Perceptrial andMotot Skills, 2000,90,204-208. O Perceptual and Motor S U s ZOO0
GROUP EXERCISE REDUCES DEPRESSION IN
OBESE WOMEN WITHOUT WEIGHT LOSS '
LORNA M. HAYWARD
ANNEMARIE C. SULLIVAN
Department of Physical Therapy
Departmetti of Cardioprtltnotzary Sciences
JOSEPH R. LIBONATI
Human Performance Loboratory
Department of Cardiopulmonary Scietzces
Bouve College of Health Sciences
Northeasfern University, Boston, M A
Szrmmary.-Given participation in a 6-mo. exercise and relaxation training 8
obese women showed significant change in scores on the Beck Depression Inventory
over the 6-mo. interval, but not on Body Mass Index or Medical Outcome Study
Short-Form-36.
One third of Americans are obese (Wing, 1993; Juczmarslu, Flegal,
Campbell, & Johnson, 1994). Research indicates that females of all races in
the USA have an especially high prevalence of obesity (Solomon & Manson,
1997), with the peak prevalence (52%) of obesity occurring between the
ages of 50 to 59 years in non-Euro-American women (Gorsky, Pamuk, Williamson, Shaffer, & Koplan, 1996). Chronic diseases associated with obesity
include hypertension, cardiovascular disease, dyslipidemia, diabetes, gallstones, respiratory dysfunction, joint and low back pain, and certain forms
of cancer (Hubert, Fedeib, McNamara, & Casteh, 1983; Runm, Starnpfer,
Giovannucci, Ascherio, Spiegelman, Colditz, & Wlllett-, 1995). In the USA
the economic impact of obesity has been estimated at $100 billion per year
(Colditz, Wdet-t, Stampfer , Manson, Hennekens, Arky, & Speizer, 1990;
Wolf & Colditz, 1998). Thus, obesity has a major effect on individuals' quality of Me and is responsible for increasing expenditures for health care
(Blackburn & Kanders, 1987; Colditz, et al., 1990; Gorsky, et al., 1996; Heithoff, Cuffel, Kennedy, & Peters, 1997; Wolf & Colditz, 1998).
It is well known that weight loss in obese individuals is correlated with
positive health benefits such as improvements in insulin sensitivity, lipid levels, and blood pressure (Resin, Abel, Modan, Silverberg, Eliahou, & Modan,
1978; Follick, Abrams, Smith, Henderson, & Herbert, 1984). Ln addition,
exercise is associated with reduced symptoms of depression (Ross & Hayes,
1988; Stephens, 1988) and may favorably affect the mental health of the
MA
Please address corres ondence to Lorna M. Hayward, Ed.D., PT, 6 Robinson Hall, Boston,
02115 or e-mail ilRayuard@~~nr.neu.edu~.
2 05
PSYCHOLOGICAL FITNESS AND OBESITY
obese population. It is unclear, however, whether reduced symptoms of depression occur secondary to physical changes, i.e., weight loss, or are drectly
related to psychological factors independent of weight loss.
Our hypothesis was that a combined 6-mo. supervised aerobic exercise
and relaxation training program (with minimal caloric expenditure) would
favorably affect depression scores and health perception without substantial
weight loss.
METHOD
Subjects were eight obese women, body mass index (weight in kilograms divided by height in meters squared) of at least 28 kg/m2 or greater,
enrolled in a 6-mo. combination supervised aerobic exercise and relaxation
training program (cf. Table 1). This study was a quasi-experimental, longitudmal design with data collected at basehe and at 3 - and 6-mo. intervals.
Perception of health status was measured using a 36-item short form (SF-36)
an inventory constructed to survey health status in the Medcal Outcomes
Study and measure patients' perception of health status over eight dimensions (Ware & Sherborn, 1992). Depression was measured using the Beck
Depression Inventory, a 21-item inventory that provides a cumulative measure of depression. In addition, body weight and height were obtained and
Body Mass Index calculated at the three measurement times.
