exercise as a recreational therapy treatment for depression tim passmore, ed.d., ctrs west virginia...
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Exercise as a Recreational Exercise as a Recreational Therapy Treatment for Therapy Treatment for
DepressionDepression
Tim Passmore, Ed.D., CTRSTim Passmore, Ed.D., CTRSWest Virginia Therapeutic West Virginia Therapeutic
AssociationAssociationAnnual ConferenceAnnual Conference
Oklahoma State UniversityOklahoma State University
8 Global Reasons 8 Global Reasons Increased Demand for OutcomesIncreased Demand for Outcomes
Eliminate poor/unnecessary practiceEliminate poor/unnecessary practice Negotiations between providers & payers Negotiations between providers & payers AccountabilityAccountability Mean for evaluation of ill (chronically)Mean for evaluation of ill (chronically) Empower consumersEmpower consumers Evaluate new service/interventionEvaluate new service/intervention Priority setting & resource allocationPriority setting & resource allocation Set, monitor & improve standardsSet, monitor & improve standards
(United Kingdom Clearing House on Health Outcomes, (United Kingdom Clearing House on Health Outcomes, 1997)1997)
The Term RecreationThe Term Recreation
Recreational Therapy/Therapeutic Recreational Therapy/Therapeutic Recreation Recreation Often not given similar consideration asOften not given similar consideration as
Other allied health professionOther allied health profession Because of the term recreationBecause of the term recreation
RegulationsRegulations Specifically state – don’t not pay or cover Specifically state – don’t not pay or cover
RecreationRecreation DiversionDiversion Maintenance Maintenance Comfort Comfort
Inpatient Psychiatric Treatment Inpatient Psychiatric Treatment FacilitiesFacilities
Section Section 20.1.2 – Services Expected to 20.1.2 – Services Expected to Improve the Condition or for Purpose of Improve the Condition or for Purpose of Diagnosis, A3-3102.1.A.2, HO-212.1A2 of Diagnosis, A3-3102.1.A.2, HO-212.1A2 of the Medicare Benefit Policy Manualthe Medicare Benefit Policy Manual Chapter 2 Chapter 2
Adjunctive Therapies – Adjunctive Therapies – Prior to July 2006Prior to July 2006 Recreational TherapyRecreational Therapy Occupational TherapyOccupational Therapy Milieu TherapyMilieu Therapy
Specific Wording of RT & OTSpecific Wording of RT & OT Replaced with term Therapeutic ActivitiesReplaced with term Therapeutic Activities
Inpatient Psychiatric Treatment Inpatient Psychiatric Treatment FacilitiesFacilities
““If the only activities prescribed for If the only activities prescribed for the patient are primarily diversional the patient are primarily diversional in nature, (i.e. to provide some in nature, (i.e. to provide some social or recreational outlet for the social or recreational outlet for the patient), it will not be regarded as patient), it will not be regarded as treatment to improve patients’ treatment to improve patients’ conditions.”conditions.”
