Re: Facilitated physical activity as a treatment for depressed adults: randomised controlled trial
Chalder et al. (1) report data from a very well designed intervention study to understand the effects of physical activity (PA) as an adjunctive treatment depressed adults in primary care. Despite no improvement of depression outcome or reduced use of antidepressants were found data showed increased PA after 12 months resulting from the intervention. As the health status in this group is reported to be of concern in various studies (2,3), the increase of PA might be underlined as an important success of the approach the authors used.
Studying the TREAD-protocol (4) used for PA-intervention I wondered why the first session did not include an active PA intervention part adressing pleasure and activation during acute exercise i.e. following the circumplex model (5)in addition to motivational interviewing. Earlier data reported acute positive affective responses in patients with major depressive disorder (6). Another concern is the the outcome measurement used by the authors, especially the assessment of antidepressant use via self-report seems to be a potential source of confounding information. Futhermore, the used Beck Depression Inventory in its second version is discussed critically (7) and there might have been a better fit using the first version cited by the authors.
(1) BMJ 2012;344:e2758 doi: 10.1136/bmj.e2758 (Published 6 June 2012)
(2) Colton CW, Manderscheid RW. 2006. Congruencies in increased mortality rates, years of potential life lost and causes of death among public mental health clients in eight states. Prev Chronic Dis 3: A42.
(3) Kopp M, Fleischhacker WW, Stürz K, Ruedl G, Kumnig M, Rumpold G. Poor health behaviour and reduced quality of life of people treated with psychotropic drugs. Hum Psychopharmacol Clin Exp 2011 Mar;26(2):161-7
(4) Haase A, Taylor A, Fox KR, Thorp H, Lewis G. Rationale and development of the physical activity counselling intervention for a pragmatic trial of exercise and depression in the UK (TREAD-UK). Ment Health Phys Act 2010;3:85-91.
(5) Ekkekakis P, Hall EE, Petruzzello SJ. Practical markers of the transition from aerobic to anaerobic metabolism during exercise: rationale and a case for affect-based exercise prescription. Prev Med 2004;38:149–59
(6) Bartholomew JB, Morrison D, Ciccolo JT. Effects of acute exercise on mood and well-being in patients with major depressive disorder. Med Sci Sports Exerc. 2005 Dec;37(12):2032-7
(7) Vanheule S, Desmet M, Groenvynck H, Rosseel Y, Fontaine J. The factor structure of the Beck Depression Inventory-II: an evaluation. Assessment. 2008 Jun;15(2):177-87
Competing interests:
No competing interests
11 June 2012
Martin Kopp
Professor of Sport and Exercise Psychology
University of Innsruck, Department of Sport Science
Rapid Response:
Re: Facilitated physical activity as a treatment for depressed adults: randomised controlled trial
Chalder et al. (1) report data from a very well designed intervention study to understand the effects of physical activity (PA) as an adjunctive treatment depressed adults in primary care. Despite no improvement of depression outcome or reduced use of antidepressants were found data showed increased PA after 12 months resulting from the intervention. As the health status in this group is reported to be of concern in various studies (2,3), the increase of PA might be underlined as an important success of the approach the authors used.
Studying the TREAD-protocol (4) used for PA-intervention I wondered why the first session did not include an active PA intervention part adressing pleasure and activation during acute exercise i.e. following the circumplex model (5)in addition to motivational interviewing. Earlier data reported acute positive affective responses in patients with major depressive disorder (6). Another concern is the the outcome measurement used by the authors, especially the assessment of antidepressant use via self-report seems to be a potential source of confounding information. Futhermore, the used Beck Depression Inventory in its second version is discussed critically (7) and there might have been a better fit using the first version cited by the authors.
(1) BMJ 2012;344:e2758 doi: 10.1136/bmj.e2758 (Published 6 June 2012)
(2) Colton CW, Manderscheid RW. 2006. Congruencies in increased mortality rates, years of potential life lost and causes of death among public mental health clients in eight states. Prev Chronic Dis 3: A42.
(3) Kopp M, Fleischhacker WW, Stürz K, Ruedl G, Kumnig M, Rumpold G. Poor health behaviour and reduced quality of life of people treated with psychotropic drugs. Hum Psychopharmacol Clin Exp 2011 Mar;26(2):161-7
(4) Haase A, Taylor A, Fox KR, Thorp H, Lewis G. Rationale and development of the physical activity counselling intervention for a pragmatic trial of exercise and depression in the UK (TREAD-UK). Ment Health Phys Act 2010;3:85-91.
(5) Ekkekakis P, Hall EE, Petruzzello SJ. Practical markers of the transition from aerobic to anaerobic metabolism during exercise: rationale and a case for affect-based exercise prescription. Prev Med 2004;38:149–59
(6) Bartholomew JB, Morrison D, Ciccolo JT. Effects of acute exercise on mood and well-being in patients with major depressive disorder. Med Sci Sports Exerc. 2005 Dec;37(12):2032-7
(7) Vanheule S, Desmet M, Groenvynck H, Rosseel Y, Fontaine J. The factor structure of the Beck Depression Inventory-II: an evaluation. Assessment. 2008 Jun;15(2):177-87
Competing interests: No competing interests