Running Head: EXERCISE-BASED INTERVENTIONS 1

Exercise-Based Interventions
Grayson Nicol
Bon Secours Memorial College of Nursing
Professor Arlene Hollowaychuk
NUR 4122
11/18/2017
"I Pledge"
EXERCISE-BASED INTERVENTIONS 2

Abstract
The goal of this integrative review is to evaluate literary works related to the use of exercise-

based interventions and their effect on depressive symptoms in the elderly. The issue of

depression in the elderly population is prevalent and overlooked. There are limited physical

exercise programs to aid the elderly in this disease process. The design of this research is an

integrative review. The utilization of computer-based search engines such as Google Journals

and PubMed were used to find relevant literature. Out of the 65 yielded articles, 5 articles fit the

criteria to be included. The analysis of the findings and results supported the use of physical

exercise programs to lower the severity of depressive symptoms. Four of five articles indicated a

positive effect of exercise programs on depressive symptoms supported by the clinical outcomes.

Limited time to complete the assignment and the student's minimal amount of expertise and

exposure to the subject were some of the limitations to the review. Research in the future should

include studies that compare exercise, nutrition, and lifestyle habits with traditional medication

regimens.
EXERCISE-BASED INTERVENTIONS 3

An Integrative Review: Exercise-Based Interventions

The purpose of this integrative review is to obtain literary works related to the use of

physical exercise programs and their effects on depressive symptoms in the elderly population.

Depression is major health problem among elderly people living in communities (Huang et al.,

2015). This disease affects multiple aspects of the individual, such as their spiritual, cognitive,

and physical wellbeing. Strategies of prevention require the collaboration of the community,

fitness professionals, and the individual, along with their support system. Group home

communities and retirement communities are key to the integration and success of these

programs. Exercise-based studies have indicated a significant impact on alleviating the

depressive symptoms in the elderly, but there is a lack of research showing a total relief from

these symptoms (Huang et al., 2015). This topic of study interests this researcher due to a

personal concern for a loved-one affected by depression who refuses to manage symptoms in any

way other than pharmacological. Therefore, the researcher's PICO question is as follows: In the

elderly population, what is the effect of physical exercise programs on depressive symptoms?

Research Design, Search Methods, & Search Outcomes

The design used with this research is an integrative review, which was utilized as a

research tool for an assignment in a research class within a nursing bachelor's degree program.

Computer-based search engines such as Google Journals and PubMed were used to search for

relevant literature. Some of the search keywords included, 'exercise', 'physical', 'depression',

'elderly', and 'exercise-based program'. The search presented 17,500 articles from Google

Journals. These results show the vast amount of information on this topic. To be current and
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relevant, the search results were limited to peer-reviewed, qualitative or quantitative research

journal literature published between 2012 and 2017. To meet the criteria, the articles had to

relate to PICO question of the researcher which inquires: " In the elderly population, what is the

effect of physical exercise programs on depressive symptoms?" The article inclusion criteria is as

follows: elderly population, depressive symptoms present, exercise-based intervention variable.

Screening of the articles was based on relevance and significance to the PICO question and the

satisfaction of inclusion criteria. If an article did not meet the requirements, it was not included

in the integrative review. Five exercise-based intervention journal articles were included; 5 of

which were quantitative.

Findings/Results

Three of the five articles revealed findings and results that indicated a positive effect of

physical exercise on depressive symptoms in the elderly (Lavretsky et al., 2015; Mokhtari et al.,

2013; Underwood et al., 2013; & Verrusion et al., 2014). A summary of the five included articles

is included in appendix 1. The integrative review was organized based on the following

classifications: exercise-based prevention interventions and results with statistical significance.

Exercise-Based Interventions

There was a consensus among the majority of included articles that exercise programs

positively affect the depressive symptoms in the elderly population (Lavretsky et al., 2015;

Mokhtari et al., 2013; Underwood et al., 2013; & Verrusion et al., 2014). In the quantitative

study conducted by Verrusio et al. (2014), it was made clear that exercise therapy was effective

in alleviating depressive symptoms, similar to the results of pharmacotherapy. Using a

randomized sampling method using 24 patients, data was gathered from two groups of random
EXERCISE-BASED INTERVENTIONS 5

sampling. Data was analyzed using conceptual themes. Subjects in the pharmacotherapy group

were given antidepressants as needed. The exercise therapy group was involved in two exercise

sessions per week. This study adds to the literature base by stating that exercise programs

effectively decrease depressive symptoms in the elderly population.

