Exercise as a Treatment for Depression

Yes, exercise. Unfortunately, most of us do not get enough exercise. But, that is no reason not to change the situation. While most therapists ignore the idea of helping their patients increase their levels of exercise, in studies where therapists have done so, definite anti-depressant benefits have consistently been reported.

Exercise has been found to be a very good treat for depression, as well as preventing heart attacks, diabetes, Alzheimer's disease, and many other human aliments. It is a powerful and important health factor. American research has found that people with lower levels of depression get more exercise (Womens Health 1997 Spring;3(1):61-70). Turkish research has found that depressed individuals have less muscle strength than non-depressed (Int J Neurosci 2001 Aug;109(3-4):149-64). While it has not been proven in prospective studies, it is likely that an inadequate level of physical health due to inadequate exercise actually causes some depression. In any case, exercise is a valuable and important part of any treatment for depression.

For the treatment of depression, both aerobic exercise like running and non-aerobic exercise like weight lifting have been found helpful (Compr Psychiatry 1989 Jul-Aug;30(4):324-31), although aerobic is best. This is the same as the findings for preventing heart attacks. British scientists have shown that the benefits of exercise occurs in as little as 10 days (Br J Sports Med 2001 Apr;35(2):114). In a large randomized study of adults over age 50, psychiatrists at Duke University even found that exercise was better than SSRI anti-depressant medication! (Psychosom Med 2000 Sep-Oct;62(5):633-8).

Harvard researchers showed that even depressed individuals over age 70 did better with exercise (J Gerontol A Biol Sci Med Sci 2001 Aug;56(8):M497-504). The elderly patients assigned to the exercise treatment also did better in follow-up with 33% still lifting weights 26 weeks later and still having less depression. At very large study at Wake Forest found older patients assigned to the aerobic group had less depression, less arthritic pain, faster walking speed, and less disability even 18 months later. In that study, weight lifting was not as beneficial as aerobics (J Gerontol B Psychol Sci Soc Sci 2002 Mar;57(2):P124-32).  Like antidepressants, exercise also increases the synthesis of new neurons in the adult brain: a 2-3-fold increase in hippocampal neurogenesis has been observed in rats with regular access to a running wheel when they are compared with control animals (J Psychiatr Neurol 2006 Mar;31(2):84-92).

At the University of Washington in Seattle, therapists combined exercise with vitamin and light treatment and found patients randomly assigned to this treatment did better (U Wash Seattle, Women Health 2001;34(3):93-112). This is a good combination. I would, of course, very strongly recommend adding fish oil as well.

Exercise is Good for Mood: In a study of 19,288 adolescent and adult twins and their families from The Netherlands Twin Registry, exercise participation (with a minimum of 60 min weekly at 4 METs (Metabolic Energy Expenditure Index)) was 51.4%. Exercise participation strongly declined with age from about 70% in young adolescents to 30% in older adults. Among adolescents, males exercised more, whereas, among older adults, females exercised more. Exercisers were less anxious (-0.18 SD), depressed (-0.29 SD) and neurotic (-0.14 SD), more extraverted (+0.32 SD) and were higher in dimensions of sensation seeking (from +0.25 SD to +0.47 SD) than non-exercisers. These differences were modest in size, but very consistent across gender and age. Regular exercise, anxiety, depression and personality: A population-based study. De Moor MH, et al. Vrije Universiteit, Amsterdam, The Netherlands. Prev Med 2006 Jan 23.

Qigong No Advantage Over Conventional Exercise for Hypertension, Depression: Qigong is a traditional Chinese exercise consisting of breathing and gentle movements. In a 16-week, randomized study of 88 patients with mild essential hypertension, blood pressure decreased significantly from 146.3/93.0 mmHg at baseline to 135.5/87.1 mmHg with qigong vs. from 140.9/93.1 mmHg to 129.7/86.0 mmHg with conventional exercise. Heart rate, weight, BMI, waist circumference, total cholesterol, renin and 24 h urinary albumin excretion significantly decreased in both groups after 16 weeks. General health, bodily pain, social functioning and depression also improved in both groups. No significant differences between qigong and conventional exercise were found. Randomised controlled trial of qigong in the treatment of mild essential hypertension. Cheung BM, Lo JL, et al. University of Hong Kong. Journal of Human Hypertension 19 May 2005

