Assignment: Exercise as Depression Treatment Essay

Assignment: Exercise as Depression Treatment Essay

A Sample Answer For the Assignment: Assignment: Exercise as Depression Treatment Essay

Title: Assignment: Exercise as Depression Treatment Essay

Assignment Exercise as Depression Treatment Essay

Antidepressants are the main treatment modalities considered for depression disorder. Unfortunately, they are known to have many side effects. Many clinicians are willing to view and in fact encourage exercise as an adjunct therapy; however, clinicians are skeptical about substituting pharmaceutical treatment with exercise. Thus, my question is rooted in the fact that many adult patients with depression are not compliant with pharmaceutical treatment given all the unwanted side effects these medications are likely to produce. Second, a bundle of available research indicates many antidepressants are not effective for many individuals. Given these facts, exercise has been under the radar as an option for treating depression (Netz, 2017).

In order to arrive at my PICOT, I will be examining numerous research and reviews conducted, which present evidence-based facts regarding the effects of exercise on depression disorder. Kandola et al. (2016) concluded the “hippocampus in depressed individuals may be affected by neuron atrophy. Additionally, the study identifies aerobic exercise as a potentiator for promoting neuroplasticity and facilitating hippocampus function. Kandola et al. (2016) further backed this claim by concluding an increase in neuroplasticity in the hippocampus may change the structure of the region’s function thereby producing beneficial effects on cognitive malfunction of depressive disorder.

According to another study “it is possible that the antidepressant effect of exercise is caused by the interaction of several neurobiological mechanisms rather than by one mechanism exclusively. It is certain that exercise generates both acute and chronic responses, mainly in hormones, neurotrophines, and inflammation biomarkers” (Schuch et al., 2016).

The Spirit of Inquiry

Definition

Major depressive disorder also referred to as depression is a common psychiatric disorder in adults characterized by mood disorders where an individual’s mood and affect are altered. Depression is classified into major depressive disorder, persistent depressive disorder, postpartum depression, and premenstrual dysphoric disorder (Olfson, Blanco & Marcus, 2016). The typical features of depression are sadness, emptiness, somatic, and cognitive changes, and decline in the functioning capacity of an individual. It is caused by biological factors such as genetic factors and decreased levels of norepinephrine and serotonin neurotransmitters in the brain (Olfson, Blanco & Marcus, 2016). In addition, psychological factors also contribute to depression and they include work-related problems, rejection, or the presence of a chronic illness.

Epidemiology

According to a research conducted in 2009-2012 by the World Mental Health Survey, 1 in 20 adults reported to having experienced depressive symptoms. In the United States (US), 7.6% of Americans above 12 years had a depressive symptom (Bandelow & Michaelis, 2015). A survey conducted in 2013-2016 by the National Health and Nutrition Examination Survey revealed that women are highly likely to have depressive symptoms compared to men with 10.4% of women reporting to have had a depressive episode compared to 5.5% in men. Females and individuals between 40-49 years had the highest prevalence of depression. Generally, depression had the lowest prevalence among non-Hispanic Asian adults with 3.1%, while Hispanic Asians had a prevalence rate of 8.2% (World Health Organization, 2017). Moreover, non-Hispanic whites had an occurrence rate of 7.9% while non-Hispanic blacks had 9.2% in both males and females.

Depression mostly affects people living in an urban setting and is also more prevalent in people of lower socioeconomic status (Bandelow & Michaelis, 2015). According to the WHO (2017), depression is the 4^th leading cause of disability in the world, and it is estimated that it will be the 2^nd leading cause in 2020. It also significantly affects an individual’s quality of life and life expectancy and accounts for about 50% of consultations in the psychiatric clinics and 12% of hospital admissions.

Clinical Presentations

Patients presenting with depression either present with a depressed mood or loss of interest in most activities most of the day and almost every day (Olfson, Blanco & Marcus, 2016). Other symptoms include sleep disturbances such as hypersomnia or insomnia, fatigue, and low energy levels, and appetite change, which results in significant weight changes. Besides, an individual has a decreased ability to concentrate and think and also has repeated thoughts of death, suicidal ideas, or suicidal attempts (Kuo, Tran, Shah & Matorin, 2015). A patient may also complain of frequent headaches, constipation, dry mouth, low libido, and abnormal menses for females (Olfson, Blanco & Marcus, 2016). The number and severity of the patient’s symptoms determine the depressive episode as major, or minor.

