Exercising for half an hour may reduce symptoms of depression for at least 75 minutes post-workout and amplify the benefits of therapy, according to two new studies led by researchers at Iowa State University.
“A lot of previous research on the effects of exercise on mental health, in general, have used very broad measures of wellbeing. What we were interested in, specifically, is: how does acute exercise—that is, one session of exercise in a day—influence the primary symptoms of depression,” said Jacob Meyer, a professor of kinesiology at ISU and the lead-author of both publications.
For the first study, the researchers recruited 30 adults who were experiencing major depressive episodes. The participants filled out electronic surveys immediately before, half-way-through and after a 30-minute session of either moderate-intensity cycling or sitting, and then 25-, 50- and 75-minutes post-workout. Those who cycled during the first lab visit came back a week later to run through the experiment again with 30-minutes of sitting, and vice versa.
Each survey included standard questions and scales used to measure symptoms of depression and several cognitive tasks, including the Stroop test; participants responded to the color of a particular font rather than the word itself (e.g., indicating red when they saw the word ‘blue’ in red ink).
The researchers then used the survey data to track any changes in three characteristics of major depressive disorder: depressed mood state (e.g., sad, discouraged, gloomy), anhedonia (i.e., difficulty experiencing pleasure from activities previously enjoyed) and decreased cognitive function (e.g., difficulty thinking, juggling multiple pieces of information at once).
During the cycling experiment, participants’ depressed mood state improved over the 30 minutes of exercise and consistently up to 75 minutes afterward. The improvement to anhedonia started to drop off at 75 minutes post-exercise, but still was better than the participants’ levels of anhedonia in the group that did not exercise.
As for cognitive function, participants who cycled were faster on the Stroop test mid-exercise but relatively slower 25- and 50-minutes post-exercise compared to participants in the resting group. Meyer said more research is needed to understand the variation.
“The cool thing is these benefits to depressed mood state and anhedonia could last beyond 75 minutes. We would need to do a longer study to determine when they start to wane, but the results suggest a window of time post-exercise when it may be easier or more effective for someone with depression to do something psychologically or cognitively demanding,” said Meyer.
He said that could include giving a presentation, taking a test—or going to therapy.
“Can we synergize the short-term benefits we know that happen with exercise and the clear long-term benefits with therapy to deliver the most effective overall intervention?” asked Meyer.
As part of the effort to answer that question, Meyer and his research team conducted a separate pilot study.
Half of the ten participants exercised on their own (e.g., cycled, jogged, walked) for 30 minutes at a pace they considered moderate intensity, which the researchers also verified with Fitbit data, before signing into an hour of virtual, cognitive behavior therapy each week. The other participants simply continued in their day-to-day activities prior to their therapy sessions.
At the end of the eight-week intervention program, participants in both groups showed improvements, but those who exercised before talking with a therapist had more pronounced reductions in symptoms of depression.
The researchers said the results indicate exercise could help amplify the benefits of therapy for adults with depression.
“With such a small group, we did not perform formal statistical testing, but the results are promising,” said Meyer. “Overall, the pilot study showed people were interested and would stick with the combined approach, and that exercise seemed to have some effects on depression and a couple of the mechanisms of therapy.”
One of those mechanisms relates to the relationship between a client and therapist. If someone feels a connection with their therapist, Meyer said, there’s a higher chance they’ll continue going to therapy and the sessions likely will have greater impact.
In the pilot study, participants who exercised before the cognitive behavior therapy session reported a quicker and stronger connection with their therapists. The researchers said the findings suggest exercise may be priming or “fertilizing” the brain to engage with more emotionally challenging work that can happen during therapy.
The researchers said they hope to expand on the innovative studies in the coming years to better understand how exercise could be incorporated into an effective treatment or intervention for people experiencing chronic depression.
The Therapeutic Effect of Exercise on Depression
The beneficial effects of exercise on depression and depressive symptoms have been demonstrated in the last decade, with a large body of research supporting the effect of physical exercise on reducing depressive symptoms in patients (26, 95). For instance, a study (30) aimed at patients with depression (aged 18–60) revealed regardless of aerobic exercise or stretching exercise, there was a significant short-term time effect for symptom severity [Hamilton Depression Rating Scale 17 (HDRS17): p < 0.001, η2 = 0.70; BDI: p < 0.001, η2 = 0.51], mental toughness (p < 0.001, η2 = 0.32), physical self-description endurance score (p = 0.013, η2 = 0.16), cognitive flexibility (p = 0.013, η2 = 0.14), and body mass index (BMI) (p = 0.006, η2 = 0.19). A meta-analytical review (109) that included 1,452 clinically depressed adults revealed that large effects in favor of exercise were found, irrespective of the exercise mode and study quality, compared to the control condition.
