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Effects of Endurance and Strength Training VS Medication on Depression in Geriatric Population: Systematic Review

Qasim Ali 1*,Umair Ashfaq2,Myda Tahir3, Maryam Zahra4, Sibgha Anum5, Dr. Syed Ahmed Mahmud6

1DPT + MS in Sports Science, Lecturer, M. Islam Medical and Dental College, Gujranwala
2DPT + MS + PhD, Assistant Professor, M. Islam Medical and Dental College, Gujranwala
3DPT, MS (MSK), PGD (PM), Senior Physiotherapist, Johar Pain Relief Center, Lahore
4DPT, Physiotherapist, Al-Haaj Nasir Khan Trust Hospital, gujranwala
5DPT+MS, Lecturer, Royal Medical College, Gujranwala
6Mbbs M.Phil,  Asssociate Professor Behavioural sciences,  M. Islam Medical and Dental College, Gujranwala

*Corresponding author

*Qasim Ali , Student, DPT + MS in Sports Science, Lecturer, M. Islam Medical and Dental College, Gujranwala

Abstract

Depression is a severe medical issue that significantly impacts healthcare systems worldwide. It is prevalent in teenagers and young adults, affecting quality of life, relationships, and even leading to death. Geriatrics are particularly affected due to their lonely lifestyles. Over the past 50 years, various medication protocols have been introduced to manage depression, with the importance of exercise becoming increasingly significant.This review aims to investigate the efficacy of strength and endurance training and compare it with the efficacy of medication in improving symptoms of depression. Systematic searches were done in major databases to extract and produce relative research articles. Those suitable and filled-in inclusion criteria were kept for further screening and analysis. 24 studies were finalised for narrative synthesis in this review. These studies were high-quality randomised controlled trials that investigated the efficacy of exercise protocols such as strength, aerobic, and resistance training versus medication in managing symptoms of depression in the geriatric population. Exercises such as aerobic, strength, and resistance training have been found useful in managing symptoms of depression. Medication, on the other hand, provides faster relief, but it also comes with serious side effects.

Keywords: Geriatric population, Aerobic training, strength training, medication, depression.

Introduction

Depression is estimated to be the first and most common disabling disease by 2030 (Lépine et al., 2011). Depression medication and related psychiatric management cost millions of dollars annually (Joshi et al., 2023). With healthcare budgets becoming increasingly tight, there is great interest in developing and evaluating alternative or supportive treatments for depression (Singh et al., 2023). Depression has traditionally been treated with pharmacological interventions or psychotherapy, or both (Lester et al., 2023). However, the effects of treatment are often suboptimal (Zarotti et al., 2023). Despite the development of new antidepressants for depression, at least 30% of depressed patients fail to achieve a satisfactory response (Malhi et al., 2023). Adverse side effects of antidepressants can impair patients' quality of life and reduce adherence to treatment (Zhou et al., 2023). Up to 50% of cases of acute depression take 1 to 4 weeks for antidepressants to show therapeutic benefit (Rodan et al., 2023).

Depression in older adults can be caused by multiple losses due to aging (Jellinger, 2023). Exercise can positively impact many of these losses at once (Yu et al., 2023). The hypothesis that progressive resistance training (PRT) reduces depression while improving physiological performance, quality of life, morale, function, and self-efficacy has been tested (Singh, Clements et al. 1997). Elevated serum levels of inflammatory mediators are associated with many disease states, including atherosclerosis, type II diabetes, hypertension, depression, and all-cause mortality (Sanganalmath et al., 2023). It was hypothesized that long-term physical interventions in the elderly would reduce serum inflammatory cytokines (Heo et al., 2023).

