As a physiotherapist I understand how exercise can help manage medical illnesses such as coronary heart disease, respiratory and musculoskeletal conditions. There is an ever growing body of research that supports the role of exercise in the management of these conditions and in the management of depression which can occur as a secondary issue following diagnosis of a life-limiting illness.
This research is not only presenting evidence that exercise can help conditions that we previously thought were immune to the effects of exercise, it is also showing that the type, intensity and duration of this exercise can mean the difference between it being effective or ineffective.
For example, walking and lifting weights are seen to be equally effective in decreasing depression symptoms1 while for liver cirrhosis higher intensity interval training has shown to be required to improve health markers.2 This high intensity interval training is a workout consisting of alternating bouts of walking and running or cycling at a high heart rate separated by easier bouts at a lower heart rate.
Secondary depression generally accounts for 40% of depression diagnosis and is due to the psychological effects of living with a life threatening or limiting illness.3 For example a person who has had a stroke and now has difficulty with speech, emotional expression or physical ability may develop depression. This 40% also includes people who find themselves unable to live the life they want to due to heart, respiratory, rheumatological and orthopaedic conditions or cancer diagnosis.
Understanding the cause of an individual’s symptoms of depression enables the creation of a more specific and efficient workout and can even increase the chance of survival for certain diseases.
If we focus on the primary illness and treat it optimally we see greater improvements in physical capacity. A link has been shown to exist between an increase in physical functioning and a decrease in depressive symptoms in people experiencing depression.1
For example, coronary artery disease symptoms have shown greater improvement with resistance exercises than aerobic workouts alone.4 So, if we know that the onset of depression is caused by coronary artery disease, we can treat both the symptoms of heart condition and depression more effectively by incorporating resistance exercises into the program.
Another example is seen in people diagnosed with breast or prostate cancer, survival rates are higher in patients who walk or take part in high intensity interval training for three hours per week, respectively. When we can efficiently increase the physical capacity of people with a diagnosis of cancer while also optimising their chance of survival through type of exercise, specific exercise prescription becomes highly important.
Knowing that following a specific, individually tailored exercise programme can increase quality of life and offer higher chances of survival can be emotionally empowering for a person. Research cites that breast cancer mortality rates are decreased by 41% in people who exercise compared to those who don’t5. In prostate cancer it is decreased by 61%6.
Safety is extremely important when implementing an exercise programme with a person who has a serious physical condition. Heart conditions that are being managed with medication, without any form of surgery, will require a stress test prior to beginning any training program to ensure adequate blood supply to the heart. Prior to beginning an exercise program, you will need to find out the upper limits of the exercise that is suitable for you from your medical team. Once you know your maximum heart rate that you can exercise at, you can safely stay below it when exercising.
People who have been coping with serious physical limitations due to prolonged illness can experience a lower level of physical fitness. Due to this, certain types of exercises will be too demanding at the start of the exercise program. It’s important to break the exercise programme down in to achievable goals.
A long term goal may be to return to an old pastime, such as soccer. In the beginning, smaller realistic monthly goals may be needed to gradually increase fitness. This will give the body time to adjust, the heart and muscle time to get stronger and the fitness level time to improve at a steady rate allowing for consistent improvements in exercise intensity and duration.
This gradual increase in exercise intensity will progressively allow people to return to their chosen pastime in a safe and effective manner. This can have a significant positive effect on a person’s sense of wellbeing.
Exercise is a vital component of managing depression. For people who experience depression secondary to other health conditions, exercise prescription can be tailored to treat both the primary illness and the secondary depression.
If you are unsure of how to create smaller goals, or realistic time scales, consult a physiotherapist or doctor who specialises in the area of your illness or in exercise prescription for medical illnesses.
A simple one size fits all approach isn’t possible and each individual will experience exercise differently. Therefore exercise type and intensity will have to be customised to the person to ensure that it is physically suited to them and safe.
Once you start an exercise programme it is best to focus on your own goals, and how to attain them and not compare your progress to others. Appreciate that as each week passes you are getting fitter and healthier, but most of all you are now taking control over the parts of your healthcare plan that you can control. With exercise you will have a greater say in how your illness determines your life.
Note: Exercise programmes for heart and respiratory conditions are provided free-of-charge through the HSE’s cardiac and pulmonary rehab courses. You can be automatically referred to these courses by your primary health provider, or you can request a referral at your next appointment with your doctor or consultant. There are also private clinics that specialise in exercise prescription
by Daniel Quinn, Physiotherapist
1.The Benefits of Exercise for the Clinically Depressed. Craft, L. and Perna, M. (2004). Primary Care Companion, Journal of Clinical Psychiatry 2004: 6 104-111.
2.Modified High Intensity Interval Training Reduces Liver Fat and Improves Cardiac Function in Non-Alcoholic Fatty Liver Disease: a Randomized Conrolled Trial. Hallsworth, k. et al. (2015). Clinical Science 2015: 129 1097-105
3.The Significance of Secondary Depression. Clayton, P. and Lewis, C. (1981). Journal of Affective Disorders 1981: 3 25-35.
4.Effect of Combined Aerobic and Resistance Training versus Aerobic Training Alone in Individuals with Coronary Artery Disease: a Meta-analysis. Marzolini, S., Oh, P. and Brooks, D. (2012). European Journal of Preventive Cardiology 2012: 19 81-94.
5. Physical Activity and Survival in Postmenopausal Women with Breast Cancer: results from the Women’s Health Initiative. Irwin, M. et al. (2011). Cancer Prevention Research 2011: 4 522-529.
6. Physical Activity and Survival after Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study. Kenfield, S., Stampfer, M., Giovannucci, E., and Chan, J. (2011). Journal of Clinical Oncology 2011: 29 726-32.