The study conducted by Huang et al. (2015) assessed over a 9-month period whether a

physical fitness exercise program would be effective in decreasing depressive symptoms among

the community-dwelling elderly population. 57 participants were selected based on the following

criteria: age 65 or older and had a score on the Geriatric Depression Scale (GDS) of 5 or higher.

The experimental group received 3 workouts per week lasting 50 minutes each. This regimen

lasted 12 weeks. A certified physical fitness trainer conducted each workout and healthcare

professionals monitored progress and results. The control group was not required to participate in

the exercise regimen and was advised to take part in their normal activities. The participants

completed the GDS test before and after the experiment ended at 12 weeks. No significant

differences were noted at baseline. This study did not show a significant difference in test results

pre-test and post-test among participants in the experimental group. This study does not add to

the collection of literature stating that physical exercise programs decrease depressive symptoms

in the elderly population.

The study conducted by Underwood et al. (2013) assessed over a 12-month period

whether an exercise program was effective in treating depression in the elderly. 891 clients were

selected based on age over 65 and living in a community home. The experimental group received

12 months of exercise programs twice per week for 45 minutes each session (Underwood, 2013).

The control group participated in normal activities with no added exercise. A professional

therapist led the experimental group during the exercise regimen. The patients completed a
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Geriatric Depression Scale test before and after the experiment took place over 12 months. The

study revealed results that indicated a lack of support towards the physical exercise programs

positive effect on depression. This study does not add to the collection of literature indicating

that physical exercise has positive effects on depressive symptoms in the elderly.

Results with Statistical Significance

The study conducted by Mokhtari et al. (2012) assessed over a 12-week period whether a

Pilates exercise program was effective in treating geriatric depression in older adults. 30 female

participants attending a rehabilitation clinic, aged 62 to 80, were selected for this study. The

experimental group received 1 hour of Pilates per day, 3 days per week for 12 weeks. The

intervention group was led by medical professionals who instructed classes and monitored

activity. The control group was assigned to complete their normal daily activities. Before the

experiment began, participants took part in completing the Geriatric Depression Scale (GDS).

Participants took this test before and after the 12-week program. This study showed positive

results in improving depressive symptoms among participants. GDS test results were

significantly lower in post-test scores among the experimental group members. These results

indicate a decrease in depressive symptoms after treatment with a 12 week Pilates program. This

study contributes to the collection of literature indicating the decrease of depressive symptoms in

the elderly as a result of participation in exercise programs.

The study conducted by Lavretsky et al. (2011) assessed over a 14-week period whether a

Tai Chi Chi program was effective in treating geriatric depression. 112 depressive participants

aged 60 years and older received a four-week course of Escitalopram., followed by incorporation

of tai chi for 10 weeks. A doctor led the intervention group, instructing tai chi and monitoring

results. The control group received antidepressants alone. A depression health exam called a
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Short-Term Health Survey was done before the experiment and at 14 weeks. This study showed

positive results in improving depressive symptoms. Short Term Health Survey test results were

significantly higher in the experimental group receiving Escitalopram and Tai Chi. The study

contributes to the base of literature indicating the positive correlation between physical exercise

and improvement of depressive symptoms in the elderly.

Discussion/Implications

The findings of the integrative review address the effects of exercise-based interventions

against control groups in several different clinical outcome measures regarding depression in the

elderly. The findings in the majority of the articles support the researcher’s PICO question. The

PICO question asked about the possible effects of exercise-based interventions on depressive

symptoms in the elderly. The Quantitative study conducted by Verrusio et. Al (2014), made it

clear that there is a need for prevention interventions in this population. The quantitative studies

showed statistical significance in outcomes among the depressed elderly population (Lavretsky

et al., 2015; Mokhtari et al., 2013; Underwood et al., 2013; & Verrusion et al., 2014). Exercise

programs incorporated into the lives of the sample group showed a positive impact on the

depressive symptoms they were experiencing. The use of exercise professionals increased the

effectiveness of the workout regimens. Future research should be conducted by a research team

with more experience and more time to ensure precise and detailed work. Future research should

also focus on aerobic versus anaerobic exercises and their effects on depressive symptoms.

The implications of the findings suggest that it is possible to positively affect depressive

symptoms in the elderly population. The use of health professionals increases the opportunity to

affect healthcare on a global level and community level.

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Limitations

The researcher acknowledged several limitations that had influence on this integrative

review. The review is the last class assignment conducted by the researcher. The biggest

limitation was time because the researcher is a full-time student and experienced difficulty

devoting time solely to this assignment. After attempting to write a literature review for the first

time, it is clear that the researcher has a lack of knowledge and expertise in this process. Despite

having several limitations, the validity of the study is still intact.

