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DEPRESSION AND EXERCISE

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A Guest Post By Clare Pentelow, Registered Social Worker and Registered Psychotherapist with a private practice called Kitchener Therapy in Kitchener, Ontario. 

Depression and Exercise

Depression can be extremely painful to experience.  Symptoms include, but are not limited to: difficulty concentrating, loss of interest in activities that were once pleasurable, feelings of sadness and emptiness, feelings of hopelessness, and fatigue. When looking for help often the most obvious treatments involve medication and counselling – and while these are important pieces of a treatment plan, I think a lot of people are unaware of how helpful exercise can be when it comes to alleviating depressive symptoms.

Can Exercise Improve Your Mood?

Research has consistently shown that exercise improves mood state, self esteem (Raglin, 1990), alertness and concentration (Alexandratos, 2012).

 

Examples of such studies include (as cited in Craft and Perner, 2004):

  • Participants exercised on a cycle ergometer 4 times a week, 30 minutes a session for 6 weeks.  This treatment was compared with a control condition in which the subjects listened to audiotapes of white noise that they were told was subliminal assertiveness training.   Results indicated that the aerobic training program was associated with a clear reduction in depression compared with the control condition, and the improvements in depression were maintained at 3 months post intervention 
  • Participants spent 30 minutes walking on a treadmill for 10 consecutive days.  This was found to produce a clinically relevant reduction in depression.
  • Depressed adults who took part in a fitness program displayed significantly greater improvements in depression, anxiety, and self-concept than those in a control group after 12 weeks of training The exercise participants also maintained many of these gains through the 12-month follow-up period.

What Type Of Exercise Will Help To Improve Mood?

It seems clear from the evidence that exercise can be very helpful in improving mood.  The question then is, do you need to engage in a certain type of exercise in order to benefit? There is some evidence that aerobic exercise at an intensity consistent with public health recommendations can be regarded as an effective treatment of mild and moderate depression, and that the effects of low-intensity exercise are not as significant (Deslandes et al., 2008).

However, there are many studies that have found the effect of both aerobic and non aerobic exercise to be comparable when it comes to improving mood (as cited in Craft and Perner, 2004):

  • Forty women struggling with depression were randomly assigned to running, weight lifting, or a waist list.  They were asked to complete 4 training sessions each week for 8 weeks.  Depression was assessed mid and post treatment, and up to 12 months after. Results indicated that the 2 activities were not significantly different, and that both types of exercise were sufficient to reduce symptoms
  • 90 in-patients diagnosed with depression were randomly assigned to aerobic (jogging or brisk walking) or non-aerobic (strength training, relaxation, coordination and flexibility training) exercise. The program was 8 weeks in length and participants exercised for 60 minutes 3 times a week.  Both groups experienced a significant reduction in depression score, with no significant differences between the two groups.
  • A metanalysis of 30 studies was conducted, and found that exercise characteristics such as duration, intensity, frequency, and mode of exercise did not moderate the effect.  Only the length of the program was a significant moderator, with programs 9 weeks or longer being associated with larger reductions in depression 

The takeaway here is to find the type of exercise you enjoy the most, and regularly do it!



How To Get Started

So now you know why getting up and moving is a good idea, however it can be hard to find the motivation to get started – whether you are struggling with depression or not.  It is important to note that, according to meta-analyses on the subject, exercise does not need to be lengthy, or intense and that fitness gains are not necessary to yield positive benefits. (Craft and Landers, 1998; Fox, 1999). The most important thing you can do is get started.  Here are some tips, based on the evidence, to help you take your first steps towards regular exercise:

Begin Slowly, Take Small Steps

It’s important to begin slowly, and choose an easily accessible form of exercise.  For many people, walking is a good place to start.  Pick a time of day when you feel more energized, so that it will be easier to get started – for example if you are exhausted by the end of the day, don’t plan to have an exercise session at 8pm.

