title: Exercise as medicine-the use of group medical visits to promote physical activity and treat chronic moderate depression: a preliminary 14-week pre-post study.
abstract: OBJECTIVE
  The evidence that regular physical activity can treat depressive disorders is increasingly robust. However, motivating patients with depression to engage in physical activity can be challenging. Interdisciplinary group medical visits (GMVs) with an integrated physical activity component may be a novel means to support patients in becoming more active.
  
  
  METHODS
  We conducted a 'pre-post' pilot study within a primary care setting. Participants were adults (≥18 years) with a chronic major depressive disorder or a bipolar 2 disorder (depression; chronic). A psychiatrist and exercise therapist co-led a series of 14 weekly 2 h GMVs. Each group visit combined specific medical advice, physical activity, patient discussions and a targeted educational component. Participants also attended 11 weekly hatha yoga classes. Primary outcome was 'steps' as measured by accelerometer (SenseWear) as well as depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalised Anxiety Disorder, GAD-7) ratings.
  
  
  RESULTS
  14 of 15 participants (93.3%) completed the 14-week programme. After 3 months postintervention, median depression scales (PHQ-9) decreased 38% from 16 to 10 (p<0.01; IQR pre/post 8/12); and median anxiety scales (GAD-7) decreased 50% from 13 to 6.5 (p<0.05; IQR 8.5/9). Median daily 'steps' increased 71% from 3366 to 5746 (IQR 2610/6237), though this was not significant (p>0.10).
  
  
  CONCLUSIONS
  While other studies have examined the efficacy of GMVs in addressing chronic illnesses and the promotion of lifestyle changes, none to our knowledge have embedded physical activity within the actual patient visits. Interdisciplinary GMVs (eg, psychiatrist/exercise professional) may be a means to decrease depression and anxiety ratings within clinical care while improving physical activity.
authors.affiliation: Department of Family Practice (DFP) , University of British Columbia , Vancouver, British Columbia , Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Adams
authors.affiliation: Mood Disorders Association of BC , Vancouver, British Columbia , Canada.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Remick
authors.affiliation: UBC School of Population and Public Health/Centre for Hip Health & Mobility (CHHM).
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Davis
authors.affiliation: CHHM/DFP.
authors.forename: Sara
authors.initials: S
authors.lastname: Vazirian
authors.affiliation: CHHM/DFP.
authors.forename: Karim M
authors.initials: KM
authors.lastname: Khan
keywords: Anxiety; Depression; Physical activity; Physical activity promotion in primary care