Management of depression in older people: A role for physical activity

Depressive illness results in considerable functional disability and decreased quality of life. The prevalence of depression in older persons ranges from 5 to 30%. Older people often have depression concurrent with other illnesses, e.g., cardiovascular disease. Depression can also impact adversely on these disorders. Current management of depression commonly involves drugs and psychotherapies, which whilst effective, have variable adherance rates. Non-pharmacological therapies offer potentially safer alternative management of depression in older people. Of the psychotherapies, cognitive behaviour therapy and reminiscence and life review have the best supporting evidence for older people. Few lifestyle change modalities have been sufficiently tested to recommend their use with older people. An exception is physical activity. Both endurance and resistance type physical activity has anti-depressant effects for older people with depression. Older depressed people have much to gain from being physically active. Physical activity offers a therapy where negative events are minimal and benefits can accrue for both physical and mental health status. Physical activity may assist both in the prevention and management of depression in older people. As a health promotion intervention, it has the potential to reduce the risk of depression and to ameliorate co-morbid conditions. Using physical activity as an antidepressant can reduce the need for pharmacological intervention, minimizing iatrogenic and polypharmacy risk that is particularly prevalent for older people.