Question

Full APA formatted citation of the selected article.

Article #1

Article #2

Article #3

Article #4

Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M., Watkins, L., Hoffman, B. M., Barbour, K. A., Herman, S., Craighead, W. E., Brosse, A. L., Waugh, R., Hinderliter, A., & Sherwood, A. (2007). Exercise and pharmacotherapy in the treatment of the major depressive disorder. Psychosomatic medicine, 69(7), 587–596.

Schuch, F. B., & Stubbs, B. (2019). The role of exercise in preventing and treating depression. Current sports medicine reports, 18(8), 299-304.

Netz, Y. (2017). Is the comparison between exercise and pharmacologic treatment of depression in the clinical practice guideline of the American college of physicians evidence-based?. Frontiers in pharmacology, 8, 257.

Kandola, A., Ashdown-Franks, G., Hendrikse, J., Sabiston, C. M., & Stubbs, B. (2019). Physical Activity and Depression: Towards understanding the antidepressant mechanisms of physical activity. Neuroscience & Biobehavioral Reviews, 107, 525-539.

Evidence Level *

(I, II, or III)

I

II

I

II

Conceptual Framework

Describe the theoretical basis for the study ( If there is no one mentioned in the article, say that here).**

To evaluate whether results achieved to form a standard antidepressant medication were completed by patients receiving aerobic exercise training performed in a supervised group or at home. It also checked if the patients experienced more significant depression reductions compared to placebo controls.

The article acknowledges that lifestyle behaviors such as physical exercise play a role in developing depression in an individual and can also be used to treat the condition. The article addresses the role of physical activity and exercise in preventing depression and PA and exercise as therapeutic strategies for depression.

Exercise as a medicine has been used to treat various conditions. However, clinical practice guideline recommends mainly antidepressant medication sidelining exercise. Epidemiological studies indicate that different pharmacological treatments and exercises have almost equal potential to treat depression. The article discusses the comparative benefits between pharmacological treatments and exercise.

The study acknowledges physical activity's ability to treat depressive symptoms and notes that its antidepressant mechanism is still unknown. The study yearns to assess the psychosocial and biological processes that enable physical activities like exercise to exert antidepressant effects.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

A randomized controlled trial was conducted with blinded care outcomes and allocation concealment in a tertiary care hospital.

A meta-analysis was performed that included prospective cohorts evaluating the effects of incident depression and PA. The study consists of people with low levels of PA to act as a baseline of comparison. Factors like cultural differences, covariates, and age were taken into consideration in the study. Several subgroup analyses were conducted to explore differences across ages, countries, and other variables.

The study examined two categories of publications: randomized controlled trials and meta-analysis/systematic reviews. The exclusion criteria f RCT reviews were if participants involved had additional co-morbid diagnoses and RCTs that assessed two kinds of interventions as add-on therapy.

A non-systematic literature search was conducted to identify possible activities that give physical activity antidepressant effects.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

Two hundred two adults (49men; 153 women) participated in the study. All participants were diagnosed with major depressive disorder. Participants were assigned randomly to one of four conditions; antidepressant medication, home-based exercise, supervised exercise in a group setting, or a placebo pill for 16 weeks.

From a sample of 266,939 participants, 49 unique studies were conducted. This totaled 1,837,794 person-hours.

The study examined all RCTs published between 1999-2016 and meta-analysis published between 2009 and 2016.

Mechanisms used in the study were based on the strength of underlying evidence.

Major Variables Studied

List and define dependent and independent variables.

Exercise and mediation- dependent variables.

Physical Activity and exercise- independent variable

Sex, country, age, covariates- dependent variables.

Exercise and antidepressants- independent variables.

Effect on treating major depressive disorder- dependent variable.

Physical activity-independent variable.

Biological and psychosocial mechanism- dependent variables.

Measurement

Identify primary statistics used to answer clinical questions ( You need to list the actual tests done).

Patients completed the Hamilton Depression Rating Scale (HAM-D).

Patients underwent structured clinical interviews for depression.

Analyzed data from studies conducted with at least one year of follow-up.

Combined comparisons analyzed results from different RCT studies and meta-analyses.

Meta-analyses and reviews from other sources.

