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Research ArticleORIGINAL RESEARCH

Effectiveness of Physical Exercise in Older Adults With Mild to Moderate Depression

Jesús López-Torres Hidalgo, Joseba Rabanales Sotos and DEP-EXERCISE Group
The Annals of Family Medicine July 2021, 19 (4) 302-309; DOI: https://doi.org/10.1370/afm.2670
Jesús López-Torres Hidalgo
1Albacete Zone VIII Health Center, Albacete, Spain
2Faculty of Medicine, University of Castile-La Mancha, Albacete, Spain
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  • For correspondence: jesusl@sescam.org
Joseba Rabanales Sotos
3Albacete Faculty of Nursing, University of Castile-La Mancha, Albacete, Spain
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    Figure 1.

    General study flow chart.

    AT = antidepressant treatment; PA = physical activity.

  • Figure 2.
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    Figure 2.

    Self-perceived health status over time.

    AT = antidepressant treatment; PA = physical activity.

Tables

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    Table 1.

    Baseline Characteristics of Patients in the Study Groups

    CharacteristicPhysical Activity n = 158Antidepressant Treatment n = 155P Value
    Sociodemographic characteristics, No. (%)
    Age, y.55
        65-74102 (64.6)95 (61.3)
        ≥7556 (35.4)60 (38.7)
    Sex.437
        Female127 (80.4)119 (76.8)
        Male31 (19.6)36 (23.2)
    Educational level.535
        Illiterate or primary education124 (78.5)126 (81.3)
        Secondary or university education34 (21.5)29 (18.7)
    Social class.401
        I-IIIa23 (14.6)28 (18.1)
        IV-Vb135 (85.4)127 (81.9)
    Marital status.895
        Single, widowed, or divorced59 (37.3)59 (38.1)
        Married99 (62.7)96 (61.9)
    Lifestyle, No. (%)
    Smoker.55
        Yes16 (10.1)19 (12.3)
        No142 (89.9)136 (87.7)
    Alcohol consumption.61
        > 100 g/week8 (5.1)6 (3.9)
        <100 g/week150 (94.9)149 (96.1)
    Physical activity.412
        Physical inactivity30 (19.0)24 (15.5)
        Moderate or intense activity128 (81.0)131 (84.5)
    Health status, No. (%).707
    Multimorbidity (≥3 diseases).343
        Yes145 (91.8)144 (92.9)
        No13 (8.2)11 (7.1)
    Polypharmacy (≥4 drugs).501
        Yes115 (72.8)120 (77.4)
        No43 (27.2)35 (22.6)
    History of depressive disorder(s).704
        Yes93 (58.9)97 (62.6)
        No65 (41.1)58 (37.4)
    Prior use of antidepressant drug(s).342
        Yes69 (43.7)71 (45.8)
        No89 (56.3)84 (54.2)
    Obesity.465
        Yes69 (43.7)76 (49.0)
        No89 (56.3)79 (51.0)
    Arterial hypertension.921
        Yes84 (53.2)76 (49.0)
        No74 (46.8)79 (51.0)
    Self-perception of health (Euro-Qol-5D questionnaire), No. (%)
    Mobility problems.921
        Yes40 (25.3)40 (25.8)
        No118 (74.7)115 (74.2)
    Self-care problems.985
        Yes2 (1.3)2 (1.3)
        No156 (98.7)153 (98.7)
    Problems performing daily activities.915
        Yes20 (12.7)19 (12.3)
        No138 (87.3)136 (87.7)
    Pain or discomfort.89
        Yes111 (70.3)110 (71.0)
        No47 (29.7)45 (29.0)
    Anxiety or depression.255
        Yes128 (81.0)133 (85.8)
        No30 (19.0)22 (14.2)
    Health status score, mean (SD)59.2 (18.6)57.1 (16.4).287
    MADRS score, mean (SD)15.1 (4.6)15.9 (3.9).106
    • MADRS = Montgomery-Åsberg Depression Rating Scale.

    • ↵a Social classes I-III: managers and university degree-related professions, administrative and service staff, and self-employed workers.

    • ↵b Social classes IV-V: skilled, semiskilled, and unskilled manual workers.

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    Table 2.

    Cumulative Incidence of MADRS Scores <10 Over Time (Intention-to-Treat and Per-Protocol Analyses)

    Physical Activity n/N (%)Antidepressant Treatment n/N (%)RR (95% CI)
    1 Month
    Intention-to-treat analysis
    Per-protocol analysis
    76/158 (48.1)
    76/135 (56.3)
    84/155 (54.2)
    84/149 (56.4)
    0.89 (0.71-1.1)
    0.99 (0.81-1.23)
    3 Months
    Intention-to-treat analysis
    Per-protocol analysis
    72/158 (45.6)
    72/96 (75.0)
    94/155 (60.6)
    94/120 (78.3)
    0.75 (0.61-0.93)
    0.96 (0.82-1.11)
    6 Months
    Intention-to-treat analysis
    Per-protocol analysis
    52/158 (32.9)
    52/66 (78.8)
    77/155 (49.7)
    77/93 (82.8)
    0.66 (0.5-0.87)
    0.95 (0.81-1.11)
    • MADRS = Montgomery-Åsberg Depression Rating Scale; RR = relative risk.

Additional Files

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  • The Article in Brief

    Effectiveness of Physical Exercise in Older Adults With Mild to Moderate Depression

    Jesus Lopez-Torres Hidalgo and colleagues 

    Background Depression is the most frequently diagnosed psychiatric disorder among older adults, with 8% to 16% of older patients presenting with clinically significant depressive symptoms. Researchers in Spain conducted a randomized clinical trial of 347 older adults with mild to moderate depression, comparing the effectiveness of physical exercise and antidepressants as treatment methods. Study participants were assigned to either a group engaged in supervised physical exercise or a group that received antidepressant treatment by their general practitioners.

    What This Study Found Depressive symptoms were not significantly different after one month between the two groups. However, after three and six months, the number of people who showed improvement was significantly higher in the antidepressant group. The authors note that the number of participants who withdrew from the study was higher in the physical activity group, while more adverse side-effects were reported in the group treated with antidepressants.

    Implications              

    • Both interventions, specifically antidepressant treatments and physical exercise carried out in group sessions, are capable of reducing depressive symptomatology among persons over the age of 65, diagnosed in primary care with mild-to-moderate depressive disorder. Although the resulting improvement in depressive symptoms is initially similar in both treatment options, antidepressant drug therapy proves superior in the medium term. Despite the fact that the appearance of adverse effects was significantly higher in the group treated with antidepressant drugs, both interventions were found to be satisfactory by the participants and impacted very favorably on their self-perceived health status.

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The Annals of Family Medicine: 19 (4)
The Annals of Family Medicine: 19 (4)
Vol. 19, Issue 4
1 Jul 2021
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Effectiveness of Physical Exercise in Older Adults With Mild to Moderate Depression
Jesús López-Torres Hidalgo, Joseba Rabanales Sotos, DEP-EXERCISE Group
The Annals of Family Medicine Jul 2021, 19 (4) 302-309; DOI: 10.1370/afm.2670

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Effectiveness of Physical Exercise in Older Adults With Mild to Moderate Depression
Jesús López-Torres Hidalgo, Joseba Rabanales Sotos, DEP-EXERCISE Group
The Annals of Family Medicine Jul 2021, 19 (4) 302-309; DOI: 10.1370/afm.2670
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Subjects

  • Domains of illness & health:
    • Mental health
    • Health promotion
  • Person groups:
    • Older adults
  • Methods:
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Keywords

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  • exercise
  • antidepressant agents
  • elderly
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