Most of us have experienced feelings of relaxation or bliss following exercise. There is a general feeling in the popular culture that exercise is a great stress reliever, if we could only get off our chairs and get moving. There is also much much information on the internet about the psychological benefits of exercise, some hype, some accurate. But is this enthusiasm backed by good science? Is there really solid scientific evidence out there that exercise combats depression long-term? The answer is “It’s complicated.”
Aerobic exercise and depression
Research studies show statistically significant benefits of exercise interventions on both mood and brain functioning. While many of these have studied people who are only mildly or moderately depressed, some studies were with people who have actually been formally diagnosed with clinical depression.
James Blumenthal and colleagues at Duke University studied the effects of aerobic exercise on depression in a study published in the journal Psychosomatic Medicine. Aerobic exercise is exercise that increases heart-rate and improves the flow of oxygen through the lungs. The researchers assigned 156 middle-aged or elderly patients with a diagnosis of major depression to either an exercise condition, an antidepressant medication condition, or a combination of the two. The exercise consisted of 3 weekly 30-minute sessions of either stationary bike-riding or running on a treadmill at 70-85% maximum heart-rate. The intervention lasted for four months, and then participants were reassessed six months later. All three groups showed significant decreases in depression, including complete remission for some. Those who exercised on their own at follow-up had a better outcome.
The issue with aerobic exercise is that it’s difficult to start a running practice, particularly if you’re a busy mom or worker. It often requires getting up at 5 in the morning. If waking up at 5am to run is difficult for most people, think how much harder it is for depressed people who often can’t get out of bed! Luckily for the less motivated among us, aerobic exercise is not the only type of exercise shown to be beneficial for depressed mood. While there is some evidence from a comparative study showing vigorous exercise is more effective than mild exercise, other studies show benefits of yoga, Taekwondo, weight-bearing exercise, and even walking on depression.
Yoga for depression
In the yoga studies, 60 minutes of yoga 3 times a week improved not only depression, but anxiety, and levels of GABA in the brain. GABA is a chemical associated with relieving anxiety and stress. Therefore, yoga seemed to change brain functioning to help people manage their stress better. Yogic breathing interventions have also been effective for people whose depression was not completely eliminated with medication. Studies by Shapiro and colleagues at UCLA demonstrated this effect and also showed beneficial effects of yoga on the variability of heart rate, an important measure of physiological wellbeing and balance. There is also evidence that physical inactivity seems to interfere with brain neuron regeneration.
So, there seems to be reason to get up off your chair and get moving – easier said than done for a depressed person, but perhaps doable if you start slowly and build up. It would be great if exercise worked as well as antidepressants because it is less costly and has fewer negative side-effects. It may begin to work fairly quickly as well. One study showed some mood benefits after a single exercise session.
How well does exercise really work?
A group called the Cochrane Collaboration statistically combined the research studies of exercise on depression to find an overall conclusion. They found that many studies had small numbers of people participating, too many people dropping out, or did not control enough for expectation of improvement. For example, people may expect to improve more with yoga than listening to a lecture or walking slowly. When they looked at the very few studies that met their strict criteria, they found only a smallish benefit of exercise that was not statistically significant. Another group of researchers from Europe did a similar type of analysis and concluded based on the 5 best studies that there were no long-term benefits of exercise on clinical depression, once expectation of improvement was controlled for.
However, just recently (2016) another meta-analysis contradicted the findings reported above. In this analysis, exercise had an overall large and significant effect on depression. Larger effects were found for people diagnosed with major depressive disorder (vs mild or moderate depression), utilising aerobic exercise, at moderate and vigorous intensities, in either a supervised and unsupervised format. In major depressive disorder, larger effects were found for moderate intensity, aerobic exercise, and interventions supervised by exercise professionals. The authors concluded that “Our data strongly support the claim that exercise is an evidence-based treatment for depression.”
It turns out that aerobic exercise is an effective treatment for people with both mild/moderate depressive symptoms and clinical depression after all. As therapists, we need to help our clients overcome barriers to beginning an exercise program. We can begin by educating patients about the mood benefits of exercise and then providing tools and strategies to help them stick with it! If you’re a reader struggling with depression, try walking for 15 or 20 minutes and then gradually increasing it. Exercise can also help you be more alert and focused and have more energy, so there are many positive benefits.
Exercise as a treatment for depression: A meta-analysis adjusting for publication bias.
Felipe B. Schuch, Davy Vancampfort, Justin Richards, Simon Rosenbaum, Philip B. Ward, Brendon Stubbs
J Psychiatr Res. 2016 Jun; 77: 42–51. Published online 2016 Mar 4. doi: 10.1016/j.jpsychires.2016.02.023
A lot of issues to consider here. I know for me I always feel better after a little exercise, but I can imagine for someone who is depressed it must be nearly impossible to do that. Thanks for another thought-provoking article!
Excellent article! Very important information. Brava!!
I love the article. Personally, I always feel happy after going on a brisk walk, even if I felt down when I started. Although getting myself to start is the hardest part. However, sometimes it's like a 30 minute high after excercise and then I feel down again. Mind over matter! As you said, definitely complicated:-)
Exercise is important it releases our happy endorphins in our brain, just like chocolate or sex. But exercise also gets our energy body moving. We have more than just our physical body that needs TLC. Getting our energy or chi flowing helps to maintain health and happiness. Yoga is good at this plus it incorporates a lot of deep breathing. I've done yoga on and off for a few years. Right now I'm trying Zumba and loving it. It's really getting me back in the flow of physical expression. I would also like to add to help reduce depression express yourself creatively somehow! Through taking photos, scrap-booking, journaling, blogging, writing, crafts, sewing. Something! Let those juices flow. Great article Melanie.
