Physical Exercise for Late‐Life Depression: Customizing an Intervention for Primary Care

Abstract

OBJECTIVES:To identify which individual-and contextrelated factors influence the translation into clinical practice of interventions based on physical exercise (PE) as an adjunct to antidepressants (AD) for the treatment of latelife major depression (LLMD). DESIGN: Secondary analysis of a randomized controlled trial. SETTING: Primary care with psychiatric consultation-liaison programs (PCLPs)-organizational protocols that regulate the clinical management of individuals with psychiatric disorders. PARTICIPANTS: Individuals aged 65 and older with major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (N = 121). INTERVENTION: Participants with LLMD were randomized to AD (sertraline) or AD plus PE (AD + PE). MEASUREMENTS: Participant characteristics that were associated with greater effectiveness of AD + PE (moderators) were identified, and effect sizes were calculated from success rate differences. Whether the characteristics of the study setting influenced participant flow and attendance at exercise sessions was then explored, and primary care physicians (PCPs) were surveyed regarding their opinions on PE as a treatment for LLMD. RESULTS:The following participant characteristics were associated with greater likelihood of achieving remission from depression with AD + PE than with AD alone: aged 75 and older (effect size 0.32), polypharmacy (0.35), greater aerobic capacity (0.48), displaying psychomotor slowing (0.49), and less-severe anxiety (0.30). The longer the PCLP had been established at a particular center, the more individuals were recruited at that center. After participating in the study, PCPs expressed positive views on AD + PE as a treatment for LLMD and were more likely to use this as a therapeutic strategy. CONCLUSIONS: The combination of PE and sertraline could improve the management of LLMD, especially when customized for individuals with specific clinical features. Liaison programs might influence the implementation of similar interventions in primary care, and PCPs viewed them positively. J Am Geriatr Soc 65: 348-355, 2017.

Do Differences in Spatiotemporal Gait Parameters Predict the Risk of Developing Depression in Later Life?

“…Furthermore, given recent evidence that physical exercise may be an effective adjunctive therapy in late‐life depression, this study also raises the possibility that exercise could also be used as a preventative strategy for depression, due to the beneficial effect it can have on gait and mobility in later life . This hypothesis would need to be tested in carefully planned interventional studies, however.…”

The neurobiological mechanisms of physical exercise in methamphetamine addiction

“…Pharmacological approaches evaluated for METH addiction may interfere with the dopaminergic reward pathways, attenuate negative reinforcing effects of withdrawal, or improve psychiatric symptoms that impair chances of remaining abstinent . This leads to several types of medications that were tested in human laboratory paradigms and in Phase II clinical trials with different outcomes as follows: dexamphetamine, methylphenidate, modafinil (DA indirectly‐acting agonists), bupropion, mirtazapine (antidepressants), aripiprazole (antipsychotics), varenicline (nicotinic receptor partial agonist), rivastigmine (cholinesterase inhibitor), perindopril (angiotensin‐converting enzyme inhibitor IECA), ibudilast (a phosphodiesterase inhibitor; glial modulator), baclofen, gabapentin (GABAergic agents), topiramate (GABAergic/glutamatergic agent), naltrexone (opioid antagonist), n‐acetylcysteine (NAC, antioxidant), ondansetron (5‐HT3 receptor antagonist), passive immunization with monoclonal antibodies against METH (ie, vaccines) . Worley et al highlighted that mirtazapine, bupropion, and methylphenidate have shown some beneficial effect in phase II clinical trials, whereas mirtazapine and bupropion increased METH abstinence, and methylphenidate reduced METH craving and use and improved depressive symptoms.…”

“…These authors found that, in a sample of 350 subjects, only 13% remained abstinent in the whole 5-year period, Initial abstinence should be addressed with supportive measures, such as healthy eating, resting, and exercising, with this one adding a promising new approach 67. These measures may aid pharmacotherapy, which is mostly unsuccessful, and psychosocial/ behavioral treatment, the main, yet flawed, strategy regarding METH , vaccines) [69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86]. Worley et al 71 highlighted that mirtazapine, bupropion, and methylphenidate have shown some beneficial effect in phase II clinical trials, whereas mirtazapine and bupropion increased METH abstinence, and methylphenidate reduced METH craving and use and improved depressive symptoms.…”

Commentary on Neural Systems in Late‐Life Depression: Clinical Presentation and Treatment Outcome

“…A study that included an interprofessional psychiatric liaison with primary care and exercise therapy randomized 121 older adults to a sertraline‐only control group or sertraline‐plus‐exercise group. Members of the group that received sertraline plus exercise were less anxious and more likely to achieve remission than those in the sertraline‐only group . Although healthcare providers have general knowledge regarding the benefits of exercise, an interprofessional team could include a physical therapist or physiatrist who could make recommendations on the most appropriate exercise based on the individual's functional status.…”

“…Increasing knowledge regarding the relationship between neural systems and LLD will help interdisciplinary teams to identify and use interventions that improve clinical outcomes . Interprofessional teams are effective in the diagnosis and treatment of multiple geriatric syndromes and could also be for LLD . The findings that Manning and Steffens present can be used to support the use of interdisciplinary teams to treat LLD, and interdisciplinary teams can use them to treat LLD and identify interventions that improve neural system function.…”