Depression Table 3 Exercise for Depression following SCI

Author Year
Country
PEDro Score
Research Design
Sample Size

Methods

Outcomes

Hicks et al. 2003
Canada
PEDro=8
RCT
NInitial=43; NFinal=32

Population: Age=19-65 yr; Gender: both; Time since injury=1-24 yr.
Treatment: Experimental group participated in a progressive exercise training program twice weekly for 9 mo on alternative day’s 90-120 min starting with warm up, upper extremity stretching, and 15 to 30 min of aerobic training. As the rate of perceived exertion decreased, workload was increased. Some resistance training took place.
Outcome Measures: Changes in cardiovascular function, muscle strength and quality of life.

 

  1. Quality of life components: Exercisers reported less stress, fewer depressive symptoms, and greater satisfaction with their physical functioning than the controls. (p=0.06). Exercisers reported less pain (p<0.01) and a better Q of L (p<0.05).
  2. Performance on the 3-stage arm crank protocol was different for those with paraplegia versus tetraplegia (p<0.05).
  3. No changes in HR and BP between groups or after 9 months of training.
  4. Arm crank protocol was different between tetraplegia and paraplegia. Training induced increases occurred in all subjects in the experimental group.
  5. No significant differences in heart rate response over the 9 mo.
  6. Significant group x lesion x time interactions were found in stages 2 (p=0.006) and stage 3 (p=0.02), indicating the tetraplegics had the greatest decrease in heart rate.
  7. Changes in muscle strength: Experimental group showed changes in muscle strength over the 9 mo period. The control group did not show any significant changes. 

Ginis et al. 2003
Canada
PEDro=6
RCT
NInitial=34; NFinal=34

Population: Mean age= 8.6 yr; Gender: 23 males, 11 females; Mean time post-injury: 10.4 yr
Treatment: Intervention group: 5 min of stretching, 15 -30 min of aerobic arm ergometry exercise & 45-60 min of resistance exercise, 2d/wk, in small groups. Control group: Asked to continue normal daily activities and not begin an exercise routine for 3 mo
Outcome Measures: Perceived Quality of Life scale (PQOL); Centre for Epidemiological Studies Depression Scale (CES-D).

  1. After 3 months, when compared to controls, exercisers had:
    – ↑ QOL (p=0.007)
    – ↑ satisfaction with physical function (p<0.01)
    – ↑ satisfaction with physical appearance (p=0.007).
    – ↓depression (p=0.02)

Latimer et al. 2005
Canada
PEDro=1
RCT
N=23

Population: Intervention group: Mean age:37.54 yr; Gender: 9 males, 4 females; Level of injury: Tetraplegia (7), Paraplegia (6); Mean time post-injury: 9.23 yr; Control group: Mean age:43.30 yr; Gender: 5 males, 5 females; Level of injury: Tetraplegia (4), Paraplegia (6); Mean time post-injury:15.70 yr
Treatment: Intervention group: A 6 mo exercise program 2d/wk in small groups (avg 3-5 people), ran by student volunteer personal trainers. Control group: Asked to continue normal daily activities and not begin an exercise routine within 6 mo
Outcome Measures: Perceived Stress Scale (PSS); Centre of Epidemiological Studies Depression Scale (CES-D); Perceived Quality of Life (PQOL); measured at at baseline, 3 and 6 mo

  1. At baseline, ↑ stress levels were related to ↑ depression rates (p<0.05). At 6 mos, the exercise group's stress and depression association had ↓ but remained significant in the control group (p<0.05).
  2. At baseline, ↑ stress levels were associated to ↓perceived QOL (p<0.05). At 3 and 6 mo the exercise group's stress and QOL association ↓, but remained ↑ across all time points for the control group (p<0.05).
  3. Exercise was found to buffer the effects of stress on QOL and depression.

