DEPRESSION AND HIIT

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Depression and High Intensity Interval Training Exercise

Kolter Smith

Arizona State University
DNP 712: Clinical Residency and Management
Dr. Ann Guthery
May 2, 2021

Author Note
Kolter Smith is a registered nurse at Chandler Regional Medical Center in the intensive care unit.
He has no known conflict of interest to disclose.
Correspondence should be addressed to Kolter Smith, Edson College of Nursing and Health
Innovation, Arizona State University, Downtown Campus, 550 N. 3rd Street, Phoenix,
AZ 85004. Email: ksmith26@asu.

DEPRESSION AND HIIT

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Abstract
Purpose: The COVID-19 pandemic has increased depression among the population. Exercise is a
useful coping mechanism for depression and high intensity interval training (HIIT) can be
utilized.
Background: A community exercise facility provides HIIT exercises for gym members. The gym
owner believed their HIIT program is a great tool for coping with depression.
Methods: The gym offered a 21-day free HIIT program. Those who signed up for the program,
18 years of age or older, and were able to exercise under the Physical Activity Readiness
Questionnaire were offered to participate in the study. Participants were given a pre-survey
before they started exercises. This survey utilized the Patient Health Questionnaire-9 (PHQ-9), a
standard depression rating tool that determines depression symptom prevalence. After the 21-day
program, participants were given a post-survey involving the same PHQ-9. The survey scores
were compared pre- to post-program. The surveys were coded to exclude any identifying
information.
Results: Mean PHQ-9 pre-test was 7.67, mean score post-test was 3. A paired t-Test resulted in a
p=0.60, showed that it was not statistically significant.
Discussion: The goal of this study was to determine if HIIT training was an effective coping
mechanism for depression. The data shows that participants had decreased PHQ-9 scores from
the pre- and post-program surveys showing a clinical significance. This data can be used to
provide those suffering from depression a coping mechanism.

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Depression and High Intensity Interval Training
The people of today are currently under the effects of a worldwide pandemic from an
infectious virus known as COVID-19. The virus has swept the world and caused problems in
every area of life, from economic, to health care. This virus has been devastating to everyone in
one form or another. Due to the pandemic, quarantine orders were put in place worldwide to
protect the population. Being in lockdown from quarantine or social distancing orders has made
members of the population feel isolated and lacking support. The social distancing orders have
prevented much of the population from going to their normal places for physical activity such as
a gym and other social areas. When unable to do normal activities that are used to cope and
improve mental and physical health this contributes to negative effects on mental health. These
negative contributions to a persons’ mental health can cause depression among other illnesses.
Exercise may help positively improve mental health and be a great coping mechanism for
depression. This paper will discuss the effects of exercise on mental health in persons suffering
from depression
Problem Statement
Isolation
Social isolation due to the pandemic is causing a decline in mental health among the
population. The isolation caused by the pandemic effects all ages. In a study by Knopf (2020),
the researcher analyzed 63 articles on the effects of isolation and depression and found that
depression and anxiety symptoms has increased during social distancing. Continued isolation and
worries about COVID-19 itself will continue to affect those with depression.

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Exercise
Isolation has also made it increasingly difficult for the population to partake in exercise.
Gyms, social clubs, and other places people could get some physical activities were closed in
many locations. In places where facilities were not closed, the fear of acquiring the virus
prevented many from going out. Not participating in physical exercise has negative effects on
not only mental health, but physical health as well. The article by Deguchi et al. (2020) describes
that a lack of exercise can cause sarcopenia or reduction in muscle mass. With the pandemic
causing social isolation and increasing depression, exercise may be a possible tool and coping
mechanism.
Purpose and Rationale
According to the World Health Organization (2021) the COVID-19 virus has infected
more than 119,603,700 people since discovery and over 2,649,700 people have died from it. In a
study by Czeisler et al. (2020) during the pandemic, June 2020, 30.9 percent of adult respondents
reported depression symptoms. This percentage shows a much-elevated level of mental health
disorders versus previous years (Czeisler et al., 2020)
Social isolation had left many without regular coping mechanisms such as loved ones and
physical activity. The World Health Organization (2021) states that about 280 million people are
diagnosed with depression and that number is increasing significantly since the beginning of the
pandemic. With depression on the rise due to restrictions, it is important to provide interventions
to help those vulnerable. The purpose of this paper is to establish physical exercise, in the form
of high intensity interval training (HIIT), as a coping mechanism for depression in the population
at an exercise facility.