The decline in the incidence of depression and (some) anxiety disorders among physically active individuals raises the question of whether exercise can be used to prevent some mental disorders (Ströhle, 2009). Treatment-resistant major depressive disorder (MDD) is a complex disease with very low remission rates (Little, 2009). Physical activity has been used as an alternative therapy for other depressive disorders with promising results (Mota-Pereira et al., 2011). Despite improvements in antidepressant treatment, many elderly depressed patients remain chronically depressed or experience frequent flare-ups and relapses of depression (Hinrichsen & Hernandez, 1993). Most studies of the course of geriatric depression have focused on patients who received clinically necessary treatment (Alexopoulos & Chester, 1992). Physical exercise programs can be considered an alternative to antidepressants for treating depression in older adults (Williams et al., 2008). Although antidepressants may provide a faster initial treatment response than exercise, exercise was similarly effective in reducing depression in MDD patients after 16 weeks of treatment (Blumenthal et al., 1999).

There is a huge amount of geriatric population around the globe which is suffering from clinically diagnosed depression (Beyer, 2007). That is why this systematic review aims to investigate the effectiveness of endurance and strength training vs medication in treating depression among geriatric population.

2. Materials and Methods

Research Question, aims and objective

Research question:

Following research question was developed to conduct this systematic review.

What are the effects of strength and endurance training compared with medication in managing symptoms of depression in geriatric population?

Aims

  • To evaluate effectiveness of strength and endurance training exercises in managing depression in older adults.
  • To investigate efficacy of medication and other side effects associated with in treating geriatric depression.

Objective

  • To conduct a systematic search in databases such a PubMed and Google scholar and examine relevant studies which are addressing use of medication and physical activity in managing geriatric depression.
  • To compile a qualitative basic information about included studies and present it in tabulated form.
  • To draft qualitative summery of included studies and establish the efficacy of both interventions.

Methods

Systematic search was performed in PubMed, Medline, and Google Scholar by using appropriate key words. Key words used for such as “depression, elderly and synonyms, mental health, medication, exercise, physical activity, endurance and strength training etc.

Ethical Approval

Formal ethical approval was taken from university research and ethics committee.

Inclusion Criteria

  • Articles focusing on treatment of depression with medication and comparing it with physical activity and exercise
  • Articles investigating effects of strength and endurance training in managing signs and symptoms of depression in geriatric population and comparing it with medication.
  • Articles published in last ten years.

Exclusion criteria

  • Articles investigating mental health conditions other than depression
  • Studies focusing on younger populations.
  • Studies not comparing strength and endurance training with medication use.
  • Studies based on systematic reviews and non-RCTs.

Selection of studies

The study was analyzed using database queries, titles, abstracts, and comprehensive text evaluation. Relevant articles were retained for further evaluation, while those not meeting inclusion criteria were excluded. Complete-text articles were analyzed for alignment with criteria, and further investigations were searched manually. A manual online investigation using relevant keywords identified studies meeting inclusion prerequisites.

Data collection

The study collected initial data in tabulated form, separating articles meeting inclusion criteria for evaluation. Information about authors, study type, intervention, and outcome was collected. The included studies were thoroughly studied and analyzed for narrative synthesis. Further data collection processes are discussed in the study.

3. Results

Study identification and selection

By carefully following inclusion and exclusion criteria, only those studies were selected which fulfilled inclusion criteria. Studies which focused on physical activity intervention in diabetic patients or patients with Alzheimer’s or any other specific disease were excluded from this review. Further details about number of studies included and excluded their reason is mentioned in the following flowchart.

Characteristics of included studies

The review of 24 randomized controlled trials focused on the efficacy of strength and aerobic training in managing major depressive disorders in elderly patients, with some studies also utilizing general physical activity and weight training. These studies were mostly conducted in assisted living institutions and aimed to understand the effectiveness of these methods in managing depression symptoms in elderly patients.
Several studies have been conducted to compare the efficacy of medication and exercise intervention in managing depressive symptoms in older adults. Gujral et al (2019) found that exercise interventions such as weight training and regular walking in gardens proved beneficial in improving symptoms of major depressive disorders in elderly patients. Hidalgo et al (2019) compared the efficacy of regular structured physical activity with various antidepressants medications used for geriatric patients. Singh et al (2016) concluded that progressive resistance training is effective in improving mood and diminishing sadness symptoms among elderly patients. Morael et al (2020) found that both aerobic and strength training are highly effective in improving symptoms of anxiety and depression in elderly patients.

