AERZTE Steiermark | April 2018

ÆRZTE Steiermark  || 04|2018 11 COVER Fotos: Martin Wiesner Ohne den Schritt Null, näm- lich „das Erkennen unserer Ungewissheiten“, könnten die anderen Schritte aber nicht gesetzt werden. Glasziou räumt auch mit übertriebenen Erwartungen auf und formuliert dafür fünf Punkte: y Dramatische Effekte von Behandlungen sind selten. y Ungewissheiten zu den Ef- fekten von Behandlungen sind sehr üblich. y Kleine Unterschiede in den Effekten verschiedener Behandlungen sind üblich und es ist wichtig, diese zu- verlässig zu erkennen. y Wenn die Antwort zu einer wichtigen Ungewissheit zu den Effekten einer Behand- lung bekannt ist, müssen Schritte unternommen wer- den, um die Ungewissheit zu reduzieren. y Es könnte viel mehr getan werden, den Patienten zu helfen, zur Reduktion der Ungewissheiten über die Effekte von Behandlungen beizutragen. Speziell der letzte Punkt, so Glaszious Kritik, wird auch in der evidenzbasierten Me- dizin zu wenig beachtet – die Rolle der Patientinnen und Patienten. „Evidenzbasierte Medizin ist die Zusammen- führung bester Forschungse- videnz mit klinischer Erfah- rung und Patientenwerten”, so seine Definition. So be- kommt dann ein Patient, der partout keine Medikamente einnehmen möchte, das Spie- len eines Blasinstruments ver- ordnet. www.racgp.org.au/handi HANDI Making non-drug interventions easier to find and use www.racgp.org.au/handi First published: October 2013. Reprinted with permission from The Royal Australian College of General Practitioners, May 2014. Intervention Supervised group exercise for 30 to 40 minutes three times a week for a minimum of 9 weeks. Any exercise is better than no exercise. However, more exercise sessions have a greater effect on mood than fewer sessions. Better outcomes are associated with supervised group exercise rather than solo activity. A mixture of resistance and aerobic training has been shown to be more beneficial than aerobic activity only. Exercise may be used as sole or supplementary therapy. To address motivation and adherence, it may be beneficial to take a graded approach to exercise. See Tips and challenges below. Indication Regular exercise programs improve mood and activity level in people with mild to moderate depression. Patients diagnosed with mild to moderate depression. Used alone, exercise has been shown to have a moderate effect on reducing symptoms of depression. Based on a small number of trials, exercise may be as effective as psychological or pharmacological treatments. Patients with subthreshold depression may also benefit from exercise therapy. Precautions Structured exercise programs are not recommended as a sole treatment for people with severe depression as their ability to participate may be affected by their reduced functioning and ability to complete everyday activities. Patients taking antidepressant medications such as tricyclic antidepressants, which are associated with side effects such as orthostatic hypotension and sedation, may experience difficulty participating in exercise programs. To prevent injury, ensure a gradual introduction to the exercise program. Before commencing exercise, perform a cardiovascular risk assessment to ensure the patient is fit enough to undertake the program. Contraindications Exercise programs may be harmful for those with concurrent disorders (e.g. anorexia nervosa). Overtraining or fixation on exercise could have a negative impact on physical and mental health outcomes. Adverse effects Adverse events in those allocated to exercise interventions in trials were uncommon, with complaints mainly limited to muscle pain and non–heart-related chest pain. Exercise: depression Glasziou-Keynote beim EbM-Kongress an der Grazer Meduni: Ungewissheiten (an-)erkennen.