Author
BLAKE H.; et al.;
How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review.
Journal citation/publication details
Clinical Rehabilitation, 23(10), pp.873-887.
Summary
The eleven studies, all randomised controlled trials, included in this systematic review varied considerably in their study methodology and the type and delivery of the physical activity (PA) interventions used. The results suggest that positive outcomes can be seen in older people in the short term but evidence of medium-term and long-term effects on depression and depressive symptoms is lacking. Further research is needed to investigate longer term outcomes, the types of physical activity that may be beneficial, the effects of the duration and intensity of interventions, and cost-effectiveness.
Context
Moderate exercise has been associated with a diverse range of health benefits, including a reduction in clinical depression, but research on the effects of exercise interventions as treatment for depressed older adults is limited. The aim of this study was to 'assess the efficacy of physical exercise interventions for alleviating depressive symptoms in depressed older people' over 60 years old.
Methods
What sources were searched?
The electronic databases searched were: Medline, EMBASE, CINAHL, PsycINFO (all from the date of inception to May 2008), the Cochrane Library (Issue 2, 2008), and the National Research Register (NRR). Reference lists of relevant articles and previous reviews were hand searched for further material.
What search terms/strategies were used?
A broad search strategy was developed using key words and synonyms for 'physical activity', 'older people' and 'depressive symptoms'. An example of a search strategy is detailed in an appendix.
What criteria were used to decide on which studies to include?
Studies had to be randomised and controlled, or quasi-experimental, trials of exercise interventions delivered by trained individuals to people aged 60 or older who had been diagnosed with depressive symptoms at recruitment. At least 80% of participants had to be over 60 in order for studies to be eligible. Studies were not excluded on the basis of language.
Who decided on their relevance and quality?
The abstracts and titles of articles identified from the electronic database searches were screened for relevance and full-text articles were obtained for further examination. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) and the Scottish Intercollegiate Guidelines Network (SIGN) guidelines (Table 3).
How many studies were included and where were they from?
Of the 4,385 references initially identified, 29 were selected for further review, ten of which met the inclusion criteria; reasons for exclusion are presented in Table 1. One additional study was identified from the reference list searches. The geographical setting of the studies is not reported.
How were the study findings combined?
The reviewers independently extracted data onto standardised forms with disagreements resolved by discussion. The characteristics and results of the included studies are summarised in Table 2 and as a narrative synthesis. Meta-analysis was not undertaken due to the heterogeneity of the studies.
Findings of the review
The 11 studies, all randomised controlled trials, varied in: the use of depression screening instruments; the type of physical activity and the intensity and duration of the PA intervention; the outcome measures used, and; the length of follow-up.
Most of the studies reported significant reduction in depression or depressive symptoms, immediately post intervention for participants in the PA activity groups compared to controls. The results for the studies in which the medium-term (3-12 months) effects were measured were mixed. Long-term (over 12 months) effects were measured in only two studies, again with mixed results.
Authors' conclusions
'Exercise intervention exerts a clinically relevant effect on depressive symptoms in older people'.
Implications for policy or practice
None are discussed.