Giving pedometers to patients screened for depression, HealthPartners Medical Group (HPMG) is prescribing walking or exercise in addition to medication and/or therapy as an effective tool in helping patients with depression.

It is estimated that 19 million Americans are living with depression, and three-quarters of patients with severe depression first seek help through their primary care clinic. The average person waits nearly a decade before seeking treatment for mental illnesses.

Research on depression and exercise shows that the psychological and physical benefits of exercise can help improve mental health. Exercise leads to changes in some of the same neurotransmitters (chemicals in the brain that affect mood) targeted by antidepressant medications used to treat both depression and anxiety disorders. Exercise can be used as part of a comprehensive treatment plan that may also include therapy and medication.

"HealthPartners believes so strongly that exercise will help our patients who have depression that our doctors are prescribing pedometers to anyone screened for depression," said Mary K. Brainerd, president and CEO of HealthPartners. "This new program goes to the heart of the mission of HealthPartners - that mental health services and care should be as accessible as help for other health conditions and that improvement in health also take place outside of the doctor's office."

HealthPartners patients are encouraged to aim for 30 minutes or more of moderate physical activity three to five days a week, but for many people with depression, that can seem overwhelming.

"The pedometer program is not meant to replace medication or therapy that may be beneficial to the patient," said Art Wineman, MD, regional assistant medical director. "But it can be an effective tool in our toolkit for patients. Exercise works because it increases the feel-good chemicals in your brain. It also improves energy, relieves anxiety and helps sleep."

The pedometer helps patients track even small amounts of physical activity and can encourage them to recognize small success, like walking around the block or parking further from the grocery store. As a patient's depression improves, they may be able to aim for more vigorous activity, which can be even more effective in improving mood. Anything from running and walking to gardening counts, even though vigorous activity may be more effective.

Three HealthPartners primary care clinics --West (St. Louis Park), Arden Hills and Health Center for Women (St. Paul) -- began the program in August 2010. So far, they have distributed more than 300 pedometers, and HPMG will make the pedometers available to patients at all its clinics this summer.

Providing access to mental health services is a priority for HealthPartners. In addition to the pedometer program, HealthPartners has partnered with other Minnesota organizations on the following depression care and mental health initiatives:

- Since 2008, HealthPartners clinics have been participating in the Institute for Clinical Systems Improvement's (ICSI) DIAMOND project- Depression Improvement Across Minnesota, Offering a New Direction. Through DIAMOND, a care manager and a consulting psychiatrist join the primary care physician in delivering more and better-coordinated care for the patient. HealthPartners uses a questionnaire, known as the PHQ-9 test, to track the symptoms of depression. It asks patients how often, in the previous two weeks, they've experienced nine common symptoms: from feelings of hopelessness to trouble sleeping to thoughts of harming themselves. The program assesses the effectiveness of treatment at 6 months by following up with patients to see if they have fewer symptoms. In 2010, the DIAMOND program received recognition from the American Psychiatric Association.

- NAMI Minnesota (National Alliance on Mental Illness), through a $100,000 grant from HealthPartners, recently launched a campaign to address the stigma of mental illnesses in hospitals and the community - starting with Regions Hospital.

HealthPartners Medical Group