Introduction and rationale
Discuss in depth some key contemporary health challenges demonstrating awareness of multiple perspectives, including the ways in which different health professions approach the issues and exploring how integrated approaches to addressing the issues may be mounted across disciplines.
Depression is a clinical mental health condition that greatly affects the functional ability of a person. Globally, around 300 million people suffer from depression being the leading cause of worldwide disability and major contributor to the burden of disease across the globe (Jorm & Reavley, 2012). Several types of depression prevail ranging from mild to severe as outlined by World Health Organization (WHO). It can be estimated that about 6% of adult Australians suffer from major depressive illness (Reavley et al., 2011). Major depression greatly affects adult Australians that are characterized by loss of pleasure, unhappy mood and feelings of dissatisfaction and tiredness causing physical and emotional problems. Effective approaches to prevention of depression are required in reducing major depressive symptoms and in improving health outcomes. According to Harvey et al., (2017) physical activity strategies can be helpful in reducing major depression symptoms in depression prevalent countries like Australia and therefore, I have chosen the research topic of how physical activity programs can be helpful in reducing the major depressive symptoms among the adults Australians aged 20 to 65 years.
For aligning the research question with the outcomes of the proposed research, it is important to conduct a systematic literature review on the research topic. Relevant evidence need to be deduced from the vast pool of available research that needs to be analysed comprehensively while carrying out systematic review. Systematic literature reviews is aimed at identification, evaluation and summarization of major study findings that can be applied into practice (Khan et al., 2011). Moreover, summarization of main findings is helpful in identifying the literature gaps, as it is the main aim of these literature reviews. Therefore, in the present research, literature review helped in understanding the relationship between physical exercise activities and major depression reduction among the adult Australians aged 20 to 65 years.
The electronic databases like PsycINFO, Pub Med, Science Direct, Public Health, Ovid Medline Elsevier BV and Cochrane Library was used to get access to wide range of scientific literature relevant to the research topic. These databases provide full-text journal articles that are reliable, authentic and peer-reviewed. Journal articles relevant to the research topic were include for the systematic literature review after the conduction of detailed database search.
Methodology
One of the vital elements of a systematic literature review is appropriate use of keywords or search terms like most commonly terms or short phrases that can be helpful in retrieving journal articles by entering in the databases. The key search terms used for the present review are major depression, depression, depression interventions, burden of depression and physical activity interventions that reduces depression in Australia. Boolean operators are also important elements in a literature review as these are logical terms that need to be added with the search terms for an authentic and appropriate search. These operations help to provide productive results by using the terms AND and OR and applied for the databases.
Selection process depends on the meticulous selection of journal articles that need to be included in the study. Inclusion and exclusion studies are guided by selection criteria set before the research. Those papers that comprises of longitudinal, cross-sectional and randomized control trails studies were included in the study published from 2008 to 2018 published only in English. Moreover, the target population that comprises of participants of age 18 to 90 years was also included. The abstract of journal articles were reviewed to make sure that the studies selected were relevant to the research question or topic of interest.
The studies that were published before 2008 and apart from English were excluded from the study along with papers that were not peer-reviewed. Moreover, the search key terms that did not match with the research topic were also excluded from the study.
A critical thematic analysis was carried out for the studies for drawing the important information from the journal articles. The papers were studied considering the aim, methodology, results, limitations and literature gaps along with implications for future research. Finally, the data was analyzed by going through the content of the articles and assessing the quality, research efforts, inflicting thoughts presented in the papers as literature reviews should focus on the debates that literature ahs undertaken. This helps to provide an insight into the available literature and its relevance to the research question.
In the current literature review, the studies were analysed by dividing them into themes like use of physical activity interventions in treating major depression for managing this condition in Australia as well as globally.
