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Patient depression

Exercise reduces depression in bariatric patients

Eight minutes of exercise a day was associated with 92% reduction in the likelihood of depression treatment post-surgery
Dr Wendy C King, lead author of the research

Increased physical activity can result in fewer episodes of depression in bariatric patients, according to new research published in the Journal of Psychosomatic Research. The study reports that bariatric surgery patients who are more physically active are less likely to have depressive symptoms and to have recently received medication or counselling for depression or anxiety than their less active counterparts.

"Typically, clinical professionals manage their patients' depression and anxiety with counselling and/or antidepressant or anti-anxiety medication," said Dr Wendy C King, epidemiologist at the University of Pittsburgh Graduate School of Public Health and lead author of the research. "Recent research has focused on physical activity as an alternative or adjunct treatment."

Previous studies have shown that preoperative depression and anxiety increase the risk of these conditions occurring after surgery and have been shown to have a negative impact on long-term surgically induced weight loss.

Adults with severe obesity are nearly twice as likely to have a major depressive disorder (13.3%) or anxiety disorder (19.6%) when compared to the general population (7.2 and 10.2%, respectively). Therefore, treating these conditions before surgery is seen as a priority.

Results

The results show that patients who exercised for eight minutes a day were 92% less likely to require treatment for depression or anxiety among adults with severe obesity, while walking 4,750 steps a day (less than half the 10,000 steps recommended for a healthy adult) reduced odds of depression or anxiety treatment by 81%.

This was a significant (p<0.05) association between exercise and a decreased odds of depressive symptoms and/or treatment for depression or anxiety, but not with impaired mental health functioning. After taking into account socio-demographics and physical health, only associations with treatment for depression and anxiety remained statistically significant.

The association between physical activity and these outcomes was strongest when only moderate intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.

"Another goal of this study was to determine physical activity thresholds that best differentiated mental health status," said King. "We were surprised that the thresholds were really low. It could be that, in this population, important mental health benefits can be gained by simply not being sedentary."

Study

The current study is part on the on-going Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery. King and colleagues examined the association between physical activity and mental health among adults undergoing bariatric surgery.

Cross sectional analysis was conducted on pre-operative data of 850 adults with a BMI 35-40 who were seeking bariatric surgery between 2006 and 2009 were included in the study. Physical activity was measured with a step activity monitor; mean daily steps, active minutes, and high- intensity minutes were determined.

Patients also completed surveys (Medical Outcomes Study 36-item Short Form, Beck Depression Inventory, and a study-specific questionnaire, respectively) to assess mental health functioning, depressive symptoms and treatment for psychiatric and emotional problems, including depression and anxiety.

Logistic regression analyses was then performed examining the associations between physical activity and mental health indicators, controlling for potential confounders

"Results of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population," said study co-author Dr Melissa A Kalarchian, associate professor at Western Psychiatric Institute and Clinic of UPMC. "Nonetheless, physical activity is a key component of behavioural weight management, and it is encouraging to consider that it may have a favourable impact on mental health as well."

The research group has recently reported that receiving physical activity counselling before and after bariatric surgery could increase the physical activity level of bariatric surgery patients by about 50% and improve patient outcomes.

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