A summary of clinical studies over the past 3 years on the exercise effects on depression is provided in Table 1. Aerobic exercises (i.e., stride walking, treadmills, cycling, cross trainers) for people with other conditions (schizophrenia, dementia, chronic stroke, at high risk of depression, etc.) (18, 66, 72, 107, 110–124) and mind-body exercises (i.e., yoga, tai chi, Qigong, Ba-Duan-Jin, Pilates) for people with other conditions (healthy state, menopause, aging, scleroderma, Parkinson’s disease, fibromyalgia, HIV, etc.) (37, 39–41, 120, 125–136) were proven to improve depression, anxiety, cognitive function, and overall functions such as sleep quality, psychological well-being, sexual function, and cardiorespiratory fitness as well.
Although aerobic exercise and mind-body exercise are the most studied types of exercise with significant results, resistance exercise, stretching exercise, endurance exercise, and other types of exercise have also proven to be effective treatment options for depression (67, 72, 107, 110, 137–140). Structured/combined exercise (including resistance, aerobic, strength, balance, relaxation, and endurance exercise) is recommended (53, 69, 141–151); however, there have been no studies comparing structured exercise with a single exercise program.
Existing studies have almost covered patients with depression in a wide range of characteristics. Most of the research subjects were adults (18–65 years old), and a few subjects were teenagers and elderly people. Exercise benefits young people in terms of improving their mental health, and there is a bidirectional relationship between physical activity and adolescent mental health (42).
Nasstasia et al. (53) used a structured multimodal exercise program combined with motivational interviewing (MI) as adjunctive therapy in patients aged 15–25 with major depression (MDD), resulting in a significant difference in the revised Beck Depression Inventory II (BDI-II) cognitive and affective subscales of the intervention group after treatment and improved somatic health and behavioral activation. Several studies of patients with late-life (older than 65) depression (152) have also confirmed that exercise reduced depressive symptoms.
There are a number of trials (29, 153–155) that have failed to prove the efficacy of exercise in treating depressive symptoms. For instance, clinical research in 2012 has shown that the provision of tailored advice and encouragement for physical activity did not improve depression outcomes or antidepressant use in adults with depression when compared with usual care (156). In Table 1, there are two experiments that failed to reveal the antidepressant effect of exercise.
One study (157) reported that a sedentary program may be more beneficial to boys’ moods than exercise. Another study (158) reported that 1-week high cadence cycling failed to improve depression symptoms. Methodological weaknesses, excessively severe depressive symptoms in participants, discrepancies in the mean age of the sample, imperfect exercise programs, and bias would affect the results.
The Role of Exercise in the Treatment of Depression—As a Single Therapy, an Adjuvant Therapy, or a Combination Therapy
Exercise can be used as a single treatment for depression (47). As a single therapy, one clinical trial (24) reported that depressive symptoms were significantly reduced in MDD patients (58%) after 8 weeks of moderate aerobic exercise, compared with 22% in the placebo group.
As a therapy to treat depression, exercise is an intervention with moderate and significant effects that can be used as an independent approach and as an adjuvant to antidepressant therapy (159). Aerobic exercise has been performed as an independent intervention and as an adjunct intervention to medication and psychotherapy (160).
For patients with major depression who are resistant to medication, moderate intensity exercise as an adjunct intervention can ameliorate depressive and functional parameters (13). For MDD patients, the addition of exercise therapy to sertraline therapy was associated with a higher rate of depression relief and a significant improvement in symptoms than the sertraline-only group, with improvements observed from the end of the 4th week of exercise (161, 162).
As adjunct treatments to pharmacotherapy for major depressive disorder (MDD) in older persons, the aerobic training and strength training groups showed significant reductions in depressive symptoms (treatment response = 50% decrease in the pre to post intervention assessment) through the Hamilton Depression Rating Scale and Beck Depression Inventory, compared with the control group (65).
In a clinical publication (4) aiming to investigate the effects of different exercise modalities on the depression severity index and arterial stiffness, the results confirmed the positive effects of aerobic exercise as adjuvant treatment for patients with depression. In addition, the combination of exercise and sertraline treatment has a positive effect on cardiac autonomic control, reducing cardiovascular risk (163).
A recent review (95) suggests that fluoxetine and running may have similar but not completely overlapping ranges of antidepressant effects and may therefore effectively complement each other to relieve depression- and anxiety-like symptoms. These findings further support the effectiveness of exercise as an adjunct to antidepressant therapy.
Cognitive behavior therapy (CBT) is one of the three major schools in the field of psychotherapy. The combination of exercise and CBT has a greater improvement for mild to moderate depression, suicidal ideation, and activities of daily living than CBT alone (16), and an exploratory randomized controlled trial reported that the combination of CBT and exercise had an anti-inflammatory effect by increasing IL-10 and reducing CRP in patients with major depression (75).