Recent research has shown that physical exercise has both physical and psychological benefits and helps in improving the mood and reducing anxiety. Regular exercise helps to ease the depressive symptoms and as a result, provide coping mechanism in dealing negative thoughts in a healthy way (Carek, Laibstain & Carek, 2011). Initially, treatment for depression included anti-depressant medication and counselling as outlined by psychologists, therapists and psychotherapists. However, from the literature review, it is highlighted that individuals who perform regular physical exercise and workouts tend to show fewer signs of depression as compared to those who do not perform physical activity. According to a study conducted by (Josefsson, Lindwall & Archer, (2014) physical exercise for minimum 30 minutes can be beneficial in reducing the symptoms of major depression and have reduced risk of developing this mental disorder condition. Happiness inducing workouts like yoga, running, dancing, hiking and strength training helps in relieving depression and anxiety. Exercise increases the blood flow to brain by releasing endorphins that are natural antidepressant that significantly relieve symptoms of major depression in the individuals. Exercise greatly relieves stress, promotes sleep, improves memory, boosts mood and as a result, improves the overall functioning of an individual in performing daily activities (Asmundson et al., 2013).
Current knowledge deduced from literature review
The above fact is illustrated in the first theme: physical activity interventions for depression where this intervention can be beneficial in preventing and treating major depression. Consistent physical activity has shown successful results as antidepressant medication in managing symptoms of depression among elderly population (Mammen & Faulkner, 2013). Moreover, it enhances social interaction among the depressive individuals and as a result, there are reduced feelings of isolation and loneliness. Physical exercise has shown to prevent depression irrespective of gender, age and exercise intensity. Exercise is considered one of the behavioural approaches that complement pharmacotherapy by relieving depressive symptoms and enhancing the overall well-being of an individual. Aerobic exercises like brisk walking or jogging, anaerobic exercise comprising of relaxation, strength and flexibility training helps to prevent the symptoms of depression in majority of individuals (Déry et al., 2013). Therefore, from the first theme, it is evident that although antidepressant effect of physical exercise remains debatable, efficacy of exercise in reducing depressive symptoms is well established.
The second theme is the nutrition and physical exercise intervention for depression management in Australia. Along with physical exercise, healthy nutrition is also needed for improving mood and alleviating signs of depression. Healthy diet alone cannot reduce the symptoms of depression and require fitness regimen to prevent future depression. The important food items like selenium, vitamin D, omega-3 fatty acids, antioxidants, vitamin B, zinc and protein containing foods greatly help in reducing the symptoms of depression (Kuczmarski et al., 2010). Selenium levels in the body are directly linked to mood as low levels contribute to poor mood. Similarly, vitamin D deficiency is also witnessed in mood disorders and therefore, this vitamin is helpful in fighting depression. According to Bloch & Hannestad, (2012) populations that do not consume omega-3 fatty acids are tend to have high depressive disorders. These fatty acids increases the availability of healthy fats to the brain, protect nerve cells and myelin sheath preservation and as a result, there is proper brain functioning reducing the risk of depression and mood disorders. Antioxidants help in preventing cell damage by making a destructive effect against the free radicals and as a result, protect the brain (Maes et al., 2012).
Apart from nutrition, physical exercise also contribute to alleviation of mood disorders like depression as it imparts psychological, physical and social wellness irrespective of gender and age. Australian adults who undertook physical exercise and healthy nutrition programs for depression showed significant results in reducing its symptoms and in preventing adverse depressive episodes (Jacka et al., 2010). In other words, it can be stated that physical exercise improves mental health of Australians adults experiencing major depression. The literature review suggests that healthy diet needs to be included in the fitness regimen so that mental disorders like depression can be prevented. Diet imparts emotional well-being mentioned in nutritional psychiatry where a dietary pattern that comprises of high intake of vegetables, fruits, whole grain, olive, fish and antioxidants can be helpful in decreasing risk of mood disorders like depression. This fact can be supported by the study conducted by Jacka et al., (2010) where physical activity programs and nutrition included in treatment regimen were found to be powerful against alleviating depressive symptoms.