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Background/Significance

Isolation
Isolation is the process of having minimal to no contact with other people. Pandemic
isolation causing depression is a new territory in the world. The study by Krendl et al. (2021)
showed that among the participants of the survey, 79.3 percent stated their social life was
negatively impacted with 69 percent stating they were spending much less time with those they
care about. Planchuelo-Gomez et al. (2020) conducted a study utilizing anxiety, stress, and depression
survey scores in the population before and during lockdown isolation. This study found an increase in
negative symptoms associated with all three; anxiety, stress, and depression (see Appendix A)
(Planchuelo-Gomez et al., 2020). Mental health is a concern in the population because poor mental

health can result in lower quality of life. In the study provided by Troutman et al. (2020) they
noted that while the social isolation recommended by the CDC can be life-saving it also carries
multiple mental health risks. They recommend socially distant activities that can provide the
necessary socializing and physical activity. In a study by Mechling et al. (2019) they correlated
peoples’ persistent mental illnesses with lower quality of life scores on survey (see Appendix A).
Exercise
Exercise is any form of physical activity utilized to improve physical health. For the
whole of the population, exercise is a positive intervention that has many health benefits. In a
study on exercise and depression by Holmquist et al. (2017), they showed that exercise has
increased prevention of depression. Physical activity helps with physical illness and has shown to
be effective in mental illness as well. The article by Baker and Clark (2020) provides multiple
interventions and rationales to help with a population isolated during the pandemic including;
physical activity which helps a person’s overall health, mental and physical. An exercise plan
can be made to begin with physical activity. During lockdown in Norway, Ernsten et al. (2020)

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did a study on the population that exercises and the general population and compared their
mental health scores. Anxiety, insomnia, and depression reports had a significant drop in the
exercise group (see Appendix A). Exercise has shown results in multiple studies improving
peoples’ mental health.
The researchers Deguchi et al. (2020) stated that at least one hour per week of any type of
exercise helps prevent depression. As little time as one hour of a person’s time every week can
show positive effects of mental health. Fluetsch et al. (2019) did a cross-sectional study
involving analyzing the data from the 2015 Behavioral Risk Factor Surveillance System and
found that higher physical activity in adults saw fewer reported days of poor mental health (see
Appendix A). One study by Huang et al. (2015), compared an exercise program to cognitive
behavioral therapy for depression. The cognitive behavioral therapy showed a significant drop in
depression symptoms among participants. The researchers went on to argue that the exercise
program also showed a large improvement of symptoms, but may have a longer-term effect on
those symptoms. The significance of this study is showing that the positive effect of exercise
may have a longer lasting effect. Callow et al. (2020) note that physical activity is also beneficial
in fighting the COVID-19 virus. In a 13-year-long study finding the correlation between exercise
and cases of clinical depression by Hallgren et al. (2019), it was found that the population who
engaged in physical activity had less cases (see Appendix A). Another study on depression and
exercise from Bennie et al. (2020), the researchers discovered that the prevalence of depression
symptoms was decreased on a self-report scale in an exercise group versus a control group (see
Appendix A).
HIIT exercise is a specific form of physical exercise. During HIIT the person will
undergo a vigorous activity for about 60 seconds followed by a short period of rest, this cycle

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continues for an hour. This exercise is designed to quickly increase heart rate, while building
muscle. Many gyms across the country offer HIIT as an exercise program.
Internal Evidence
An exercise facility that services a large population in Phoenix Arizona. This facility
provides group physical activity classes to anyone 18 years old and up, of any fitness level.
These classes were led by a fitness trainer, where they teach correct form for exercises. The
owner of the gym utilized a health survey they developed for new clients that asks basic
questions about mental health. The owner believed that the HIIT can help improve peoples’
overall well-being, physical, and mental health. The owner had agreed to implement a standard
mental health survey for this research study to participants before and after starting a standard
physical activity program. This gym offers participants a 21-day free HIIT exercise program.
Discussion
The COVID-19 pandemic has been difficult for the whole world. All countries were
affected by the introduction of the COVID-19 virus. Social distancing to stop the virus spread
has left the population vulnerable to mental health issues. Many studies have been started since
the beginning of the pandemic on this issue and have had results indicating the negative impact
on mental health. There have also been many studies on the effects of exercise and mental health.
These studies generally show a clear improvement in mental health.
PICO Question
This inquiry has led to the clinically relevant PICO question, “In the population, age 18
and older, affected by the COVID-19 pandemic, how does a structured exercise program affect
depression symptoms versus no structured exercise program.”

