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      Effects of different amounts of exercise on preventing depressive symptoms in community-dwelling older adults: a prospective cohort study in Taiwan

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          Abstract

          Objectives

          To compare the effects of four different amounts of exercise for preventing depressive symptoms in community-dwelling older adults.

          Design

          Prospective cohort study.

          Setting

          A nationally representative sample in Taiwan.

          Participants

          Four waves of the survey ‘Taiwan Longitudinal Study on Aging (TLSA)’ from 1996 to 2007 were analysed. A total of 2673 older adults aged 65 years and over were recruited.

          Primary and secondary outcome measures

          Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Four different types/amounts of exercise were examined including: (1) 3 times/week, 15 min/time; (2) 3 times/week, 30 min/time; (3) 6 times/week, 15 min/time; and (4) 6 times/week, 30 min/time. All exercise types were required to have at least moderate intensity. The impacts of different amounts of exercise on depressive symptoms were analysed using generalised linear mixed models.

          Results

          More than one-fifth of the elder individuals under consideration had depressive symptoms (CESD ≥10). About 38.6% of older adults met the lowest criteria for exercise type 1, and fewer (28.0%) met the highest criteria for type 4. Only exercise type 4 in the current survey was initially related to lower depressive symptoms (OR=0.8, 95% CI 0.66 to 0.95). However, after considering the interaction between time and changes in exercise patterns, the results showed that all persistent exercise models, even if a very low amount (3 times/week, 15 min/time), had significantly preventive effects on depressive symptoms (OR=0.56~0.67).

          Conclusion

          Consistent exercise with at least 15 min per time, three times a week of moderate intensity is significantly associated with lower risk of depressive symptoms. This low amount of exercise may be easier to promote at the community and population level than other alternatives.

          Trial registration

          Registry number 104040 of the Institutional Ethics Committee of Chia-Yi Christian Hospital.

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          Most cited references25

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index.

            Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original.
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              The antidepressive effects of exercise: a meta-analysis of randomized trials.

              Several meta-analyses examining the effects of exercise on depression have been criticized for including studies of poor methodological integrity. More recent meta-analyses addressed the most common criticism by including only randomized control trials; however, these analyses suffer from incomplete literature searches and lack of moderating variable analyses. Using a more extensive search procedure, the current meta-analysis examines the effects of exercise on depressive symptoms in 58 randomized trials (n = 2982). An overall effect size of -0.80 indicates participants in the exercise treatment had significantly lower depression scores than those receiving the control treatment. This frac34; SD advantage represents level 1, Grade A evidence for the effects of exercise upon depression. Analysis of moderating variables examined the influence of population characteristics, exercise characteristics and methodological characteristics. Examination of clinical significance in 16 trials with clinically depressed patients found 9 of 16 exercise treatment groups were classified as 'recovered' at post-treatment, with another three groups classified as 'improved'. Analysis showed dropout rates for the exercise treatment were similar to those found in psychotherapeutic and drug interventions.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Open (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                2 May 2017
                : 7
                : 4
                : e014256
                Affiliations
                [1 ] departmentDepartment of Community Health , Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chia-Yi City, Taiwan
                [2 ] departmentDepartment of Medical Research , Kuang Tien General Hospital , Taichung, Taiwan
                [3 ] departmentInstitute of Gerontology , National Cheng Kung University College of Medicine , Tainan, Taiwan
                [4 ] departmentDepartment of Public Health , National Cheng Kung University College of Medicine , Tainan, Taiwan
                Author notes
                [Correspondence to ] Dr Susan C Hu; shuhu@ 123456mail.ncku.edu.tw
                Author information
                http://orcid.org/0000-0003-2437-5918
                Article
                bmjopen-2016-014256
                10.1136/bmjopen-2016-014256
                5623457
                28465305
                33301820-e615-434e-a57d-095598873934
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 13 September 2016
                : 26 February 2017
                : 21 March 2017
                Funding
                Funded by: Research Center for Humanities and Social Sciences, National Cheng Kung University.;
                Categories
                Mental Health
                Research
                1506
                1712
                Custom metadata
                unlocked

                Medicine
                exercise,depression,mental health,elderly,generalized linear mixed models,cohort study.
                Medicine
                exercise, depression, mental health, elderly, generalized linear mixed models, cohort study.

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