Exercise has long been known to have beneficial effects on cardiovascular and musculoskeletal health. It is also increasingly recognized for its positive effect on mental health, and psychiatrists often encourage their patients to develop an exercise routine. A comprehensive review recently published in Molecular psychiatry by Ryan Ross and colleagues concludes that physicians should be more forceful when discussing exercise with their patients as a treatment for depression.
The authors detail studies addressing exercise both as a stand-alone treatment for depression and as an augmentation strategy complementing other treatments. They look at data for both aerobic exercise and resistance exercise. They define aerobic exercise as “activities performed continuously or at intervals with the aim of improving the efficiency of the cardiovascular and pulmonary systems and increasing aerobic capacity”. Resistance exercises involve “activities that require sustained or intermittent exertion of forces against resistance with the intent of improving musculoskeletal function and increasing muscular strength or endurance.”
The overall conclusion of their review was that exercise “3 to 5 sessions per week, for 45 to 60 minutes per session, and at a moderate to vigorous intensity” has antidepressant properties similar to those of drugs to reduce depressive symptoms in people with unipolar depression. . Exercise in combination with drug therapy is also effective. Although some evidence suggests the possibility that vigorous exercise is more effective than moderate exercise, both exercise intensities are superior to no exercise at all. Most of the studies in this review lasted between one and four months.
Most studies have looked at the benefits of aerobic exercise; however, available data suggest that resistance-based exercise is also helpful. The authors encourage exercise programs that include both aerobic and resistance-based training.
Another recent report by Hiral Master and Evan Brittain examined the association between long-term exercise, as measured by Fitbit fitness trackers, and the incidence of chronic disease. They concluded that “higher daily step counts in data collected over multiple years of Fitbit fitness tracker use were associated with a lower risk of common chronic diseases, including diabetes, hypertension, gastrointestinal reflux esophagus, depression, obesity and sleep apnea”.
Mechanisms of the antidepressant effects of exercise
How does exercise exert its antidepressant effects? Although numerous studies have attempted to determine possible mechanisms, the data are inconsistent. Two mechanisms of interest involve the anti-inflammatory properties of exercise and its influence on brain-derived neurotrophic factor (BDNF) levels. BDNF is a chemical produced by the brain that influences cell connectivity and growth. A variety of antidepressant treatments influence BDNF levels.
Depression is common and is one of the leading causes of disability in the United States and around the world. Not everyone responds adequately to current treatment options or has access to mental health care. Adding such an inexpensive option as exercise to the depression treatment arsenal could have far-reaching implications. We would like to add that other lifestyle efforts may also be beneficial in improving and possibly preventing episodes of depression. These “therapeutic lifestyle changes” include diet, stress reduction, and sleep hygiene in addition to exercise.
Motivate patients to exercise
It is often difficult to motivate someone with depression to start an exercise regimen. Psychotherapeutic techniques and telephone applications can be helpful. This review should motivate clinicians to be more rigorous in either encouraging exercise as augmentation therapy or, especially in those unwilling to participate in psychotherapy or drug therapy, as sole therapy. According to the authors: “This is not a call for exercise to replace existing therapeutic strategies, but for the systematic integration of exercise as an additional first-line treatment for depression.
Eugene Rubin, MD, Ph.D., and Charles Zorumski, MD, wrote this article.
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