Physical activity interventions for depression
The third theme suggested that sedentary lifestyle increases the risk of mood disorders like depression and physical exercise helps to curb this risk and future depression. A study conducted by Hidaka, (2012) stated that adults who are physically active experience less depressive thoughts than individuals who do not perform physical exercise. Sedentary behaviours include too much sitting that is detrimentally linked to various disease progressions like diabetes, cardiovascular disease and premature mortality (Pasco et al., 2011). Depression is associated with sedentary behaviour and moderate-to-vigorous exercise helps to reduce the depression symptoms encouraging individuals to perform physical exercise (Helgadóttir, Forsell & Ekblom, 2015). A study conducted by Hallgren et al., (2016) showed that exercise-related mechanisms help to alter NE, 5-HT and BDNF, reduce pro-inflammatory cytokine levels and increase proliferation of hippocampus cells. These pro-inflammatory processes indirectly or directly affect depression development influencing 5-HT system and adiposity interactions. High levels of adiposity functions both consequence and as precursor of depression that reflects bidirectional relationship driven by inflammation (Lackland & Voeks, 2014). This fact supports the third theme suggesting that sedentary behaviour greatly contribute to depressive thoughts. KYN/TRP ratio depicts changes in both brain and peripheral blood that was found to be high among obese or overweight adults as compared to people who are not indulged in active living (Herring, O’connor & Dishman, 2010). Sedentary lifestyle is associated with depression as inflammatory markers contribute to increased adiposity via interactions with 5-HT system (Helgadóttir, Forsell & Ekblom, 2015). The third theme highlights the fact that adiposity and inflammatory markers contribute to depression witnessed in sedentary behaviour and therefore, physical exercise has antidepressant effects that can be helpful in alleviating symptoms of depression.
From the above current knowledge gained from literature review, it is clear that physically active individuals tend to experience less depressive thoughts as compared to physically inactive counterparts.
Sedentary behaviour
One of the key issues that arise from the literature review is sedentary behaviour contribution to depression prevalence. According to a study conducted by Schuch et al., (2017) sedentary behaviour (SB) and physical inactiveness is seen in individuals with major depressive disorders. SB increases the risk for cardiovascular diseases, obesity and diabetes that imparts depressive thoughts in the individuals due to lifestyle restrictions leading to social exclusion and loneliness. According to Australian Institute of Health and Welfare, 2010 14% of adult Australians suffer from mental illness with 15% of children of the age 16-24 years as compared to 27 million people affected globally (World Health Organization, 2015). Adults who are engaged in SB tend to show depressive behaviour and therefore, physical activity interventions can be helpful in alleviating major depressive symptoms and chances of future depression. Another study conducted by (Teychenne, Ball & Salmon, 2010) showed that physical activity, SB and depression are linked as SB increases of depression. Individuals who are engaged in leisure-time exercises are less likely to experience depressive thoughts as compared to individuals who spend hours sitting (Schuch et al., 2017). Individuals engaged in SB are at high risk of depression and therefore, physical activity promotion can be helpful in imparting better mental health among individuals with SB.
Nutrition and physical exercise intervention for depression management in Australia
Physical exercise
Physical exercise interventions are one the best ways to alleviate depression symptoms and prevent future depression. Exercise is considered beneficial for mood disorders like depression as these interventions make individuals happy by uplifting their mood. Although, exercise frequency relation with depression is still unknown, light, moderate and vigorous exercise influence physical activity behaviour and SB patterns in the individuals. A study conducted by Aspin et al., (2010), in Australia showed that physical inactivity is a risk factor for debilitating illnesses where about 70% of Australians suffer from one chronic disease increasing the burden of disease that in turn impacting the whole healthcare system. When individuals are engaged in exercise intervention, there is an increase in physical activity and motivation and gradual decrease in sedentary duration that prevented mood disorders like depressive thoughts in them (Cooney, Dwan & Mead, 2014). With regular exercise, there is improvement in overall well-being of an individual that is effective in preventing depressive feelings and treatment of mild depression, although to a lesser extent. Physical exercise including yoga, meditation and brisk walking are considered beneficial in terms of cognitive behavioural treatment in reducing its symptoms in addition to pharmacotherapy (Rimer et al., 2012).