Complications

Depression is a leading cause of morbidity in both men and women and the health burden is twice higher in women than in men. Post-partum depression is a significant cause of maternal mortality and poor growth in newborns since women having depressive symptoms are not able to adequately breastfeed (Gelaye et al., 2016). Furthermore, suicidal thoughts and attempts are complications of depression among both adults and adolescents, and it is estimated that about one million people commit suicide yearly (Kuo, Tran, Shah, & Matorin, 2015). Depressive symptoms may become chronic and affect a person’s ability to perform self-care activities. Lastly, abnormal menses may result in amenorrhea and female infertility.

Depression is diagnosed based on the patient’s history and by use of depression screening instruments. There are currently no available laboratory tests that can precisely diagnose depression. However, there are focused laboratory tests that are performed to

rule out medical conditions that present with symptoms of depression (Kuo, Tran, Shah & Matorin, 2015). Self-reporting depression screening tools include PHQ-9, which consists of 9 items with a score of 0-3 for each and a total score of 0-27. The PHQ-9 tool measures the degree of depression as none, mild, moderate, and severe. Other self-reporting screening instruments for adults include the Beck Depression Inventory (BDI), Zung Self-Rating Depression Scale, and Center for Epidemiologic Studies-Depression Scale (Olfson, Blanco & Marcus, 2016). Nonetheless, there are screening tools used by health care providers such as the Hamilton Depression Rating Scale as well as the Geriatric Depression Scale used for older adults.

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PICOT QUESTION: For adult female and male patients between the ages of 30-50 years of age who have been diagnosed with major depression (P) will exercise therapy (I) compared to pharmacological treatment with antidepressants alone (C) decrease symptoms of depression (O) over a period of 3 months (T).  

Search Strategy Conducted

The search undertaking reveals that whereas there is a wealth of information out there regarding a PICOT question, not all data bases have the necessary articles, as demonstrated in Appendix 1. The CINAHL database did not yield any search results. This search used the following keywords:  Adult major depression; Exercise therapy; Pharmacological intervention: Antidepressants treatment. Moreover, the search was limited to Full Text; Research Articles: Evidence Based Studies: Publication Date = 2015-2019. In addition, even the CINHAL Heading search did not yield any results after using the above keywords and limiting it to Evidence-Based Practice:  Full-text; Peer-Reviewed.

The PubMed Database search was a more fruitful as it yielded 882 articles using major depressive disorder exercise therapy as its keyword search. The search for relevant articles was limited to: Review, Free Full Text, and Publication date =5 years; Age=All Adult: Open Access Free Articles. These Limiters were important as they enabled me to filter only the articles that are relevant to this study. Moreover, the PubMed also allowed me to use the MESH search whose keywords were major depressive disorder: major depressive disorder adults: exercise therapy. However, it produced zero articles.

The Cochrane Library used the Keyword search for major depressive disorders; major depressive disorders adults: exercise therapy. The search was limited to Cochrane Reviews: Cochrane Protocols; Publication dates= 2015-2019. However, none of the search yielded any results. However, its MESH search using major depressive disorder keyword and therapy (TH); Explored both topics searched; With Qualifier therapy limiters producing 1316 articles.

In addition, the Dynamed database was also searched for relevant articles. It produced 100 articles using depressive disorders and major depressive disorders as keywords. Further, the articles were produced as a result of both Basic and Advanced searches.

On the other hand, the TRIP Database produced 61 articles that were limited to Systematic Reviews and US Guidelines regarding the management of depression in adults. The search used the PICOT format wherein all the PICOT aspects of the project were used as the keywords.

Lastly, the SU Library had various features. It allowed for one to either use conventional search or use the PICOT format. I employed the conventional format using the following keywords: Major Depressive Disorder; Major Depression Adults; Exercise Therapy. As a consequence, around 300 articles were found.