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Search Strategy

A review of current evidence based on the PICOT question. Three databases were
utilized; Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and
PsychINFO. The databases were selected due to the relevancy on mental health as well as
COVID-19 isolation. These databases contain quality, peer-reviewed material pertaining to the
medical field.
Key Terms
When using the databases key terms were utilized to narrow and filter the results to
address the PICOT question. Key terms included; depression, mental health, COVID-19,
isolation, exercise and various synonyms and variations of each to be more inclusive. Some of
the other filters applied included articles dated between the years 2016 and 2021, peer-reviewed
journal articles, and English language. Geography filter was left out at this time.
Search Yield
The initial search of CINAHL using the key terms, exercise, and depression yielded 780
results. Once the key term isolation was added increased the results to 1,800, while adding
COVID-19 reduced it to 28 results. These results were with the added filters of article date, peerreviewed, and English language.
Searching PsychInfo using the same key terms from the CINAHL search; exercise and
depression, yielded 100 results. Adding COVID-19 returned three results. Article dates between
2016-2021, and peer-reviewed filters were applied. COVID-19 is a new topic starting in 2020,
thus adding COVID-19 to searches will produce a smaller number of results.
The PubMed database yielded over 10,000 results with the same initial key terms as
above. Adding the key term isolation narrowed it down to 220 results, and adding COVID-19

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brought it to 77 results. The filters applied were articles dated 2016-2021, English language, and
peer-reviewed. This database yielded the most initial results with all key terms and filters
applied.
From these databases after reviewing the titles and abstracts of articles, 20 relevant
studies were selected. Full text copies of these 20 studies were obtained and reviewed using a
critical appraisal checklist. From the checklist, 11 studies showed high quality research relevant
to the PICOT question. These studies included six description studies, four randomized control
trials, one systematic review.
Inclusion and Exclusion Criteria
Inclusion criteria included studies looking at depression symptoms in the population 18
years or older in isolation and studies that tested the effects of exercise on depression symptoms.
Exclusion criteria included studies looking into only the physical outcomes of exercise or
isolation. Without a huge pool of studies to compare at this time, the selection of studies was
limited. Another limitation is with the pandemic being new to the world, long term effects cannot
be determined. These studies all evaluate parts of the PICOT question including; mental health
during lockdown and isolation, and the effects of exercise on mental health.
Critical Appraisal & Synthesis of Evidence
The quality and strength of evidence of the articles was determined utilizing a rapid
critical appraisal tool that was developed by Melnyk & Fineout-Overholt (2019). The studies
were quantitative, measuring scores on several mental health questionnaires, that applied scores
based on symptoms. These studies were chosen based on their relevance to mental health and
isolation, or exercise, or both isolation and exercise. These studies were included in evaluation
and synthesis tables (see Appendix A).

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The majority of participants in the studies were defined as anyone older than 18 years of
age. Demographics were widely varied, but favored female over male in many studies. Study
tools included standard mental health questionnaires in all studies although the studies used
several different types. The types of exercise varied greatly from study to study, but were well
defined within each. Due to the variance of exercise, it is impossible to determine if a specific
type of exercise is better for mental health than another. From this evidence there is a clear
relation between the positive effects of exercise and mental health including; depression, anxiety,
and stress. People suffering from mental health issues should consider exercise as a viable option
for improvement of mental health.
Theory Application
The Health Promotion Model (HPM) was chosen because the model endorses activities
that help improve and maintain well-being (see Appendix B). Polit et al. (2017) describe the
assumptions of HPM as a person who will actively regulate their behavior when there are valued
benefits in doing so. This model also iterates that people change and are changed by the
environment around them and health care professionals can exert their influence on those
peoples’ environment. It is up to the person to change their behavior on the environment for
positive outcomes (Polit et al., 2017). This model is directed towards promoting health, utilizing
exercise for the improvement of mental health fits into this belief. The environment during the
pandemic is one that can promote isolation which has been shown through studies to decrease
mental health. While not explicitly stated in the research studies in this paper, most seem to
employ he HPM as well. This model will assist in promoting behaviors that assist in well-being
such as exercise.

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Implementation Framework

This research study implements an evidence-based practice model known as the Iowa
Model for Evidence-Based Practice to Promote Quality Care or Iowa Model (see Appendix B).
According to Polit et al. (2017) this model begins with identifying the problem-focused trigger,
in this case the problem being poor mental health outcomes during COVID-19 isolation and how
exercise affects this. The next step is to assemble research on the topic, critique and synthesize
the research (see Appendix A). Once a sufficient research base is developed, then begins the
pilot of change in practice; selecting outcomes, collect data, implementation, evaluation, and
modify practice. If this change project is appropriate for adoption, then there can be initiation of
change in practice, or continued evaluation of quality, followed with dissemination of results
(Polit et al., 2017).
Methods
The participants were those who came to the gym and signed up for the 21-day exercise
program. The participants had to be 18 years and older, male or female, and any race. Exclusion
criteria included: people under 18 years old, those who cannot participate in the physical
activities as deemed by the Physical Activity Readiness Questionnaire, and those who do not
finish the program. Those who signed up were sent an e-mail with the necessary information
and survey. It was made clear that taking the survey was consent to start the program. The
participants then completed the pre-program survey, completed the exercise program, then
completed the post-program survey. Participants names were excluded from the data obtained,
and the results were stored on the nurse practitioner student’s computer, until DNP program
completion. Data on symptoms of depression were then compared.