The initial phase of cognitive activation allows patients to find the benefits of exercise on a psychological level and thus increase their motivation to exercise, which in turn benefits patients with depression more, making this is a benign combination. In addition, there is preliminary evidence (160) that suggests the feasibility of combining repetitive transcranial magnetic stimulation (rTMS) with aerobic exercise.
Evidence suggests that exercise programs can improve depressive symptoms and overall functioning as an adjunct to traditional therapies such as medication or psychotherapy.
Comparison of Exercise Therapy With Other Therapies or Between Exercise Therapies
Exercise therapy is believed to be equivalent to psychotherapy and medication therapy (32). A meta-analysis (159) showed that when compared with established psychotherapy (cognitive behavioral therapy, interpersonal psychotherapy, and cognitive therapy) or antidepressant treatment, there was no difference in the therapeutic effect of exercise.
Another meta-analysis (164) specifically compared exercise therapy and selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and found no difference in efficacy. Chronotherapy is the application of temporal pharmacology to improve efficacy and reduce adverse reactions.
Exercise therapy is less effective than chronotherapy in patients with major depression (165), but both therapies are viable treatments, with depressive symptoms continuing to be improved and remitted during long-term follow-up. In addition to the comparisons between exercise therapy and traditional treatment methods such as medication and psychotherapy, there are some studies comparing exercise methods with different doses or different programs (4, 63–65, 166–173).
The following information can be obtained from existing studies: The benefits of exercise therapy are comparable to traditional treatments for depression (168–170). In general, moderate intensity exercise is enough to reduce depressive symptoms, but higher doses are better for overall functioning (4, 63, 166). Mind-body exercise or aerobic exercise under supervision are recommended, and they are superior to stretching exercise and breathing exercise (30, 64, 171, 172).
The Role of Exercise in Depression Combined With Other Diseases
Currently, an increasing number of people focus on combined depression because the prognosis of the patient is generally worse when disease is combined with depression. As a treatment for these patients, exercise has a considerable beneficial effect (174). For example, exercise reduced the depressive symptoms of cancer patients with primary lung cancer, chemotherapy cancer, and gastroesophageal junction cancer (14, 19, 107).
While reducing the depressive symptoms of diabetes and other chronic diseases, exercise can also reduce cardiovascular risk factors and improve psychological status and the quality of life (36, 175). For clinical heart failure patients, exercise has obvious benefits for depressive symptoms, and the beneficial effects are consistent regardless of age, intervention duration, exercise settings, and test quality (78).
In addition, exercise has a certain degree of curative effect on depressive symptoms and the overall function of patients with schizophrenia, Alzheimer’s disease, Parkinson’s disease, hemodialysis, arthritis, and other rheumatisms, heart transplantation, multiple sclerosis, etc. (10, 95, 140, 176–179). In prenatal and postpartum depression, exercise is an effective treatment method, which has been confirmed by several studies (82, 180). Consequently, exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state and systemic functions. The advantages of exercise therapy are reflected when the body has contraindications to drugs.
Additional Effects of Exercise
Exercise as an optional treatment for depression can not only improve depression symptoms and reduce their severity, but also has a positive effect on the overall function of the body, cardiorespiratory fitness (45, 181), and cognitive function (24, 26). As mentioned earlier, the combination of structural physical exercise and sertraline treatment may be beneficial to the autonomous cardiac control of elderly MDD patients (163). Another large sample study (44) showed that the combination of exercise and sertraline can also improve the risk factors for coronary heart disease in patients with MDD and reduce the risk of atherosclerotic cardiovascular disease (ASCVD). In addition, exercise improves arterial stiffness (4).
Many depressed patients have persistent symptoms after taking antidepressants, such as cognitive impairment. One investigation (182) explored the effects of different doses of exercise on the cognitive function of MDD patients and concluded that the cognitive function of participants in the high-dose group [16 kcal per kg per week (KKW)] was significantly improved compared to that of the low-dose group (4 KKW).
In both groups, depressive symptoms and cognitive functions in multiple areas, such as psychomotor speed, visuospatial memory, and executive function, were improved. On the other hand, a systematic meta-analysis by Sun et al. (183) reported that exercise failed to show significant effects on the overall cognitive function and individual cognitive domains of MDD patients. However, interventions that combine physical exercise with cognitive activities can significantly enhance overall cognitive function.
Low-intensity exercises show a more positive effect than high-intensity exercises, which may be related to better compliance with low-intensity exercises. There is direct evidence that exercise can improve the performance of cognitive tasks such as spatial memory, pattern separation, situational fear adjustment, and new object recognition (95). The multiple beneficial effects of exercise therapy make its clinical application more valuable.
reference link : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602192/#:~:text=Exercise%20can%20be%20used%20as,22%25%20in%20the%20placebo%20group.
Original Research: Closed access.
“Magnitude, timing and duration of mood state and cognitive effects of acute moderate exercise in major depressive disorder” by Jacob D. Meyer et al. Psychology of Sport and Exercise