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Exercise and Depression

Author: Stan Reents, PharmD
Original Posting: 05/06/2007 08:59 AM
Last Revision: 01/15/2016 07:58 AM

Estimates of the prevalence of depression vary widely: A review of the literature in 1990 reported that approximately 6% of primary care patients and 11% of hospitalized patients have major depression, compared with 3% in the general population (Katon W, et al. 1990). Others have reported the prevalence in US adults to be as high as 17% (Kessler RC, et al. 1994). Based on year 2000 census, this equates to over 35 million Americans.

The exact percentage is not nearly as important as the following stats:

  • The Global Burden of Disease Study reported that, in developed nations, depression ranked second only to ischemic heart disease in lost years of healthy life due to premature death or disability (Murray CJL, et al. 1997).
  • 30-40% of patients do not respond adequately to first-line antidepressant therapy (Brosse AL, et al. 2002).

Paffenbarger et al. found that depression rates were lower in physically-active Harvard alumni (Paffenbarger RS et al. 1994). So, considering how widespread the problem of depression is, combined with a fairly unreliable response to traditional therapy, perhaps this idea of using exercise to "treat" depression is worth considering.

EXERCISE AS A TREATMENT FOR DEPRESSION

It's not uncommon to hear people talk about a "runner's high", or, that they exercise because it makes them "feel good." No doubt, exercise is invigorating, but, can exercise actually be "therapeutic" in people who are depressed?

It turns out that plenty of evidence exists showing that exercise is beneficial in patients who are depressed. In fact, the effects of exercise on depression have been studied for over 2 decades. Exercise has been shown to be beneficial for depression in the elderly (Palmer C. 2005), in college students (Kim KB, et al. 2004), in post-partum mothers (Wilkinson J, et al. 2003), and in adults ages 20-45 years (Dunn AL, et al. 2005).

EXERCISE FOR DEPRESSION IN PATIENTS WITH CHRONIC DISEASE

Exercise is also beneficial when patients with chronic disease become depressed, even in patients with conditions that severely limit exercise capacity:

  • Cardiac Patients:  In one study of 338 patients undergoing cardiac rehab after a major cardiac event, 20% reported depressive symptoms. After 3 months of aerobic exercise, two-thirds of these depressed patients had improvement (Milani RV, et al. 1996).
  • Patients with COPD:  Several studies have shown that an exercise program can improve not only exercise capacity in patients with COPD, but that symptoms of anxiety and depression also improve (Emery CF, et al. 1991) (Emery CF, et al. 1998) (Withers NJ et al. 1999). One study utilized a "pulmonary rehabilitation" program that included: 30-minute stretching and breathing classes, 40-minute exercise classes, treadmill and upper-extremity training, leisure walking, and recreational activities. After 24 weeks, patients showed improvements in exercise capacity and ratings of emotional function (Goldstein RS, et al. 1994).
  • Patients with Arthritis:  Depression in patients with rheumatoid or osteoarthritis improved after a 12-week program of either aerobic walking or aerobic water exercise (Minor MA, et al. 1989). In another study, patients with ankylosing spondylitis who performed 20 minutes of exercise daily for 8 consecutive weeks showed improvements in depression scores (Lim HJ, et al. 2005).
  • Patients receiving Hemodialysis:  Fourteen hemodialysis patients were enrolled in a program consisting of exercise on a bicycle ergometer, a treadmill, or an upper limb ergometer 60 minutes per session, 3 times per week, for 12 weeks. Ratings for both anxiety and depression improved (Suh MR, et al. 2002).

WHAT TYPE OF EXERCISE IS BEST?

Using the "FITT" acronym (frequency, intensity, type, time), what is the most appropriate exercise "prescription" for depression?

Researchers at the Cooper Institute in Dallas have attempted to figure out how much and how "hard" exercise should be to provide benefit for depression (Dunn AL, et al. 2002) (Dunn AL, et al. 2005):

Since prior research showed that various levels of exercise intensity improve symptoms of depression, the Cooper Institute investigators let their subjects exercise at their own intensity. Instead, they focused on AMOUNT and FREQUENCY.

Eighty people were randomly placed into 1 of 5 groups. Two of the 5 groups participated in treadmill running or riding a stationary bicycle: one group exercised 3 days per week, the other group exercised 5 days per week. Two more groups also exercised either 3 or 5 days per week, but performed less exercise per week. The fifth group did not do any aerobic exercise, but participated only in stretching and flexibility exercises 3 days per week.

After 12 weeks, the 2 groups who performed a higher amount of weekly exercise had a 47% decrease in depressive symptoms; it didn't matter whether they exercised 3 or 5 days per week. The 2 groups who were in the lower amount of weekly exercise showed a 30% decline in symptoms, while the stretching-flexibility exercise group showed a 29% decline (Dunn AL, et al. 2005).

The "higher amount" exercise group burned up 17.5 kcal/kg per week; this was divided into either 3 sessions, or 5 sessions. To put these numbers into a more practical discussion, a 70-kg person would have exercised (moderately) for 180 minutes during the week. If that exercise was divided into 3 sessions, then they would have walked or jogged about 4 miles per session.

