Measurement of Mental health
Mental health was assessed with the CES-D depression questionnaire.
The 20 items in the CES-D scale reflect on the components of depression in nine different groups as defined by the American Psychiatric Association Diagnostic and Statistical Manual–5. These components include:
· Sadness (Dysphoria)
· Loss of Interest (Anhedonia)
· Appetite
· Sleep
· Thinking/Concentration
· Guilt/Worthlessness
· Tiredness/Fatigue
· Movement/Agitation
· Suicidal Ideation
A CES-D cut-off score of 16 or greater reflects individuals at risk for clinical depression. More specifically: 0-16 = No to mild depressive symptomatology; 16-23 = Moderate depressive symptomatology and 24-60 = Severe depressive symptomatology.
Number of Patients with Mental Health Symptomology at baseline
We’ve tested 323 referred patients since we started in January 2018.
A total of 33.2% of these patients presented with moderate (15.6%) and severe (17.6%) depressive symptomology at baseline.
Relationship of Mental health Symptomology with measures of Health and Fitness
Depressive symptomology contributed significantly to the variances of measures of health and fitness in both males and females, at baseline.
In Males, depressive symptomology contributed statistically significantly (p<0.05) to the variances of resting heart rate (4.8%), systolic blood pressure exercise response (4%), percentage body fat (6.3%), VO2peak, (5.8%) and overall cardiovascular risk (4.4%).
The depression score contributed statistically significantly (p<0.05) to the variances of BMI (13.7%), waist circumference (10.2%), percentage body fat (7.3%), fat weight (12.3%) and VO2peak (9.6%), in females.
A total of 134 of the 323 starters have so far completed 10-weeks training at OraKinetics. The programme effect on the mental health of these patients is presented in Table 4.1.
As can be seen in Table 4.1 the 10-weeks training had a statistically significant (p<0.01) and large effect size impact (ES>0.8) on all three of the symptomology groups (mild depression - ES=1.1; moderate depression – ES=2.1 and severe depression – ES=1.9).
The effect of the programme on the patients with severe depression (CES-D≥24) was impressive with the mean baseline value of 30.2 decreasing to 17.1 (p<0.001: ES=1.9) at the final assessment. It calculates as a 44% change. From a clinical perspective, these patient’s classification, therefore, shifted from severe depression to mild depressive symptomatology.
Table 4.1: Programme effect on Mental Health (January 2018 to March 2019); (n=134)
ES=effect size (>0.3 – small effect; >0.5 moderate effect; >0.8 large effect); * = p < 0.01
In the 64 patients with mild and severe depressive symptomology the programme improved resting hemodynamic variables (e.g., resting systolic blood pressure, resting diastolic blood pressure, Mean Arterial pressure and resting heart rate) by respectively 4.4%, 4.8%, 4.7%, and 5.3%. The mean VO2peak of this group with depressive symptomology improved by 24%.
Cardiovascular fitness was linearly related to the CES-D scores at baseline which indicates a clear positive relationship between cardiovascular fitness and mental health.
However, the post-training data reveals that baseline cardiovascular fitness did not limit our programme effect on depression. The amount of improvement made over 10-weeks in cardiovascular fitness did not impact on the depression results. Those whose cardiovascular fitness improved by less than 20% evidenced similar (46% vs. 44%) reductions in depression symptomology than those whose VO2peak values improved by more than 40%.
Summary
The data indicates that disease-imposed restrictions on trainability (e.g., inability to improve cardiovascular fitness due to the level of disease development) did not negate the impact of our programme on mental health. It is a pleasing result which demonstrates programme effect on mental health independent from the severity of the problem.