According to the evidence provided by the literature, it can be deduced that exercise attainment depends on amount of exercise undertaken. Evidence showed that walking or running (aerobic exercise), three times for at least 30 minutes and eight weeks is helpful in preventing depressive thoughts, although more research is required in the future. However, the current recommendation is exercise for at least 30 minutes of moderate intensity is most effective preferable for all days of the week (Josefsson, Lindwall & Archer, 2014).
Healthy Diet
According to a research conducted by Deakin University in Australia suggests that there is powerful influence of food on mood as published in the journal BMC medicine (Jacka et al., 2015). This groundbreaking finding demonstrates that people suffering from mild to severe depression should eat healthy diet in order to improve their mood and prevent disorder complications. Poor diet is considered to a leading risk factor for depression as unhealthy diet makes one depressed and feels sicker. Unfortunately, only 5% men and 10% women in Australia eat healthy diet as per Australian Dietary Guidelines suggesting that majority of Australians eat unhealthy food that is affecting mental health and predisposing factors for chronic illnesses (Jacka et al., 2010). Healthy diet is viewed as medicine in depression as physical exercise alone cannot relieve depressive symptoms The research also suggests that cytokines (inflammatory molecules) produced by body fat may spark inflammation that increases the risk of depression and causes harm to blood vessels lining (Jacka et al., 2015). On contrary, healthy fats like omega-3 fatty acids increases the production of neurotrophin proteins that act as manure for the brain promoting new brain cells growth in the hippocampus suggesting strong correlation between diet and hippocampus size (O’Neil et al., 2013). Therefore, healthy diet and physical exercise interventions implementation among adult Australians can be helpful in reducing depressive feelings and preventing future depression.
Depression is a major public health issue and one of the leading causes of disability globally including Australia. It has negative health outcomes and decline in functional ability of individuals affected with major depression in Australia. In extreme cases, it can inflict suicidal thoughts and ideation in individuals experiencing mood disorders like anxiety and depression. Various studies showed that SB and unhealthy diet can affect mood and increases the risk of mood disorders like depression. Therefore, physical exercise and healthy diet can help to improve mood and prevent depressive thoughts. Physical exercise interventions along with healthy eating can improve the mental health of the adult Australians experiencing major depression.
However, many studies in the review showed no relation between physical exercise and major depression symptom reduction. Studies conducted by Kritz-Silverstein, 2008 and Birkeland, Torsheim, & Wold, 2009 showed an indirect correlation between leisure-time and major depression among adults. These studies suggested that anti-depressive effects of physical exercise remains unclear having implications for future research. Moreover, these findings do not provide any information regarding intensity and frequency of exercise having protective effect against depression. These studies do not align with the research question as physical activity showed no effect on preventing individuals against depression. There were gaps seen in the literature review, as there was no correlation shown between exercise intensity on treatment and reduction of major depressive symptoms. Moreover, depression being the second cause of disability in Australia contribute to burden to disease and has policy implications. The policy should emphasize on encouraging physical exercise and healthy eating among adults in Australia in colleges and workplaces. However, the policy fails in educating and developing understanding of importance of healthy living to curb major depression. Therefore, the policy is expected to promote healthy living and encourage individuals to inculcate physical exercise in their daily life through dissemination of important information.
Conclusion
According to the Australian health statistics, about 45% of people experiences mental health problems like anxiety and depression once in their lifetime. In a year, about 1 million adults in Australia suffer from depression and about 2 million experience anxiety disorders. Depression has become of the leading causes of disability among adult Australians as well as globally affecting daily functioning of affected individuals. In the past people considered depression can be treated by pharmacotherapy, however physical exercise and nutrition diet can be helpful in improving mood conditions and preventing future depression. Recently, in Australia, people are focusing on lifestyle interventions like physical activity and nutrition for addressing this issue. However, future studies are required to curb depression by studying intensity and frequency of physical exercise required along with protective factors that can help in preventing future depression.
References
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