The "lower amount" group burned up 7 kcal/kg per week. A 70-kg person would have exercised (moderately) only about 80 minutes total for the week.

This study from the Cooper Institute is one of the only studies attempting to determine the proper "dose" of exercise that is "therapeutic" for depressed patients. They concluded that AMOUNT, but not INTENSITY or FREQUENCY, is the most important variable.

Type of Exercise:

Most of the research has been conducted using some type of aerobic exercise (running, biking, aerobic walking, etc.). However, one study of cardiac patients showed that the addition of strength training to a cardiac rehab program provided even greater improvement in depression (Beniamini Y, et al. 1997).

Others note that group exercise is likely to be beneficial for depressed patients simply due to the social support it provides. That is why the Cooper Institute study summarized above specifically excluded group exercise. They found that exercise was beneficial even if performed only on a treadmill or exercise bike.

SUMMARY AND RECOMMENDATIONS

Research from the past 2 decades offers strong evidence that moderate exercise can be a beneficial tool in the management of depression. Despite this, few psychotherapists promote exercise. Further, even when they do, suggestions to depressed patients to exercise are rarely followed (Pollock KM. 2004).

We'll leave it up to the scientists to debate what type of exercise works best. From our perspective, ANY exercise is better than none. Nevertheless, clinicians caution that exercise should not be the sole basis of treatment for depression.

FOR MORE INFORMATION

Readers may also be interested in:

EXPERT HEALTH and FITNESS COACHING

Stan Reents, PharmD, is available to speak on this and many other exercise-related topics. (Here is a downloadable recording of one of his Health Talks.) He also provides a one-on-one Health Coaching Service. Contact him through the Contact Us page.

REFERENCES

Beniamini Y, Rubenstein JJ, Zaichkowsky LD, et al. Effect of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation patients. Am J Cardiol 1997;80:841-846.  Abstract

Brosse AL, Sheets ES, Lett HS, et al. Exercise and the treatment of clinical depression in adults. Sports Med 2002;32:741-760.  Abstract

Dunn AL, Trivedi MH, Kampert JB, et al. The DOSE study: a clinical trial to examine efficacy and dose response of exercise as treatment for depression. Control Clin Trials 2002;23:584-603.  Abstract

Dunn AL, Trivedi MH, Kampert JB, et al. Exercise treatment for depression: efficacy and dose response. Am J Prev Med 2005;28:1-8.  Abstract

Emery CF, Leatherman NE, Burker EJ, et al. Psychological outcomes of a pulmonary rehabilitation program. Chest 1991;100:613-617.  Abstract

Emery CF, Schein RL, Hauck ER, et al. Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychol 1998;17:232-240.  Abstract

Goldstein RS, Gort EH, Stubbing D, et al. Randomised controlled trial of respiratory rehabilitation. Lancet 1994;344:1394-1397.  Abstract

Katon W, Sullivan MD. Depression and chronic medical illness. J Clin Psychiatry 1990;51:3-14.  Abstract

Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994;51:8-19.  Abstract

Kim KB, Cohen SM, Oh HK, et al. The effects of meridian exercise on anxiety, depression, and self-esteem of female college students in Korea. Holist Nurs Pract 2004;18:230-234.  Abstract

Lim HJ, Moon YI, Lee MS. Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis. Rheumatol Int 2005;25:225-229.  Abstract

Milani RV, Lavie CJ, Cassidy MM. Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events. Am Heart J 1996;132:726-732.  Abstract

Minor MA, Hewett JE, Webel RR, et al. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum 1989;32:1396-1405.  Abstract

Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349:1436-1442.  Abstract

Paffenbarger RS, Lee IM, Leung R. Physical activity and personal characteristics associated with depression and suicide in American college men. Acta Psychiatr Scand Suppl 1994;377:16-22.  Abstract

Palmer C. Exercise as a treatment for depression in elders. J Am Acad Nurse Pract 2005;17:60-66.  Abstract

Pollock KM. Exercise in treating depression: broadening the psychotherapist's role. J Clin Psychol 2001;57:1289-1300.  Abstract

Suh MR, Jung HH, Kim SB, et al. Effects of regular exercise on anxiety, depression, and quality of life in maintenance hemodialysis patients. Ren Fail 2002;24:337-345.  Abstract

Wilkinson J, Phillips S, Jackson J, et al. "Mad for Fitness": an exercise group to combat a high incidence of postnatal depression. J Fam Health Care 2003;13:44-48.  Abstract

Withers NJ, Rudkin ST, White RJ. Anxiety and depression in severe chronic obstructive pulmonary disease: the effects of pulmonary rehabilitation. J Cardiopulm Rehabil 1999;19:362-365.  Abstract

ABOUT THE AUTHOR



Stan Reents, PharmD, is a former healthcare professional. He is a member of the American College of Sports Medicine (ACSM) and holds current certifications from ACSM (Health & Fitness Specialist), ACE (Health Coach) and has been certified as a tennis coach by USTA. He is the author of Sport and Exercise Pharmacology (published by Human Kinetics) and has written for Runner's World magazine, Training and Conditioning, Club Solutions, and other fitness publications.




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