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EXCI 420-A > PPT 7 ET/Depression > Flashcards

PPT 7 ET/Depression Flashcards

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1
Q

What is depression?

A

Common and serious illness that negatively affects how you feel, the way you think and how you act

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2
Q

DSM-V criteria for major depression. Main plus 4+ symptoms

A

1- depressed mood and or uninterested in activities
2- symptoms: weight gain or loss, insomnia/hyper, psychomotor retardation/agitation, fatigue, feeling of guilt, reduced concentration, suicidal ideas

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3
Q

% of global annual incidence of MDD

A

3%

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4
Q

Lifetime incidence of MDD

A

15-20%

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5
Q

% of adolescents will have diagnosis of depression by the age of 18

A

11%

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6
Q

Does risk for depression increases with age

A

yes

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7
Q

what is the third leading cause of death among adolescents

A

suicide

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8
Q

is MDD a leading cause of illness and disability across all ages

A

yes

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9
Q

women or men have higher rates of depression

A

women

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10
Q

women 18-24 have x amount higher depression than men

A

3x

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11
Q

is depression more prevalent in people with chronic disease

A

yes

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12
Q

Canada: is ? higher in chronic disease population compared to general population (~5%)

A

two- to threefold

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13
Q

4 categories of non communicable diseases

what is the % worldwide of death and in canada

A

1- cvd
2- diabetes
3- chronic resp disease
4- cancer

  • 70%
  • 64% canada
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14
Q

4 things that cause depression

A

1- inflammation
2- genetic
3- neurochemical
4- life experiences

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15
Q

1- inflammation 4 traits

A

heat
pain
swelling
redness

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16
Q

Individuals living with depression typically tend to exhibit higher OR lower levels of the pro-inflammatory cytokines compared to non-depressed individuals

A

higher

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17
Q

2- Genetics: is there a gene

A

no

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18
Q

3- Neurochemical is what, list 3 NT

A

problems or imbalances in the brain, specifically with the NT:

  • serotonin,
  • norepinephrine,
  • dopamine
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19
Q

4- Life Experiences describe + ex like divorce etc.

A

Major stressful event can contribute to development of depression
Divorce, being bullied, financial difficulties, death of a child or other family member.

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20
Q

2 ways to treat depression

A

1- Pharmacotherapy

2- Psychotherapy- Cognitive-behavioural therapy

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21
Q

Issues with Pharmacotherapy 5

A

1- Individual variability from person-to-person

2-Many side effects (e.g. bleeding, seizure)

3-Low adherence rate

4-Cost of treatment

5-Low perception of effectiveness among patients

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22
Q

Issues with Psychotherapy- Cognitive-behavioural therapy 2

A

1- Accessibility issues

2- Costs

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23
Q

Name some benefits of ET

A 
1- Maintains healthy weight
2- Improves cardiorespiratory capacity
3- Improves sleep
4- Beneficial effects on physical health
5- Improves quality of life
6- Improves + mood
7- Promotes social integration 
8-Increases energy
9-Reduces stress levels
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24
Q

3 benefits on physical health

A

1-Reduces risk of mortality in CVD
2-Reduces dyspnea in COPD/Asthma
3-Improves survival in cancer

