Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to post-covid-19 condition? 2023

[SNT Gatchaman]

Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to patients with post-covid-19 condition? A systematic review and meta-analysis
Tommaso Piva, Sabrina Masotti, Andrea Raisi, Valentina Zerbini, Giovanni Grazzi, Gianni Mazzoni, Martino Belvederi Murri, Simona Mandini

The Coronavirus Disease 2019 (Covid-19) pandemic had dramatic effect on mental health, causing long-term psychiatricmorbidity. At present, there are no randomized trials reporting the effect of physical exercise on individuals with post- Covid-19 condition are available. The aim of this review was to summarize the evidence regarding the evidence on exercise as a treatment for anxiety and depression symptoms secondary to chronic diseases, which may be generalized to individuals suffering from the post- Covid-19 condition.

Trials were included if they reported the effects of physical exercise programs on anxiety or depression symptoms in adults, either healthy or affected by chronic diseases. Outcomes were changes of anxiety or depression severity after an exercise-based intervention.

Of the 2161 RCTs identified, eight out of 15 studies were included. Exercise was associated with greater improvements of depressive (SMD = −0.169; 95 % CI −0.302 at −0.003; p = 0.013) and anxiety symptoms (SMD = −0.263, 95 % CI −0.418 at −0.109; p = 0.001), compared with control interventions.

Supervised exercise programs were effective against symptoms of anxiety or depression among individuals with chronich illnesses. Pending specific clinical trials, exercise may be considered for adoption among patients with the post Covid-19 condition.

Link (Journal of Affective Disorders)

 

[SNT Gatchaman]

The paper could have benefited from an editor.

The aim of this review was to summarize the evidence regarding the evidence on exercise as a treatment for anxiety and depression symptoms secondary to chronic diseases, which may be generalized to individuals suffering from the post-Covid-19 condition.

Right... So to summarise the summary then. There are no RCTs on exercise in "post-Covid condition" so we've published this paper that looked at depression and anxiety associated with various "chronic diseases". We looked at over 2000 papers and discarded all but 8. These were looking at patients with depression and anxiety in association with mostly (it seems) being female, overweight or having dementia. Also "stress-related exhaustion".

For depression, the patients comprised —

872 subjects were examined, 471 from intervention groups (average age of 52.0 years of which 84 % female, 50 % obese, 20 % with dementia, 10 % with stress-related exhaustion, 9 % healthy, 5 % with heart failure, 3 % dysmetabolic, 2 % hypertensive, 2 % with postpartum depression and 1 % with musculoskeletal diseases)

For anxiety, the patients comprised —

653 subjects were examined, 360 belonging to the intervention groups (average age of 47.53 years of which 87.3 % female, 66 % obese, 13 % with stress related exhaustion, 7 % with heart failure and 7 % healthy, 3 % hypertensive, 3 % dysmetabolic and 1 % with musculoskeletal diseases

Words, tables and diagrams follow, with reference to Cochrane. The conclusion is —

This systematic review evaluated and synthesized the available evidence on exercise for depression and anxiety in different population of adult and elderly subjects. Exercise was more effective than control interventions to reduce the severity of anxiety and depression, thus may be a useful strategy for patients with Post-Covid-19 condition. Exercise is defined as type of physical activity that is planned and structured towards improving physical fitness. The potential mechanisms involved in the development of the neuropsychiatric manifestations of COVID-19 seems to be mainly related to the systemic immune-inflammatory response and to the psychological stressors induced by SARS-CoV-2 infection.

This bit's good too —

Promising results were observed in one study who have proposed an aerobic dance program. This study does not reach the statistical significance because of the amplitude of the standard deviation but presents a moderate effect size favorable to the intervention (SMD = −0,479). This suggests that activities with high psychosocial involvement such as aerobic dance, although not improving the functional parameter probably due to poor customization of physical exercise, can instead improve depressive symptoms.

So the patients didn't get fitter but were less depressed. To the contrary, they noted in another study —

[Regarding] anxiety symptoms, the only RCT that did not show an improvement in anxiety symptoms in the intervention group compared to control was the study in which a home-based walking protocol was used. This study showed a significant improvement in functional outcome (6MWT) but did not improve anxiety symptoms. This suggests that supervised exercise, frequently associated with more opportunities of social interactions, is more effective in the improvement of anxiety symptoms.

So exercise didn't help anxiety, but did make people fitter? Still, go ahead and recommend all this for "post-Covid condition".

The benefits of regular physical exercise on different aspects of human health are widely known. [...] The positive effects of exercise on psychopathological symptoms associated with others chronic pathologies, allow us to suppose that the enrolment of post-Covid-19 condition patients in exercise programs, supervised by exercise physiologists, may be useful in the maintenance or improvement of their mental health.

 

[Trish]

How does this nonsense get published? First they assume Long Covid is psychiatric, then they assume what maybe worked a bit in some other unrelated conditions should work for long covid too - maybe.
I think the evidence regarding the evidence is that there is no evidence.

 

[rvallee]

Journal of Affective Disorders

Then they compare to chronic diseases, where I guess they think that any such anxiety or depression, even when they define it by asking about symptoms, is just a mood disorder about being ill, not caused by the illness itself. It couldn't be more clear that anxiety and depression are merely perceived as mood/affective disorders in medicine.

The idea that there is any parity between physical and mental health is one of the cruelest sick jokes in the world, the least competent medical care is far better than the most competent mental health care, the whole field is still stuck at a level comparable to what medicine was at the time of the Humors.

 

[Solstice]

How does this nonsense get published? First they assume Long Covid is psychiatric, then they assume what maybe worked a bit in some other unrelated conditions should work for long covid too - maybe.
I think the evidence regarding the evidence is that there is no evidence.

Never thought about it like that tbh, but what if you just started handing out the same pills to people with very different conditions. It sounds very weird, yet for psychology it's the norm.

 

[Sean]

I think the evidence regarding the evidence is that there is no evidence.

 

[SNT Gatchaman]

what if you just started handing out the same pills to people with very different conditions. It sounds very weird, yet for psychology it's the norm.

See transdiagnostic process

To date, no biological marker or individual cognitive process has been associated with a unique mental diagnosis but rather such markers and processes seem implicated across many diagnostic categories.