Data Analysis Statistical or

Qualitative findings

( You need to enter the actual numbers determined by the statistical tests or qualitative data).

41% achieved remission. They no longer meet the criteria for major depressive disorder.

They had a HAM-D score of <8.

Remission rates for different groups were as follows:

· Home-based exercise= 40%

· Placebo= 31%

· Supervised exercise= 45%

· Medication= 47%

According to subgroup analyses, protective effects were as follows:

Age;

· Adolescents and children- 10% odds decrease.

· Adults- 12% odds decrease.

· Older adults-21% odds decrease.

Country;

· Europe- 17% odds decrease.

· Asia- 24% odds decrease.

· Oceania- 35% odds decrease.

· North America- 14% odds decrease.

All but one study evaluated in the article showed improvement in patients using exercise treatment on MDD compared to their medication counterparts.

All but two meta-analysis reviews on exercise vs. other treatments, e.g., medication, supported exercise in treating the condition.

The studies found that exercise acquired antidepressant effects by affecting various bi=oy functions in different ways. These body functions included:

· Neuroplasticity.

· Inflammation.

· Oxidative stress.

· Neuroendocrine system.

Some psychosocial factors exercise impacted on giving positive effects include:

· Self-esteem.

· Social support.

· Self-efficacy.

Findings and Recommendations

General findings and recommendations of the research

The efficacy of patients receiving antidepressant medication was comparable to patients under exercise therapy. Both groups achieved better results than placebo patients.

The study shows that PA and exercise in the treatment of major depressive disorder are effective. It can confer protection in adults, children, and older adults from developing MDD.

Studies examining non-pharmacologic treatments vs. pharmacologic treatments examined limited evidence on exercise use, hence disregarded the use of exercise in treatment. On the contrary, all other reviews examining exercise vs. other treatments advocated for exercise in treatments. Overwhelming evidence supporting the use of exercise was found in more recent articles.

Exercise has the effect of promoting biological processes that have antidepressant effects. For instance, exercise promotes the release of neurotrophins that have lasting effects on brain structure, such as improved vasculature and hippocampus.

Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of the study?

What are the risks associated with the implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

This study's results are conclusive and, if applied in the treatment of the major depressive disorder, will allow patients to choose from either exercise therapy or medication to treat their condition. The use of placebo treatment should be avoided if possible due to its low efficacy rates.

The only weakness of the study is found in its sample distribution. Too many participants were women, gender distribution was not well addressed there.

The article analyses other scholarly work and compares it against its study. This establishes similarities and concludes that PA and exercise are indeed helpful in treating major depressive disorder.

It acknowledges that the medication is not widely used though effective; the rollout should be quick since risks associated with the risk are minimal. The use of the study results is highly feasible.

The study reviews numerous academic works reviewing exercise vs. other treatment methods and concludes that an exercise is indeed a viable option. It doesn't need to be argued further since the source used in this work were numerous, and most converged towards similar conclusions. The study is, therefore, strong evidence that the use of exercise is indeed feasible in treating MDD.

For exercise to have antidepressant effects, numerous biological and psychosocial mechanisms have to occur, as shown in the study. Therefore, the study results are useful in that they enable physicians and patients to understand the complex mechanisms that occur, hence providing future research on the topic. The study is thus feasible.

Key findings

Exercise therapy achieves almost similar results to medication treatment of major depressive disorder.

There is a reduction by 17% in major depression when PA is included. The inclusion of covariates and other factors reduced the odds to 41%.

Exercise is indeed an evidence-based medicine for the treatment of major depressive disorder as an add-on to antidepressants.

Exercise promotes the secretion and activation of some biological factors that have antidepressant effects.

Outcomes

Exercise can be used as an alternative treatment of antidepressants for major depressive disorders.

The use of exercise in the treatment of depression was justified.

Exercise is proven to be an evidence-based method of treatment.

Biological and psychosocial factors that give exercise antidepressant effects identified.

General Notes/Comments

Exercise should be used in the treatment of MDD more often.

Exercise should also be recommended in medication for MDD.

Exercise is an evidence-based method of treatment.

Further research can be conducted on biological and psychosocial factors based on this study.