The Effects of Aerobic Exercise Among Adolescents with Depression, Psychology, College Term Papers.com


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The Effects of Aerobic Exercise Among Adolescents with Depression

The Effects of Aerobic Exercise Among Adolescents with Depression The Effects of Aerobic and Anaerobic Exercise Among Adolescents with Mild to Moderate Depression Kaplan and Sadock (as cited in Brollier, Hamrick & Jacobson, 1994) stated that depression, during the teen years, has become an increasing area of concern in psychiatry (Kaplan & Sadock, 1991. Kashani, Carlson, Beck, Hoeper, Corcoran, McAllister, Fallahi, Rosenberg and Reid (as cited in Brollier, Hamrick ,& Jacobson, 1994) studied the prevalence of depression in adolescents and reported that approximately 8% of adolescents experienced depressive disorders. Kaplan and Sadock (as cited in Brollier et al., 1994) suggested that new forms of treatment are needed when dealing with adolescents because adolescents often do not respond well to medications, electroconvulsive therapy, and psychotherapy, which are used on adults. Exercise, or physical activity, of an aerobic nature has been widely used as part of the recommended medical treatment for many health problems, and the physiological health benefits associated with exercise have been well documented. Brown, Ramierez,, and Taub (as cited in Mihevic, 1982) have stated that within recent years, exercise has been increasingly used for the treatment of depression as well. The results of a study conducted by Maroulakis and Zerva (1993) have shown that all dimensions of mood were positively affected by exercise to a significant extent. They went further to say that exercise is the most important natural mood modulator. Many studies have been conducted which examine the effects of aerobic exercise on depression scores of normal adult patients, and adult patients with depression. One such study, conducted by McCann and Holmes (1984), concluded that participation in a program of strenuous aerobic exercise was effective in reducing depression in adults. There seems to be a considerable gap in the area with regard to the effects of exercise on depressive symptoms in healthy adolescents, as well as the effects of exercise on adolescents with mild to moderate depression. Only a handful of studies have been completed to observe this area of study. Norris, Carroll and Cochrane (1992) found that students at a secondary school who stated they exercised regularly, produced lower scores on the Multiple Affect Adjective Check List, developed by Zukerman and Lubin. Brown, Welsh, Labbe, Vitulli and Kulkarni (1992) found that aerobic exercise was beneficial for 54 depressed patients, of both sexes, with the average age being 15.6 years of age. However, this study found that the female participants reported a greater amount of change in depression, anger, exhaustion, anxiety and confusion, following the nine week study. Although the male subjects did see improvements in their psychological states, the female participants were slightly better off. Another study conducted by Brollier et al. (1994) found that of the four adolescent, male participants they were able to work with in their study, all were able to gain some benefit from the aerobic exercise of jogging. All the participants reported less depressive symptoms, as well as enhanced energy, and a better self concept in general. Although there have been a few studies conducted in the area of exercise and depression, almost all the studies have used aerobic exercise as their independent variable, with only a few looking at the effects anaerobic exercise has on depression in adults .Doyne, Ossip-Klein, Bowman, Osborn, McDougall-Wilson and Neimeyer (1987) demonstrated that in the adult population, it is not necessary to improve cardiovascular fitness in order to demonstrate significant reductions in depression. The female participants in this study showed improvements in their depression from engaging in anaerobic exercise alone, namely weight lifting, when compared to a group of women who participated in a jogging aerobic exercise program. Tucker (as cited in Stein & Motta, 1992) was able to repeatedly show that weight lifting, compared to a non weight lifting group, enhanced self concept in male college students. While these studies do look at anaerobic exercise as a possible treatment for depression, this type of treatment has never been studied in the adolescent population. Aerobic exercise and anaerobic exercise have been shown to promote thoughts of mastery among participants. Classic symptoms of helplessness, hopelessness and worthlessness were challenged by maintaining an effective exercise program (Stein & Motta, 1992). Adolescents who suffer from depression would most likely benefit from any treatment which increases their self esteem and self concept, since one of the diagnostic criteria, as stated in the DSM-III, is a feeling of worthlessness. This could be helped if adolescents felt they had some sort of control, or mastery over their own bodies, in the sense of how it looks. Using weight lifting as a form of treatment will allow adolescents to see their bodies changing in terms of muscle tone, and the overall shape. Adolescents, in general, have many issues concerning their body shape and type. Depressed adolescents might benefit more from anaerobic exercise in terms