Depression : exercise has a comparable effect to therapy and medication

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Exercise can certainly be beneficial for individuals with mental health disorders.

To focus on a few benefits, the symptoms of disorders such as depression and schizophrenia can improve with exercise, as well as cardiorespiratory fitness and quality of life.

Only depression, however, has adequate evidence to suggest exercise has a comparable effect to therapy and medication; studies have shown exercise alone is beneficial to participants with depression, and when compared to typical treatment options, exercise can either work similarly to these treatments or can be more advantageous.

That being said, I think the public should understand the importance of checking the sources of information used in an article before believing something to be fact.

Although the original article quotes David Tomasi, the lead researcher of the study, saying psychiatry facilities should include exercise as the primary treatment for mental health disorders, nowhere in the study does it state this, yet the article ran with this statement as the title.

What the article does state is the patients self-reported they felt better both mentally and physically and had the intention of continuing to exercise following the implementation of an exercise program in addition to nutrition sessions; 93.2-96.8% of individuals believed exercise improved their mood and 97.6-100% believed they would continue to exercise after the program.

The finding of this study alone cannot be relied on for a new mental health prescription, due to the lack of consistency within this area of research and the lack of reliability of the study.

There are many questions that arise from reading this study that I believe need to be answered before it can influence treatment prescription: what role did the nutrition portion of the program play in the patients’ perceived mood changes?

Did the fact that the exercise room was the only shared area on the ward that had natural light and scenery decorations affect mood and desire to exercise?

At what intensity were the patients performing exercise?

Were the patients taking medication during this study? What about long-term effects and adherence rates to exercise prescription?

Would a follow-up study find different results?

How would the results compare using objective data? Can this be generalized to other patient populations?

The answers to these questions could be different compared to what another study finds, but as a consideration: a meta-review about exercise and severe mental illness found exercise for major depression and schizophrenia to be most beneficial at a moderate to vigorous intensity, overall 17.2% of depression patients and 26.7% of schizophrenia patients dropped out of interventions, and in some follow-up studies there was no longer a significant exercise effect reported.

These are all factors to consider when prescribing exercise as a treatment for mental illness disorders, and additional factors that have not gotten enough attention include training of professionals and cost.

Only depression, however, has adequate evidence to suggest exercise has a comparable effect to therapy and medication; studies have shown exercise alone is beneficial to participants with depression, and when compared to typical treatment options, exercise can either work similarly to these treatments or can be more advantageous.

As a kinesiology student, I understand how important physical activity is for all individuals, including those with mental health disorders.

Unfortunately, the research does not provide enough evidence overall to state that exercise should be the primary source of treatment.

Ultimately, until all the details are worked out, exercise needs to be promoted along with other traditional therapies, such as psychotherapy and medication or should be done on a case by case basis in consultation with medical professionals if it is to be the sole treatment.


Depression exerts an enormous impact on different domains of individual functioning, as well as physical health (12).

Physical exercise is increasingly recognized as an effective intervention to improve these outcomes.

Patients with major depression seldom receive adequate treatment.

When they do, there is a high likelihood they remain depressed or relapse after first-line treatment (34). Whereas, a substantial proportion of patients go on to receive intensive pharmacological care (56).

Besides mental health outcomes, recent studies cast great concern on the physical health of depressed individuals.

Depression is, in fact, accompanied by behavioral and biological features that are deleterious for physical health, particularly in the cardiovascular system (7).

Moreover, when depression arises as a consequence of pre-existing physical problems, it may amplify disability, anticipate recurrences, and increase disease-related mortality (89).

Recently it was estimated that individuals with major depression die, on average, about 10 years earlier than those who are not depressed, even when excluding deaths by suicide (1012).

There is wide agreement that current research and clinical efforts to address these issues are arguably not proportional to their gravity.

There is an urgent need to develop and implement novel treatments that are effective to treat symptoms of depression and, at the same time, are beneficial for physical health (13). One such intervention is physical exercise, which is increasingly recognized as both an antidepressant agent (14) and a potent tool to delay mortality (15).

