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Overview of Depression

This condition is a mood disorder characterized by extreme sadness, gloominess, or a sense of melancholy that is frequently associated with physical injury or chronic diseases. Clients may present with persistent muscle and joint pain that is part of a depressive mood disorder. Clients with a history of trauma, low back pain, and systemic diseases are at an increased risk for developing depressive disorders.1 Depression develops from biochemical and neuroendocrine mechanisms as well as from sleep and psychosocial factors. Depression can be classified as a major depressive disorder, an organic mood disorder, or a bipolar illness. Clients with depression may also suffer from chronic pain, physical impairments, and disease processes, which interfere with daily activities and preclude them from participating in recreational activities. Aerobic endurance activities at moderate intensities have been found to be effective for clients with major depressive disorder of mild to moderate severity.2

Comorbidities to Consider

  • Chemical dependency is a frequent comorbidity of depression that affects an individual's ability to change behaviors.

  • Clients with a history of diseases that affect the cardiovascular and musculoskeletal systems may have limited capacity to improve their endurance and reverse the effects of their disease.

Conditions That May Limit Physical Activities in Clients With Depression

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Coronary artery disease Heart failure
Parkinson disease Cerebral vascular accident
Diabetes mellitus Infections
Fibromyalgia Chronic fatigue syndrome
Arthritis Cancer treatments

Client Examination

Keys to Examination of Clients

  • Screen clients for cardiovascular and musculoskeletal problems that may limit or restrict their participation in an exercise program.

  • Assess clients' readiness to begin an exercise program.3

Recommended Baseline Testing of Fitness Levels

  • Assess baseline aerobic fitness with a 6-minute walk test to assess their progress.

  • The Hamilton Rating Scale for Depression can be used as a baseline measurement for depression.4

Exercise Prescription


Type: Walking, cycling, recreational pursuits

Intensity: Low to moderate intensity using their perceived exertion

Duration: 15–30 minutes

Frequency: 3–5 days per week

Getting Started

Clients should choose other recreational activities, especially group activities, as these will help them develop regular exercise behaviors.3,5,6 Strength training can be a useful form of exercise, beginning with low intensities, using multiple sets of 12 to 15 repetitions. A circuit of upper- and lower-extremity exercises is optimal for improving overall strength and endurance while providing the benefits of exercise for depression. A circuit of high-intensity exercise at 80% of maximum, using three sets of eight repetitions, has been shown to decrease depression levels in elderly persons.7 Clients should be encouraged to ...

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