of being able to feel more self confidence in the way they look, which in turn, may help alleviate some of their depressive symptoms. Humphries, Gruber, Hall and Kryscio (1985) concluded that adolescents diagnosed with depression usually experience impairment in neuroendocrine regulation in the central nervous system. This will usually result in poor performance in terms of balance, bilateral coordination, upper limb coordination and response speed, compared with the average adolescent with no symptoms of depression. By implementing an exercise treatment program which includes weight lifting, some of the areas of motor proficiency which are lacking, could be improved since weight lifting and aerobic exercise have a positive effect on propreoception and psychomotor skill enhancement (Arnheim and Prentice, 2000). The present study is designed to investigate the effects of anaerobic exercise treatment programs in improving depression in adolescents. This study will address gaps in previous literature and expand upon past research which indicates that aerobic exercise results in a decrease in depressive symptoms of depressed youth. The experiment will be 12 weeks in length, as this is the amount of time needed to see any effects of exercise. The experiment will consist on three exercising groups, one being a combination of aerobic and anaerobic exercise, one being just aerobic exercise, and the other one being just anaerobic exercise. The use of these three groups will be able to provide information on the benefits on one type of exercise over another, as well as provide information on whether or not a combination of the two types of exercise is more beneficial than one alone. A control group will not be used in this study, as it has already been shown in past literature that aerobic exercise has the ability to improve depressive symptoms. It is hypothesized that the group with the combination of aerobic and anaerobic exercise will produce a lower post test score on the BDI questionnaire, compared with the aerobic group and the anaerobic group. Subjects were volunteers selected from inpatients of a private psychiatric facility where adolescents are hospitalized. Participants have to have a diagnosis of mild to moderate depression. Severe depression was not looked at in this study. Thirty adolescents will participate in this study after obtaining parental consent and medical clearance from the doctors in the psychiatric facility. The ages of the participants will be in the range of 13 to 18 years of age. The participants will be divided in to three groups. Ten will be in the aerobic and anaerobic exercise group, 10 in the aerobic group, and 10 in the anaerobic group. The sex of the participants is not important to this study. The Beck Depression Inventory (BDI) (Beack, Steer, &Garbin, 1988) will be used to measure depression throughout the experiment. The BDI measures several concepts related to the model of human occupation. These include social withdrawal, work difficulty, sense of failure, self-dislike and indecisiveness. Heart Rate monitors will be used to measure the heart rates of the participants. This experiment will use a randomized, controlled design. The pre-test and post-test scores will be compared between the three groups in the experiment. The participants of the study will be randomly assigned to one of the three groups: the combination of aerobic and anaerobic exercise, aerobic exercise, and anaerobic exercise. Once again, there will be no control group in this experiment as it has been show, in several studies, that aerobic exercise has a positive effect on depression, therefore, a control group would be of no use to help support any findings. The participants will not be told the reason for this experiment. They will, however, be told that mood and fitness levels were being measured in order to reduce expectancy bias. This is one of the reason why measures of heart rate are used in this experiment. The independent variable is the type of exercise performed in this study. Aerobic exercise is defines as aerobics, for 45 minutes, two to four times per week, and anaerobic exercise is defined as weight lifting two or two to four times per week, depending on the condition. The dependent variable is depression. This is defined by the diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (America Psychiatric Association, 1987) as dysphoric and/or irritable mood or loss of interest and pleasure accompanied by four of the following: significant weight change, sleep disturbance, psychomotor agitation or retardation, energy loss, feelings of worthlessness or guilt, indecisiveness, and suicidal thoughts. It is also measured by the BDI in this experiment. Participants will be randomly assigned to one of the three exercise groups, these being the combination group, the aerobic group, and the non aerobic group. The pre-test for depression will consist of the participants filling out the BDI questionnaire. This will asses the state of each participant prior to exercise implementation. The scores of each participant will be recorded by the experimenter. Following the BDI questionnaires, the participants will be assigned to their respective groups. Attendance will be taken at the beginning of each session. The combination of aerobic and anaerobic exercise group will meet four times per week, for a 12 week period. Twice a week, on alternate