The aim of this perspective article is to provide a concise update on the effectiveness of exercise for depression and cardiovascular mortality reduction.

A specific section is dedicated to treatment of elderly patients, in consideration of their increasing demographic relevance (2).

English-language reviews and meta-analyses published in the last 10 years were considered, identified with the following search string in the Pubmed database: (exercis*[ti] OR “physical activity”[ti]) AND depress*[ti] AND (review*[pt] OR review*[tiab]).

Exercise is Effective for the Physical Health of Depressed Patients

Physical activity and exercise have a wide range of beneficial effects (72) that involve both “body” and “mind.”

Bearing in mind this is an artifactual and anachronistic convention, here we provide an overview of exercise effects on the body “from the neck down” that could be relevant to individuals with depression. Table ​Table11 reports recent literature addressing this issue.

Together with dietary caloric restriction, exercise is the main component of interventions that are effective at reducing and managing weight (7375).

The positive effect of exercise is likely mediated by enhanced regulation of appetite hormones (76) and by increased metabolic rate (477778). Moreover, exercise improves sleep quality and duration (79).

Exercise also causes beneficial adaptations in homeostatic systems involved in the response to stress, including the HPA axis (8082).

Moreover, it dampens inflammatory processes while delaying the aging of the immune system (5153). Exercise also improves the autonomic visceral control by restoring sympathovagal balance (578384) Finally, it improves cardiorespiratory fitness both in healthy individuals (47) and individuals with depression (85).

While the formal acknowledgment of the salutary effects of exercise in the medical sciences has been a lengthy process, regular exercise is now recognized as an important lifestyle behavior that can ameliorate the negative impact of chronic diseases (86).

Overall, it is estimated that exercise can reduce mortality to a similar extent as medications in individuals with coronary heart disease, stroke, heart failure, and diabetes (15). It would be urgent to verify if such findings can be translated to depressed subjects.

Among the many salutary effects of exercise, arguably the least researched—and probably the most controversial—are its effects on other lifestyle and health behaviors.

Both the number of randomized controlled trials and the methodological quality of the trials in this area are rising.

While concepts and methods continue to evolve, some early results related to smoking cessation and reducing problem drinking among individuals with mental health disorders show promise (8789).

However, at this stage, systematic reviews of the evidence on the effectiveness of exercise in promoting abstinence from smoking (60) or alcohol (58) indicate no beneficial effect.

On the other hand, the effect of exercise on reducing the use of illegal substances is significant (90). In addition, whether a structured exercise intervention can reduce sedentary behavior or encourage engagement in subsequent physical activity remains hotly debated (64).Go to:

Exercise is Effective Against Symptoms of Major Depression

Physical exercise has been shown to be an effective treatment for major depression in adults 1491 in several randomized controlled trials comparing it to a wide range of other treatments, including usual care, psychological interventions, and antidepressant medications 1492.

Although there have been contrarian meta-analytic findings [e.g., 93], closer inspection of methodological details reveals a pattern of debatable choices (91).

Exercise interventions consisting of three sessions per week for 12–24 weeks typically result in a medium to large reduction in the severity of depression, measured by symptom rating scales (91).

Moreover, exercise interventions have been found to result in 22% higher likelihood of remission from depression than treatment as usual (93), the latter in turn being associated with the remission of about a third of patients (34).

Generally, exercise is well-tolerated and leads to about 18% of dropout rates (94).

Based on the available data, the efficacy of exercise seems greater if it is aerobic, delivered in groups, and supervised by an instructor (95).

Although there are relatively few head-to-head comparisons and duration of treatment may be different, the efficacy of exercise may be comparable in terms of magnitude to that of psychotherapies (39497) or antidepressant medications (98).

Some authors claim the psychological effects of exercise largely depend on “placebo,” or “non-specific” psychosocial effects, such as attention by staff (99100).

Consistently, exercise is still listed among “alternative and complementary” therapies in some guidelines [e.g., (101)].

