|Ugh, not again|
That's the momentary pause that providers experience just prior to an appointment when their hand is on the examination room door handle, but they're wishing that they were going somewhere else. When that happened to the DMCB, its unease would usually be over the patient's depression. That would often be manifest by an inability to make lifestyle changes, take their medicines or comply with treatment plans.
Among persons with a chronic condition, it turns out that depression is quite common. As a result, most national guidelines recommend all patients with a chronic condition should be screened for it and if it's found, treatment options include anti-depressants or counseling.
Talking to a patient about taking another drug or committing to weekly counseling sessions is another reason for docs to display the "door handle sign." That's why the DMCB was interested in this article that was recently published in the Archives of Internal Medicine on the topic of using exercise to battle symptoms of depression among persons with a chronic illness.
The authors pooled all the published research on the benefit of exercise among adults who had a chronic condition, were sedentary, who had a baseline assessment of their mood and were then randomly assigned to either exercise or non-exercise.
Of 90 studies, 39 involved persons with various types of cardiovascular disease, 37 had persons with chronic pain other than fibromyalgia and 32 with fibromyalgia. The remainder involved conditions such as neurologic illness and COPD. Depression was assessed using standard scales such as the Beck, Center for Epidemiological Studies Depression Scale and the Hospital Anxiety and Depression Scale.
The mean age of the study subjects was 51 years and 61% were women. The exercise on average consisted of 3 sessions a week lasting 42 minutes for17 weeks. The adherence rate was 77%
While the effect size was difficult to understand due to the use of scales and the underlying statistical methods, the authors ultimately found that the impact on depression was "small" but consistent. Using a "number needed to treat" (NNT) methodology, benefit occurred in an impressive 1 out of 6 persons. Persons with worse depression symptoms seemed to benefit the most.
The DMCB thinks the study is solid and enough to warrant the recommendation for rigorous exercise by both physicians as well as population health management service providers who care for persons with chronic conditions who have depression. While the commitment is significant (40 minutes, 3 times a week for more than 4 months), it should appeal to a significant number of persons who don't want to take a pill and are disinterested in counseling. In addition, the DMCB wonders if the use of exercise couldn't supplement other treatments for depression, but that will involve another research study.
Unfortunately, the DMCB also doesn't know if these results would be generalized beyond persons with cardiovascular disease and chronic pain to other patients, such as those with diabetes or heart failure. Based on the findings above, the DMCB suspects a closely monitored exercise program is also likely to be of benefit but more research is needed.
One less reason to fear that door handle, says the DMCB.
Image from Wikipedia