Critical Appraisal of the Evidence Performed

Adult depression is often managed using primary care. It normally occurs alongside certain somatic illness. However, evidence-based studies have led to the realization that hitherto unheralded methodologies such as exercise therapy can also manage the symptoms of adult depression. The adoption of these non-pharmacological treatments has occurred due to the fact that pharmacological therapies result in polypharmacy and other drug interactions. A study by Schuch et al. (2017) revealed that exercise therapy is indeed efficacious in the management of adult depression symptomatology after a critical analysis of several studies.  The authors further posit that the studies that they analyzed had a wealth of evidence concerning the reduction of depression biomarkers after the initiation of exercise as a therapy among the various populations who were incidentally adults of varied ages, denoting late adult depressive symptoms. However, Schuch et al. (2017) noted the absence of symptom heterogeneity screening during the exercise interventions, which they suggest that future studies should examine.  Al-Qahtani, Ashique, and Shaikh (2018) assert that depression is a major health burden that correlates with impaired functioning and deteriorating quality of life. However, the authors postulate that substantial supportive research exists for the utilization of exercise therapy in the management of depressive symptoms. The prevalence of such research was occasioned by the realization that psychological therapy and antidepressant medication interventions were fraught with limitations. Al-Qahtani, Ashique, and Shaikh (2018) conducted a literature search of various studies from the year 2006-2017 regarding the efficacy of exercise as a treatment modality for treating depression as well as the possible pathways through which exercise modulates depressive symptoms. The review of the numerous researches confirmed that exercise plays a beneficial role in depression as seen in the enhancement of the outcomes as well as the multifarious psychobiological parameters examined. Therefore, the articles by Al-Qahtani, Ashique, and Shaikh (2018) and Schuch et al. (2017) support the fundamental premise of the author’s PICOT statement, which is that treating depression with exercise is a more effective therapy than pharmacological interventions with antidepressants.

Implementation of EBP Change

In response to the PICOT statement that seeks to compare whether exercise therapy decreases depression symptoms among adult aged between 30-50 years just like using antidepressants alone for three months, a project will be implemented to determine the efficacy. Research indicates that supervised group exercise is as effective as sertraline in treating a major depressive disorder (Toups et al., 2015). The first step of the project will be a baseline assessment where community members who meet the Diagnostic and Statistical Manual of Mental Disorder fifth criteria for MDD will be enrolled in the program. The patients Hamilton rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI) scores will be recorded (Hidalgo, 2019). The eligible participants will then be randomly assigned to either an exercise therapy or medication. A stratified randomized procedure will be used to ensure that proportionate numbers of mildly and moderately to severely depressed participants are assigned to each treatment condition. Treatment will begin one week after the diagnostic interview.

The participants who will participate in the exercise therapy will attend three supervised exercise sessions per week for 16 consecutive weeks. The training ranges for each participant will be calculated using the treadmill test where 70% to 85% maximum heart rate reserve will be used as the parameter (Schuch et al., 2017). The exercise used will be aerobic sessions which will begin with a 10-minute warm-up exercise period the followed by thirty minutes of continuous walking or jogging with an intensity that would sustain the heart rate within the set training range. The exercise session will then be concluded using five minutes of cool-down exercises. Heart rate will be monitored using radial pulses and recorded as well as ratings of perceived exertions. A trained exercise physiologist will take the records three times during each exercise session.

For the group that will take medication, they will receive sertraline which is a selective serotonin reuptake inhibitor. The medication is selected because research indicates that it is efficient and it impacts favorable side profile among adults (Hearing et al., 2016). The medication will be handled by a staff psychiatrist who will meet each patient at study onset, and weeks 2, 6, 10, 14 and 16.  During the set meetings, the psychiatrist will evaluate treatment response, side effects and titrate the drug dosage accordingly. Treatment will be initiated with 50mg and titrated until a well-tolerated therapeutic dosage will be achieved up to 200mg. The usual care guidelines for medication management will be followed although a different antidepressant will not be permitted during the study.

The outcomes that will be assessed by the project are treatment response where HAM-D and the BDI scores will be recorded throughout the study period. The aerobic capacity will also be assessed at the beginning and end of the study and a symptom-limited graded exercise treadmill test will be used. The success of the project will reveal that exercise can be used as an alternative to antidepressant and will help in establishing related risks and costs (Hearing et al., 2016). For one to prescribe physical exercise as a remedy for chronic disease, the ideal approach is to have ample knowledge of the suitable exercise, its duration, frequency, and intensity.

Evaluation of Outcome

The execution of any evidence-based practice protocol or change, an evaluation of the suggested change’s efficacy as well as the compliance of the studied population to it becomes necessary. According to Melnyk and Fineout-Overholt (2015), “Stetler Model explains that the evaluation step of evidence-based practice is evaluating the plan in terms of the degree to which it was implemented and whether the goals for using the evidence were met”. The collection of the information on the present author’s PICOT that focuses on major depressive disorder: For adult female and male patients between the ages of 30-50 years of age who have been diagnosed with major depression (P) will exercise therapy (I) compared to pharmacological treatment with antidepressants alone (C) decrease symptoms of depression (O) over a period of 3 months (T), will make it possible for the efficacy of the intervention to be determined through the application of multifarious evaluation tools. In the present study, depression measuring tools such as the PHQ-9 tool, the Hamilton Depression Rating Scale, and the Beck Depression Scale will be adopted to gather data from the patients.

