Exercise

Background: 

Exercise is sometimes an afterthought in the treatment of depression. I have sat in a number of psychiatric interviews and it is rarely mentioned or recommended. I think something that would solidify exercise’s place in therapy is to put a number to how effective it can be.

Picture that a prescription medication was released that could be added to any other medication without interactions or side effects. Imagine that this medication further reduced depression scales by 3-6 points. A medication like this would make millions of dollars. Every prescriber would be trying to get this for their patients. Exercise is a harder sell. Exercise takes time, energy and potentially money. Exercise is hard but a 3-6 point drop on a depression scale can be huge. An example is question one of the Beck Depression Inventory. It reads:

Sadness:
0 – I do not feel sad
1 – I feel sad much of the time
2 – I am sad all the time
3 – I am so sad or unhappy that I cannot stand it

Imagine how important a decrease of 1 point can be. Now imagine 3 points just by exercising.

There are a lot of variables with exercising such as exercise type or intensity. I try to do at least 30 minutes of moderate-intensity exercise three times a week.

Effectiveness:

(1) A meta-analysis reviewed 25 studies to determine the effects of exercise on depression. 1,487 patients with depression were analyzed. 757 patients were randomized to exercise and 730 patients did not exercise. The exercise types included aerobic, resistance and mixed. The Hamilton depression scale was decreased by 4.52 points and the Beck depression inventory was depressed by 6.46 points. This analysis found large antidepressant effects of exercise on depression.

(2) A meta-analysis was conducted on ten trials. Aerobic and strength training were compared against the control group. The two types of exercise showed similar effects on treating depression and the average decrease in the Hamilton depression scale was 3.49 points.

My experience:

I utilize resistance exercise. I go to a gym around 4 times a week for 45 minutes. I sleep much better and I am definitely nicer at work on the days that I go to the gym. I also like to ride my bike and go outside. Sometimes being outside is much nicer than going to the gym.

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References:

1. Schuch F, Vancampfort D, Richards J, et al. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research Volume 77, June 2016, pages 42-51.

2. Silveira H, Moraes H, Oliveira N, et al. Physical Exercise and Clinically Depressed Patients: A Systematic Review and Meta-Analysis. Neuropsychobiology 2013;67:61–68.