Severely Affected Persons Are Still Left Behind

Letters to the Editor regarding the article Resistance Training in Depression by Noah Augustin, M. Sc., Dr. rer. medic. Antonia Bendau, Selina Heuer, M. Sc., Jan Kaminski, M. Sc., and Prof. Dr. med. Andreas Ströhle in issue 45/2023

In their interesting article regarding resistance training (1), the authors expand the evidence regarding exercise as an intervention in depressive disorders. The presented effect sizes are high and the reported risk of adverse effects low—consequently this intervention should be used preferentially. The 2022 German National Disease Management Guideline for unipolar depression (2) included exercise as a strong recommendation (reading: “should be motivated. . .”).

As the authors of the article rightly point out, motivating depressive persons to undertake exercise is often challenging (1). Psychopathologically, the key symptoms of depression are loss of motivation and a feeling of exhaustion—these are important obstacles to implementing the recommendation.

From our perspective as care providers in private practice the evidence is satisfactory and we do not require any new initiatives that time and time again confirm the effectiveness of exercise therapy. Recently, the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) announced that exercise therapy should be included in basic and regular care because of data (3) showing that participants’ motivation was improved with the help of psychotherapists. However, we fear that it will probably still be the more active and intrinsically motivated—i.e. less severely ill—patients who will benefit from this service.

Instead more attention should be given to implementing exercise therapy in the basic and regular care of severely affected/ill persons. The crucial question is not whether exercise is effective, but how we can introduce severely ill patients to exercise and keep them adherent. Perhaps even ideas such as providing exercise therapy in a search+motivate model might be useful, or a collection service. Affected persons mostly understand that exercise makes sense. Ultimately, however, because of their illness they lack the necessary impulse to put this into practice.

DOI: 10.3238/arztebl.m2024.0022

Prof. Dr. med. Wolfgang Freund
Neurozentrum Biberach
Mitglied im Vorstand des BVDN
(Berufsverband Deutscher Nervenärzte)
Baden-Württemberg und BDN
(Berufsverband Deutscher Neurologen)

Dr. med. Klaus Gehring
Neurozentrum am Klosterforst, Itzehoe
Vorstand des BVDN,
Mitglied im Vorstand BDN

References

1. Augustin N, Bendau A, Heuer S, Kaminski J, Ströhle A: Resistance training in depression. Dtsch Arztebl Int 2023; 120: 757–62.

2. Bundesärztekammer (BÄK), KBK, Arbeitsgemeinschaft der Wissenschaftlichen medizinischen Fachgesellschaften (AWMF) Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung, Version 3.2. 2022.

3. Gemeinsamer_Bundesausschuss: Sporttherapie bei leichter und mittelschwerer Depression: Innovationsausschuss empfiehlt Transfer in die Regelversorgung. In: G-BA (ed.): Pressemitteilung des G-BA 2023.