Treating depression in seniors with walking or weight training – Blog en santé

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 A clinical trial compared the efficacy of brisk-walking and muscular strengthening in reducing depressive symptoms in people over 60 with arthritis.

 A randomized controlled trial published in 2002 by Penninx and colleagues in the Journal of Gerontology compared the benefits of a walking (endurance) program and of a muscular strengthening (resistance) program to reduce depressive symptoms in people over 60 years of age suffering from arthritis. After 18 months, the endurance program yielded better results.

The Study Rationale

The psychological benefits of physical activity for seniors are less known than the physiological effects. Several cohort studies have suggested that people who exercise regularly are less depressed than physically inactive ones. Other studies have shown that depressed people have more sedentary lifestyles then nondepressed ones. Even so, these studies did not highlight any direct causal effect between regular physical exercise and mood disorders. No proof was given that the adjunct of a physical activity program to the daily life of seniors could significantly reduce their depressive symptoms.

Moreover, these cohort studies did not distinguish between physical activities. Should endurance exercise, such as walking, swimming, biking or rowing be favored? Or should resistance exercise, such as muscular training with repetitions, or gymnastics, be recommended instead? Or is it possible all activities yield equal results after all?

The Question

Should seniors with arthritis engage in endurance or resistance training to alleviate their depressive symptoms?

The Protocol

This American randomized controlled trial published in 2002 by Penninx and colleagues in the Journal of Gerontology compared two physical exercise programs to reduce depressive symptoms in seniors: one program focused on endurance and involved brisk-walking; the other was based on resistance training and involved muscular strengthening with repetitions. The endurance program comprised 3 one–hour supervised sessions per week of indoor walking for 3 months, followed by a 15-month personalized at-home walking program performed either outdoors, indoors or on a treadmill at home. Each session consisted in a 10-minute warm-up followed by 40 minutes of walking at an intensity equivalent to a 50-70% heart reserve rate, and was concluded with a 10-minute cool down phase including stretching. Monthly telephone support was offered to participants. The resistance program was also based on 1-hour supervised sessions. The 40-minute core of each session included upper-body and lower-body muscular strengthening. Weights were adjusted individually. Each participant had to complete at least 2 sets of 10 repetitions. At home, participants were required to maintain the same regularity as that required for the endurance program. Weights could be exchanged upon request.

428 people of a mean age of 69 years participated in the study. They were randomly assigned to either of three groups: the endurance group, the resistance group and the health education group, which received arthritis management advice (3 sessions over 3 months, plus follow-up).

Main Results

After 18 months, the results evidenced a statistically significant effect of the endurance program on depressive symptoms. Conversely, there was no statistically significant change in the resistance or health education groups. The effect was greater for people with higher depression levels and higher program compliance rates. Both pain and disability were reduced for members of the two exercise groups. At the end of the 3-month program, symptomatology scores were reduced by 20% for the health education group, 30% for the resistance group, and 40% for the endurance group.

What it means for Patients

When fighting depression after 60 years of age, it is best to engage in endurance physical activities such as brisk-walking three times per week than in muscular training exercise.

What it means for Healthcare Professionals

This study revealed the antidepressant effect of brisk-walking 3 times per week in people over 60 with arthritis. This activity was the most beneficial for people with the highest depressive scores.

What it means for Researchers

This study focused on a comorbidity of arthritis. In the end, it is not clear whether depressive symptoms, as measured with the CES-D self-report scale, are related to ageing or to the consequences of arthritis.

What it means for Policymakers

Endurance-type physical activity performed three times per week should be recommended for people over 60 to reduce depressive symptoms.

 The reference

Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, Pahor M (2002). Exercise and depressive symptoms: A comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. Journal of Gerontology: Psychological Sciences, 57, 124-132.

To reference this Blog en Sante ©  article.

Ninot G (2014). Treating depression in seniors with walking or weight training. Blog en Sante, A26.

© Copyright 2014 Grégory Ninot. All rights reserved.