It takes a combination of a consistent healthy diet and an exercise routine to reach your maximum physical health goals. However, many people underestimate the power of exercise as a way of not only staying physically healthy but mentally healthy as well. In fact, there has been an increasing amount of research over the past decade supporting a regular exercise routine as a mode of treatment for major depressive disorder.

Major depression affects 10% of the U.S. population annually. Interestingly, major depression commonly co-occurs with other medical conditions including obesity, diabetes, and cardiovascular disease, with approximately 20% of patients with heart disease meeting criteria for depression.1

Most people experience good days and bad days, but depression is much more than being in a bad mood. According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), Major Depressive Disorder is defined as either a depressed mood or loss of interest or pleasure in daily life accompanied by four or more of the following criteria: a decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or inappropriate and excessive guilt; an inability to concentrate or indecisiveness; and recurrent thoughts of death or suicide. These symptoms must be present almost everyday for at least a two week period and cause significant distress or impairment in areas of functioning, such as socially or occupationally.

The evidence supporting the treatment of depression with exercise, both as a sole treatment and an adjunct treatment, is growing. In fact, according to the American Psychiatric Association’s treatment guidelines for depression, exercise alone may be used in patients with mild depression as a form of treatment.2 In one particular study, 156 adults with major depression were assigned to four months of either aerobic exercise, a standard antidepressant medication, or a combination of the two. After 16 weeks of the study, the level of depression symptoms did not differ between the exercise group and the medication group, suggesting that exercise and medication treatments were equally effective. Interestingly, in a 10-month followup study, participants who reported engaging in regular exercise during this followup period were much less likely to be depressed compared with the non-exercisers.1

The evidence supporting the treatment of depression with exercise, both as a sole treatment and an adjunct treatment, is growing.

Although much research in this area is new and more large studies are needed, according to what we know, exercise is an effective treatment for depression. However, for improving depression symptoms, is all exercise created equally? Most of the supporting research focuses on aerobic exercise, such as walking, running or cycling. Fewer studies have been conducted on resistance training, and although the research that exists is promising, it is limited. People looking to improve depression symptoms should exercise at least three to five times a week for 45-60 minutes in duration. Higher intensity workouts have shown to be more effective that lower intensity, although both intensities have shown improvements in symptoms. For aerobic exercise, the goal intensity of the workout should be 50-85% of a person’s maximum heart rate. Finally, it is important to adhere to the exercise plan for an extended period of time. Some people may experience improvements in mood in four weeks, however, continued exercise for at least 10-12 weeks is necessary for the greatest effects.3

Because of the nature of depression, when a person is depressed it may be difficult for them to become motivated to actually start and maintain an exercise routine. It’s important to not think of exercise as a chore but as a tool to get better, the same as one would think of their medication or therapy.

If suffering from depression, it is imperative to get a mental health care provider’s guidance and support in order to discuss treatment options and to monitor the treatment plan. Depression can be a deadly and debilitating disease and those with moderate to severe depression will probably need much more than exercise alone, including a combination of psychotherapy, medication, and exercise. Whether as a primary treatment or an adjunct to medication and therapy, exercise should be considered an important part of depression recovery. Starting an exercise routine may be difficult, but by taking those first steps a person can greatly improve both their physical and mental well-being.

References:

1. Blementhal JA, Smith PJ, Hoffman BM. Opinion and Evidence: Is Exercise a Viable Treatment for Depression? American College of Sports Medicine’s Health and Fitness Journal. 2012;16(4):14-21.

2. Gelenberg AJ, Freeman, MP, Markowitz JC, et al. Practice guideline for the treatment of patients with major depressive disorder, 3rd edition. Arlington, VA: American Psychiatric Association; 2010 (available at http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6, accessed June 16, 2013).

3. Rethorst CD, Trivedi MH. Evidence-Based Recommendations for the Prescription of Exercise for Major Depressive Disorder. Journal of Psychiatric Practice. 2013;19(3):204-212.

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