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Facilitated physical activity as a treatment for depressed adults: randomised controlled trial

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2758 (Published 06 June 2012) Cite this as: BMJ 2012;344:e2758

Re: Facilitated physical activity as a treatment for depressed adults: randomised controlled trial

Many of the respondents have already commented on this interesting study on technical grounds and the media portrayal of its findings. As clinicians, we expect the researchers to be more careful and cautious when they said1, “Clinicians and policy makers should alert people with depression that advice to increase physical activity will not increase their chances of recovery from depression”

The BMJ is one of the most influential journals in the field of medicines and has its following in whole of the world.

Without going into the details of the robustness of the study or the correctness of the interpretation, it is also our duty to be aware of the potential effects on the audience. A study 2 about the efficacy of antidepressants resulted in editorials in the serious and respectable newspaper3 questioning the use of antidepressants, thus raising the anxiety among a sizable proportion of depressed patients in Pakistan. The fact is that public is largely ignorant of the complexities of research. Therefore, media and public report, interpret and perceive things from their own angle and perspective. However, it is not just Pakistan.

In this week’s Lancet4 , Richard Horton commented that “Many scientists and doctors will have hoped that wider coverage of medical science in the media, better science education in schools, and greater access to scientific findings through the Internet would have improved the public's understanding of research. But, maybe these assumptions are unreasonable. The idea of a scientifically engaged society is still a distant dream”, highlighting the same issue in the developed world where awareness, education and access to information is far better than most of the developing world. This situation demands extra responsibility on medical profession.

It is very important that we must give the right information to our patients, but it is equally important that we should weigh the pros and cones of our statement on the ‘whole person’ in a wider society. For example, in this part of the world where diabetes is touching to an extent of an epidemic5, the prevalence of depression is very high. The present study comes up with different findings from the previous ones and its conclusions are still being questioned, will such categorical statements be helpful for patients? We know that obesity, diabetes, hypertension and cardiovascular illnesses are increasing all over the world. We also know that antidepressants cause weight gain. In this background, should we really “alert”. Wouldn’t a careful statement like “although our study does not confirm the previous findings but given the additional benefits of exercise in reducing the risks of many physical illnesses that may indirectly reduce the future risks of episodes of depression, the clinicians should continue to follow the guidelines of NICE until the matter is settled” be more helpful?

This sort of a careful approach could have avoided misquotations and misperceptions by the media and public.

1. Chalder M, Wiles NJ, Campbell J, Hollinghurst SP, Haase AM, Taylor AH, et al. Facilitated physical activity as a treatment for depressed adults: randomised controlled trial. BMJ 2012;344:e2758.
2. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008; 5: e45.

3. http:// Dawn.com March 02, 2008

4. http://dx.doi.org/10.1016/S0140-6736(12)60948-9, 14 June 2012.

5. Priya Shetty, India’s diabetes time bomb S14 | NATURE | VOL 485 | 17 MAY 2012

Competing interests: No competing interests

18 June 2012
Muhammad Naim Siddiqi
Consultant Psychiatrist
Saleha Sami
Sindh Institute of Urology and Transplant
Karachi, Pakistan