Conclusion

The findings of this integrative review support the effort to establish prevention

interventions in the depressed elderly population. Beneficial findings included in the review

include significant decreases in GDS scores and overall decrease in depressive symptoms. The

integration of exercise programs into the lives of the elderly proved itself to be beneficial. Health

professionals and fitness professionals increased outcomes by providing quality work and

inspiration. Techniques of innovation, such as aqua-aerobics, could have been included in this

population. Longitudinal research that last longer than the durations of the studies can view the

long term effects of exercise programs in the depressed elderly population. Nurses have the

opportunity to make an impact on a personal, community, and global level. Individual

interactions and conversations make huge impact on the patients, personally. Local clinics and

classes make an impact with the community. Published research accomplished by nurses has the

potential to impact the world because of internet capabilities. On all levels, nurses play a key role

in impacting this vulnerable population in a positive way.

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References

Haung , T. (2015, June 10). Physical fitness exercise versus cognitive behavior therapy on reducing the

depressive symptoms among community-dwelling elderly adults: A randomized controlled trial.

Retrieved October 31, 2017, from

http://www.sciencedirect.com/science/article/pii/S002074891500190X

Lavretsky, H., M.D. (2012, July 12). Complementary Use of Tai Chi Chih Augments Escitalopram

Treatment of Geriatric Depression: A Randomized Controlled Trial. Retrieved October 31, 2017,

from http://www.sciencedirect.com/science/article/pii/S1064748112601341

Mokhtari, M. (2013, February 15). The Effect of 12-Week Pilates Exercises on Depression and Balance

Associated with Falling in the Elderly. Retrieved October 31, 2017, from

http://www.sciencedirect.com/science/article/pii/S1877042813002474

Underwood, M., MD. (2013, July 6). Exercise for depression in elderly residents of care homes: a cluster-

randomised controlled trial. Retrieved October 31, 2017.

Verrusio, W. (2014, June 06). Exercise training and music therapy in elderly with depressive syndrome: A

pilot study. Retrieved October 31, 2017, from

http://www.sciencedirect.com/science/article/pii/S0965229914000971
EXERCISE-BASED INTERVENTIONS 10

Table 1- Qualitative and Quantitative Article Evaluation

First Author  Huang (2015) – School of Nursing, College of Medicine, Chang

Year Gung University. Taiwan
Qualifications
Background  Depression is a major health issue among the elderly population
Problem living in communities.
Statement  Limited resources are available to the elderly population to help
decrease depressive symptoms, better support can be available if
researchers determine to most effective practice.
Conceptual/  Researchers wanted to see the effects of physical exercise versus
Theoretical cognitive therapy on depressive symptoms in the elderly.
Framework
Design/Method/  Quantitative Experimental
Philosophical  Prospective Randomized Control Trial
Underpinnings  Elderly patients were either given cognitive behavior therapy or
physical exercise. They were later assessed for the severity of
depressive symptoms.

Sample/Setting/  57 people with depressive symptoms

Ethical  Three communities in Taiwan
Considerations  Informed consent, exclusion of names for the research study.
Major  Experimental Group = Physical Exercise 1 hour 3 times per week.
Variables  Control Group= Normal activities of daily living.
Studied
Measurement  Geriatric Depression Scale
Tool Data
Collection
Method
Data Analysis  Means, standard deviations
 Analysis was not blind.

Findings  GDS scores were higher in the the physical exercise group.
Discussion  Findings were not in favor of the physical exercise group. The
findings did not show significance between the two groups.
Appraisal  Physical exercise has a minimal effect on depressive symptoms.
Worth to
practice
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First Author  Lavretsky (2011) – Faculty David Geffen School of Medicine at

Year UCLA. California
Qualifications
Background  Almost 66% of elderly with depression who receive treatment do not
Problem achieve remission of symptoms from pharmacology.
Statement  The combination of tai chi and medicinal therapies is not common
and resources are limited.
Conceptual/  Researchers wanted to see the effect of tai chi, along with
Theoretical escitalopram, on depressive symptoms in the elderly.
Framework
Design/Method/  Quantitative Experimental
Philosophical  Randomized Controlled Trial
Underpinnings  Over a 14-week period, patients either received escitalopram or a
combination of tai chi exercise two hours per week and
escitalopram. They were later assessed for the decrease in depressive
symptoms.
Sample/Setting/  112 adults with major depression age 60 or older.
Ethical  California
Considerations  Informed consent, exclusion of patient names in research
publications.
Major  Experimental Group= Tai Chi two hours per week along with
Variables Escitalopram
Studied  Control= Escitalopram
Measurement  Hamilton Depression Rating Scale (HDRS)
Tool Data  Demographic Information
Collection  Questionnaire of 36 items.
Method
Data Analysis SAS version 9.1 measured the HDRS scores.
Findings  Experimental Group participants were more likely to show a
Discussion decrease in depressive symptoms than the control group.
 The results showed a significant difference in outcomes.
Appraisal  Nurses can help make this change and support exercise.
Worth to  Outcomes were better when pairing tai chi exercise and medication
practice for depression in the elderly.
EXERCISE-BASED INTERVENTIONS 12