Skepticism has been fueled, among other reasons, by difficulties to demonstrate a clear dose-response relationship, such as would be expected in drug trials.

Recent studies, however, have started to detect significant associations between the intensity and length of exercise interventions, and their antidepressant efficacy (102103); of note, such relationship is likely to follow non-linear patterns (104).

Another long-held belief among clinicians is that exercise does only ameliorate non-specific somatic symptoms, such as sleep and appetite changes.

Whereas, extant results suggest that exercise indeed reduces core symptoms of depression, such as depressed mood, anhedonia, and suicidal ideation (105106).

On the other hand, studies examining the effects of exercise interventions on cognitive function among individuals with depression [e.g., 107] at present do not indicate substantial benefits (108110).

Exercise may be effective improving several biomarkers that have been implicated in depression (e.g., impaired neuroplasticity, autonomic, and immune imbalances). However, at present, evidence derived from non-depressed individuals still needs to be replicated among clinical populations (111).

Nevertheless, recent trials have begun to show efficacy in treating patients with severe mood disorders (112114) and individuals with treatment-resistant depression, either alone or as an add-on to medications (115116). Lastly, exercise can be effective for individuals who may present concerns about drug treatment, such as women with pregnancy or post-partum depression (117) and adolescents (118119).

At present, research is still needed to establish the efficacy of exercise in the long-term course of major depression.

Some analyses suggest that the antidepressant effects may diminish beyond the duration of the exercise intervention (92). However, individuals who regularly engage in moderate physical activity maintain reduced risk of incurring depressive episodes (120121).Go to:

Effectiveness of Exercise in Late Life Depression

The clinical features and pathophysiology of late-life depression are largely distinct from that encountered among younger adults (122124).

Specifically, depression in late life is associated with a higher prevalence of physical illnesses, greater prevalence of cognitive impairments and inadequate response to antidepressant drugs (125128).

Despite these differences, late-life depression seems to respond to exercise as well as adult depression (129131).

Moreover, among studies appraised in recent meta-analyses, participants receiving exercise did not report any significant side effects. More recently, the SEEDS study showed that exercise was an effective add-on to antidepressant drugs for mild to moderate depression (132).

Interestingly, adding exercise to antidepressant drugs primarily affected core symptoms of depression rather than somatic symptoms (133).

Moreover, individuals receiving aerobic exercise plus antidepressants displayed greater improvements in cognition and autonomic balance compared to those only receiving antidepressants (134135). The intervention was well-received by patients and physicians alike (136).

Despite these promising results, the available evidence remains insufficient to conclude whether exercise can improve cognition in patients with late-life depression (108109).

At present, studies suggest that exercise may not improve cognition among non-impaired, non-depressed individuals (137), but it may, to some extent, improve cognitive performance among individuals diagnosed with cognitive impairment (irrespective of depression), dementia, or physical diseases (138141).

non-depressed individuals (137), but it may, to some extent, improve cognitive performance among individuals diagnosed with cognitive impairment (irrespective of depression), dementia, or physical diseases (138141).


Source:
Neuroscience News
Media Contacts: 
Catherine Murrin
Image Source:
The image is in the public domain.

Original Research:

Kvam, S., Kleppe, C. L., Nordhus, I. H., & Hovland, A. (2016). Exercise as a treatment for depression: A meta-analysis. Journal of Affective Disorders. doi: 10.1016/j.jad.2016.03.063

Stubbs, B., Vancampfort, D., Hallgren, M., Firth, J., Veronese, N., Solmi, M., … Kahl, K. G. (2018). EPA guidance on physical activity as a treatment for severe mental illness: A meta-review of the evidence and position statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental. European Psychiatry doi: 10.1016/j.eurpsy.2018.07.004.

Tomasi, D., Gates, S., & Reyns, E. (2019). Positive patient response to a structured exercise program delivered in inpatient psychiatry. Global Advances in Health and Medicine. doi: 10.1177/2164956119848657

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