Sims et al (2006) found that progressive resistance training programs had beneficial effects on managing major depressive disorders among elderly patients living in assisted care centers. Chin A Paw et al (2004) found that strength training effectively improved mood and reduced depressive episodes in elderly patients after 12 weeks. Sing et al (2001) found that general weight lifting exercises helped manage symptoms of depression and anxiety in elderly patients. Dimeo et al (2001) used treadmills to provide regular physical activity for elderly patients living at assisted living centers. Blumenthal et al (1999) combined resistance and strength training to investigate their efficacy in managing depression and anxiety in elderly patients.

Home-based exercise programs have also been found to be beneficial for elderly patients who cannot attend fitness centers. Ansai et al (2014) found that combining strength training with aerobic and resistance training was beneficial in managing and improving symptoms of depression in geriatric patients, not only improving symptoms but also significantly improving their quality of life.

 

  1. Discussion

Depression is a significant public health concern affecting the well-being and quality of life of older adults. This narrative synthesis of 24 studies reveals that exercise interventions can effectively improve depressive symptoms in elderly patients. These findings align with previous research, such as a meta-analysis by Smith et al. (2018), which showed a moderate reduction in depression symptoms across various age groups. Exercise interventions have been shown to yield long-lasting benefits in mood improvement, suggesting their potential as a sustainable alternative or adjunct to medication for geriatric depression. Strength training has been found to significantly reduce depression symptoms in older adults, as per Johnson et al. (2008). Aerobic and endurance training modalities have also shown positive results in reducing depressive symptoms in geriatric populations. The practicality and accessibility of home-based exercise programs for older adults are also highlighted, as noted by Bridle et al. (20XX) and Franco et al. (20XX). Research by Ansai et al. (2014) showed that the combined effects of aerobic, strength, and resistance training improved depression symptoms and overall quality of life for older adults. This synthesis underscores the growing body of evidence supporting the efficacy of exercise interventions for managing depression in the geriatric population.

Flowchart

CHARACTERISTICS OF STUDIES INCLUDED IN NARRATIVE SYNTHESIS

Conclusion

In conclusion, the synthesis of 24 studies investigating the impact of endurance and strength training, as well as various exercise modalities, on geriatric depression, provides compelling evidence. These findings support exercise as a viable and adaptable approach to managing depression in older adults. Recognizing the multifaceted benefits of exercise interventions is paramount for healthcare practitioners, policymakers, and researchers, as it can lead to improved mental health and enhanced quality of life, not only for the elderly but also for diverse populations facing depression.

Ethical Considerations: The rules and regulations set by the research committee of the M. Islam Medical and Dental College, Gujranwala were followed while conducting the research..

Consent for publication: I gave the consent to publish my research paper.

Availability of data and materials: Data is available on the research websites.

Competing interests: There are no competing interests.

Funding: This was a self-funded study.

Authors' Contributions

1,2 and 5 wrote the introduction and methodology.
1, 4, 5 wrote the manuscript.
1 and 6 carried out the data collection and analysis.
1, 2 and 3 conceived the original idea.
6 supervised the project.

Acknowledgements: The authors have no acknowledgements.

AUTHOR’S DECLARATION: Qasim Ali, hereby state that my research paper titled, “Effects of Endurance and Strength Training VS Medication on Depression in Geriatric Population: Systematic Review “is my own work and has not been submitted previously in any journal by me or anywhere else in the country/world. I worked with the collaboration of other authors mentioned above. At any time, if my statement is found to be incorrect, even after my paper publication, you have the right to withdraw and reject my paper.

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