TBM TBM page 1 of 8 Published online: XX XXXX 2018 Evidence-based practice: a comparison of International Clinical Practice Guidelines and current research on physical activity for mild to moderate depression Courtney Wynne Hess , Justin Karter, Lisa Cosgrove, Laura Hayden ABSTRACT In 2016, the U.S. Preventive Services Task Force recommended routine depression screening for individuals aged 13 and above. Questionnaire-based screening will likely increase treatment in patients with milder symptoms. Although professional groups who develop clinical practice guidelines recognize the impor- tance of considering the risks and benefits of interventions, no official mandate exists for a stepped-care approach. Physical activity warrants increased consideration in guidelines, given the optimal risk/benefit profile and the increasing evidence of efficacy for the treatment and prevention of depression. The aim of the current study was to evaluate clinical practice guide- lines for the treatment of major depressive disorder, specifically the recommendation of physical activity and adherence to a stepped-care approach. Authors searched three databases to identify treatment guidelines for depression. Guidelines were reviewed on the following domains regarding recommendation of physical activity: (a) front-line intervention, (b) explicit but not front-line recommendation, (c) inexplicit recommendation, (d) no mention, (e) adherence to a stepped-care approach, and (f) presentation of empirical support for their recommendation. Seventeen guidelines met inclusion criteria. Four guidelines recommended physical activity as a front-line intervention, two did not mention physical activity, eleven made some mention of physical activity, seven presented evidence to support their rec- ommendation, and seven employed a stepped-care approach. The majority of guidelines did not use a stepped-care approach and varied greatly in their inclusion of physical activity as a recommended intervention for mild to moderate depression. Implications for practice, research, and policy are discussed. Keywords Health psychology, Depression, Systematic review, Mental health intervention INTRODUCTION In recent years, there has been a push to imple- ment universal screening for major depressive dis- order (MDD) both in the USA and internationally [1–3]. In 2016, the U.S. Preventive Services Task Force (USPSTF) recommended universal depres- sion screening for patients over the age of 13 in pri- mary care in order to increase detection and prevent under-treatment [4, 5]. However, researchers have found high rates of false positives when question- naire-based screening instruments are used in pri- mary care settings, with some estimates as high as 70 per cent [6, 7]. Furthermore, research suggests that use of the most common questionnaire-based screen- ing tool, the PHQ9, is associated with a depression diagnosis and subsequent antidepressant prescrip- tion even among patients who are unlikely to have major depression [8]. Although numerous meta-analyses as well as sys- tematic and narrative reviews (e.g., Refs. 9–11) have clearly shown that antidepressants are not, on aver- age, efficacious for mild depression, once given an MDD diagnosis, most patients are offered pharma- cological treatment [12]. In light of concerns around the lack of efficacy of antidepressant medication for the treatment of milder forms of depression, as well as the negative side effects associated with pharmacological intervention [13–15], there has been increased research into, and consideration of, Implications Policy: Policy makers (e.g., Institute of Medicine, U.S. Preventative Task Force, Agency for Healthcare Research and Quality) should develop stricter standards for guidelines, and for guideline development groups, to require adher- ence to a stepped-care approach, and improve translation of current research evidence into pro- fessional practice (e.g., use of physical activity for treatment and prevention of mild to moderate depression). Practice: Clinicians working with people expe- riencing mild to moderate depression should explore the potential for physical activity and exercise to reduce symptoms before suggesting psychopharmacological intervention, or other interventions with inferior benefit to risk profiles. Research: Future research should be conducted to better inform what exercise protocols are most effective, and what dose–response relationship exists for the treatment and prevention of mild to moderate depression. Department of Counseling & School Psychology, University of Massachusetts, Boston, MA 02125, USA ORIGINAL RESEARCH © Society of Behavioral Medicine 2018. All rights reserved. For permis- sions, please e-mail: journals.permis- sions@oup.com. Correspondence to: C W Hess, Courtney.Hess001@umb.edu Cite this as: TBM 2018;XX:XX–XX doi: 10.1093/tbm/iby092 Downloaded from https://academic.oup.com/tbm/advance-article-abstract/doi/10.1093/tbm/iby092/5128824 by guest on 13 October 2018