Inpatient Psychiatric Treatment Inpatient Psychiatric Treatment FacilitiesFacilities
Adjunctive Therapies (Recreational Adjunctive Therapies (Recreational Therapy/Activity Therapy)Therapy/Activity Therapy) Expected to improve Expected to improve
Psychiatric conditionPsychiatric condition Assist with diagnosisAssist with diagnosis
Required to Provide Required to Provide Active TreatmentActive Treatment Recreational Therapy interventionsRecreational Therapy interventions
Specific interventions intended to improve Specific interventions intended to improve psychiatric conditionpsychiatric condition
Assist with diagnosisAssist with diagnosis
Inpatient Psychiatric Treatment Inpatient Psychiatric Treatment FacilitiesFacilities
Therapeutic Recreation – must followTherapeutic Recreation – must follow Physician’s OrdersPhysician’s Orders AssessmentAssessment Goals & ObjectivesGoals & Objectives Treatment PlanTreatment Plan Delivery of Services or InterventionsDelivery of Services or Interventions Documentation of Provision of Documentation of Provision of
Services/InterventionsServices/Interventions ReevaluationReevaluation Discharge Recommendations & SummaryDischarge Recommendations & Summary
Outcomes TerminologyOutcomes Terminology
EffectivenessEffectiveness Effectiveness ResearchEffectiveness Research EfficacyEfficacy Evidence-based PracticeEvidence-based Practice Clinical ImportanceClinical Importance
Effectiveness/Effectiveness Effectiveness/Effectiveness ResearchResearch
EffectivenessEffectiveness How interventions work in typical clinical How interventions work in typical clinical
practicepractice Effectiveness ResearchEffectiveness Research
Compares practice or interventionsCompares practice or interventions
EfficacyEfficacy
Efficacy Efficacy Performance of interventionPerformance of intervention Controlled studyControlled study
Evidence Based PracticeEvidence Based Practice
Evidence Based PracticeEvidence Based Practice Based on best available scientific Based on best available scientific
Evidence Evidence KnowledgeKnowledge
Clinical Importance Clinical Importance
Important difference in patientImportant difference in patient OutcomesOutcomes Health StatusHealth Status Different from statistical significance Different from statistical significance
Outcomes Characteristics Outcomes Characteristics
Desired outcomes identifiedDesired outcomes identified Based on settingBased on setting Client needClient need
MeasurableMeasurable DistanceDistance Time toleratedTime tolerated ROMROM Number of Coping MechanismsNumber of Coping Mechanisms Number of Positive Self Comments Number of Positive Self Comments Etc…Etc…
Evidence Based ResearchEvidence Based Research
1970’s Early Research – Exercise & 1970’s Early Research – Exercise & DepressionDepression Reported positive outcomes of exercise Reported positive outcomes of exercise
& depression levels& depression levels 1980’s – Researchers – Compared 1980’s – Researchers – Compared
Exercise & a Combination of Exercise Exercise & a Combination of Exercise & Psychotherapy & Psychotherapy Combination – greater effect on lowering Combination – greater effect on lowering
levels of depressionlevels of depression
Evidence Based ResearchEvidence Based Research
1980’s Research1980’s Research Compared counseling & aerobic exerciseCompared counseling & aerobic exercise
Aerobic exercise had greater effect on Aerobic exercise had greater effect on depression levelsdepression levels
Later StudiesLater Studies Compared exercise & exercise in Compared exercise & exercise in
combination with pharmacotherapy & combination with pharmacotherapy & pharmacotherapy alonepharmacotherapy alone
Exercise alone was found to be as effective Exercise alone was found to be as effective as combination or pharmacotherapy aloneas combination or pharmacotherapy alone
Evidence Based ResearchEvidence Based ResearchCurrent Studies – Last 10 YearsCurrent Studies – Last 10 Years
Support earlier studiesSupport earlier studies Individuals who exercise after diagnosis Individuals who exercise after diagnosis
of depression of depression Report decreasing levels of depression Report decreasing levels of depression Maintains lower levels of depressionMaintains lower levels of depression
Studies Comparing pharmacotherapy Studies Comparing pharmacotherapy with exercisewith exercise Indicate exercise elicits similar Indicate exercise elicits similar
outcomes as medication outcomes as medication
DiagnosisDiagnosis
DepressionDepression Dysthymia Dysthymia Persistent depression that has Persistent depression that has
symptoms such as fatigue, low self-symptoms such as fatigue, low self-esteem, insomnia, and appetite esteem, insomnia, and appetite disturbances but is not severe enough disturbances but is not severe enough to amount to a psychosisto amount to a psychosis
InterventionInterventionExerciseExercise
