Holly Blake

How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review

Background: The benefits of physical exercise in reducing clinically defined depression in the general population have been established, although a review of the evidence for older adults is needed. Objectives: To assess the efficacy of physical exercise for the treatment of depressive symptoms in older adults (>60 years). Data sources: We searched: MEDLINE (1966—May 2008); EMBASE (1980—May 2008); Cumulative Index to Nursing & Allied Health Literature (CINAHL; 1982—May 2008); PsycINFO (1966—May 2008), The Cochrane Library (Issue 2, 2008), and National Research Register (NRR; Issue 2, 2008). Review methods: Randomized controlled trials and quasi-experimental studies of physical exercise interventions for depression were included where 80% or more of participants were >60 years. Abstracts were assessed to determine whether they met specified inclusion criteria. Primary analysis focused on the prevalence of diagnosable depressive disorder following intervention. Secondary outcome was depression or mood scores on standardized scales. Results: Eleven randomized controlled trials with a total of 641 participants were included in the review. Short-term positive outcome for depression or depressive symptoms was found in nine studies, although the mode, intensity and duration of intervention varied across studies. Medium- to long-term effects of intervention were less clear. Conclusion: Physical exercise programmes obtain clinically relevant outcomes in the treatment of depressive symptoms in depressed older people. Exercise, though not appropriate for all in this population, may improve mood in this group. Further research is needed to establish medium- to long-term effects and cost-effectiveness.

Factors associated with strain in co-resident spouses of patients following stroke

Objective: To identify the factors associated with carer strain following stroke. Design: Co-resident spouses of stroke patients were sent questionnaire measures of their perceptions of strain, stress, mood, handicap, adjustment, social support, life satisfaction and personality, and patients mood and independence in activities of daily living. Setting: Stroke spouses were identified from the stroke register at City Hospital, Nottingham. Results: In a sample of 222 carers, 37% had significant strain. Strain was highly correlated with negative affectivity on the Positive and Negative Affectivity Scale, carer mood on the General Health Questionnaire-12 (GHQ-12) and carers perceptions of patients independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Logistic regression analysis of 96 of these carers supported the correlations and showed three factors, carer GHQ-12, patient EADL and negative affectivity, were independently associated with carer strain. Conclusion: The relationship between these factors and strain needs to be tested prospectively. Early identification of carers who may be at risk of strain later on will enable services to be targeted at prevention rather than cure.

Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis

To synthesize evidence from randomized and non‐randomized studies of physical activity interventions in children and young people with Type 1 diabetes so as to explore clinically relevant health outcomes and inform the promotion of physical activity.

‘Do as I say, but not as I do’: Are next generation nurses role models for health?

Aim: Promoting healthy lifestyles plays a key role in professional nursing yet nurses do not always practice what they preach. Efforts are currently being made to improve the health of NHS staff, yet little is known about the health and lifestyle behaviours of pre-registration nurses in the UK although these individuals are our next generation of NHS employees. The aim of this study was to investigate the health behaviours and wellbeing of pre-registration nurses based at an acute NHS teaching hospital in England. Methods: In this cross-sectional questionnaire survey, 325 pre-registration nurses (50% response rate) completed a health and lifestyle questionnaire, measuring levels of physical activity, smoking and alcohol behaviour, dietary practices and general health. Results: Age ranged from 19-53 years, and 96% of the sample was female. More than half of the sample did not meet public health recommendations for physical activity. Just under one-fifth were current smokers and over three-quarters did not consume five servings of fruit/vegetables per day. Two-thirds reported exceeding the recommended maximum daily alcohol intake and around one third were classified as either overweight or obese. Those who were physically inactive were less likely to report good general health, good dietary practices and more sleep, and were more likely to report cigarette smoking and alcohol consumption than their active counterparts. Conclusions: This study indicates that the health profile of pre-registration nurses is relatively poor, and that those who are sedentary engage in other negative lifestyle behaviours also. Despite significant education relating to health promotion and health behaviours of patients being targeted at pre-registered nurses, it seems that this knowledge is not always transferred to their own behaviour. There is a need for timely intervention to establish healthy lifestyle behaviours amongst nurses early in their career.