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Outcomes were measured utilizing the Patient Health Questionnaire-9 (PHQ-9) (see
Appendix C). The PHQ-9 is a questionnaire that measures severity of depression symptoms.
According to Kroenke (2001), the PHQ-9 is modeled after the Diagnostic and Statistical Manual
of Mental Disorders, 5th Edition (DSM-5). The diagnostic symptom criteria in the DSM-5 are
relayed in the survey as nine questions with a Liker-scale from zero to four score of severity
associated with it. Kroenke (2001) conducted a study where 6,000 patients completed the PHQ9 and as the severity scores increased so did a decrease in functional status, concluding that the
PHQ-9 is a reliable tool for depression severity. This survey is commonly used among mental
health practitioners in assisting a diagnosis of depression (Kroenke, 2001). The PHQ-9 scores
were compared from pre-program to post-program surveys. The change in scores were collected
to see if the program had any effect on depression severity. These measures relate to the HPM
because the participants were seeking an intervention with a perceived value, that being a healthy
lifestyle. The environment being the exercise program provided the change people are seeking.
The Iowa Model related to the outcomes because it identified a problem causing trigger,
depression, then found outcomes. The outcome was change in depression symptoms after
exercise program completion. The project was implemented, data collected, then evaluated for
effectiveness. If the data is shown to be effective the project can be evaluated for quality and
information disseminated to other locations.
Study was not started until Arizona State University’s Institutional Review Boards
approval (see Appendix D). Collection of data began in November, 2021 and ended in January,
2022. There was no budget or funding provided on this project. The outcome of this project was
expected to show that HIIT would be a positive coping mechanism for depression.

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Results
There were 74 participants that signed up for the initial program information and survey.
Three participants completed the entire program and surveys. The mean PHQ-9 score of the
three participants before the program began was 7.67. The mean PHQ-9 score of the three
participants after program completion was 3. The scores were compared using Intellectus
Statistics (2019), a paired t-Test to determine if the difference in mean was statistically
significant, the p=0.60.

(Intellectus Statistics, 2019)

Discussion
The results showed that each participant had a reduction in depression symptoms scored
on the PHQ-9. This means there was a clinical significance that HIIT reduced depression
symptoms. The data did not reach statistical significance with the p=0.60. More participants
would have likely made the data reach statistical significance.
Due to the nature of the exercise being higher intensity, there was an anticipated loss in
participants who would drop out in the middle of the program. Participants left after one or two

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weeks of exercise, did not complete two days of exercise per week, or did not complete the
surveys. The gym owner did provide free 21-days of exercise for free for participants, this
allowed for a lot of initial participants. The free program also allowed participants to leave
without financial consequences. The owner highly endorses the mental health benefits of HIIT
exercises and helped promote the program at the facility. Future studies need to have more
participants finish the program to gain statistical significance. Future studies should also look
into other aspects of mental illness such as anxiety.
Conclusion
People having the ability to head back into their normal routines, exercise facilities, and
social areas can help with that increase of depression diagnoses since the pandemic started. This
provides an opportunity for the population to find new coping mechanisms for depression. HIIT
needs continued study and evidence for its efficacy as a coping mechanism. However, the data
suggests that HIIT exercises do reduce depression symptoms on a PHQ-9 scale. Providers can
offer exercise as a coping mechanism to their clients and HIIT could be part of that
recommendation.

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Appendix A
Table 1
Evaluation Table of Quantitative Studies
Citation

Theory/
Conceptual
Framework

Design/
Method

(Fluetsch et al.,
2019)

Not explicitly
stated, Health
Promotion Model
implied.

Cross-sectional

Country: USA
Analyzing data
from the
BRFSS and
correlating the
number of poor
mental health
days to level of
physical
activity.

Quantitative

Purpose: To show
the correlation
between exercise
and poor mental
health days.

Sample/ Setting

Inclusion/exclusio
n criteria:
50 years or older,
able to walk outside
for 10 minutes, no
medical conditions
or cognitive
limitations, and at
least mild
depression.
n=441,456
Control:
age: 18-65 and
older
male: 48.7%
female: 51.3%

Major
Variables &
Definitions

Measurement/
Instrumentation

Data Analysis
(stats used)

Findings/
Results

Level/Quality
of Evidence;
Decision for
practice/
application to
practice

IV – Exercise

Self-reported poor
mental health days on
the BRFSS.

Multiple linear
regression model

Increase in
levels of
physical activity
reduced the
reported poor
mental health
days among the
population.

Limitation:
Study was not
randomized,
individuals were
selected based
on if they chose
to enter the
exercise
program or not.
Larger amount
of people in the
exercise group.

DV – Poor
mental health
days due to
depression,
anxiety, and/or
stress.

