Question

Can anyone summarize these sections for me?

5. How to Prescribe Physical Activity to Depressed Individuals:

Physical activity has been included as a treatment for depression in the context of some clinical guidelines for depression, although its importance still remains downplayed for obscure reasons [13,125], whereas it is considered as an important treatment option to reduce mortality, especially mortality associated with cardiovascular conditions [126,127]. Despite the available evidence on its efficacy for depression, exercise remains under-prescribed. The reasons may be many, but among them, clinicians are often unaware of available indications on how to deliver physical activity to depressed individuals [128–133]. Actually, one of the first obstacles to overcome in order to improve the prescription of physical activity has been identified in physician prejudices and resistance based on the belief that patients will not adhere [13,134,135], whereas depressed patients usually display good adherence to exercise programs [136]; dropout rates from RCTs that include an exercise protocol are usually low and not different from those of control groups [115]. However, the presence of an instructor or other types of supervision may be crucial to motivate patients with severe mental illnesses to adhere to exercise programs [137]. Among depressed individuals, supervision is suggested at least in the initial phases [110]. Another reason why physicians may be reluctant to prescribe exercise to depressed individuals might depend on the perception that insufficient evidence is available on its efficacy, or on difficulties identifying the right “dose” to indicate to patients. In fact, historically, it has been difficult to identify a consistent threshold in terms of frequency and duration that achieves a meaningful reduction in cardiovascular disease incidence and mortality [13,101,138]. Moreover, the existing recommendations are mainly based on guidelines derived from the general or cardiovascular populations [114,139]. Some indications, however, may be translated to depressed populations in the absence of more specific data: cardiovascular benefits are immediately evident even adding small amounts of physical activity to the daily routine. Sedentary individuals, such as depressed patients, may display a steep risk decline even adding very short bouts (e.g., 10 min or less) of moderate–vigorous physical activity. Finally, reducing sedentary time or engaging in light physical activity also reduces cardiovascular risk, although it may require more time per day [138]. In sum, little physical activity is always “better than nothing” when it comes to cardiovascular risk reduction. Similar indications may become available regarding specific effects on mood and other depressive symptoms, with preliminary evidence suggesting that resistance and mixed training may yield higher efficacy than aerobic-only training [65]. By all means, however, the pleasure associated with exercise performances should be taken into account when prescribing physical activity [140]. In this so-called affect-based exercise, the goal of physical activity programs is mainly focused on the performance of activities associated with pleasant feelings, which may in turn also favor adherence to the exercise treatment. Ladwig and colleagues [140] suggest encouraging the patient to evaluate the pleasure associated with practice on a Likert rating scale regarding personal feelings, and then autonomously regulate the intensity and duration of exercise in order to maintain a satisfactory rating score on the aforementioned scale. Despite anhedonic experiences which are commonly observed in depression, these patients may still perceive exercise Int. J. Environ. Res. Public Health 2020, 17, 5545 9 of 18 as pleasant [141–143]. The positive affective response obtained with exercise is also associated with treatment response, predicting both the improvement of depressive symptoms as well as the adherence to the exercise program [144,145]. Moreover, another barrier to the prescription and delivery of physical activity may depend on the need to involve different professionals and not necessarily physicians and other health professionals. However, for depressive and other mental disorders, it is highly recommended that the professionals involved have experience in the mental health field [146]. A collaborative and integrated approach with various disciplines is also highly recommended. Taking the public health perspective, several interventions have been promoted to increase the physical activity level of the general population [62,63]. Some have proven effective, such as those involving telephone-assisted interventions, as well as changes in the workplace environment [138]. Furthermore, it has been observed that public health interventions for the promotion of physical activity have a high probability of being cost-effective in the general population [147] and among patients with mental disorders [148]. In this context, primary care might be a preferential setting to improve the physical activity habits of patients, benefiting especially patients with cardiovascular risk factors [149,150]. However, barriers limiting the prescription of exercise by clinicians need to be addressed. Some strategies deriving from behavioral economics have been provided to help overcome decision biases concerning physical activity [149]. Limitations This narrative review entails some limitations, the most evident being the lack of a systematic approach to the literature review. However, given the complexity of the topic and the heterogeneous methodological approaches (including epidemiology, mechanisms, as well as trial results on multiple outcomes), we deemed it useful to present the public health audience, as well as clinicians, with an overview of extant secondary literature, rather than focusing on more specific aspects.

6. Conclusions:

The premature mortality of individuals with depression is a major unsolved issue not only for the mental health field, but also for public health. This phenomenon largely depends on a detrimental effect of depression on cardiovascular health, because this disorder leads to developing or exacerbating unhealthy lifestyles as well as causing imbalances across different body homeostatic systems. Among modifiable cardiovascular risk factors, physical inactivity may be the preferential target for clinical and public health interventions which may ultimately reduce the mortality gap. In fact, delivering physical exercise or physical activity may not only improve depression severity, but also directly tackle the constitutive elements of cardiovascular risk. Nonetheless, several challenges remain to be addressed by further research: (1) to provide more robust, direct evidence on the reduction in cardiovascular risk and mortality in depressed subjects; (2) to further tailor exercise- and physical activity-based interventions for depressed populations; (3) to extend the knowledge on, and tackle barriers to, exercise prescription by clinicians, and to provide them with streamlined indications to increase the prescription of exercise; (4) to assess the cost-effectiveness of exercise-based interventions; (5) to elaborate and assess public health strategies based on this effective, inexpensive and safe behavior.

Answer 1

Depression:- it is a mental health disorder in which persistently low mood or Loss of interest in activities, leads to a significant impairment in daily life.

premature mortality of individuals with depression is a major unsolved issue not only for the mental health field but also for public health

what are the barriers of recommondation of physical activity by clinicians to depression

--unawarness of available indications on how to deliver  physical activity

-prejudices and resistance based on the belief that patient will not adhere to physical activity

-RCTs( randomized controlled clinical trails) shows an exercise protocols for depression are usually low and not different from there of controlled group

-perception of inefficient evidence is available on its efficacy

-difficulty to identfy the right dose to indicate to client

-difficulty tp identify a cosistent threshold in terms of frequency and duration that achieves meaningful reduction in cardio vascular diseases and mortality

-Existing recommondations are mainly based on guidlines derived from the general or cardiovascular population

-need to involve different professionals and not necessarily physicians and other health professionals .

-a collaberative and integrated approach is highly recommonded for the effectivness of physical activity

role of physical activity in C.V.D

-Small amount of physical activities to the daily routine of client with cardio vascular disease shows good mmediate outcome

role of physical activity in depression

-sedentary individuals such as depressed clients may display a steep risk decline even adding very short bouts( 10 minutes or less) moderate vigorous physical activity

-make good changes in specific effect on mood and other depressive symptoms.

-rmixed training may yield higher efficacy than aerobic-only training

- affective based exercise helps to improve pleasant feelings

-positive affective response obtained with exercise is helps to improve treatment response

-good physical activity helps to improve depressive symptoms and increase adherence to exercise

-Ladwig and colleague suggest encourage patient to evaluate the pleasure associates with activities with the help of Likert rating scale(it is a scale used for rating personal feelings)

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what are the interventions that already done for  improving  physical activities in general population

-telephone assisted intervention

-changes in work place environment

-cost effective intervention

effect of depression on cardiovascular health

depression

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developing or exacerbation of of unhealthy lifestyle

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imbalance across different body on homeostatic systems

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cardiovascular risk

physical exercise not only improve depression severity but also tackle the constitutive elements of cardiovascular risk

several challenges remain needed to be addressed by further researches which includes:-

1)to provide more robust ,direct evidence on the reduction in cardiovascular risk and mortality in depressed subjects

2)to further tailor exercise and physical activity based intervention for depressed populations

3) to extent the knowledge on , and tackle barriers to, exercise prescription by clinicians ,and to provide them with streamlined indications to increase the prescription of exercise

4) to assess the cost effectivness of exercise based intervention

5)to elaborate and assess public health strategies based on this effective ,inexpensive and safe behavior.