Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, PhD, DNSc, CRNA

Second Advisor

Whitney Markowitz, DNP, PMHNP-BC


Purpose: The aim of this Doctor of Nursing Practice project was to increase exercise counseling rates in the treatment of depression by (1) implementing a focused educational training program and (2) understanding factors that impacted utilization of the practice change.

Background: Approximately 280 million individuals suffer globally from depressive disorders. Depression remains the fourth leading cause of disabilities, significantly contributing toward the global burden of disease by increasing morbidity and mortality risk. Psychopharmacology and psychotherapy are current gold standards of treatment; however, providers often overlook the significant role exercise serves in reducing depressive symptoms and severity, as it remains underutilized.

Methods: A mixed quantitative and qualitative approach was used to identify the reasons Nurse Practitioner (NP) trainees in the UC San Diego Psychiatric NP Training Program adopted the interventional training [Physical Activity Counseling to Patients with Depressive Disorders] into clinical practice for delivery with adults diagnosed with depressive disorders served at an outpatient mental health clinic. The Evidence-Based Practice Attitude Scale was highlighted.

Results: The primary outcome of performing exercise counseling per patient with a depressive disorder indicated an overall 7-fold increase of 15% from July 2022 to September 2022. Secondary outcomes indicate there to be a vast discrepancy between the cohort’s perceived and actual rates of counseling, including positive attitudes toward practice adoption.

Evaluation: Focused educational training is a favorable approach to encourage providers to recommend exercise to patients. Considerations should be made to mitigate barriers of practice implementation. Further research is needed to understand the long-term impact.

Keywords: prescribing exercise, physical activity, depression, attitudes, mental health