Being
insufficiently
active reduced
days of poor
mental health by
−1.34
days/month
(95% CI: −1.27,
−1.41), being
active by −2.03
days/month
(95% CI: −1.96,
−2.10), and being
highly active by
−2.23
days/month
(95% CI: −2.17,
−2.29)

PICOT:
The exercise
program shows
evidence of
effectiveness on
depression.

Key: BDI – Beck Depression Inventory; BRFSS - 2015 Behavioral Risk Factor Surveillance System; DASS-21 – Depression Anxiety
and Stress Scale; DV – dependent variable; GAS – Geriatric Anxiety Scale; GDS – Geriatric Depression Scale; HADS – Hospital
Anxiety and Depression Scale; HLI – Healthy Lifestyle Interventions (diet and exercise); IV – independent variable; MMSE – MiniMental State Exam; MSE – Muscle Strengthening Exercise; n – number of participants; OPQOL – Older People Quality of Life
questionnaire; PASE – Physical Activity Scale for the Elderly; PGWBI – Psychological General Well-being Index; PSS – Perceived
Stress Scale; QOL‐AD - Quality of Life in Alzheimer's Disease; SPMI – Severe and Persistent Mental Illness; SWLS – Satisfaction
With Life Scale.

ISOLATION AND MENTAL HEALTH

20

Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentation

Data Analysis
(stats used)

Findings/
Results

Level/Quality
of Evidence;
Decision for
practice/
application to
practice

Losing to gain:
The effects of a
healthy lifestyle
intervention on
the physical and
psychosocial
well-being of
clients in a
communitybased mental
health setting.

Social Cognitive
Theory.

Quasiexperimental
between subject
group research
design.

Inclusion/Exclusion
criteria:
Over the age of 18,
diagnosed with
SPMI, physically
able to perform
various physical
exercise.

IV – Anxiety
symptoms
DV - HLIs

PGWBI

Multiple
comparison
independent ttest.
Control: (M
=18.42, SD
=5.00;
t(55)=−2.70,
p=.009)

Mean anxiety
symptoms as
reported by
PGWBI were
14.42 for the
intervention
group, and 18.42
for control
group at three
months. This
shows
improvement of
anxiety
symptoms after
HLI’s.

Limitations:
Sample was not
randomly assigned,
attrition from
initial participants
occurred.

Funded by J.
Richard Corbett
Charitable Trust
(Grant No.
#621120).

Quantitative

Purpose was to
examine the
effects of HLIs
on patient’s
with SPMI.

n – 54
Intervention- 33
Control - 21

Intervention:
p (M=12.50,
SD=2.16;
t(56)=−2.79,
p=.007)

PICOT:
Continued support
on the
effectiveness of
exercise on
anxiety.

No change at six
months.

No bias
reported.

Key: BDI – Beck Depression Inventory; BRFSS - 2015 Behavioral Risk Factor Surveillance System; DASS-21 – Depression Anxiety
and Stress Scale; DV – dependent variable; GAS – Geriatric Anxiety Scale; GDS – Geriatric Depression Scale; HADS – Hospital
Anxiety and Depression Scale; HLI – Healthy Lifestyle Interventions (diet and exercise); IV – independent variable; MMSE – MiniMental State Exam; MSE – Muscle Strengthening Exercise; n – number of participants; OPQOL – Older People Quality of Life
questionnaire; PASE – Physical Activity Scale for the Elderly; PGWBI – Psychological General Well-being Index; PSS – Perceived
Stress Scale; QOL‐AD - Quality of Life in Alzheimer's Disease; SPMI – Severe and Persistent Mental Illness; SWLS – Satisfaction
With Life Scale.

ISOLATION AND MENTAL HEALTH

21

Citation

Theory/
Conceptual
Framework

Design/ Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentation

Data Analysis
(stats used)

Findings/
Results

Level/Quality of
Evidence; Decision
for practice/
application to
practice

(Hallgren et al.,
2019)

Not explicitly
stated, Health
Promotion Model
implied.

Longitudinal
association

Inclusion/Exclusion
Criteria:
Older than 18 years,
excluded for
diagnosed mental
disorder.

IV – Cases of
Depression

Clinical cases of
depression

Cox proportional
hazard regression
model.
Engaging in
≥300 min of
MVPA per week
reduce the risk of
depression by
25% compared to
engaging in
<150 min per
week (HR 0.75,
95% CI = 0.58–
0.97)

Hazard Ratio
Below: 1

Increased physical
activity correlated
with less cases of
depression over 13year period.

Country:
Sweden

Quantitative
Funding by
regional
agreement on
medical training
and clinical
research
between
Stockholm
County Council
and Karolinska
Institutet.

Title:
Prospective
associations
between physical
activity and
clinician
diagnosed major
depressive
disorder in
adults: A 13-year
cohort study.