I have to say that I believe that exercise helps change your state of mind, and the act of changing your physiology often leads to a change in psychology.
Yoga and meditation work wonders for me, personally. It's the combination of deep breathing and use of your own body weight that allows so many of your core and supporting muscles to be engaged.
Great summary of the research. It's also great to empathize with the difficulties (logistics) of working out, let alone if you can't get out of bed due to the depression itself!
Thanks so much everybody for your comments. There does seem to be a consensus that exercise, particularly yoga, has mental benefits as well. I think the issue with these research summaries is that they may combine different types of exercise, which may wash out the effective ones. It may not be that exercise doesn't work but that it doesn't add a lot beyond just expecting to change if you're clinically depressed. People who do exercise tend to have high expectation of it being beneficial. If you take that out statistically, is there any effect yet? it could also be there is an effect but the studies that showed it had methodological problems (e.g., too few subjects, too much dropout) so they weren't counted. The big issue with exercise interventions is getting people to maintain it over time. If they stop exercising after the intervention, you won't see much effect 4-6 months later.
I really appreciate everybody's thoughts and contribution.
As a clinically depressed woman I appreciate this post because it is rooted in scientific data. I can tell you from experience that although medication never improved my symptoms much, exercise did wonders. I am intrigued by the information on Yoga and will attempt to add it to my exercise to see if it helps. Thanks!
I agree fully with you where benefits of Yoga are concerned.I was a long-term patient of Thyrotoxicosis.Then i took Radio-active Iodine &used to take 100mg of Eltroxin daily.But Yoga&Pranayam(breathing exercises)have brought it down to 50mg. Even my B.P medicine has come down from 40H mg to 20mg. Of course it would be difficult for the depressed to make the effort but all good things come with a price
Thanks to everybody for the comments. Much appreciated. It is nice to hear from people about their struggles with health and depression issues and whether exercise helped.
I loved the article, I think the key of it is to make a person who is depressed, with the low energy that comes with it, to get up and exercise. Not only this person will have the physical benefits but also a feeling of accomplishment. But the dark side is that if s/he fails to exercise it might bring guilt, self-criticism, and other thought distortions that can worse the depression. For us therapists it’s important to be aware of it and help the client.
Thanks for your insightful comment. For clinically depressed patients, I think we need to present exercise as a potentially helpful adjunct to therapy, not a substitute. I agree that not exercising can be another source of guilt, so the idea might be to set very reasonable goals at first, in collaboration with the client.
Yet another reason why I need to get moving! I do find myself very happy when I get into a regular routine of using an eliptical or joining an aerobic class – it's just I usually end up good for 6 weeks, then something comes along and breaks momentum for a week and I don't get back into it.
I think it's time to at least start another cycle of it! 🙂
Daria, Thanks for your comment. I struggle with the same issues of getting interrupted and then giving up the exercise routine for a while. The longer you stop, the more difficult it is to start again. Actually, research shows the same thing. Difficulties with adherence may be the reason that long-term benefits of exercise have not been shown for clinical depression. Unfortunately, gyms use monthly fees, so there is no financial incentive for them to bring people in more often. I think like any behavior, it's a matter of incentivizing exercising, daily monitoring of how many minutes we exercise, constantly reminding ourselves why we want to exercise and scheduling it in our diaries as we would a work appointment.
Thanks for your article. Is be interested in research on anaerobic exercise (e.g., weightlifting) on depression.
Also, altho gen consensus here seems to be meds as the primary tool against "serious' depression, the side effects of them-especially when you're talking anti-psychotics and mood stabilizers-is often severe and long term. That needs to be factored into the effectiveness comparison, too. For example, tardivw dyskinesia, word searching, reduced life span…
Also, issue as posited leaves out nutrition (including supplements) and other useful and effective tools.
Thanks for your post.
Yes. Side-effects of medication do have to be factored into the equation. However, being depressed may sometimes have similar side-effects, such as low sex drive. And there are other choices supported by good research, such as Cognitive-Behavioral or Interpersonal Therapy. These studies are normally well-designed so I would assume the researchers made sure the groups weren't different to begin with on supplement use. This would be important to do.
Excellent article! I think all would agree that exercise does help one to feel better. And it releases feel-good neurotransmitters.
Regarding depression and exercise, in neuroscience we do know that exercise is important in expressing the brain-derived neurotrophic factor (BDNF). And BDNF is important in increasing the size of the hippocampus. Hence, producing more serotonin was found. In that regard, exercise does work. I agree with your assessment that other intervention is needed, and more along the line of CBT.
In my case, I challenge myself physically when I am feeling a little down. And even do stuff that has that adrenaline rush. Currently, it's Parkour/Free Running/Natural Movement… Hey, I'm only 61! And I do find joy in doing it. I believe that the challenge in addition to the physical exercise helps. You know, the state of flow… Okay, 'nuff said…
Again, thanks for the nice article Melanie!
Encouraging article and responses. I struggle with post surgery ( bilateral knee replacements) and know exercise would benefit both physical and mental. It’s hard to get my shoes on and out the door. I make up any excuse not to. I need motivation and encouragement for exercise and healthy eating- just thinking about it brings me “ failure thoughts “ sad but watching tv I look forward to – for distraction and relaxing. That doesn’t help exercise nor weight. Any suggestions
Thanks for your comment. I would start small. Just set a goal to do a 10 minute walk 3 times a week. Once you’ve reached this goal, the success will inspire you to do more. Then you can gradually increase the time and add in another day.