Can group medical visits promote physical activity and treat depression?

Can group medical visits promote physical activity and treat depression?

If a single medicine could prevent or treat numerous diseases, including depression, would you take it? Would you recommend it to your friends, to your family?

If there ever were a ‘silver bullet’ to better health it would be physical activity. As a medicine, physical activity is described as a “polypill”[1]–a single treatment effective in improving a wide variety of outcomes, including risk of several cancers, heart disease, diabetes, as well as depression.

But exercise is not a prescription that is easily filled at a pharmacy– especially when it comes to mental disorders. Many people living with a mood disorder, especially those with depression, find it difficult to become or remain active.  

Mental disorders, including depression, contribute more to the burden of disease worldwide than either cardiovascular disease or cancer. Within Canada, 6.7 million people live with a mental illness and when family and caregivers are included almost everyone is affected. You probably even know someone with depression.

So it’s not surprising that when the Secretary-General of the United Nations said, “there can be no health without mental health,” The World Health Organization, the Pan American Health Organization, the European Union Council of Ministers, the World Federation of Mental Health, and the United Kingdom Royal College of Psychiatrists all agreed.

If the global health community agrees, and there are millions living with diagnosed mental illnesses in Canada, what can we do to find cost-effective solutions?

Physical activity is also a simple, inexpensive means to bring relief and wellness to people, suffering from depression. The highest levels of evidence (systematic reviews) have concluded that physical activity has a significant potential for reducing depression. A smaller number of studies found no differences in efficacy between exercise and antidepressants or Cognitive Behavioural Therapy (CBT). 

Centre for Hip Health researchers David Adams, Dr. Jennifer Davis, Dr. Sara Vazirian, and Dr. Karim Khan, with others from UBC and in collaboration with the Mood Disorders Association of BC (MDABC) recently published a preliminary study of a 14-week intervention that integrated physical activity into a series of 14 weekly group medical visits (GMVs) intended to motivate patients diagnosed with a chronic mood disorder to engage in regular physical activity.

Group Medical Visits (GMVs) are a promising approach to mental health care. Group Medical Visits are organized around a group of people living with a specific condition[2]. Typically, in lieu of a short individual visit, a patient will participate in a longer (60-120 minutes) group visit with six to 14 other patients, led by a physician and/or other healthcare practitioner. 

While other studies have examined the efficacy of GMVs in addressing chronic illnesses and the promotion of lifestyle changes none to our knowledge have embedded physical activity within the actual patient visits. 

The results of CHHM’s preliminary study are promising: fourteen of 15 participants completed the program, and after three months post-intervention, median depression scales (PHQ-9) decreased 38% and, median anxiety scales (GAD-7) decreased 50%. Median daily “steps” increased 71%.

We need novel strategies for promoting physical activity and self-management that are also physically, financially, and psychologically accessible. Perhaps there is a moral and ethical obligation then to promote physical activity as a first-line treatment for depression. Ultimately, one question remains, ‘how do we better motivate individuals, dealing with depression, to become more physically active?’ Interdisciplinary GMVs (eg, psychiatrist/exercise professional) may be a means to decrease depression and anxiety ratings within clinical care while improving physical activity.

References:

1. Fiuza-Luces C, Garatachea N, Berger NA, et al. Exercise is the Real Polypill. Physiology 2013;28(5):330-58 doi: 10.1152/physiol.00019.2013[published Online First: Epub Date].
2. Northern Health Authority. The Group Medical Appointment Manual. First Edition ed: Northern Health Authority, 2007.