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).