Compare cases
of depression
among different
activity level
groups over 13year period.

n – 25,520

DV – Physical
activity levels;
Below (<150
minutes a week)
Achieve (150299 minutes a
week)
Exceed (>300
minutes a week)

Achieve: 0.86
Exceed: 0.75

Limitations: selfreported
instruments used
for physical
activity
PICOT:
Shows associations
between physical
activity and
depression.

Bias not noted.

Key: BDI – Beck Depression Inventory; BRFSS - 2015 Behavioral Risk Factor Surveillance System; DASS-21 – Depression Anxiety
and Stress Scale; DV – dependent variable; GAS – Geriatric Anxiety Scale; GDS – Geriatric Depression Scale; HADS – Hospital
Anxiety and Depression Scale; HLI – Healthy Lifestyle Interventions (diet and exercise); IV – independent variable; MMSE – MiniMental State Exam; MSE – Muscle Strengthening Exercise; n – number of participants; OPQOL – Older People Quality of Life
questionnaire; PASE – Physical Activity Scale for the Elderly; PGWBI – Psychological General Well-being Index; PSS – Perceived
Stress Scale; QOL‐AD - Quality of Life in Alzheimer's Disease; SPMI – Severe and Persistent Mental Illness; SWLS – Satisfaction
With Life Scale.

ISOLATION AND MENTAL HEALTH

22

Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentation

Data Analysis
(stats used)

Findings/
Results

Level/Quality
of Evidence;
Decision for
practice/
application to
practice

(Bennie et al.,
2020)

Not explicitly
stated, Health
Promotion Model
implied.

Cross-sectional
study.

Inclusion/Exclusion
: 18 years or older.

IV – Cases of
Depression

PHQ-8

Examine
associations
between MSE
and depression
symptoms.

n – 23,635
Male – 10,735
Female – 12,900

DV – MSE in
days per week;

Generalized
linear models
with Poisson
regression – used
to calculate
prevalence ratios.
Prevalence of
moderate
depression
symptoms, in
exercises per
week:
1 times per week
0.62 (0.52–0.73)
2 time per week
0.66 (0.56–0.79)
3-4 times per
week
0.72 (0.60–0.86)

For Moderate
depressive
symptoms, the
prevalence were
as follows;
0 - 7.8%
1 – 5.5%
2 – 5.6 %
3-4 – 5.6%
>5 – 4.7%

Limitations: Study
was on a self-report
scale. Significantly
higher amount of
people in the 0
category leading to
potentially skewed
numbers.

Musclestrengthening
exercise and
depressive
symptom
severity among
a nationally
representative
sample of
23,635 German
adults
Country:
Germany
Funded by the
Social and
Health Sciences
in Sport
Institute of
Sport Science,
University of
Bayreuth.

Quantitative

People who did
MSE in amount of
times per week;
0=13,367
1=3085
2=2990
3-4=2531
>5=1662

Other levels of
depression
scores were
similar.

MSE was
associated with
decreased
likelihood of
depressive
symptoms.
PICOT:
Shows strength
exercise effects on
depression
symptoms. Also
shows different
types of exercise

Key: BDI – Beck Depression Inventory; BRFSS - 2015 Behavioral Risk Factor Surveillance System; DASS-21 – Depression Anxiety
and Stress Scale; DV – dependent variable; GAS – Geriatric Anxiety Scale; GDS – Geriatric Depression Scale; HADS – Hospital
Anxiety and Depression Scale; HLI – Healthy Lifestyle Interventions (diet and exercise); IV – independent variable; MMSE – MiniMental State Exam; MSE – Muscle Strengthening Exercise; n – number of participants; OPQOL – Older People Quality of Life
questionnaire; PASE – Physical Activity Scale for the Elderly; PGWBI – Psychological General Well-being Index; PSS – Perceived
Stress Scale; QOL‐AD - Quality of Life in Alzheimer's Disease; SPMI – Severe and Persistent Mental Illness; SWLS – Satisfaction
With Life Scale.

ISOLATION AND MENTAL HEALTH

23

Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentation

Data Analysis
(stats used)

Findings/
Results

Level/Quality
of Evidence;
Decision for
practice/
application to
practice

(PlanchueloGomez et al.,
2020)

Not explicitly
stated, Health
Promotion Model
implied.

Longitudinal
study.

Inclusion: Age 18
years and older,
living in Spain.

IV – Depression,
Anxiety, Stress.

DASS-21

Longitudinal
analysis with
Generalized
Linear Mixed
Models.
Percentage of
people who
reported
symptoms before
compared to after
lockdown. Such
as 34.00% and
37.03% for
anxiety.

Percentage in
people who
reported
symptoms from
first to second
survey.

Levels of anxiety,
depression, and
especially stress,
significantly
increased through
the lockdown.

Anxiety: 34% to
37.03%

Limitations:
participants
younger than 35
composed more
than half of the
sample. Majority of
female participants
PICOT:
Shows increase in
negative mental
health symptoms
from lockdown.