Intense Exercise Helps Depression: Three Hours of Fasting Walking per Week: In a 12-week random assignment study of 80 adults ages 20-45 with mild to moderate major depressive disorders, four different exercise treatment groups varied total energy expenditure (7.0 kcal/kg/week or 17.5 kcal/kg/week) and frequency (3 days/week or 5 days/week) or an exercise placebo control (3 days/week flexibility exercise). The 17.5-kcal/kg/week dose met public health recommendations for physical activity and was termed "public health dose". Hamilton depression scores were reduced by 47% with the more intensive exercise compared with 30% for modest exercise and 29% for the control stretching group. It made no difference if the exercises were done 3 or 5 days a week. Exercise treatment for depression Efficacy and dose response. Dunn AL, Trivedi MH, et al. Cooper Institute, Golden, Colorado. Am J Prev Med. 2005 Jan;28(1):1-8. Ed: A 160 pound person (73 kg) would have to burn 1240 calories/week which equals fast walking for 3 hours. For someone 165-185 pounds, 2.5 hours would do it or only 2 hours for those over 190 pounds. Jogging would need only 2 hours, 1 hour 40 min, and 1 hour 25 min for the respective weight groups. 

Exercise Helps Depression in Stroke Victim Study: In a 9-month study of 100 stroke victims, 7.5% of those assigned to the exercise group had significant depressive symptoms compared with 25% who received usual care (P=.07). Participants with and without baseline depressive symptoms had equivalent treatment-related gains in impairments and functional limitations, but only participants with depressive symptoms had improved quality of life. Exercise may contribute to improved quality of life in those with poststroke depressive symptoms. Therapeutic exercise and depressive symptoms after stroke. Lai SM, et al. University of Kansas. J Amer Geriatric Soc 2006 Feb;54(2):240-7. 

Depression in College Assoc with Less Midlife Exercise: Lower depression, social introversion, and psychopathic deviance scores on testing with in college of 4500 students were associated with increased probability of exercising in midlife for both men and women. Women's Health 1997 Spring;3(1):61-70

Alzheimer's: Exercise May Be Important in Alzheimer's Depression: In a study of 224 Alzheimer's victims, 18% depressed patients took exercise compared with 44% of non-depressed [OR = 2.9, p = 0.001]. Independent predictors of depression were: lack of exercise (p < 0.001, OR = 3.4), taking cholinesterase inhibitors (p < 0.05, OR = 2.4) and having less involvement in hobbies or interests (p < 0.05, OR = 1.2). Relationship of exercise and other risk factors to depression of Alzheimer's disease: the LASER-AD study. Regan C, Katona C, et al. University College London, London, UK. Int J Geriatr Psychiatry. 2005 Feb 16;20(3):261-268

Exercise Increases BDNF in Hippocampus: Neuroscience, 9/30/03, confirmed that exercise increases the chemical BDNF – brain-derived neurotrophic factor – in the hippocampus, a curved, elongated ridge in the brain that controls learning and memory. BDNF is involved in protecting and producing neurons in the hippocampus. This is the same center where anti-depressants are thought to increase the number of neurons and achieve their anti-depressant effect.

Aerobic vs. Non-Aerobic Exercise: Both Helped Depression: 99 patients were randomly assigned. Both groups had decreases in depression compared to controls. Compr Psychiatry 1989 Jul-Aug;30(4):324-31

Improved Mood in Exercising Adults: In a University of Illinois study of 401 adults, researchers found participation in exercise, sports, or physical activity associated with decrease in depression, anxiety, and ill feeling such as insomnia and fatigue. Moderate non-aerobic associated with improved mental well-being. Ross, Am J Epid 88;127:762

Weight-Lifting Helps Depression, Especially Severe: Decreases in depression occurred in three-quarters of adults ages 60-84 in a 20 week strength-training program for upper and lower bodies vs. one-third of a control group who received health lectures. Benefit most pronounced on severe depression. J Gerontology: Med Sci 56A:M497 ’01.

