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Relation of Physical Activity with the Depression: A Short Review.

According to the studies, physical exercise can prove to be a viable tool for the treatment of depressed patients. In the present review, various research studies from the year 2017-2019 were analyzed. Various reviews also confirmed that exercise played important role in the treatment of depression. After study, it was confirmed that structured and adherence to the exercise played an important role in the success of exercise protocol towards the treatment of patients. Conventional methods such as pharmacotherapy and psychotherapy were also discussed. It was also studied that sedentary behavior of patients with mental disorder can affect the patient badly. Therefore, all the studies concluded that exercise can be considered as better tool for the treatment of depressed patients if exercise are structured and protocol are regularly performed.


INTRODUCTION
It is the most common neuro-disorder which is always neglected and many individuals are affected by this neuro-disorder. According to the data, it was among the fourth most disease burden globally [1]. Even there are many diseases which also lead to the depression. Depression is affecting the quality of life among individuals. Depression has now gained interest to public health because of its severity and increased percentage of mortality among individuals.
Depression affects the day to day activity of patient and its quality of life. There are many symptoms related to depression such as no pleasure in any activity, loss of appetite and weight, Fatigue, sitting idle, indecisive, and persistent thought of finishing life [2]. There are two main treatment methods available for the treatment of depression are psychological intervention and pharmacotherapy [3]. Psychological interventions can brings positive results but it is very time consuming process and sometimes person also do not consider the depression any psychological and mental disturbance. There are various psychological therapeutic interventions such as cognitive behavioral therapy (CBT), problem solving therapy (PST) and Interpersonal psychotherapy (ITP). The regular presence of patient is must for each therapeutic session. Due to social stigma, these psycho-therapeutic interventions are not popular among patients [4,5].
Another therapy that is pharmacotherapy it involves the usage of drugs [6]. Drugs can be linked with many side effects specially it greatly affects the cardio-vascular function [7].

Lifestyle Medicine
Moreover, antidepressants drugs also become habit of patient and leaving the drug can further alleviate the problems.
Depression is mainly associated with the autonomic and central nervous system [8,9]. Therefore it opens the path for physical rehabilitation. Physical rehabilitation has many advantages as compared to other conventional approaches as it is non-invasive, no side effects, requires minimal input and patient also get involved in some physical activities which ultimately affects the nervous system and hormonal balance [10]. The present review describes the various studies and data which confirmed that physical rehabilitation is better tool for the treatment of patients infected with depression.
Depression affects the motor nerve system as motor nerve system is mainly involved in activities and depression affects the daily routine activities. However other psychological and social factors can also affects the motor nervous system [11,12]. Some researchers confirmed that depression or anxiety affects the motor nervous system in which the patient feel little bit low and have lost the urge to do anything.

EXERCISE AND HORMONES
Exercise can be linked with the release of hormones. As we know that hormones plays an important role in the mood swings and mental health [14]. Exercise is mainly involved in the release of endorphins which is responsible for increasing the availability of hormones. Endorphins mainly interact with the brain receptor and thus reduce the perception of pain [15]. Endorphin hormones are mainly acting as sedative and analgesics. Exercise can be successful measure for the treatment of moderate or low depression [16]. Sitting idle and doing nothing can prove to be harmful for depressed patients. Therefore exercise and sports activities can prove to be good option for the treatment of depressed pateints [27] significant reduction in depression level and moods swings [18]. Keating et al. demonstrated running exercise as aerobic exercise in order to reduce the depression symptoms.

DISCUSSION
Though he described that social support is also a parameter which affects the depression [17]. If social support is provided then aerobic exercise can cause substantial improvements in the depression level. The effect of both psychotherapeutic and physical exercise on the depression was also studied [19]. week but major limitation of the study was less number of participations and inadequate physical activity among females. They concluded that inadequate exercise among female can lead to major problem [20]. Therefore exercise intervention in school and education to the parent regarding inadequate exercise among female and children should be given. Aerobic exercise can prove to be good method for the treatment of depression. However aerobic exercises should be well structured and supervised otherwise the research would not be able to come to the conclusion. Researchers also confirmed that mere exercise cannot be considered as viable tool [21]. Other parameters such as intensity, type, duration are also impacting majorly on the depression level. Study demonstrated the effect of anti-depressant drugs played a role in controlling the depression by inducing autophagy. Extensive study was done in order to assess the mechanism of anti-depressants [22]. The various barriers and enablers of treatment of depression with the physical exercise were also discussed [23]. There are various important obstacle and enablers such as knowledge, skills so-cial professional roles, capabilities, optimisms, intentions, goals, memory enforcement etc. These parameters mainly affect the treatment of depression as they have concluded from various databases and researches [23]. A Study demonstrated the effect of exercise on academic performance and depression. Participants are mainly from Pakistan University [24]. They found that depression and self-esteem are acting as mediator in between physical exercise and academic performance. Researcher found that self-esteem played important role in academic performance of the students.
Depression also played role as mediator but self-esteem was acting as important mediator in between the physical exercise and academic performance [24]. Researchers demonstrated that attention should be paid toward the adherence to the exercise with specific protocol [25]. Exercise needs not to be improved but regular and adherence to the exercise protocol can increase the chance of effective treatment. There are various factors associated with the adherence with the exercise such as flexibility in work environment and any addiction of drugs and alcohol [25]. Study described that people are not aware about the usage of exercise in treatment of depression [26]. Therefore education is being imparted to the Australian women for the benefits of exercises in the treatment of depression [26]. Ehrber et al. concluded that sedentary behavior of patients with mental disorder affected them more while introduction of physical exercise resulted in the improvement in mental disorder patients [27]. All studies are also summarized below in Table 1 for more interpretations and analysis.

CONCLUSION
All studies concluded that physical exercise can be considered as a viable tool for the treatment of patients with mental disorder and depression. But there are many factors which influenced the treatment such as adherence and structured exercise. Therefore video assisted and structured exercise can prove to be more beneficial agent for the treatment of depression. Moreover adherence and education of the exercise protocol for the treatment of depression is also an important factor which should be keep in mind.