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

BMJ 2012; 344 doi: (Published 06 June 2012) Cite this as: BMJ 2012;344:e2758

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

The rapid responses to this article have been very interesting reading. I am in agreement with many of the points made by correspondents including that the conclusions drawn (by media and authors) seem to overreach the scope of the study. The authors' appear to do the equivalent of 'looking at the floor' as described by Nita Saini in her response about how people with depression start off walking.

This study looked at the effect of the intervention on the CIS-R and the BDI. The results were perhaps predictable but I am not sure the question posed was the one we want the answer to. This maybe one reason for the large number of responses and the media interest.

Sandy Whitelaw is the only correspondant so far to mention mental wellbeing but this is an area that is unexplored by the study which obviously was not set up to capture any potential wider benefits of exercise for people with depression.

Studies that use measurement scales are suitable in some circumstances and make the design of RCTs easier but this study is as notable for what it leaves out as for what it looks at.

Mental wellbeing is a dimension of feeling good and functioning well that is worthy of study in its own right and should not be seen solely as opposite to or the absence of depression (1). So, for instance, just because this intervention did not have a significant effect on BDI does not mean that it did not promote wellbeing which could be of value to the participants.

Exercise is identified as one of the 'five ways to wellbeing'(2) as discussed in the Foresight Report (3). It is an area where evidence is emerging and study is challenging but findings so far should not be dismissed. This is alluded to by other correspondants such as Carol Sinnott and Weber and Murray (11 June responses) who point out that there are all sorts of benefits of exercise; social interaction, structure to the day, taking responsibility etc.

Such factors are complex to look at but rather than continuing to confine ourselves to the foothills of measuring the negative it is high time clinicians, the research community and research funding awarding bodies rose to the challenge of research design that builds understanding of mental health that will have application for both medicine and wider society.

1. Warwick Edinburgh Mental Wellbeing Scale
2. Aked J, Marks N, Cordon C, Thompson S. (2008). Connect; Be active; Take notice; Keep learning; Give. Five Ways to Wellbeing. Centre for Wellbeing (new economics foundation)
3. Foresight Mental Capital and Wellbeing Project (2008). Final Project report – Executive Summary. The Government Office for Science, London.

Competing interests: No competing interests

03 July 2012
Sarah K Corlett
Public Health Consultant
NHS Lambeth
1 Lower Marsh, London, SE1 7NT