Take small steps – your fitness goals should not feel overwhelming or impossible to you.  It’s ok to start small, and then work up to 3 sessions of exercise a week. The pace of exercise, and the amount of time you exercise is less important in the beginning – what’s important is that you do some form of exercise 3 times a week.  I can’t emphasise this enough, when it comes to seeing results with regards to mood, frequency should be your #1 priority: remember, there are positive mood effects from exercise involvement, independent of fitness gains (Craft and Landers, 1998; Fox, 1999). Once you are regularly exercising at least 3 times a week, you can work towards scheduling 20 minutes of moderate intensity exercise – this is enough to significantly reduce symptoms of depression (Craft and Perner, 2004).

Make it Enjoyable

Try to make exercising enjoyable for you.  You may need to try different types of exercise, in different locations.  Maybe you are someone who enjoys running along a trail, or perhaps you find going for a swim a fun way to workout.  Be creative, and don’t try to force yourself to do high intensity exercises – the point is to try and make exercising sustainable.  Moderate-intensity exercise (60%-80% of maximum heart rate) generally produces greater enjoyment than more intense activity and roughly one half the dropout rate (Craft and Perner, 2004).

Social Support

When it comes to continuing to exercise, social support has been found to be helpful, however not all types of social support are created equal.  While it’s great to have a partner, family, or friends provide you with support, if they are doing it from the couch while they watch TV that may not help keep you focused on your workout goals.  The best kind of support is what is termed “active social support”, and it involves having someone, such as a fitness coach or workout buddy that is involved in your workout program and provides regular check ins (Rackrow et al., 2014; Rodrigues et al., 2019). 

It can feel so challenging to start exercising, especially when you are dealing with low energy and/or depression.  Often when people think of exercising they think of the physical health benefits.  While your physical health is a great reason to start to exercise, there are also very real benefits to your mental health. My hope is that by laying out the evidence people will understand, and be motivated by, what a change regular exercise can make to your life.

Warning: 

As the saying goes, moderation in all things.  It is important not to overdo it when it comes to exercising.  Excessive exercise can result in mood disturbances and worsened physical health (Raglin, 1990).  Excessive exercise can be defined as exercise that interferes with important activities, or exceeds three hours a day and causes distress if you are unable to exercise.

Please note that the advice provided may not fit your unique circumstances.

Clare Pentelow is a Registered Social Worker and Registered Psychotherapist with a private practice in Kitchener, ON.  You can find out more about her at www.kitchenertherapy.ca

References:

Alexandratos, K., Barnett, F., and Thomas, Y. (2012) The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review, British Journal of Occupational Therapy, 75(2).

Buckworth J, Wallace LS (2002) Application of the transtheoretical model to physically active adults. J Sports Med Phys Fitness. 42:360–367.

Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. Primary care companion to the Journal of clinical psychiatry, 6(3), 104–111.

Craft LL, Landers DM (1990) The effect of exercise on clinical depression and depression resulting from mental illness: a meta-analysis. J Sport Exerc Psychol, ;20:339–357. 

Deslandes, A. et al. (2009) Exercise and Mental Health: Many Reasons to Move, Neuropsychobiology, 59:191–198

Duncan KA, Pozehl B.(2002) Staying on course: the effects of an adherence facilitation intervention on home exercise participation. Prog Cardiovasc Nurs. 17:59–65.

Fox KR.(1999) The influence of physical activity on mental well-being. Public Health Nutr. 2:411–418.

Fox KR Boutcher SH, eds. Physical Activity and Psychological Well-Being. London, England: Routledge. 2000

King AL, Taylor CB, and Haskell WL. et al. (1988) Strategies for increasing early adherence to and long-term maintenance of home-based exercise training in healthy middle-aged men and women. Am J Cardiol. 61:628–632.

Lawlor DA, and Hopker SW (2001). The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomized controlled trials. BMJ. ;322:763–767

Rackow, P., Scholz, U., & Hornung, R. (2014). Effects of a new sports companion on received social support and physical exercise: An intervention study. Applied Psychology: Health And Well-Being, 6(3), 300-317.

 Raglin, J.S. (1990) Exercise and Mental Health. Sports Med 9, 323–329

Rodrigues, F., Teixeira, D., Cidland, L., and Monteiro, D. (2019) Promoting Physical Exercise Participation: The Role of Interpersonal Behaviors for Practical Implications, Journal of Morphology and Kinesiology, 4(40)

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