Question:
In older adults with depression in a ward or community setting, how effective is physical activity (including exercise and physiotherapy), compared to any other intervention, in improving patient outcomes (reduction of depressive symptoms / positive effect on mood, improved skills of daily living, improved quality of life measures, improved adherence to physical and/or social activity long-term, reduced risk and frequency of falls)?
Answer:
No
definite clinical implications can be made from the available
evidence. The systematic review (SR) literature suggests that
exercise, including both aerobic exercise and resistance training
programmes, may reduce depression or depressive symptoms in older
people, with immediate and clinically relevant effects. The
mechanisms of this effect were however, unclear, and it was
suggested that there may also be a social or group effect. On the
other hand, two well-conducted randomised controlled trials (RCTs)
found no benefit of exercise programmes compared to controls on
depressive symptoms, which suggests that this relationship may not
be straightforward.
Recommendations in the literature were that exercise may be
useful as a supplementary treatment for depression in older people.
In addition, it was also suggested that as the effects of exercise
may diminish with time, exercise
should be continuous. One RCT (conducted in Taiwan) recommended
that a yoga programme be incorporated as an exercise activity in
senior activity centres or community-centres.
There is consensus among the available evidence that further
well-designed studies are needed to clarify the effectiveness of
different intervention modalities, to investigate the medium- and
long-term impact of exercise programmes, and to investigate
effectiveness of interventions in older people with different
clinical subgroups (e.g. minor, moderate, major depression).