Treadmill 10 Day Anti-Depressant: 10 patients with major depressive episodes exercised on a treadmill for 30 minutes a day for 10 days. Hamilton depression scores decreased from 19.5 to 13, p=.002. Br J Sports Med 2001 Apr;35(2):114-7. Isokinetic muscle performance was found to be worse in major depressive disorder than in healthy controls. Int J Neurosci 2001 Aug;109(3-4):149-64, Turkey.

Exercise Better than Sertraline: Psychosom Med 2000 Sep-Oct;62(5):633-8. Random assignment of 156 adults with major depressive disorders and over age 50 to exercise, sertraline or the combination found that after 4 months, all groups improved equally, although the medication patients did faster. However, exercise group was best at 10 month follow-up, especially for those still exercising on their own, R=.49. Babyak, Duke. There was a possible anti-medication bias in the study since many patients were disappointed to be assigned to the medication group. They had been recruited by newspaper ads.

Exercise May Help Depressed Inpatients: After six weeks, participants showed significant decreases in their levels of reported depression, and nonsignificant trends toward a decrease in anxiety and an increase in their sense of accomplishment. The program did not ameliorate many disturbing feelings such as anger and fear, nor did it elicit a wide range of positive affects such as cooperation and feelings of acceptance. Hosp Community Psychiatry 1982 Aug;33(8):641-5

Exercise Helps Elderly Depressed- Two Studies: Randomized assignment to exercise classes or health education talks for 10 weeks with assessments made "blind" at baseline, and at 10 and 34 weeks using Hamilton Rating Scale for Depression (HRSD), Geriatric Depression Scale, Clinical Global Impression and Patient Global Impression found that at 10 weeks there was a significantly higher proportion of the exercise group (55% v. 33%) experiencing a greater than 30% decline in depression according to HRSD, OR=2.51, P=0.05. U Dundee, Mather, Br J Psychiatry 2002 May;180:411-5; A Harvard study with randomization of 32 elderly aged 70 or older and depressed found that the BDI depression score was significantly reduced at both 20 weeks and 26 months of follow-up in exercisers compared with controls (p <.05-.001). At the 26-month follow-up, 33% of the exercisers were still regularly weight lifting, versus 0% of controls (p <.05). NA Singh, J Gerontol A Biol Sci Med Sci 2001 Aug;56(8):M497-504; Another study suggests that increased cerebral blood flow may be a beneficial factor, although this is only an hypothesis. 

Exercise Helps Elderly Depression: 439 persons over age 59 with knee osteoarthritis were randomized to health education (control), resistance exercise, or aerobic exercise. Depressive symptoms and physical function (disability, walking speed, and pain) at baseline and 3, 9, and 18 months. Aerobic exercise significantly lowered depressive symptoms over time. No such effect was observed for resistance exercise. The reduction in depressive symptoms with aerobic in both among the 98 participants with initially high depressive symptomatology and 340 participants initially low depressive symptomatology; strongest for the most compliant persons. Aerobic and resistance exercise significantly reduced disability and pain and increased walking speed both, and to an equal extent, in persons with high depressive symptomatology and persons with low depressive symptomatology. Wake Forest U, J Gerontol B Psychol Sci Soc Sci 2002 Mar;57(2):P124-32

Exercise-Vitamins-Light Helps Depressed Women: 112 women 18-79 mild to moderate depressed without meds randomized to treatment or placebo vitamins and benefit found after 8 weeks on each of five tests of depression. MA Brown, U Wash Seattle, Women Health 2001;34(3):93-112

Exercise Helps Depression and Physical in Fibromyalgia: Significant improvements were seen for exercise in 6-minute walk distances, BDI depression ratings, STAI, FIQ, ASES, and MHI scores. These effects were reduced but remained during intent-to-treat analyses. Toronto General, Arthritis Rheum 2001 Dec;45(6):519-29