title: "Crawling Out of the Cocoon": Patients' Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression.
abstract: BACKGROUND
  Although the effectiveness of physical exercise for depression has been studied for many years, few studies have described patients' experiences of what exercise means to them, beyond the biological focus. Moreover, exercise as a treatment for depression is rarely explored in a physical therapy context.
  
  
  OBJECTIVE
  The purpose of this study was to explore a physical therapy exercise intervention, as experienced by people with major depression.
  
  
  METHODS
  This study had an inductive approach and used qualitative content analysis.
  
  
  METHODS
  Semistructured interviews were conducted with 13 people who participated in physical therapist-guided aerobic exercise in a randomized controlled trial. All participants were diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders. Data were collected and analyzed in an inductive manner using qualitative content analysis according to Graneheim and Lundman.
  
  
  RESULTS
  Four categories emerged: (1) struggling toward a healthy self, (2) challenging the resistance, (3) feeling alive but not euphoric, and (4) needing someone to be there for you. The participants experienced that although the exercise intervention was hard work, it enhanced the feeling of being alive and made them feel that they were doing something good for themselves. These feelings were a welcome contrast to the numbness and stagnation they experienced during depression.
  
  
  CONCLUSIONS
  The study was conducted in Swedish primary care. Transferability of results must be viewed in relation to context.
  
  
  CONCLUSIONS
  Exercise in a physical therapy context can improve the patients' perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient's vulnerability and ambiguity in an empathic and perceptive way.
authors: L. Danielsson, PT, PhD, Institute of Medicine, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden; and Närhälsan Gibraltar Rehabilitation Centre, Gibraltargatan 1C, 411 32 Gothenburg, Sweden. louise.danielsson@gu.se.
authors: Louise
authors: L
authors: Danielsson
authors: B. Kihlbom, PT, Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, University of Gothenburg and Närhälsan Gibraltar Rehabilitation Centre.
authors: Birgitta
authors: B
authors: Kihlbom
authors: S. Rosberg, PT, PhD, Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, University of Gothenburg, and University of Gothenburg Centre for Person-Centred Care (GPCC).
authors: Susanne
authors: S
authors: Rosberg
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000628:therapy*; D005081:Exercise Therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010809:Physical Fitness / Q000523:psychology; D036301:Qualitative Research; D020377:Self Efficacy; D055815:Young Adult