Aerobic TypeAerobic Type TreadmillTreadmill Stationary bikeStationary bike 10 minute warm-up10 minute warm-up 45 minutes45 minutes 60% to 70% of Target Heart Rate60% to 70% of Target Heart Rate
Goal of aerobic typeGoal of aerobic type
InterventionInterventionExerciseExercise
ResistiveResistive Free WeightsFree Weights Exercise MachinesExercise Machines Exercise BandsExercise Bands Weight appropriate Weight appropriate
3 sets3 sets Weight appropriate for prescribed Weight appropriate for prescribed
repetitions repetitions 10 repetitions each set10 repetitions each set
Exercise RoutinesExercise Routines
2 types 2 types Aerobic typeAerobic type Combined aerobic type & resistiveCombined aerobic type & resistive
3 X’s per week3 X’s per week 10 to 15 minute warm-up period10 to 15 minute warm-up period 45 minutes45 minutes
Discharge RecommendationsDischarge Recommendations
Continue Exercise RoutineContinue Exercise Routine Locate post discharge facility to Locate post discharge facility to
exerciseexercise CommercialCommercial
Senior Citizen CenterSenior Citizen Center Community CenterCommunity Center Exercise FacilityExercise Facility
Exercise in the community/at homeExercise in the community/at home Not recommended – due to Not recommended – due to
IsolationIsolation Reasons causing diagnosis Reasons causing diagnosis
Data & AnalysisData & Analysis
21 patients21 patients 11 assigned to combined exercise group11 assigned to combined exercise group 10 assigned to aerobic type exercise group10 assigned to aerobic type exercise group
Completed Beck Depression Inventory Completed Beck Depression Inventory atat AdmissionAdmission DischargeDischarge 6 week post discharge6 week post discharge 12 week post discharge12 week post discharge
Instrument Beck Depression Instrument Beck Depression InventoryInventory
ScaleScale Measures reported levels of depressionMeasures reported levels of depression 0 to 630 to 63 See next slideSee next slide
Instrument Beck Depression Instrument Beck Depression InventoryInventory
Below 4 = Possible denial of depressionBelow 4 = Possible denial of depression FakingFaking Below usual scoresBelow usual scores
05 - 09 Considered normal05 - 09 Considered normal 10 - 18 Mild to Moderate depression10 - 18 Mild to Moderate depression 19 - 29 Moderate to Severe depression19 - 29 Moderate to Severe depression 30 - 63 Severe Depression30 - 63 Severe Depression Over 40 Significantly above severe depressionOver 40 Significantly above severe depression
Suggests possible exaggeration of depressionSuggests possible exaggeration of depression Possibly characteristic of borderline personality Possibly characteristic of borderline personality
disorders. Significant levels of depression are still disorders. Significant levels of depression are still possible (Groth-Marnat, 1990).possible (Groth-Marnat, 1990).
ResultsResultsComparision of BDI Scores Arithmetic Means
30.4
34.18
7.9
10.45
12.1 12.27
15.2 15
0
5
10
15
20
25
30
35
40
1Admission Discharge 6 Week 12 Week
Ari
thm
eti
c M
ea
ns
Aerobic
Combined
ResultsResultsAdmissionAdmission
90% of the 11 Combined Subjects90% of the 11 Combined Subjects Scored in range of clinical depressionScored in range of clinical depression
100% of the 10 Aerobic Subjects100% of the 10 Aerobic Subjects Scored in the ranges of clinical Scored in the ranges of clinical
depressiondepression
ResultsResultsDischargeDischarge
80% of Combined Group80% of Combined Group No presences of depressionNo presences of depression Two had scores of 17Two had scores of 17
Had decreases in depression scores of 31 Had decreases in depression scores of 31 points & 19 pointspoints & 19 points
100% of Aerobic Group100% of Aerobic Group No presences of depressionNo presences of depression
Results Results 6 Week Post Discharge6 Week Post Discharge
Between groups Between groups No significant differenceNo significant difference
In adherenceIn adherence In depression scoresIn depression scores
Both Groups Both Groups Significant difference – between those Significant difference – between those
who continued & those who did notwho continued & those who did not
ResultsResults12 Week Post Discharge12 Week Post Discharge
Between GroupsBetween Groups No significant differenceNo significant difference
In adherence In adherence In depression scoresIn depression scores
Both GroupsBoth Groups Significant difference – between those Significant difference – between those
who continued & those who did notwho continued & those who did not
Contact InformationContact InformationParticipate in ResearchParticipate in Research
Tim Passmore, Ed.D., CTRSTim Passmore, Ed.D., CTRS
Assistant ProfessorAssistant Professor
School of Applied Health & EducationalSchool of Applied Health & Educational
Psychology - Leisure Studies ProgramPsychology - Leisure Studies Program
Oklahoma State UniversityOklahoma State University
(405) 744-1811(405) 744-1811
[email protected]@okstate.edu