TABLE 1
BASELINEPHYSICAL
CHARACTERISTICS
OF THE SAMPLE( N = 8 )
Variable
M
Age, yr.
Weight, kg
Height, cm
BMI, kg/m2
Attendance, % compliance
45
104
166.7
37.5
65
SEM
5
.
7.6
1.1
2.2
9.0
Participants met two times per week for 6 mo. to partake in an hour
and a half of exercise and relaxation training. Participants exercised for 60
min. at an intensity of 50-85% of their peak oxygen consumption, intermittently dispersed with rest periods as needed. A 20-min, session of relaxation,
deep breathing, and guided imagery followed the exercise program one time
per week. Average attendance for the group during the 6-mo. program was
55% with a range of 20-90%.
RESULTSAND DISCUSSION
At basehe, subjects' mean score was 11.1 (SEM 2.9) on the Beck Depression Inventory, with five of eight women exhibiting "mild to moderate"
levels of depression, i.e., scores between 11 and 40. At the second measurement time, the average Beck Depression Inventory score was 7 (SEM 1.8).
206
L. M. HAYWARD, ET AL
At measurement time three, the average Beck Depression Inventory score
was 4.9 (SEM 1.6), and only one of eight women was classified as mildly depressed p < .05 (score = 11) (Table 2). For our subjects, body weight did not
change over the course of training, and similarly, Body Mass Index was unchanged with exercise (Table 2). None of the eight short form-36 health
dimension scores were statistically significant. Our results indicate that these
subjects who are overweight exhibit poor perception of health, as measured
by the Short Form-36 which was unchanged by this course of exercise and
relaxation training.
TABLE 2
SCORESO N T H E BECKDEPRESSION
INVENTORY,
BODYMASSINDFX, WEIGHT,
AND
HEALTH
PERCEMIONS
FORTHE THREEMEASUREMENT
TIMES( N =8)
Measure
Baseline
3-mo.
6-mo.
11.1"
2.8
7 .o
1.8
4.9
1.6
37.5
2.19
37.6
2.34
37.62
2.58
Beck Depression Inventory
M
SEM
Body Mass Index, kg/m2
M
SEM
Weight, kg
M
SEM
104.0
7.6
105.0
7.9
105.0
8.06
60.6
8.7
70.6
9.7
73.1
8.5
60.3
6.7
54.7
8.2
46.5
13.9
62.5
14.9
56.2
13.9
65.6
15.6
66.5
15.4
62.4
15.9
62.4
15.9
68.0
3.3
71.5
6.6
73.5
6.8
Health Perceptions
(1) Physical Function
M
I
SEM
(2) Social Function
M
SEM
(3) Role Limitation-Physical
M
SEM
(4) Role Limitation-Emotional
M
SEM
(5) Mental Health
M
SEM
(6) Vitality
M
SEM
51.7
62.5
52.3
3.1
6.8
9.7
(continued on next page)
Note.-Scoring range for the Beck Depression Inventory: 0-10 Normal u s and downs; 11-16
Mild mood disturbance; 17-20 Borderline depression; 21-30 Moderate Bepression; 31-40 Severe depression; 40+ Extreme depression. "Dtfference berween baseline and 6-mo. Beck Depression scores was statisticaly significant ( p < .05).
PSYCHOLOGICAL FITNESS AND OBESITY
TABLE 2 (CONT'D)
SCORESON THE BECKDEPRESSION
INVENTORY,
BODYMASSINDEX. WEIGHT.AND
HWTH PERCEPTIONS
FORT H E THREEMEASUREMENT
TIMES(N=8)
Measure
(7) Bodily Pain
M
SEM
(8) General Health
M
SEM
Baseline
3-mo.
6-mo.
60.3
6.8
54.7
8.2
46.5
13.9
63.2
4.8
66.2
6.6
71.2
7.6
Note.-Scoring range for the Beck Depression Inventory: 0-10 Normal u s and downs; 11-16
Mdd mood disturbance; 17-20 Borderline depression; 21-30 Moderare Jpression; 3 1 4 0 Severe depression; 40+ Extreme depression. 'Difference between baseline and 6-1130. Beck Depression scores was statistically significant ( p < .05).