Hicks et al. 2005
Canada
Pre-Post
N=14

Population: Chronic incomplete SCI: N=14; Tetraplegic=11, Paraplegic=3; Gender: males=11, females=3; Age range= 20-53 yr; Mean time post injury=7.4 yr; ASIA: B=2, C=12.
Treatment: Body weight supported treadmill training (BWSTT -robotic) – up to 45 min, 3x/week, 144 sessions (12 mo).
Outcome Measures: CESD

  1. Increased life satisfaction and increased physical function satisfaction (p<0.05), after BWSTT.
  2. No change in depression or perceived health.

Warms et al. 2004
USA
Pre-Post
N=16

Population: Gender: males=13, females=3; Mean age= 43.2 yr; Mean time post injury=14.4 yr.
Treatment: “Be Active in Life” program: included educational materials (2 pamphlets, 2 handouts), a home visit with a nurse (90 min. scripted motivational interview, goal and personal action plan establishment), and follow up calls at day 4, 7, 11 & 28 (approx. 8 min each). Program lasted for 6 wk, and had a final follow up 2 wk post-completion.
Outcome Measures: SRHS, CESD

  1. Physical activity: Counts/day increased in 60% of subjects and self-reported activity increased in 69% of subjects, but both were not significant.
  2. Self-rated abilities: no change. Exercise self-efficacy: ↑ (p=0.01).
  3. Self-rated health: increased (p=0.04).
  4. Depression: no change.

Guest et al. 1997
USA
Pre-Post
N=15

Population: Traumatic complete paraplegics; N=15; Gender: males=12, females=3; Mean age= 28.8 yr; Mean time post injury=3.8 yr.
Treatment: Electrically stimulated walking program – 32-sessions, using the Parastep® FNS ambulation system.
Outcome Measures: TSCS, BDI

  1. Physical Self-Concept: decreased after electrically stimulated walking (p<0.05). Those with lower baseline score had the most significant improvements.
  2. Depression: decreased after electrically stimulated walking (p<0.05).

Kennedy et al. 2006
UK
Pre-Post
N=35

Population: Gender: males=30, females=5; Age: 18-61 yr, Level of injury: paraplegia = 20, tetraplegia=15.
Treatment: Back-Up: 1 wk single or multi-activity course in an integrated, residential environment. Activities include skiing, horseback riding, waterskiing, canoeing, rappelling and gliding. Questionnaires were completed at baseline and end of 1 wk activity courses
Outcome Measures: LSQ, HADS

  1. Significant improvement (p=0.016) in life satisfaction and satisfaction with leisure (p=0.007)
  2. Anxiety levels were significantly reduced (p<0.01).
  3. No overall improvement in perceived manageability however some difference (p=0.016) post-test was observed for engage “in what happens around me” indicating some use of Perceived Manageability strategy.
  4. Self-efficacy scores improved post-test (p=0.012).
  5. HADS scores demonstrated significant (p<0.01) improvement in anxiety levels over the duration of the course.

Bradley et al. 1994
USA
Cohort
N=37

Population: Gender: males=24, females=13; Mean age=32.03 yr; Level of injury: tetraplegic=12, paraplegic=25; Mean time post injury=6.51 yr
Treatment: Intervention group: 3 mos. FES exercise program; Control group: no intervention.
Outcome Measures: MAACLR

  1. Increased in depression & hostility for those who had unrealistic expectations of the FES program (p<0.01 & p<0.05, respectively).
  2. No other significant effects were found.

Note: BP=blood pressure; BWTT=Body Weight Treadmill Training; CESD=Centre of Epidemiological Studies Depression Scale; FES=Functional Electrical Stimulation; HADS=Hospital Anxiety and Depression Scale; HR=heart rate; LSQ=Life Satisfaction Questionnaire; MAACLR=Multiple Affect Adjective Check List; PQOL=Perceived Quality of Life; PSS=Perceived Stress Scale; QoL=Quality of Life; SF-36=Short Form 36 Item Health Survey; SRHS=Self Rated Health Scale; TSCS=Tennessee Self-Concept Scale.

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