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Paed MH – Exercise can be an effective treatment option for adolescents diagnosed with depression.

Evidence Summary
1.1 Eight randomised controlled trials (RCTs), written as nine papers (since one RCT published two papers, one exploring cost/benefit analysis the other looking at treatment effects(1, 3]), were identified exploring physical activity intervention for the treatment of depression diagnosed in adolescent children. Additionally one meta-analysis and two single armed trials were identified.

1.2 All trials demonstrated a benefit compared to control/alternative intervention groups (where applicable), although one study [see 1.5] only found superior benefit after 6 months.

1.3 The majority of interventions involved a twelve week training program [2, 3, 4, 7, 8, 9]. Overall activity interventions ranged from six to twelve weeks and once weekly to three times weekly, although most scheduled three times weekly sessions.

1.4 An RCT of 176 adolescents with depression compared four treatment groups [study 10]. The authors found depression symptoms significantly reduced in the physical activity group compared to psycho-education with medium effect sizes for self-reported and clinician-rated variables. In effect the PA group had ‘minimal depression’ at the end of the study compared to mild depression for the psycho-education group. A significantly greater number of children in the PA group depression scores indicated remission of their depression.

1.5 An RCT of preferred intensity exercise of 87 adolescents receiving treatment for depression randomised patients into treatment as usual (TAU) or TAU+12 sessions of aerobic exercise(1). Immediately post intervention no change was seen between groups. However, at 6 months depression scores were statistically significantly improved in the intervention group.

1.6 Various exercise intensity strategies were implemented across the different studies, including preferred intensity [6, 10, 3], moderate intensity [11] and vigorous intensity [4]. Types of physical activity interventions included circuits [5, 3], aerobic exercises [1, 4, 7], self-directed exercise [10], pool walking [11], sport/games-based [12], dance-movement [9], small group exercise sessions [8]. Interventions were generally supervised, with some unsupervised or combination of both.

1.7 Team sport was found to be more effective than individual sports at reducing depression Beck depression Inventory scores in adolescents [12]. This was a trial of 100 students randomised to control, volleyball, badminton or soccer.

1.8 The DATE trial [5] randomised non-medicated adolescents with DSM-IV major depression into a standardized vigorous aerobic exercise program versus stretching. Both groups saw improvement in anger, fatigue, tension and depressive symptoms. The exercise group saw a quicker and significantly greater fall in CDRS depression scores by 6 and 9 weeks although these differences were no longer evident by week 12. Remission rates at the end of the trial were higher in the exercise group. By 6 months, the entire exercise group had remission with most continuing to exercise reporting they felt back to their ‘normal selves’ in terms of school performance, relationships with peers and families, and self-concept (compared to 70% in stretch group). This high remission rate persisted at one year follow-up.

Quality of Evidence
A. Several RCTs and a meta-analysis have been undertaken investigating the use of exercise for the treatment of depression in adolescent children.
Strength of Recommendation

  1. There is strong agreement between studies supporting the use of an exercise program for the treatment of depression in adolescent children.
    Conclusion
    Eight RCTs, (nine papers), one meta-analysis and two single armed trials were identified exploring physical activity intervention for the treatment of depression diagnosed in adolescent children. All demonstrated that exercise was beneficial in reducing symptoms of depression, when compared to control/alternative intervention groups. The DATE trial also found that exercise was associated with improvement in school performance and relationships with peers and families, although this association may occur after several months of exercise [see 1.5].
    References
  2. Carter T, Guo B, Turner D, Morres I, Khalil E, Brighton E, Armstrong M, Callaghan P. Preferred intensity exercise for adolescents receiving treatment for depression: a pragmatic randomised controlled trial. BMC psychiatry. 2015 Dec;15(1):247.
  3. Dop R. Exercise as Treatment for Adolescents With Depressive Disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2018 Oct; 57 (10)
  4. Cost-effectiveness of a preferred intensity exercise programme for young people with depression compared with treatment as usual: An economic evaluation alongside a clinical trial in the UK
  5. Exercise for Adolescents with Depressive Disorders: A Feasibility Study
  6. Hughes CW, Barnes S, Barnes C, et al. Depressed Adolescents Treated with Exercise (DATE): A pilot randomized controlled trial to test feasibility and establish preliminary effect sizes. Mental health and physical activity. 2013 Jun 1;6(2):119-31.
  7. Carter T, Morres I, Repper J, Callaghan P. Exercise for adolescents with depression: valued aspects and perceived change. Journal of psychiatric and mental health nursing. 2016 Feb;23(1):37-44.
  8. Bailey AP, Hetrick SE, Rosenbaum S, Purcell R, Parker AG. Treating depression with physical activity in adolescents and young adults: a systematic review and meta-analysis of randomised controlled trials. Psychological medicine. 2018 May;48(7):1068-83.
  9. Callister R, Giles A, Nasstasia Y, Baker A, Halpin S, Hides L, Kelly B. 12-weeks supervised exercise training is a feasible and efficacious treatment for reducing depression in youth with major depressive disorder. Journal of Science and Medicine in Sport. 2013 Dec 1;16:e16.
  10. Jeong YJ, Hong SC, Lee MS, Park MC, Kim YK, Suh CM. Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression. International journal of neuroscience. 2005 Jan 1;115(12):1711-20.
  11. Parker AG, Hetrick SE, Jorm AF, Mackinnon AJ, McGorry PD, Yung AR, Scanlan F, Stephens J, Baird S, Moller B, Purcell R. The effectiveness of simple psychological and physical activity interventions for high prevalence mental health problems in young people: a factorial randomised controlled trial. Journal of affective disorders. 2016 May 15;196:200-9.
  12. Roshan VD, Pourasghar M, Mohammadian Z. The efficacy of intermittent walking in water on the rate of MHPG sulfate and the severity of depression. Iranian journal of psychiatry and behavioral sciences. 2011;5(2):26.
  13. Das MR. A study and comparison of the effect of team sports and individual sports on depression among graduate level tribal students. Online International Interdisciplinary Research Journal. 2015;5(5):397-405.

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