First Author  Mokhtari (2013) – Faculty-Department of Sport Sciences,

Year University of Isfahan, Iran
Qualifications
Background  Depression is one of the most frequently documented cognitive
Problem disorders in the elderly population.
Statement  Special focus and attention should be given to this topic to increase
the available resources for information.
Conceptual/  Researchers wanted to study the possible effects that Pilates had on
Theoretical decreasing depressive symptoms in the elderly.
Framework
Design/Method/  Quantitative experimental
Philosophical  Quasi-experimental
Underpinnings  Patients participated in Pilates exercises for one hour per week or
completed ADLs. Both groups were assessed after 12 weeks for a
possible decrease in depression.
Sample/Setting/  30 elderly women ages 82-60
Ethical  Informed consent
Considerations
Major  Experimental Group = 6 weeks of Pilates using mats, 6 weeks using
Variables bands. One hour per week for a total of 12 weeks.
Studied  Control Group= No exercises. Completed normal daily activities.
Measurement  Pretest and posttest- Geriatric Depression scale.
Tool Data  15 question test
Collection
Method
Data Analysis  Mean, correlation coefficient, validity
 The GDS scale was used to determine outcomes.
Findings  Pilates decreased depressive symptoms.
Discussion  Trends are present that reinforce the findings of this study.
Appraisal  Results show the amount of effect that exercise has on depressive
Worth to symptoms in the elderly population.
practice
EXERCISE-BASED INTERVENTIONS 13

First Author  Underwood (2013) Faculty MD at University of Warwick.

Year
Qualifications
Background  Depression is a common occurrence in the elderly and can lead to
Problem other health issues.
Statement  Exercise can offer benefits to help alleviate depressive symptoms.

Conceptual/  Researchers wanted to study the effects that physical had on the
Theoretical symptoms of depression in the elderly.
Framework
Design/Method/  Cluster-Randomized Controlled Trial
Philosophical  Quantitative Experimental
Underpinnings  Over 12 months, patients participated in physical exercise programs
twice per week.
Sample/Setting/  Sample size of 891.
Ethical  Informed Consent
Considerations
Major  Independent Group- 45-minute exercise program led by therapist
Variables twice per week.
Studied  Control Group- Normal Activities
Measurement  Geriatric Depression Scale Test
Tool Data  15 item questionnaire
Collection
Method
Data Analysis  Cross-sectional analysis including over 130 additional clients.

Findings  Alternative strategies to manage depressive symptoms are needed in

Discussion the elderly population.
Appraisal  Results show that other options are available to help alleviate
Worth to depressive symptoms.
practice
EXERCISE-BASED INTERVENTIONS 14

First Author  Verrusio (2014)

Year  Faculty Sapienza University of Rome
Qualifications
Background  Recent studies have shown facts that medications are mildly
Problem effective on depression.
Statement
Conceptual/  Researches wanted to evaluate the effects that physical exercise
Theoretical program had on depression in the elderly population.
Framework
Design/Method/  Quantitative Experimental
Philosophical  Randomized Trial
Underpinnings  Over 6 months, Patients participated in exercise programs.
Sample/Setting/  24 clients selected.
Ethical  Informed Consent, no names shared in study
Considerations
Major  Experimental Group- Physical exercise regimen a few times per
Variables week with light to moderate activity.
Studied  Control Group- Normal activities of daily living.
Measurement  Hamilton Depression Scale
Tool Data  Geriatric Depression Scale
Collection  Collected at 3 and 6 months.
Method
Data Analysis  Mean, THF-a level analysis.

Findings  GDS scores were lower in the experimental group.

Discussion  Exercise programs are proven to be effective in treating mild to
moderate depressive symptoms.
Appraisal  This study adds to the literature supporting the use of physical
Worth to exercise programs to alleviate the symptoms of depression in the
practice elderly population.