While our participants displayed no significant changes in weight loss,
Body Mass Index, or health perception, they d d show statistically significant
changes in scores on depression. O u r results support the idea that a combined program of exercise and relaxation therapy has a cumulative and rnitigative effect on depression in obese women, even without weight loss. Given
that this was a small sample, however, caution should be exercised when
generahzing these results to the population of obese women.
REFERENCES
B ~ C K B U RG.
N ,L., & KANDERS,
B. S. (1987) Medtcal evaluation and treatment of the obese patient with.cardiovascular disease. American Jozrrrzal of Cardiology, 60, 55G-58G.
COLDITZ,G. A,. WLLLEYT,W. C., STAMPFER.
M. J., MANSON,
J. E., HENNEKENS,
C. H., ARKY, R.
A.. &SPEIZER,
F. E. (1990) Weight as a risk factor for Anical diabetes in women. American Journal o/ Epidemiology, 132, 501-513.
FOLLICK,
M., ABRAMS,D., SMITH,T., HENDERSON.
L., &HERBERT,I? (1984) Contrasting acute
and long term changes in weight on lipoprotein levels. Archives of Internal Medicine, 144,
1571-1574.
GORSKY,R. D., PAMUK,E., WILLIAMSON,
D. F., SHAFFER,P. A., & KOPLAN,
J. l? (1996) The 25year health care costs of women who remain overweight after 40 years of age. Americarr
lozrrnal of Preventive Medicine, 12, 388-394.
HEIMOFF.K. A,, CUFFEL.
B. J., KENNEDY,
S., &PETERS,
1. (1997) The association between body
mass and health care expenditures. Clinical Therapy, 19, 811-820.
HUBERT.H. B., FEINLEIB,
M., MCNAMARA,
F. M., &CASTELLI,
W. P. (1983) Obesity as an independent risk facror for cardiovascular disease: a 26 year follow-up of participants in the
Framingham Heart Study. Circulation, 67, 968-977.
JUCZMARSKI,
R. I., FLEGN,K. M., CAMPBELL,
S. M., &JOHNSON.C. L. (1994) Increasing preva272,
lence of overweight among U.S. adults. Jounzal of the American Medico[ Associa~ior~,
205-211.
RESIN, E., AEIEL,R., MODAN.M.. SILVERBERG,
D. S., ELIAHOU.
H. E., &MODAN,B. (1978) Effect
of weight loss without salt restriction on the reduction of blood pressure in overweight
hypertensive patients. New England Jorrrnal of Medicine, 198, 1-6.
RIMM,E. B., STAMPFER,
M. J.. GIOVANNUCCI.
E., ASCHERIO.A,, SPIEGELMAN,
D., COLDITZ,G. A,,
& WILLETT.
W. C. (1995) Body size and fat distribution as predictors of coronary heart
disease among middle-aged and older U.S. men. American Journal of Epidemiology, 141,
1117-1127.
Ross. C. E.. & HAYES,D. (1988) Exercise and psychological well-being in the community.
A??zericanJorlrnal of E p i d e ~ n i o l o ~127,
, 762-77 1.
SOLOMON,
C. G., &MANSON,J . E. (1997) Obesity and mortality: a review of the epidemiologic
data. American Journal of Clinical Nutrition, 66, 1044s-1050s.
STEPHENS,
T. ((1988) Physical activity and mental health in the United Srates and Canada: evidence from our population surveys. Preventative Medicine, 17, 35-47.
C. D. (1992) The MOS 36-item short-form health survey (SF-36), 1:
WARE,1. E., &SHERBORN,
conceptual framework and item selection. Medical Care, 30, 473-483.
WING,R. R. (1993) Obesity and related eating and exercise behaviors in women. Atztzals of
Behavioral Medicine, 15, 124-134.
WOLF,A. M., &COLDITZ,
G. A. (1998) Current estimates of the economic cosr of obesity in
the U.S. Obesity Research, 6, 97-106.
Accepted January 20, 2000