Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 191

Psychological well‐being is vital to optimal ageing and is dependent on a host of factors, including genetic traits, social support systems, personality types, and the presence of positive and negative psychological constructs such as happiness, optimism, morale, depression, anxiety, self‐esteem, self‐efficacy, and vigour. Participating in physical activity has been shown to be associated with more positive psychological attributes and a lower prevalence and incidence of depressive symptoms in cross‐sectional and prospective epidemiological studies and experimental trials.^75,109 It is notable that effects are most significant in those with comorbid illness, such as cardiovascular or pulmonary disease or major depression,^109,110 attesting to the clinical relevance of this exercise adaptation.

The experimental evidence for exercise as an isolated intervention for treating clinical depression in both younger and older cohorts is robust and consistent. Both aerobic and resistance training exercise produce clinically meaningful improvements in depression in such patients, with response rates ranging from 25 to 88%. In the studies that have addressed exercise modality, resistance training was found to be equivalent to aerobic training in young adults with depression and yoga as effective as aerobic exercise. Blumenthal et al.¹¹⁰ directly compared high‐intensity aerobic exercise with antidepressant medications in older adults with major depression and found the two approaches to be equipotent, with no added benefit of combined exercise and medication. Singh et al.⁷⁵ compared high‐ and low‐intensity progressive resistance training to GP referral and care in older adults with major depression and found that a clinical response (50% reduction in Hamilton Rating Scale for depression) was achieved in 61% with high‐intensity training, significantly different than the 29% with low‐intensity training and 21% with the GP care control group who responded similarly to placebo rates.⁷⁵ Similarly, low‐intensity aerobic training in older adults with depression has been shown to be similar in efficacy to social contact controls, reducing depression scores by only 30%. Thus, the literature on exercise and depression suggests that it is effective in young and old, it is approximately as effective as antidepressants in clinical cohorts, both aerobic and resistance modalities appear equally beneficial, and optimal responses are seen with higher intensities of training.