days, the participants in this group will engage in aerobic exercise. This will consist of a certified aerobics instructor leading a 45 minute class to music. Each session will begin with a warm up of five to seven minutes. This can include walking on the spot, side steps, or anything which is very low impact and somewhat low energy. During each session, a participant will be randomly assigned to wear a heart rate monitor to make it seem as though fitness levels are being measured. It will also be used to make sure that the participants will exercise at a target zone of 70 to 80% of their maximum heart rates. This will ensure that the participants are actually benefiting from the exercise, and not just standing around for the entire class. The fitness instructor will instruct the participants at this time that they should work at a level which feels comfortable for them, and they should not overexert themselves. The next 32 to 35 minutes of the class will be used as the aerobic portion of the class. During this time, the participants will have the option of working at a high , moderate, or low intensity. Moves for each intensity will be clearly demonstrated to the participants, for each exercise. The high intensity work will consist of more jumping exercises, while the lower intensity work will consist of keeping on foot on the floor at all times. The remaining five to seven minutes of the class will be used for a cool down and stretching exercises. Heart rate monitor readings will be taken by the experimenter at the end of each session. The other two days of the week will consist of anaerobic exercise. This again will be led by a certified personal trainer. The participants will be instructed to use both free weights and weight machines. The goal of this portion of the experiment is to improve both muscle strength by low repetitions and high resistance, and muscle endurance by doing many repetitions with a low resistance. One day can be used to muscle strength training, while the other day can be used for muscle endurance training. Each session will begin with a 10 minute warm-up consisting of stretches and slight increase in heart rate to slightly increase muscle temperature. This will be followed by 40 minutes of weight training. The personal trainer will instruct the participants how to perform the exercises with a correct posture and weight to prevent any sort of injury. Each session will end with a 10 minute cool down consisting of stretching. Participants will also be instructed to rest for approximately one to three minutes between sets. The aerobic group will follow the same exercise routine, however they will participate in the aerobic routine only, four times per week. The same will apply to the anaerobic group, participating in weight lifting four times per week. Following the 12 week exercise treatment program, the participants will be asked to fill out another BDI questionnaire in the same manner as was done at the beginning of the experiment. Changes in depression will be compared between the three groups. At the conclusion of the experiment, the participants will be debriefed and told the purpose and hypothesis of the experiment. The results of the BDI questionnaires will be statistically analyzed to test the experimental hypothesis that the combination group will experience a greater decrease in depressive symptoms, and this will be statistically compared with the aerobic and anaerobic groups respectively. A two-way ANOVA will be used to compare changes in scores on the BDI questionnaires within the groups and between the groups. A p-test will be conducted to see if the results occurred by chance, or if they were statistically significant. This study will be conducted in a ethical manner. All participants will participate on a voluntary basis. No incentive is given here except of lowering their depression and gaining some physical benefit from the exercise at hand. Therefore, there is no way the participants can feel as though they are being coerced. All participants will have to sign an informed consent form where it will be explained to them what will be taking place in the study. Although the exact purpose and hypothesis of the study will not be divulged to the participants before the experiment is to take place, they will be debriefed at the end of the experiment. Since some of the participants will be somewhat young, they will be able to ask the experimenters questions about what is to take place in the experiment, before they sign the informed consent form. The participants will not be at risk of any harm, and they will have the opportunity to leave the study at any time, if they feel they need to do so. The results of the questionnaires will be kept confidential. Information of any type will not be disclosed to anyone but the researcher and the assistants in this experiment. Several outcomes are possible as a result of this experiment. The first outcome could prove the hypothesis correct, which would mean the exercise combination group will produce lower post test scores on the BDI questionnaire. This could be very plausible because the effects of both types of exercise, aerobic and anaerobic, have been shown to be beneficial in the adult population. By combining the effects of the two types of exercise, the experimental group will most likely receive the most benefit from the experiment. The exercise combination