Evaluation of cognitive assessment in stroke rehabilitation

Objective: To assess the effect of cognitive assessment on the functional outcome of stroke patients and quality of life for both patients and their carers. Design: A multicentre, single-blind, randomized controlled trial. Setting and participants: Two hundred and twenty-eight stroke patients were recruited from hospital wards in three UK centres. Interventions: Patients were screened for cognitive impairment and randomly allocated to either routine care (116 patients) or routine care plus a detailed cognitive assessment (112 patients). Main outcome measures: Outcome was assessed three and six months after recruitment by an independent assessor blind to the intervention on Extended ADL, Cognitive Failures Questionnaire, General Health Questionnaire-28 for patients and carers and Carer Strain Index. Results: There was no signi”cant difference between the two groups in patients’ functional outcome, perceived cognitive ability, level of psychological distress or satisfaction with care. There was a trend for the assessment group to have lower levels of carer strain (p = 0.06). Conclusions: The provision of information about cognitive assessment in stroke rehabilitation may decrease carer strain.

Computer-based learning objects in healthcare: the student experience.

Web-based computer learning objects, such as Reusable Learning Objects (RLOs), are becoming more commonplace in nursing and medical education. However, evaluation of RLOs specifically has been limited. The aim of the study was to determine how RLOs impact on the student learning experience and to compare the use and evaluation of RLOs by nursing and medical students. An online questionnaire survey was completed by 233 students (163 nursing and 73 medical). RLOs were more commonly used by nursing students than medical students. Students in both disciplines valued RLOs for flexibility of learning, as revision aids, and to supplement classroom-based learning. Nursing and medical students have different learning needs, and developing materials at the right level of learning is important. Barriers to the use of RLOs included lack of IT competence, technical difficulties, and lack of staff awareness of computer-based learning aids.

Physical activity and exercise in the treatment of depression

Mental health problems continue topresent a global challenge and contributesignificantly to the global burden ofhuman disease (DALYs). Depression isthe most common psychiatric disorderand is thought to affect 121 million adultsworldwide, and as such was rated as thefourth leading cause of disease burden in2000 (Moussavi et al., 2007), projected tobecome the highest cause of disease bur-den by 2020. Antidepressant drugs are aneffective and commonly used treatmentfor depression in primary care (Arrollet al., 2009), although almost half of thosetreated do not achieve full remission oftheir symptoms, and there remains a riskof residual symptoms, relapse/recurrence(Fava and Ruini, 2002). In those patientswho do demonstrate improvements indepressive symptoms with antidepres-sant therapies, a time-lag in the onset oftherapeutic effects is frequently reported.Antidepressant drugs are associated withadverse side effects (Agency for HealthResearch and Quality (AHRQ), 2012)and an increased risk of cardiovascu-lar disease, particularly in those withpre-existing cardiovascular conditions ormajor cardiovascular risk factors (Waring,2012). Furthermore, adherence to antide-pressant medications is often poor andpatients often prematurely discontinuetheir antidepressant therapy; it has beensuggested that approximately 50% of psy-chiatric patients and 50% of primary carepatients are non-adherent when assessed6-months after the initiation of treatment(Sansone andSansone, 2012).Psychological treatments for depres-sion have been recommended in theUK National Institute for Health andClinical Excellence (NICE) guidelines(NICE, 2009) and are becoming morecommonplace for helping to reducesymptoms in depressed adults (Ambresinet al., 2012; Brakemeier and Frase, 2012),with even brief psychosocial interven-tions showing promise for improvingadherence to depression medication treat-ment in primary care settings (Sirey et al.,2010).However,attendance atpsychologi-cal intervention sessions can be poor sincemany depressed adults who may benefitfromsuch treatments choosenotto attendmental health clinics due to the perceivedstigma ofpsychological therapies.As such there has been an increasinginterest in the role of alternative inter-ventions for depression. Physical exercisehas been proposed as a complementarytreatment which may help to improveresidual symptoms of depression and pre-vent relapse (Trivedi et al., 2006). Exercisehas been proposed by many as a poten-tial treatment for depression and meta-analysis has demonstrated that effect sizesin intervention studies range from -0.80to -1.1 (Rethorst et al., 2009). However,the evidence is not always consistent;recent research has shown that that pro-vision of tailored advice and encourage-ment for physical activity did not improvedepression outcome or antidepressant usein depressed adults when compared withusual care (Chalder et al., 2012). Otherresearchers have failed to find an antide-pressant effect of exercise in patientswith major depression but have foundshort term positive effects on physicaloutcomes, body composition and mem-ory (Krogh et al., 2012). Others haveargued that the nature of exercise deliv-ery is an important factor, with exer-cise of preferred (rather than prescribed)intensity shown to improve psychological,physiological and social outcomes, andexercise participation rates in depressedindividuals(Callaghanet al., 2011).Research findings have beensummarized by a recent Cochrane reviewwhichreportedthefindingsof32random-ized controlled trials in which exercisewas compared to standard treatment,no treatment or a placebo treatment inadults (aged 18 and over) with depression(Rimeretal.,2012).Thisreviewconcludedthat exercise seems to improve depressivesymptoms in people with a diagnosis ofdepression when compared with no treat-ment or control intervention, althoughhighlighted that this should be interpretedwith caution since the positive effects ofexercise were smaller in methodologi-cally robust trials. Similarly, a systematicreview found that physical exercise pro-grams obtain clinically relevant outcomesin the treatment of depressive symptomsin depressed older people (

