Prevention of depression and anxiety in community-dwelling older adults: the role of physical activity

Abstract Background With the growth of the elderly population in Brazil and the increasing impact of depression and anxiety, the importance of preventing these disorders has been highlighted. Studies have shown an inverse relationship between rates of depression/anxiety and physical activity, pointing out its role as a possible protective factor. Objectives To conduct a randomized study with elderly adults in the community, who present with subsyndromal depression and anxiety, that will evaluate the effectiveness of physical activity with a collaborative stepped-care strategy; and to compare the effectiveness of physical activity in preventing subsyndromal depression and anxiety, with regard to the usual care group. Methods The article contains the methodological description of an arm of a large study entitled “Prevention and Treatment of Depression in Elderly”, in which 2,566 Brazilian older adults were screened to identify clinically significant depressive and anxiety symptoms. Those with clinically significant depressive or anxiety symptoms, not meeting criteria for depressive or anxiety disorder, will be invited to participate in a randomized clinical trial with 2 intervention groups: a step-by-step preventive care programme using physical activity, and usual care. The effectiveness of physical activity in the prevention of depressive and anxiety disorders will be evaluated. Discussion New health policies could be implemented, aiming to reduce the number of elderly people with depression and anxiety in primary care. In addition, training may be implemented for family health teams so that screening tools could be used to make an early identification of individuals with (or at risk of developing) mental disorders.

摘要
**研究背景**：随着巴西老年人口规模持续扩大，抑郁与焦虑问题的社会影响日益凸显，预防此类精神障碍的重要性愈发突出。已有研究证实，抑郁/焦虑患病率与体力活动水平呈负相关，提示体力活动或可作为此类疾病的潜在保护性因素。
**研究目的**：针对社区中存在亚综合征抑郁与焦虑症状的老年人群开展随机对照研究，评估采用协作阶梯式护理策略的体力活动干预效果；并与常规护理组对比，分析体力活动在预防亚综合征抑郁及焦虑障碍方面的有效性。
**研究方法**：本文详细阐述了一项名为《老年人群抑郁的预防与治疗》的大型研究的单个研究分支的方法学内容。该大型研究共筛查2566名巴西老年人，以识别存在临床意义的抑郁及焦虑症状人群。对于存在临床意义的抑郁或焦虑症状但未达到抑郁或焦虑障碍诊断标准的受试者，将邀请其参与一项随机临床试验，设置两个干预组：采用体力活动的阶梯式预防护理方案组，以及常规护理组。本研究将评估体力活动在预防抑郁及焦虑障碍方面的有效性。
**讨论**：未来可制定并推行新的卫生政策，以减少基层医疗中罹患抑郁与焦虑障碍的老年人群数量。此外，还可针对家庭医疗团队开展专项培训，使其能够运用筛查工具早期识别存在精神障碍（或存在发病风险）的个体。