Exercise And Mental Health, Part 1 - Depression
Note: it goes without saying that this article is not intended to diagnose or treat any mental health condition. If you struggle with depression or any other aspect of mental health, please visit your doctor. You can also get support from Aware. This article is merely detailing the results of some interesting research and is meant for informational purposes only.
The physical benefits of exercise are well known. A better looking body, stronger muscles, less fat mass, and more energy are just some of the amazing things regular exercise can result in.
Although more information is getting out onto the internet about the mental health benefits of exercise, I thought a series of three detailed articles that look at some research on different areas of mental health and exercise would be worth doing. I hope if this is an area that you want to learn more about that you gain some valuable knowledge from this article and the other two (now five.. here's part 2 on the topic of exercise and self-esteem).
I want to state straight away that I have not suffered from depression. I cannot and will not pretend to know what it is like. Although I likely flirted with depression following losing my brother a few years ago, it did not develop into the crippling illness that some sufferers experience.
I have, however, had a few clients over the years that have been very honest about how exercise has helped them deal with depression. It was always enlightening to hear their perspective, as I have not experienced those benefits of exercise first-hand, and there is plenty of research out there that backs up their experiences in dealing with the "black dog".
When trawling through the internet for a good summary of how depression is affected by exercise, I came across a recent meta-analysis from the Journal of Psychiatric Research, by Schuch et al. I found reading this exceptionally difficult due to the dense scientific language and the fact that it was written by people much cleverer than I, who also have some serious academic chops.
I've recently also been reading up on how to interpret statistics, and this came in handy as I was actually able to understand things like effect size. Admittedly...even understanding the basics of this huge review took literally every brain cell I had. A few cells probably short-circuited when reading it and trying to make sense of it objectively.
The contention of the authors is that various biases in research have meant that there has never been a clear picture of just how exercise affects those suffering from depression. They adjusted for these biases in their meta-analysis to see how much they affected the results of an exercise intervention on depression vs a control group. The control groups in the studies analysed were either given a placebo, received no change in their care, were on a waiting list, or were taking part in other social activities that did not involve exercise.
Their conclusions were fascinating. They state: "our results provide robust evidence that exercise can be considered an evidence-based treatment for the management of depression", and "our novel ES [effect size], calculated adjusting for publication bias, confirms and strengthen the case that exercise is an evidence-based treatment for depression." In essence, they re-interpreted a lot of the same data as other meta-analyses and concluded that exercise is probably more useful than previously thought.
I will admit, straight away, that I don't understand exactly how some of the statistical analyses and other clever number-crunching, such as adjusting for bias works (all of that kind of stuff is on my ever-increasing reading and learning list). But their final findings are illuminating. It suggests that other analyses might, such as the most recent Cochrane Review, Exercise For Depression, have got things slightly wrong. The Cochrane Review authors concluded that exercise is more effective than no treatment but no more effective than any other treatments, and that exercise only has a very small effect.
The methodology of the Cochrane Review was thoroughly scoured in this amusingly titled paper: Honey, I shrunk the pooled SMD! The author of this paper suggested a few adjustments in how the studies analysed were interpreted and selected, and these tweaks resulted in an increase in the benefit that exercise delivers for sufferers of depression. This finding is in line with what Schuch et al. concluded.
Schuch et al. mention that exercise is an evidence-based option for the treatment of depression. However, in another paper, the author suggests that there is some reluctance amongst medical professionals when it comes to suggesting exercise as a treatment or management option. Hopefully more high-quality research on this subject, which is huge, will help not only clarify how useful exercise is for sufferers of depression, but also give healthcare professionals clear guidelines on how to prescribe it for maximum benefit.
All the reading I have done has suggested that:
- Exercise is an option for those with depression
- Exercise is potentially a valuable adjunct to antidepressant therapy
- Moderate to high intensity exercise seems to yield best results
- Supervised programs will help adherence and maximise benefits
- Training in groups could be better than alone
That's several days of reading and note-taking for those five points 😂😂
Time well spent I say.
So, in practice, what could a sufferer of depression consider doing?
First step: consult their doctor. If their doctor thinks exercise is advisable, then they have several options open to them.
Now, I can't diagnose or treat depression but I am good at helping people enjoy exercise and I hope the following suggestions prove useful.
Suggestion 1: keep the barriers to entry low. Exercise doesn't require gym membership, personal trainers (although we can help people adhere to a programme and see it through) or expensive equipment. I would suggest getting out and about in the glorious Irish countryside (or if you're reading from overseas, any countryside near you). I recently walked around the spectacular Glendalough with my wife and we, two pretty fit people, were absolutely out of breath and working hard on some stretches of the route we took. Totally worth it for the views, however!
Suggestion 2: do something with a friend, or group of friends. Here's a list of things someone could do with other people that would be challenging and at the right intensity suggested by the research:
- Go for a bike ride
- Kick a football around
- Throw a rugby ball/frisbee/boomerang/pair of scissors (only kidding on the last one) around
- Go jogging
- Try a day at a climbing wall
- Try one of those awesome places with trampolines everywhere
- Go swimming in the sea or at a pool
- Consider taking up a martial art
- Try Crossfit
That's only a tiny list, but hopefully there's at least one idea on there that would appeal to someone. I hope this blog post proves valuable if you suffer from depression, or know someone who does. It's taken a lot of work (a few days worth!!), so if it helps even one person in some way then that's great. I welcome any comments, criticism, feedback or conversation in the Disqus comments below.