A study published on February 14 in the BMJ suggest that engaging in physical activities such as jogging or resistance training can be highly effective in alleviating depression, either independently or as a component of a comprehensive treatment regimen involving therapy and medication.
The researchers discovered that while more intense exercises led to more pronounced improvement in depression symptoms, milder activities like walking and yoga also offered significant benefits.
“Our findings support the inclusion of exercise as part of clinical practice guidelines for depression, particularly vigorous-intensity exercise,” said the authors in a press release. They noted that health systems may consider providing physical activity as an alternative or supplementary option, alongside established interventions, to reduce both depression and the associated health risks.
An associate professor in psychiatry and behavioral sciences at Duke University School of Medicine in Durham, North Carolina, who was not involved in the study, Benson Hoffman, PhD, says, “Overall, the findings confirm and strengthen previous research that’s shown exercise to be a useful treatment for clinically diagnosed depression.”
Dr. Hoffman emphasizes that the statistical methods employed in the analysis illuminated the genuine impacts of various types of exercise, revealing the considerable advantages that physical activity can confer on mood.
Nearly 3 out of 10 Adults in the United States Have Received a Diagnosis of Depression
As per a 2023 Gallup poll, 29% of U.S. adults acknowledge having received a diagnosis of depression at some juncture in their lives, marking a nearly 10-percentage-point increase from 2015.
Depression correlates with an elevated risk of heart disease, diabetes, stroke, chronic pain, and Alzheimer’s disease.
The Analysis Encompassed Over 200 Clinical Trials Examining the Relationship Between Exercise and Depression
Despite the common recommendation of exercise for depression management, guidelines and prior reviews present conflicting conclusions regarding which types of exercise and intensity levels offer the greatest benefit, as well as how exercise should be “prescribed.”
In order to enhance clarity, researchers meticulously searched through databases to identify randomized trials that compared the following:
- Exercise as a therapeutic approach for depression
- Established treatments such as antidepressants and cognitive behavioral therapy
- Active controls, which encompassed usual care, social support, placebo tablets, or no treatment at all
Researchers uncovered over 200 pertinent trials involving 14,170 participants diagnosed with depression. Factors such as the nature, intensity, and frequency of each exercise intervention, as well as participant demographics like sex, age, and baseline depression levels, were carefully considered during the analysis.
Key findings from the study include:
- When compared with usual care, dance exhibited significant reductions in depression symptoms, while walking or jogging, yoga, strength training, mixed aerobic exercises, and tai chi or qigong showed moderate symptom alleviation.
- Combining exercise with SSRIs or therapy yielded moderate and clinically significant effects, indicating the potential supplementary benefits of exercise alongside traditional treatments.
- Exercise proved effective for individuals both with and without other health conditions, across various levels of depression severity.
- Among older adults, yoga demonstrated superior effectiveness in improving depression, while strength training showed greater efficacy among younger individuals.
- While walking or jogging were beneficial for both genders, strength training proved more effective for women, and yoga or qigong appeared to be more effective for men.
What Factors led to the Influence of Participants’ Gender on the Benefits of Specific Exercise
What Factors Led to the Influence of Participants’ Gender on the Benefits of Specific Types of Exercise?
The authors noted that the reasons behind why gender seemed to influence the effectiveness of certain types of exercise remain unclear.
According to Steven Wengel, MD, a psychiatrist at Nebraska Medicine in Omaha who was not part of the research team, it is possible that the benefits were more pronounced in activities that were perceived as new or novel by the participants.
“It’s just a hypothesis, but generally speaking, perhaps few women had participated in strength training previously, or in men, perhaps fewer had tried yoga, and so when they did those activities, they experienced a greater benefit,” he says.
Intense Physical Activity Yielded Greater Benefits in Alleviating Depression
As per the analysis, while light physical activities like walking and yoga did offer clinically significant effects, the benefit were more pronounced with vigorous exercises like running and interval training.
“It makes sense that there’s a dose effect with exercise. The higher the intensity of exercise, the bigger the effects. If a little is good, a lot may be better in people who can safely exercise,” says Dr. Wengel.
He adds, “But in some people, because of cardiac conditions or health conditions, it may not be safe for them to participate in higher intensity activities. Before you start exercising, especially if you’re interested in vigorous exercise, check with your physician first.”
Reasons Why Exercise Could Help With Depression
Dr. Wengel explains that it’s not completely understood why exercise helps with depression, however it’s probably because of a number of factors.
“There is a social aspect to some types of exercise that could add to its effects, like when you’re taking an exercise class or going for a walk with a friend. We know that being around other people can raise our mood,” he says.
The authors additionally highlight the advantages of spending time in “green spaces.” According to Dr. Wengel, individuals engaging in outdoor activities like walking or yoga in parks may experience added stress-reducing benefits in addition to those from the activity itself.
Moreover, there is evidence suggesting that physical activity enhances the production of a brain chemicalknown as brain-derived neurotrophic factor (BDNF), notes Dr. Wengel. He explains that BDFN is particularly beneficial for brain health, and simply put, make neurons ‘happier and healthier.’”
Dr. Hoffman also emphasizes a fundamental principle regarding depression: behavioral activation is beneficial.
“Getting up and accomplishing something — anything — can increase your ability to do other things. It increases your self-confidence, especially if you’re seeing results — for example, seeing yourself getting stronger — and shows that you can achieve things,” he says.
Greater Benefits Resulted from Clear Direction
The study revealed an intriguing finding: when individuals had more autonomy, such as being instructed to increase exercise without specific guidelines regarding the type or duration of activity, the benefits observed were diminished.
“That makes a lot of sense to me as a physician. The more specific the exercise prescription, the more effective it was. So in other words, just telling a patient that they should get more exercise probably isn’t very helpful. Instead, we should talk to them about what they like to do, and what has worked for them before, and then give them a specific prescription tailored to their needs and preferences,” says Wengel.
Exercise Shouldn’t Replace Antidepressant Medication
Lead study author, Michael Noetel, PhD, a senior lecturer in the School of Psychology at the University of Queensland in St. Lucia, Australia, advises, “While medication proves beneficial for some individuals coping with depression, those prescribed medication should continue their regimen.”
“Nevertheless, given its numerous health advantages, exercise warrants consideration as a primary treatment for depression, alongside therapy,” Dr. Noetel suggests.
Exercise Shouldn’t Substitute Antidepressant Medication
According to Michael Noetel, PhD, lead study author and senior lecturer in the School of Psychology at the University of Queensland in St. Lucia, Australia, medication is effective for certain individuals managing depression, and those prescribed medication should maintain their regimen.
However, Dr. Noetel also advocates for exercise as a primary treatment for depression, alongside therapy, emphasizing its numerous health benefits.
“Exercise improves your mood while also improving dozens of other areas of your health, and therapy improves your mood while also helping overcome specific problems you’re facing,” he says.
No single treatment is a panacea, but considering the profound impact of depression, nearly all patients should be provided with both exercise and therapy, Dr. Noetel suggests.
Helpful Tips to Staring Physical Activity If You Have Depression
Dr. Wengel says, “We know that when people have clinical depression their energy tends to be low and their motivation tends to be low, and so it’s oftentimes especially hard for them to get started. And we don’t want to lay more guilt on them about what they ‘should be’ doing.”
He suggests to be practical and find ways to start small. “You don’t have to dive in and immediately get 30 minutes of exercise a day. Start by taking a walk around the block or do a few minutes of yoga — whatever is practical for you. Do that consistently and then build on it,” says Dr. Wengel.
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