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Depression and physical activity

Hoax of drugs against mild or moderate depression? Best remedy: physical exercise.

Some of the most prestigious doctors and scientists around the world are coinciding about the inefficiency of drugs to treat many diseases, one of which: depression.

The new-generation antidepressants do not work except in the most severe cases and in most patients only have a placebo effect, according to a study published in ePublic Library of Science, conducted by scientists from the UK, USA and Canada.

In the words of Professor Irving Kirsch: “People with depression can improve without resorting to such treatments” (1)

Irving Kirsch Ph.D is the Associate Director at the Harvard Placebo Studies Program and Professor Emeritus at the University of Hull, Professor at the University of Connecticut, and Professor of Psychology at the University of Plymouth. Researching the placebo effect of drugs, Kirsch asked them to send him the clinical trials that pharmaceutical companies presented to the FDA. This body is responsible for approving drugs and regulate their use, so the FDA generally gets more data from the pharmaceutical companies than whatever gets published in scientific journals.

Functional neuroimaging studies show that both the administration of a placebo as an antidepressant produce similar and well defined responses, with changes in the nervous system that share a common pattern in limbic and paralimbic areas. When published and unpublished studies were matched in 38 clinical trials involving 3000 patients, Kirsch found that the response of the inert placebo was 75% of the effect of antidepressant drugs

When compared, there is no significant difference between an antidepressant drug to a placebo with active with side effects. Checking results with Corrado Barbui and Andrea Cipriani at the University of Verona, Kirsch found that when the side effects of placebo fit, the results showed that 20% difference between antidepressant and placebo disappeared. A Cochrane review confirms that the use of inert placebos literally “inflate” the results of these studies. All this is not new. It is not a discovery of Kirsch. It was already suggested in 1982, and of course, conveniently ignored by the medical industry.

Scientific culture generates the belief that  clinical outcomes yield more, the closer the research is related to science fiction. However, the opposite is true. If only 10% of what has been invested today, would be invested in biomedical technology or to study molecular events in trials with physical exercise, the incidence of cancer, heart disease, depression, diabetes and vastness of other uncontrolled diseases would be infinitely less than it is nowadays.

Exercise is similarly or more antidepressant than many of the administered drugs (2), but it is also anti-inflammatory, anti-obesity, anti-stress, analgesic, antihypertensive, cardioprotective, neuroprotective, osteogenic, promotes neurogenesis, increases the number of neuronal synapses, improves learning, memory, stimulates muscle growth, improves balance, strength, endurance and prevent falls in the elderly, prevents cancer of the lung, prostate, breast, colon, cervix and the list goes on.

(1) Interview with Irving Kirsch: http://www.infocop.es/view_article.asp?id=3842

(2) Ernst C, Olson AK, Pinel JPJ, Lam RW, Christie BR. Antidepressant effects of exercise: evidence for an adult-neurogenesis hypothesis? J Psychiatry Neurosci. 2006; 31 (2): 84-92. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413959/

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Exercise therapy vs. manual therapy for chronic low back pain (LBP).

Exercise therapy vs. manual therapy for chronic low back pain (LBP).

About 70% of the population in the western world will experience low back pain (LBP) at some stage in life. There are three stages, acute, sub-acute and chronic low back pain.

The effect of exercise therapy and manual therapy on chronic low back pain with respect to pain, function, and spinal range of movement have been investigated in a number of studies. The results are, however, conflicting and we therefore have compared the outcomes of several randomized controlled trials1 to compare the effect of manual therapy to exercise therapy in patients with chronic low back pain.


Two treatments, exercise therapy and manual therapy.


Four common outcome measures for each treatment:

- Spinal range of motion
- Pain perception
- Function
- General Health


All studies showed significant improvement on all four outcome measures in both approaches. However:

- The exercise therapy approach resulted in significantly greater improvements than manual therapy on function and general health in chronic lower back pain.

- In chronic lower back pain the manual therapy approach shows significantly greater improvements than exercise therapy on spinal range of motion.

- Both groups showed equal significant improvement on pain levels but no significant difference between manual therapy and exercise therapy.

Due to a favourable prognosis in the acute stages, 80% to 90% of the patients will improve considerably within 6 to 8 weeks. The prognosis for chronic LBP is considerably less favourable causing potentially long-lasting suffering to the patient and significant socioeconomic costs.

Significant improvements in pain, general health, and functional disability were observed in both groups from before to after treatment.

A number of different conservative treatment methods have been studied, but controversy remains as to the preferred treatment. It has been proclaimed that various national guidelines for treatment in primary care are fairly consistent, but discrepancies were emphasized with regard to exercise and spinal manipulation. Several recent reviews claim also claim a strong evidence of effectiveness for exercise therapy in chronic LBP and moderate evidence of ineffectiveness in acute LBP. There is some evidence for a dose-response effect of exercises for chronic low back pain, although the effect was dependent on regular and continuous exercise activity.

Another recent study of LBP patients found no significant difference between graded medical exercise therapy and conventional physiotherapy with lesser intense exercise regime in acute or sub-acute lower back pain. In a recently published report by the International Paris Task Force on Back Pain, it was concluded that “there is sufficient scientific evidence to recommend that patients who have chronic low back pain perform physical, therapeutic, or recreational exercises”, however we have found that some specific active techniques or methods have proven superior to other.

Most studies of manipulation in LBP focus on patients in the acute or sub-acute stages. Review studies presented over the past 13 years of randomized controlled trials conclude that the effect of spinal manipulation is promising but the results still inconsistent.

1.               Van Tulder et al., Anderson et al., Abenhaim et, al. Coste et al.

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