Effects of Tai Chi exercise on physical and psychological health of older people.

Tai Chi is a traditional Chinese form of conditioning exercise derived from martial arts and rooted in eastern philosophy and Chinese Medicine. Based on the inter-relatedness of mind, body and spirit this form of exercise focuses on producing an inner calmness which is thought to have both physical and psychological therapeutic value. This article provides a brief overview of selected current evidence examining the relationship between Tai Chi and physical, neurocognitive and psychosocial outcomes in older people. This is an emerging and growing area of research and improvements have often been reported in health functioning, physical and emotional health, reducing falls, fear of falling and risk of falls, and possibly enhancing cardiovascular functioning in older adults although the effects on bone density, cognitive and immunological functioning are less clear. Results overall are inconsistent and health improvements have not been evident in all studies. Tai Chi is becoming increasingly popular in practice, and more recent evidence is emerging which is based on experimental and longitudinal designs, although many of the proposed benefits of Tai Chi are yet to be validated in large, randomised controlled trials.

Five-year workplace wellness intervention in the NHS.

Aims: Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace. Method: A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to encourage employees to make healthy lifestyle choices and sustained behaviour changes. An employee questionnaire survey was distributed at baseline (n = 1,452) and at five years (n = 1,134), including measures of physical activity, BMI, diet, self-efficacy, social support, perceived general health and mood, smoking behaviours, self-reported sickness absence, perceived work performance and job satisfaction. Results: Samples were comparable at baseline and follow-up. At five years, significantly more respondents actively travelled (by walking or cycling both to work and for non-work trips) and more were active while at work. Significantly more respondents met current recommendations for physical activity at five years than at baseline. Fewer employers reported ‘lack of time’ as a barrier to being physically active following the intervention. Significantly lower sickness absence, greater job satisfaction and greater organisational commitment was reported at five years than at baseline. Conclusions: Improvements in health behaviours, reductions in sickness absence and improvements in job satisfaction and organisational commitment were observed following five years of a workplace wellness intervention for NHS employees. These findings suggest that health-promoting programmes should be embedded within NHS infrastructure.

Reasons for participating and not participating in a e-health workplace physical activity intervention

Purpose – The purpose of this paper is to investigate the reasons for participating and not participating in an e-health workplace physical activity (PA) intervention. Design/methodology/approach – Semi-structured interviews and two focus groups were conducted with a purposive sample of employees who enrolled and participated in the intervention and with those who did not complete enrolment, hence did not participate in it. Data were examined using thematic analysis according to the clusters of “reasons for participation” and for “non-participation”. Findings – Reported reasons for participation included a need to be more active, to increase motivation to engage in PA, and to better manage weight. Employees were attracted by the perceived ease of use of the programme and by the promise of receiving reminders. Many felt encouraged to enrol by managers or peers. Reported reasons for non-participation included lack of time, loss of interest towards the programme, or a lack of reminders to complete enrolment. Practical implications – Future e-health workplace behavioural interventions should consider focusing on employees’ needs and motivators to behaviour change, provide regular reminders for participants to complete enrolment and ensure that procedures are completed successfully. Barriers to participation could be identified through formative research with the target population and feasibility studies. Originality/value – This study combines a qualitative analysis of the reasons why some employees decided to enrol in a workplace PA intervention and why some others did not. This study highlights factors to consider when designing, implementing and promoting similar interventions and that could inform strategies to enhance participation in workplace PA interventions.