group will most likely develop more self esteem when they realize their bodies have gotten stronger, and look better in general. The combination of exercise has been proven to be the most beneficial exercise in terms of health benefits and cosmetic benefits, in the everyday population. These benefits could have a strong effect on the adolescent�s self esteem. As well, since there are two different types of exercise, the participants may find it more enjoyable and less boring than performing either aerobic or anaerobic exercise separately. Another outcome could be that the exercise combination group gains the same amount of benefit from the experiment as the other two exercise groups. This could be another very plausible outcome. Since the effects of each type of exercise have been shown to improve depression in the adult population, combining them may be a futile exercise. It could be possible that exercise in general, no matter what type, produces a certain amount of benefit which levels off after a certain point, with no additional benefit from combining exercises. It is unlikely that the combination group will produce results lower than the other exercise groups. Since it has been proven that aerobic exercise is beneficial, each group will have to gain some sort of benefit. Since anaerobic exercise has never been tested in the adolescent population, no benefit from anaerobic exercise could occur, however, the combination group will have still received a benefit from the aerobic exercise portion of their experimental group. However, since this group would have only received two days of aerobic exercise per week, slightly lower scores are a small possibility. If it is indeed the case that the combination of anaerobic and aerobic exercise produces lower depression scores in adolescents, this could be utilized in treatment programs for depressed youth, and maybe used as a program to stop healthy youths from developing symptoms of depression. Future research, in this area of the affect of exercise on depressed adolescents, could study a number of things. First, the intensity of the aerobic exercise could be looked at. Studies have not been done to show whether the intensity of the exercise would change any benefits in depression received from exercise. An exercise routine which has a higher intensity could produce more beneficial consequences for the exercising group. Another area which could be interesting to look at is the issue of adherence to the exercise program. Since these adolescents are depressed, they most likely do not have very much motivation to continue with an exercise program. Trying to make a depressed adolescent adhere to an exercise program could be very different from what it would take a depressed adult to adhere to a program. Different things could be motivating for adolescents compared with adults. Also, differences may be found in what it would take a male subject to adhere, compared with a female subject. One last issue, which could be difficult to research further, is that of a bigger sample size for experiments dealing with depressed adolescents. This could be difficult because it would not be easy to find a large group of depressed adolescents who would be willing to take part in a study which is at least 12 weeks in duration. However, if a larger sample size could be attained, the generalizability to the greater population would be enhanced. Arnheim, D., & Prentice, W. (2000). Principles of Athletic Training. Boston, MA: McGraw-Hill. Beck, A., Steer, R., & Garbin, M. (1987). Psychometric properties of the Beck Depression Inventory. Journal of Clinical Psychology, 40, 1365-1367. Brollier, C., Hamrick, N., & Jacobson, B. (1994). Aerobic exercise: A potential occupational therapy modality for adolescents with depression. Occupational Therapy in Mental Health, 12, 19-29. Brown, S., Welsh, M.C., Labbe, E.E., Vitulli, W.F., & Kulkarni, P. (1992). Aerobic exercise in the psychological treatment of adolescents. Perceptual and Motor Skills, 74, 555-560. Doyne, E.J., Ossip-Klein, D.J., Bowman, E.D., Osborn, K.M., McDougall-Wilson, I.B., & Neimeyer, R.A. (1987). Running versus weight lifting in the treatment of depression. Journal of Consulting and Clinical Psychology, 55, 748-754. Humphries, L., Gruber, J., Hall, J., & Kryscio, R. (1985). Motor proficiency in depressed adolescent inpatients: Biochemical and clinical diagnostic correlates. Developmental and Behavioral Pediatrics, 6, 259-262. Maroulakis, E., & Zervas, Y. (1993). Effects of aerobic exercise on mood of adult women. Perceptual and Motor Skills, 76, 795-801. McCann, I.L., & Holmes, D.S. (1984). Influence of aerobic exercise on depression. Journal of Personality and Social Psychology, 46, 1142-1147. Milhevic, P.M. (1982). Anxiety, depression and exercise. Quest, 33, 140-153. Norris, R., Carroll, D., & Cochrane, R. (1990). The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being. Journal of Psychosomatic Research, 34, 367-375. Norris, R., Carroll, D., & Cochrane, R. (1991). The effects of physical activity and exercise training on psychological stress and well-being in the adolescent population. Journal of Psychosomatic Research, 36, 55-65. Stein, P.N., & Motta, R.W. (1992). Effects of aerobic and nonaerobic exercise on depression and self-concept. Perceptual and Motor Skills, 74, 79-89. Bibliography:

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