Country: Spain
Quantitative
Longitudinal
evaluation of
the
psychological
impact of the
COVID-19
crisis in Spain.
No Funding.
No bias noted.

Examine
symptoms of
depression,
anxiety, and
stress due to the
impact of the
COVID-19
virus and
lockdown.

Mass survey sent out
to population on
March 28, 2020,
second survey sent
out to participants on
April 28, 2020.
n – 4,724
Male – 1,626
Female – 3,098

IES
DV – Lockdown
from COVID-19

Depression:
44.41% to
46.88%
Stress: 39.30%
to 49.34%

Key: BDI – Beck Depression Inventory; BRFSS - 2015 Behavioral Risk Factor Surveillance System; DASS-21 – Depression Anxiety
and Stress Scale; DV – dependent variable; GAS – Geriatric Anxiety Scale; GDS – Geriatric Depression Scale; HADS – Hospital
Anxiety and Depression Scale; HLI – Healthy Lifestyle Interventions (diet and exercise); IV – independent variable; MMSE – MiniMental State Exam; MSE – Muscle Strengthening Exercise; n – number of participants; OPQOL – Older People Quality of Life
questionnaire; PASE – Physical Activity Scale for the Elderly; PGWBI – Psychological General Well-being Index; PSS – Perceived
Stress Scale; QOL‐AD - Quality of Life in Alzheimer's Disease; SPMI – Severe and Persistent Mental Illness; SWLS – Satisfaction
With Life Scale.

ISOLATION AND MENTAL HEALTH

24

Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentation

Data Analysis
(stats used)

Findings/
Results

Level/Quality
of Evidence;
Decision for
practice/
application to
practice

(Ernstsen et al.,
2021)

Not explicitly
stated, Health
Promotion Model
implied

Cross-sectional
study.

Inclusion –
Members of
Norwegian fitness
association.

IV – Depression,
Anxiety, Sleep
disturbance

HADS

Binary logistic
regression
Authors stated
that data is not
shown.

The percentage
of participants
reporting
symptoms was
compared to
general
population.
Percentage of
people reporting
symptoms
decreased

Limitation: Study
took place during
lockdown,
impossible to know
everything about
sample population
before lockdown,
therefore not
possible to
conclude the
results of this study
are accurate.

Country:
Norway

Quantitative
Mental health
and sleep
disturbances in
physically
active adults
during the
COVID-19
lockdown in
Norway.
Funding by
Eckbo’s Family
Foundation,
Saving Bank of
Mid-Norway’s
Research Fund
for NTNU, and
Dam
Foundation.

Assess mental
health and sleep
disturbances
among
physically
active adults
during
lockdown in
Norway.

E-mail sent to
members for online
survey.
n – 1281
Female – 397
Male - 884

DV – Lockdown
from COVID-19

Karolinska Sleep
Questionnaire.

Anxiety: 9% in
physically active
group to 14.2%
in general
population.

PICOT:
Shows the effects
of lockdown on
mental health.

Key: BDI – Beck Depression Inventory; BRFSS - 2015 Behavioral Risk Factor Surveillance System; DASS-21 – Depression Anxiety
and Stress Scale; DV – dependent variable; GAS – Geriatric Anxiety Scale; GDS – Geriatric Depression Scale; HADS – Hospital
Anxiety and Depression Scale; HLI – Healthy Lifestyle Interventions (diet and exercise); IV – independent variable; MMSE – MiniMental State Exam; MSE – Muscle Strengthening Exercise; n – number of participants; OPQOL – Older People Quality of Life
questionnaire; PASE – Physical Activity Scale for the Elderly; PGWBI – Psychological General Well-being Index; PSS – Perceived
Stress Scale; QOL‐AD - Quality of Life in Alzheimer's Disease; SPMI – Severe and Persistent Mental Illness; SWLS – Satisfaction
With Life Scale.

ISOLATION AND MENTAL HEALTH

25

Citation

Theory/
Conceptual
Framework

Design/
Method

Sample/ Setting

Major
Variables &
Definitions

Measurement/
Instrumentation

Data Analysis
(stats used)

Findings/
Results

Level/Quality
of Evidence;
Decision for
practice/
application to
practice

(Callow et al,
2020)

Not explicitly
stated, Health
Promotion Model
implied.

Descriptive
cross-sectional
study

Inclusion/exclusion
criteria:
Older than 50 years
old who completed
the survey.

IV – Physical
Activity

PASE

Multiple linear
regression

If p<0.05 is
significant in the
amount of
activity and
lowering
depression
scores in a linear
regression
model.

Limitation:
Impossible to
determine if
physical activity
decreased
depression
symptoms or if
increased
depression
symptoms
decreased physical
activity.

Country:
United States of
America and
Canada
The Mental
health benefits
of physical
activity in older
adults survive
the
COVID-19
pandemic.
No funding
noted.

