Depression and Exercise

Mar 28

This is a message I am sure most of you have already heard.

Exercise is an important part of holistic treatment for various mental health conditions, including depression.

Maybe in the past, your GP or therapist has given you or a friend or family member this advice. They wern’’t wrong in doing so, however, it is not easy to find the enthusiasm to start increasing exercise when you may already be lacking in motivation and energy for life.

However, the evidence for activity and exercise being beneficial for low mood is everywhere, and as a result, experts argue that there needs to be a greater drive to make exercise treatments accessible to those with mental health conditions.

How big a problem is depression?

Depression is very common in Australia with 1 in 4 women and 1 in 10 men suffering from depression at a point in their lives. It is thought to be one of the greatest causes of disability worldwide and there is evidence that inadequate treatment of depression is widespread. Depressive disorders are also associated with an increased risk of other medical conditions, increased healthcare costs and increased risk of premature death.

What is depression?

Depression is a condition in which someone has a generally low mood as well as other symptoms of depression each day for at least two weeks. Other key symptoms include loss of interest or pleasure in activities or things that previously brought enjoyment, poor sleep, change in appetite, tiredness, agitation, poor concentration, feelings of worthlessness or inappropriate guilt. Some people experience thoughts of self harm or suicide. Depression may range from mild to severe but the impact it can have on that individual should not be underestimated.

Pathophysiology of Depression

The precise mechanism of depression is not known. There seems to be strong association with genetics, as family, twin and adoption studies have shown, however no single gene has been implicated.

Individual specific environmental effects such as life trauma, low social support and family problems certainly play a strong role. There also seems to be a strong association between higher stress levels, as well as the presence of inflammatory markers, which are thought to activate stress pathways and impair the central serotonin system.

Those with major depressive disease have been shown to have lower levels of serotonin, noradrenaline and dopamine. The majority of drug medications used to treat depression act to increase levels of these.

There are many other potential theories for the pathophysiology of depression, including impaired circadian rhythm and dysfunction of specific brain regions, but no one cause or theory of the above has been decided on.

Basically, it’s complex!

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How does Exercise work in reducing depression?

Physical fitness appears to improve resilience, which is defined as “the ability to withstand, recover and grow in the face of stressors and channelling demands”.

This seems to serve as a stress-resistant resource for both physical and mental health. This theory has been tested in cross-sectional and prospective studies that show those with high exercise levels have fewer health problems when they encounter stress.

“In fact, 16 weeks of regular exercise has been found to be equally effective as antidepressant medication in the treatment of mild to moderate depression. A recent study found that an increase of physical activity from inactive to three times a week resulted in a 20% decrease in the risk of depression over a five year period.” (1)

Can exercise prevent depression in the first place?

A large meta-analysis study looked at 49 studies with over 266,000 patients who were free of depression or depressive symptoms at baseline and were followed up for an average of around 7 years (2). It was found that physical activity consistently protected against the risk of depression and that higher levels of physical activity were associated with a lower risk of developing depression or depressive symptoms. Interestingly, the positive effect of exercise was seen across all age groups and across several geographical locations all around the world.

How does exercise compare to medication?

Exercise as a treatment may be as effective as antidepressant medications.

The SMILE study conducted from 2000 to 2005 compared treatment in four groups:

supervised exercise in groups
home-based exercise
antidepressant medication
or a placebo pill for 16 weeks

All treatment groups had lower depression scores after the treatment period. The remission rate for supervised exercise was 45% compared to 47% in the medication groups, showing very similar effects of the intervention. One year follow up of this study revealed an increase in remission for exercise participants to 66% and regular exercise during the follow-up period predicted reduced depression scores (3).

* It is important to note that medication can be incredibly important in the management of various levels of depression and should never be ignored or neglected in a treatment plan in place of just exercising. The evidence is encouraging as it suggests exercise can be added to management plans for depression alongside standard treatment.

What if exercise is used alongside medication?

Multiple studies have shown an overwhelming benefit of exercise when used in addition to antidepressant medication. This includes studies of varying length using many different forms of activity from light activity and low-intensity cardio to high-intensity cardio and strength training (4). Higher intensity workouts seemed to show the greatest improvements.

What about resistance training?

A meta-analysis that looked at 44 clinical trials including over 1800 participants shows that resistance exercise training was associated with a significant reduction in depressive symptoms regardless of patients age, sex or health status. The effect was also seen regardless of program duration, session duration, intensity, frequency or total prescribed amount of resistance exercise across the different studies (5).

Summary.

It is clear that exercise is extremely beneficial, not only for physical health but also, mental health. Having a regular training regimen is essential regardless of your health status, sex or age.

Not sure how to go about adding exercise into your lifestyle? Please, reach out to our personal trainer, Jack.

(1) https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/5-exercise_depression.pdf

(2) Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Stubbs B et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatry 2018 Jul 1;175(7):631-648. doi: 10.1176/appi.ajp.2018.17111194. Epub 2018 Apr 25.

(3) Netz Y. Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based. Front Pharmacol. 2017 May 15;8:257. doi:10.3389/fphar.2017.00257. eCollection 2017.

(4) Netz Y. Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based. Front Pharmacol. 2017 May 15;8:257. doi:10.3389/fphar.2017.00257. eCollection 2017.

(5) Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of Efficacy of Resistance Exercise Training with Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomised Clinical Trials. JAMA Psychiatry. 2018 Jun 1;75(6):566-576. doi: 10.1001/jamapsychiatry.2018.0572