The PHQ-9 tool will play an important role in determining the severity of depression amongst the chosen population as it offers insights into the severity of depression. In order to arrive at this, patient information regarding the symptomatology of depression and the manner in which they have reduced or increased during the exercise period will be determined. Data concerning the patient’s interest in doing things and feeling depressed will be gathered for exercise and pharmacological interventions populations. Moreover, questions about the effect of the tool on the quality of sleep enjoyed by the patients will also receive attention using the PHQ-9 tool (Adams et al., 2015). In other words, the tool will be used to determine whether the prevalence of symptoms as indicated by the patients at the beginning of the regimen will have reduced or increased by the end of the project period.

Moreover, the effectiveness of major depression amongst the respondents will be determined using the Hamilton Depression Rating tool. In this tool, the present author will administer a structured interview containing 17-items related to the symptomatology of major depression (Knapen, Vancampfort, Moriën, & Marchal, 2015). In addition to the interest of the patient in doing things, the HDR tool will also look to examine the patients’ appetite levels, their concentration levels on aspects such as newspaper reading and speaking or moving slowly in a noticeable manner will be gathered. The data collection will occur for the group that will be subjected to exercises and the one that will be using antipsychotic drugs during the same period in order to get data regarding the effectiveness of both in managing depression.

Once the data has been gathered using the above instruments, a statistical analysis will be conducted for specific interventions. Afterwards, a statistical comparison will occur to determine the effectiveness of each of the interventions. The comparison will reveal whether using exercise as a standalone therapy is more effective compared to antidepressants. Moreover, the results will be shared with the relevant stakeholders to facilitate application in practice (Brewer & Alexandrov, 2015). Also, disseminating the results of the study to professionals in the field using methodologies such as peer-reviewed journals will be crucial as it will add onto the increasing body of evidence regarding the application of exercise as a therapy to reduce the symptoms of depression. As such, clinical decision-making will be enhanced as a consequence of the present EBP project as it makes a comparative analysis of two interventions.

Project Dissemination

            The evidence-based project focused on determining whether exercise may prove essential in the prevention and management of depression in adult patients. The examination of the literature revealed that indeed exercise is integral in the management of adult depression. The result will play an integral role in managing the condition amongst the project population. As a matter of fact, depression is amongst the leading causes of death amongst the study group. As such efforts need to be made to curb it. One of the ways that this can be done is through the dissemination of the present evidence-based study. However, in order to get the information to the necessary stakeholders, it becomes imperative to determine an appropriate methodology. One of the ways that this can occur is through the adoption of peer reviewed journals. Publishing the results of the outcome revealing that exercise may manage major depressive disorder will aid health care practitioners to formulate appropriate strategies exclusive of antidepressants. As such, people suffering from the condition will not suffer from adverse events associated with antidepressants.

            Printing the results in journal articles will aid about 46% of practitioners who depend on the channel to make evidence based decisions as regards appropriate methodologies for the management of the same. Moreover, the dissemination of the evidence-based project outcome will be paramount to policy holders and the manner in which they make decisions. As such, using methodologies such as PowerPoint presentation to disseminate the results to internal stakeholders will prove instrumental. In addition, group meetings wherein the health care provider will present the outcome of the present study will also fundamentally influence their decisions and policies as regards the management of major depressive disorder. Other channels such as group meetings, focus groups and seminars.

Sample Answer for Assignment: Exercise as Depression Treatment Essay Included

Assignment: Exercise as Depression Treatment Essay Conclusion

            Major depressive disorder has been linked with several adverse events chief among them suicide. Moreover, people suffering from this conditions suffer from other associated difficulties such as functional challenges. The diagnosis of major depressive disorder occurs through several symptomatology. The evaluation of the literature review revealed that interventions such as exercise therapy are effective in the management of major depressive disorder. The evaluation of the data occurred based on the reduction of the symptoms of major depression when both antidepressants and exercise therapy were used. In other words, the remission levels of the major depression disorder symptoms were adopted to determine the effectiveness of exercise therapy. Moreover, multifarious methodologies such as journal articles, group discussions and PowerPoint presentations would be used to disseminate the project outcomes.

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Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource