Influence Of Psychotherapy And Gender On Depression

In addition to these general effects, some of these meta analyses (Landers & Petruzzello, 1994; Petruzzello et al., 1991) that examined more studies and therefore had more findings to consider were able to identify several variables that moderated the relationship between exercise and anxiety reduction. Compared to the overall conclusion noted above, this is based on database. More research, therefore, is warranted to examine further the conclusions derived are based on a much smaller variables. The meta-analyses show that the larger effects of exercise on anxiety reduction are shown here:

a. The exercise is “aerobic” (e.g., running, swimming, cycling) as opposed to nonaerobic (e.g. handball, strength-flexibility training),
b. The length of the aerobic training program is at least 10 weeks and preferably greater than 15 weeks, and  
c. Subjects have initially lower levels of fitness or higher levels of anxiety. The “higher levels of anxiety” includes coronary
(Kugler 1994) and panic disorder patients (Meyer, Broocks, Hillmer – Vogel, Bandelow, & Ruther, 1997).

In addition, there is limited evidence which suggests that the anxiety reduction is not an artifact “due more to the cessation of a potentially threatening activity than to the exercise itself” (Petruzzello, 1995, p. 109), and the time course for postexercise anxiety reduction is somewhere between four to six hours before anxiety returns to pre-exercise levels (Landers & Petruzello, 1994).

It also appears that although exercise differs from no treatment control groups, it is usually not shown to differ from other known anxiety-reducing treatments (e.g., relaxation training). The finding that exercise can produce an anxiety reduction similar in magnitude to other commonly employed anxiety treatments is noteworthy since exercise can be considered at least as good as these techniques, but in addition, it has many other physical benefits.
EXERCISE AND DEPRESSION
Depression is a prevalent problem in today’s society. Clinical depression affects 2-5% of Americans each year (Kessler et al., 1994) and it is estimated that patients suffering from clinical depression make up 6-8% of general medical practices (Katon & Schulberg, 1992). Depression is also costly to the health care system in that depressed individuals annually spend 1.5 times more on health care than nondepressed individuals, and those being treated with antidepressants spend three times more on outpatient pharmacy costs than those not on drug therapy (Simon, VonKorff, & Barlow, 1995). These costs have led to increased governmental pressure to reduce health care costs in America. If available and effective, alternative low-cost therapies that do not have negative side effects need to be incorporated into treatment

plants.

nondepressed, clinically exercise and persists beyond the end of the exercise program (Craft, 1997; North et al., 1990). These effects are also consistent across age, gender, exercise group size, and type of depression inventory.

a. The exercise training program was longer than nine weeks and involved more sessions (Craft, 1997; North et a;., 1990); 

b. Exercise was of longer duration, higher intensity, and performed a greater number of days per week (Craft, 1997); and
c. Subjects were classified as medical rehabilitation patients (North et al., 1991) and, number on questionnaire instruments, were classified as moderately/severely depressed compared to mildy/moderately depressed (Craft, 1997).
The latter effect is limited since only one study used individuals who were classified as severely depressed and only two studies used individuals who were classified as moderately to severely depressed. Although limited at this time, this finding calls into question the conclusions of several narrative reviews (Gleser & Mendelberg, 1990; Martinsen, 1987), which indicate that exercise has antidepressant effects only for those who are initially mild to moderately depressed.

The meta-analyses are inconsistent when comparing exercise to the more traditional treatment for depression, such as psychotherapy and behavioural interventions (e.g., relaxation,  meditation), and this may be related to the types of subjects employed. In examining all types of subjects, North et al. (1990) found that exercise decreased depression more than relaxation training or engaging in enjoyable activities, but did not produce effects that were different from psychotherapy. Craft (1997), using only clinically depressed subjects, found that exercise produced the same effects as psychotherapy, behavioral interventions, and social

contact. Exercise used in combination with individual psychotherapy or exercise together with drug therapy produced the larges effects; however, these effects were not significantly different from the effect produced by exercise alone (Craft, 1997).

That exercise is very effective as more traditional therapist is encouraging, especially considering the time and cost involved with treatments like psychotherapy. Exercise may be a positive adjunct for the treatment of depression since obesity can also cured through exercise which behavioral interventions do not. Thus, since exercise is cost effective, has positive health benefits, and is effective in alleviating depression, it is a viable adjunct or alternative to many of the more traditional therapies future research also needs to examine the possibility of systematically lowering antidepressant medication dosages while concurrently supplementing treatment with exercise.

OTHER VARIABLES ASSOCIATED WITH MENTAL HEALTH 

Positive mood: The Surgeon General’s Report also mentions the possibility of exercise improving mood. Unfortunately the area of increased positive mood as a result of acute and chronic exercise has only recently been investigated and therefore there are no meta analytic reviews in this area. Many investigators are currently

examining this subject and many of the preliminary results have been encouraging.

It remains to be seen if the additive effects of these studies will result in conclusions that are as encouraging as the relationship between exercise and the alleviation of negative mood states like anxiety and depression.
Self-esteem: Related to the area of positive mood states in the area of physical activity and self-esteem. Although narrative reviews exist in the area of physical activity and enhancement of self-esteem, there are currently four meta-analytic reviews on this topic (Calfas & Taylor, 1994; Gruber 1986; McDonald & Hodgdon, 1991; Spence, Poon, & Dyck, 1997). The number of studies in these meta-analyses ranged from 10 studies (Calfas & Taylor, 1994) to 51 studies (Spence et al., 1997). All four of the reviews found that physical activity/exercise brought about small, but statistically significant, increases in physical self-concept or self-esteem.

These effects generalized across gender and age groups. In comparing self-esteem scores in children, Gruber (986) found that aerobic fitness produce much larger effects on self-esteem scores than other types of physical education class activities (e.g., learning sports skills or perceptual-motor skills). Gruber 91986) also found that the effect of physical activity was larger for handicapped compared to non handicapped children.
Restful sleep: Another area associated with positive mental health is the relationship between exercise and restful sleep. Two meta analyses have been conducted on this topic (Kubitz, landers, Petruzzello, & Han, 1996; O’Connor & Youngstedt, (1995). The studies reviewed have primarily examined sleep duration and total

sleep time as well as measures derived from electroencephalographic (EEG) activity while subjects are in various stages of sleep. Operationally, sleep researchers  have predicted that sleep duration, total sleep time, and the amount of high amplitude, slow wave EEG activity would be higher in physically fit individuals than those who are unfit ( chronic effect) and higher on nights following exercise (i.e. acute effect).
This prediction is based on the “compensator’ position, which posits that ‘fatiguing daytime activity (e.g. exercise) would probably result in a compensatory increase in the need for and depth of nighttime sleep, thereby facilitating recuperative, restorative and/or energy conservation processes” (Kubtiz et al., p.  278).
The sleep meta-analyses by O’Connor and Youngstedt (1995) and Kubitz et al. (1996) show support for this prediction.
Both reviews show that exercise significantly increases total sleep time and aerobic exercise decreases rapid eye movement (REM) sleep. REM sleep is a paradoxical form in that it is a deep sleep, but it is not as restful as slow wave sleep (i.e, stages 3 and 4 sleep). Kubtiz et al. (1996) found that acute and chronic exercise was related to an increase in slow wave sleep and total sleep time, but was also related to a decrease in sleep onset latency and REM sleep.
These findings support the compensatory position in that trained subjects and those engaging in an acute bout of exercise went to sleep more quickly, slept longer, and had a more restful sleep than untrained subjects or subjects who did not exercise. There were moderating variables influencing these results. Exercise had the biggest impact on sleep when:
a. The individuals were female, low fit, or older,
b. The exercise was longer in duration; and
c. The exercise was completed earlier in the day (Kubitz et al.,1996).