Quantitative

Examine
association
between
physical activity
levels and
anxiety and
depression
symptoms.

n – 1,046
age – 50+
Male – 212
Female - 834

GDS
DV – Depression
scale scores

GAS

Light activity:
0.03
Moderate
activity: 0.04
Vigorous
activity: 0.03
No relationship
between
exercise and
GAS
Bias toward
GDS scores due
to low amount
of GAS
analysis

Future studies
should use more
objective measures
in determining how
the pandemic is
affecting the
population.
PICOT:
Shows benefits of
physical activity on
mental health.

Key: BDI – Beck Depression Inventory; DASS-21 – Depression Anxiety and Stress Scale; DV – dependent variable; GAS – Geriatric
Anxiety Scale; GDS – Geriatric Depression Scale; HADS – Hospital Anxiety and Depression Scale; HLI – Healthy Lifestyle
Interventions (diet and exercise); IV – independent variable; MMSE – Mini-Mental State Exam; n – number of participants; OPQOL
– Older People Quality of Life questionnaire; PASE – Physical Activity Scale for the Elderly; PGWBI – Psychological General Wellbeing Index; PSS – Perceived Stress Scale; QOL‐AD - Quality of Life in Alzheimer's Disease; SPMI – Severe and Persistent Mental
Illness; SWLS – Satisfaction With Life Scale.

ISOLATION AND MENTAL HEALTH

26

Table 2
Synthesis Table
Study
(Author,Year)

(Fluetsch et
al., 2019)

(Mechling et
al., 2019)

(Hallgren et
al., 2019)

(Bennie et
al., 2020)

(Ernstsen et
al., 2021)

(Callow et
al, 2020)

Crosssectional

(PlanchueloGomez et
al., 2020)
Longitudinal
association

Design

CrossSectional

Quasiexperimental

Longitudinal
association

Crosssectional

Exploratory
analysis

441,456

54

25,520

23,635

4,724

1281

1,046

USA

USA

Sweden

Germany

Spain

Norway

USA

HPM

SCT

HPM

HPM

HPM

HPM

HPM

Sample
n subjects
Country
Framework
Outcomes
Anxiety

+

+

-

-

+

+

-

Depression

+

-

+

+

+

-

+

Stress

+

-

-

-

+

-

-

QOL

-

-

-

-

-

-

-

Exercise

Exercise

Exercise

Exercise

Isolation

Both

Both

Exercise
Isolation
Both

Key: HPM - Health Promotion Model; n – Number of participants; QOL – Quality of Life; SCT – Social Cognitive Theory

ISOLATION AND MENTAL HEALTH

27

Appendix B
Health Promotion Model

(Pender, 2011)

ISOLATION AND MENTAL HEALTH
Iowa Model

(Iowa Model Collaborative, 2017)

28

ISOLATION AND MENTAL HEALTH

29

Appendix C
Patient Health Questionnaire-9

(Kroenke, 2001)

ISOLATION AND MENTAL HEALTH
Appendix D
IRB Correspondence Letter

APPROVAL: EXPEDITED REVIEW
Ann Guthery
EDSON: DNP
602/496-0794 Ann.Guthery@asu.edu
Dear Ann Guthery:
On 10/28/2021 the ASU IRB reviewed the following protocol:
Type of Review: Initial Study
Title: Depression and HIIT Exercise
Investigator: Ann Guthery
IRB ID: STUDY00014790
Category of review:
Funding: None
Grant Title: None
Grant ID: None

30

ISOLATION AND MENTAL HEALTH

31

Documents Reviewed: •
Intro letter with consent details, Category:
Consent Form;
•
Letter with modification replies., Category:
Other;
•
Pre-survey, Category: Measures (Survey
questions/Interview questions /interview guides/focus
group questions);
The IRB approved the protocol from 10/28/2021 to 10/27/2022 inclusive. Three weeks before 10/27/2022 you are to submit a
completed Continuing Review application and required attachments to request continuing approval or closure.
If continuing review approval is not granted before the expiration date of 10/27/2022 approval of this protocol expires on that date.
When consent is appropriate, you must use final, watermarked versions available under the “Documents” tab in ERA-IRB. In
conducting this protocol you are required to follow the requirements listed in the INVESTIGATOR MANUAL (HRP-103).
REMINDER - All in-person interactions with human subjects require the completion of the ASU Daily Health Check by the ASU
members prior to the interaction and the use of face coverings by researchers, research teams and research participants during the
interaction. These requirements will minimize risk, protect health and support a safe research environment. These requirements apply
both on- and off-campus. The above change is effective as of July 29th 2021 until further notice and replaces all previously published
guidance. Thank you for your continued commitment to ensuring a healthy and productive ASU community.

Sincerely,

IRB Administrator
cc:
Kolter Smith