How can we measure and evaluate Psychological Well-being in relation to Physical Activity and Health and what might be the problems or weaknesses with this approach?

Depression is a debilitating condition that can have a negative effect on the quality of life for the millions of people worldwide it affects each year (Stanton & Reaburn, 2014). Recent studies continue to support a growing literature suggesting that exercise, physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes (Penedo & Dahn, 2005). With a specific focus on the treatment of depression, there are suggestions that exercise can be as effective as antidepressants and other medications (Dunn et al., 2005). However, measuring and evaluating depression in relation to physical activity and health can be complicated and it often doesn’t occur without problems and weaknesses.

Many studies have been published on this topic each with varying participants, methods, results and limitations. Here is a table to give a short summary of some of the most common methods used to measure depression and physical activity as well as the relationship between these two factors (click on graphs to enlarge):

Depression is a mood disorder that causes persistent feelings of sadness, despondency and dejection and its symptoms can occur in the context of a variety of medical conditions (Brosse et al., 2002). There isn’t just one method for measuring the severity of depression in fact there are many scales both clinician-related and self-report designed and used. In the cases where a clinician-related scale is being used, a clinician (ex. psychologist, psychiatrist) rates the severity of a number of symptoms through a combination of observations and interviews with the patient. Hamilton Rating Scale for Depression (HRSD) as shown in the graph is most commonly used but the Montgomery Asberg Depression Rating Scale (MADRS) is also a commonly used clinician-rated scale. Self-report questionnaires are to be done by the patients completely on their own and they usually consist of a series of written questions with multiple-choice responses. The Beck Depression Inventory (BDI) seems to be the most popular in the graph above; however, other examples include the Center for Epidemiological Studies Depression Scale (CES-D), the Symptom Checklist 90 (SCL-90) and the Zung Self-Rating Depression Scale. More commonly questionnaires are used due to their ease and low cost of administration (Brosse et al., 2002).

Physical activity is movement of the body that expends energy. There are three basic types of exercise; however, most exercise intervention studies only investigate the effects of aerobic exercise (Brosse et al., 2002). A common theme from the studies in the graph was to separate participants into different levels of physical activity or into groups that were physically active in comparison to sedentary. Most exercise seems to be closely monitored and recorded by the physicians instituting the physical activity, or through methods such as treadmill tests. As in the measurement of depression, questionnaires are also commonly used to measure physical activity. An example is the 1-item, 4-level Saltin Grimby Physical Activity Level Scale which is meant to separate the participants according to their answers into 4 different levels of physical activity varying from sedentary to engaging in vigorous activity daily (Lindwall et al., 2014).

When analyzing longitudinal data of physical activities effect on depression the multilevel model and the latent growth curve model are often used (Lindwall et al., 2014). Both these methods seem to provide valid associations of change between physical activity and depression, however, if the measurements of physical activity and depression are subject to bias the results may be jeopardized. The frequent use of personal questionnaires to measure physical activities effect on depression causes bias limitations. In order to avoid bias and examine possible causations biological mechanisms must be measured as well. Alterations in central norepinephrine activity, reduced activity of the hypothalamopituitary-adrenocortical axis and increased secretion of beta endorphins, have been suggested as mechanisms by which exercise improves mood, no method is yet available to address these possibilities (Blumentha et al.,1999).

Some additional limitations include many of the participants being volunteers that don’t represent the general population, short follow up periods and group settings as well as additional psychological mechanisms effecting positive outcomes such as, self-efficacy, improved self-concept, and reduced dysfunctional or negative thought patterns (Blumentha et al., 1999).

Although there are many current methods for measuring depression and physical activity each one contains limitations. Both clinician-related and self-report techniques are being used to measure depression and surveys as well as various exercise testing are used to measure physical activity. To be able to thoroughly address associations of change between the two, measurements of physical activity and depression must first be perfected. Multiple measurement types that examine physiological factors as well as biological factors must be included. A natural setting as well as a long follow up period should also be requirements. Once this criterion is met both multilevel models and the latent growth curve models can be used to measure the relation.

References:

1. Babyak, M., Blumenthal, J., Herman, S., Khatri, P., Doraiswamy, M., Moore, K., & ... Krishnan, K. (2000).Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months.Psychosomatic Medicine, 62(5), 633-638.
2. Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., ... & Krishnan, K. R. (1999). Effects of exercise training on older patients with major depression. Archives of internal medicine, 159(19), 2349-2356.
3. Brosse, A. L., Sheets, E. S., Lett, H. S., & Blumenthal, J. A. (2002). Exercise and the Treatment of Clinical Depression in Adults: Recent Findings and Future Directions. Sports Medicine, 32(12), 741-760.
4. Chalder, M., Wiles, N. J., Campbell, J., Hollinghurst, S. P., Haase, A. M., Taylor, A. H., & ... Lewis, G.(2012). Facilitated physical activity as a treatment for depressed adults: Randomised controlled trial. BMJ: British Medical Journal, 344(7860).
5. Dunn, A. L., Trivedi, M. H., Kampert, J. B., Clark, C. G., & Chambliss, H. O. (2005). Exercise treatment for depression: efficacy and dose response. American journal of preventive medicine, 28(1), 1-8.
6. Hughes, J., Casey, E., Doe, V., Glickman, E., Stein, P., Waechter, D., & ... Rosneck, J. (2010). Depression and heart rate variability in cardiac rehabilitation patients: exploring the roles of physical activity and fitness. Perceptual And Motor Skills, 111(2), 608-624.
7. Lindwall, M., Gerber, M., Jonsdottir, I. H., Börjesson, M., & Ahlborg, G. J. (2014). The relationships of change in physical activity with change in depression, anxiety, and burnout: A longitudinal study of Swedish healthcare workers. Health Psychology, 33(11), 1309-1318. doi:10.1037/a0034402,
8. Miser, W. F. (2000). Exercise as an Effective Treatment Option for Major Depression in Older Adults. Journal Of Family Practice, 49(2), 109-110.
9. Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Current opinion in psychiatry, 18(2), 189-193.
10. Stanton, R., & Reaburn, P. (2014). Exercise and the treatment of depression: a review of the exercise program variables. Journal of Science and Medicine in Sport, 17(2), 177-182.