Exercise in Geriatric Psychiatry

Abstract

Depression, cognitive impairment, and dementia are among the most prevalent psychiatric disorders among older adults (e.g., Blazer, 2003; Prince et al. 2013). Despite the large demand for efficient treatment options, most older adults with mental health problems do not receive adequate treatment and preventative interventions are scarce (Bartels, Moak, & Dums, 2014). There is growing evidence for the efficacy of physical exercise interventions in the prevention and treatment of mental health problems in older adults. For depression, there is a growing number of randomized controlled trials that show an immediate effect of physical exercise on depression (Mura & Carta, 2013). In mild cognitive impairment, there is limited evidence for an improvement in cognitive performance and a reduction in the progression rates toward overt dementia (Gates, Singh, Sachdev, & Valenzuela, 2013). For dementia itself, there is increasing evidence that physical exercise could improve cognitive functioning and activities of daily living (Forbes, Thiessen, Blake, Forbes, & Forbes, 2013). So, why are physical exercise interventions not being broadly implemented in geriatric mental healthcare? The specific challenges of physical exercise interventions in geriatric psychiatry include a variety of different settings, individual differences in care-receivers, especially with respect to physical disabilities and multi-morbidity, as well as lower awareness, social unacceptance of mental disorders (Schomerus et al., 2012), and therapists’ bias toward treatment efficacy in older adults. The present issue of GeroPsych elucidates the efficacy of physical exercise interventions in geriatric psychiatry and presents implementation trials, including some with a pilot nature, to foster further discussion and implementation of physical activity in geriatric mental health. First, Heinzel and colleagues (Heinzel, Lawrence, Kallies, Rapp, & Heissel, 2015) provide a systematic review and meta-analysis of physical exercise interventions for adults aged 60 or older. They show a moderate effect size for physical exercise interventions, which seems to depend somewhat on setting (home-based versus supervised), but convincingly remains stable when including active control groups to adjust for social activation effects. Heissel and colleagues (Heissel et al., 2015) show how such exercise interventions for depression may be transferred to inpatient geriatric psychiatry services. They present preliminary results that raise hope for both feasibility and efficacy in this setting. Links to the neurobiology of depression are discussed. Next, Fleiner and colleagues (Fleiner, Trost, Depiereux, Zijlstra, & Haussermann, 2015) take exercise to a geriatric psychiatry inpatient ward across disease groups in their program Geriatric Psychiatry in Motion and provide a detailed account of implementation strategies, feasibility, and adherence in a geriatric psychiatry inpatient populations. Yet mental health outcomes are not the only target of physical exercise interventions in old age. Alexander and colleagues (Alexander, Sartor-Glittenberg, Bordenave, & Bordenave, 2015) in their brief report demonstrate how balance training can increase physical activity and decrease fear of falling – both are prerequisites for successful physical activity interventions in older adults. Finally, differences in activities of daily living as a function of specific profiles of mild cognitive impairment are presented by Avila and colleagues (Avila et al., 2015), who convincingly suggest that cognitive profiles distinguish subtypes of mild cognitive impairment.