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25
Benefits of exercise Regarding depression | 4
Exercise is related to positive changes in mood state Less (if none) negative side effects than antidepressants May reduce the negative side effects of antidepressants (e.g. constipation) Inexpensive treatment
26
Exercise and depression in adults greater in older or younger
older
27
Long-term effect of ET
small effect in favour of exercise
28
clear dose–response relationship overall?
no | Even infrequent participation in exercise (e.g. 1–2 days/week) is associated with reduced likelihood of depression
29
is ET able to decrease depressive symptoms in people with chronic disease
yes
30
Name gaps in the literature for chronic illness and ET. | 3 (focused, few studies and no ? reviews)
1- focus on multi-component interventions but just ET 2- Few studies has assessed the relationship between exercise and depression in patients with asthma and type 2 diabetes (T2D) 3- No systematic reviews have examined specifically the role of aerobic exercise on depressive symptoms in NCDs
31
What was her thesis
Assess the efficacy of aerobic exercise on depressive symptoms in people living with a NCD compared to no treatment (i.e. usual care).
32
What was the type of study
Type of study: Systematic review and meta-analysis
33
What is a systematic review?
Literature review designed to synthesize all empirical evidence relating to a clearly formulated research question
34
What does a systematic review identify, appraises and summarizes?
Identifies relevant studies, appraises their quality and summarizes the evidence through explicit methodology
35
What kind of answers does a systematic review provide
Provides informative and evidence-based answers
36
List the type of studies from low evidence to high 9
``` 1- background info 2- individual case reports 3- case series or studies 4- cohort 5- non randomized controlled trials 6- randomized controlled trials 7- critically appraised literature 8- systematic review 9- meta analysis ```
37
8 procedure steps of systemic review
``` 1-Develop research question (Population, Intervention, Control, Outcome) 2-Develop search strategy 3-Contact research librarian 4-Literature search 5-Data extraction 6-Data analysis 7-Interpretation of findings 8-Writing & editing for publication ```
38
Define the PICOS of the study
P: Adults living with a NCD I: Aerobic exercise intervention; C: No exercise (usual care) O: Reduction in depressive symptoms or depression
39
What was the aerobic exercise intervention criteria. | Intensity and time
Moderate intensity (> 50% HRT), at least twice a week, 4 weeks
40
Her main question was can aerobic...
Can an aerobic exercise intervention, compared to no exercise, reduce depressive symptoms in adults living with a NCD?
41
Type of study what was the: intervention language published date
- randomized/non - english or french - studies published until june 29th 2017
42
What was the chosen population
age above 18 | living with NCD
43
What was the intervention
aerobic exercise
44
Name some data analysis methods that were used. 4
1- standardized difference in means 2- random effects model 3- funnel plot 4- Cochran's Q and Higgings I2 test
45
Subgroup analyses performed according to. 4
1- # days of training 2- duration of sessions 3- length of intervention 4- type of NCD
46
standardized difference in means effect ranges
small: 0.2-0.5 med: 0.5 - 0.8 large: 0.8 and higher
47
Results: how many participants and their age
4111 age 34-70
48
Results intervention criteria: frequency training time of session length of program
frequency: 2 and 5 sessions/week Time: 20 and 80 mins Length: 4 and 24 weeks
49
What were the two limitations
1- lack of homogeneity across studies | 2- Usual care may not have been similar across studies and NCDs
50
What were the two strengths
1- Thorough search methods 2-Studies different on several levels (patient populations, quality…)
51
lack of homogeneity was driven from what
driven by some large effect sizes and small sample sizes
52
lack of homogeneity reduces what
Reduces clinical impact of findings
53
Usual care may not have been similar across studies and NCDs. Attempts to reduce what
Attempt to reduce disparities using inclusion/exclusion criteria
54
Studies different on several levels (patient populations, quality…) increases?
Increases generalizability of findings
55
what was the conclusion
Overall, aerobic exercise more efficacious than usual care. Most efficacious in CVD
56
are Length of intervention, number of days and duration key factors
no
57
What are the NICE ET guidelines
45-60 minutes/session 3 sessions per week 12 weeks
58
What are the potential mechanisms explaining a link between exercise and depression?
1- Physiological | 2- psychological
59
What are the 3 - Physiological hypothesis
1-Monoamine hypothesis 2-Inflammation hypothesis 3-Endorphin hypothesis
60
Explain the monoamine hypothesis
Exercise increases the availability of brain neurotransmitters
61
monoamine hypothesis studies are conducted on who
animals. unknown if applicable to human brain
62
2-Inflammation hypothesis
Individuals with depression have elevated concentrations of pro-inflammatory biomarkers Exercise has been shown to reduce these biomarkers.
63
3-Endorphin hypothesis
Exercise leads to surge of endorphins | Reduce pain and provide state of euphoria
64
Do endorphins directly alter mood state or indirectly facilitate improved mood through energy conservation during exercise
it is unclear
65
Can euphoria state can be experienced at low level of intensity
yes
66
Is High intensity level of exercise required to release endorphin
yes
67
4- Psychological mechanisms
1-Distraction hypothesis 2-Self-efficacy theory 3-Mastery hypothesis 4-Social interaction
68
1-Distraction hypothesis
Diversion from unpleasant stimuli or painful somatic complaints leads to improved affect following exercise
69
Distraction hypothesis: support for long term effect?
no
70
2-Self-Efficacy Theory
Level of confidence that one feels it possesses to meet the challenge at hand Confidence in one’s ability to exercise is strongly related to one’s actual ability to perform the behavior
71
Individual with high self-efficacy for exercise are more likely to exercise yes or no
yes
72
Mastery Hypothesis
Mere fact of exercising can make patients feel like they have achieved something
73
Mastery Hypothesis mediator between
PE and QOL
74
Social Interaction Theory
Social relationships and mutual support provided to one another by co-exercisers might account for antidepressant effects
75
Social Interaction Theory results
mixed, Could be more important for older people
76
``` 4 Limitations of current studies 1- gap in 2- lack of studies 3- most studies do not 4- Most studies dont look at whether exercise can.. ```
Gaps in litterature regarding long-term effects of exercise Lack of studies looking at potential mechanisms Most studies do not assess for clinical depression Most studies do not look at whether exercise can treat clinical depression
77
4 reasons why good quality research is lacking
1-Not always a distinction between PA and PE (except in intervention studies) 2- Few studies intent-to-treat 3-Not always including a control group 4-Usually targeting low/mild depression
78
Overall conclusion about ET
it provides moderate benefits
79
What exercise is a good treatment of mild to moderate depression
Both high & low-dose aerobic exercise
80
True or False: Exercising 3 times per week is at least as effective as 5 times per week
true
81
Exercise therapy should be done by what person
qualified professionals
82
True or false: encourage exercise as an adjunct to other forms of therapy
true
83
should FITT be common or individualized
individualized
84
In future: RCTs should include 2 things
allocation concealment | Intent-to-treat analysis
85
In future: studies should compare what
exercise and other alternative treatment to depression (e.g. music therapy)
86
should there be a Systematic follow-up to see effect on long-term on depression and adherence to exercise
yes

EXCI 420-A (7 decks)

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