Abstract
This paper reports the qualitative component from a pragmatic randomized controlled trial (PRCT), the quantitative component is reported in Callaghan, Khalil, Morres and Carter (2011). Exercise may be effective in treating depression, but trials testing its effect in depressed women are rare. Our previous research found that standard exercise programmes, prescribed by General Practitioners and based on national guidelines of intensity levels thought to produce health benefits, are not suitable for this group, as they find them discouraging and lonely, with many dropping out very early on. Exercise that is matched to participants’ preferred intensity improves mental health outcomes and attrition rates. Our aim was to develop such a programme. This study addressed the question: does mentored exercise of preferred intensity lead to better psychological, physiological and social wellbeing outcomes and improved adherence rates when compared with exercise of prescribed intensity in 38 depressed women? Focus groups were conducted with participants from both arms of the study, to explore their experience of the exercise programme and to gather information that might help to explain the quantitative outcomes, a technique recommended by previous researchers conducting pragmatic trials. Women in the experimental programme experienced a statistically significant improvement in their mood, physical health, sense of wellbeing, self-esteem and quality of life. They reported achieving these gains via a positive experience which encouraged continued attendance. In contrast, women who received the “exercise as usual” programme experienced no significant benefits, were less likely to continue attending, and markedly less enthusiastic.
Highlights
The Link between Physical and Mental IllnessHealth is “a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity” (World Health Organisation, 2007)
In terms of barriers to exercise, the most often stated obstacles were doing it alone, cost, prioritising the time, and other’s attitudes. This qualitative component of a larger PRCT study aimed to explore the participants’ experiences of a tailored programme of low effort physical activity and psychosocial support on global well-being in a community-based sample of women living with depression, to help in interpreting the quantitative findings of the PRCT study, and because there is a paucity of qualitative studies of exercise as a treatment for depression (MHF, 2004)
Some of the women in this study reported being offered exercise on prescription as a method of weight maintenance, but not as a treatment of depression
Summary
The Link between Physical and Mental Illness. Health is “a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity” (World Health Organisation, 2007). Within the notion of global wellbeing, there are physical, psychological and social constructs, and between them is a complex interplay (Department of Health [DoH], 2006; Mental Health Foundation, 2006; Seymour, 2003). Depression impacts on a range of physical health outcomes; it is associated with asthma, arthritis and diabetes (Turner & Kelly, 2000), is a risk factor for stroke (Ostir, Markides, Peek, & Goodwin, 2001) and increases the risk of heart disease by four times (Hippisley-Cox, 1998). Depression occurs in between 5% and 10% of people seeking primary care in the UK and is expected to be the second most common cause of disability worldwide; rates for women are double that of men (Richardson, Faulkner, McDevitt, Skrinar, Hutchinson, & Piette, 2005).
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