Depression is now the leading cause of global disease burden. This means that depression is a greater cause of loss of quality of life and days without illness than other illnesses such as heart disease and type 2 diabetes. This week the Mental Health Foundation published a report indicating that only 13% of people in the UK report living with good mental health. More than ever we need to find ways to support mental wellness and increase the efficacy of standard treatment.

I have reported elsewhere research indicating the beneficial effects of physical exercise on mental health. Exercise improves brain function in a number of ways including increasing blood flow to the brain, promoting the growth of new brain cells and increasing levels of serotonin and dopamine, neurotransmitters associated with good mood and satisfaction. A new study compared the effectiveness of Cognitive Behavioural Therapy (CBT), a recognised effective treatment for depression, against a combined treatment package of exercise and CBT for treating depression. In this Iranian study 54 (70 started, 16 dropped out) sedentary people with mild to moderate depression were assigned to either a combined CBT and exercise group or a CBT only group. The CBT was delivered in groups of 4-6 people, one 90-minutes session per week for 12 weeks. Interestingly, and importantly, the exercise was not strenuous or high-impact. It involved:

5 minutes of warm up flexibility exercises
5 minutes of clapping and light movements
20 minutes walking at moderate intensity
5 minutes cool down and deep breathing.

This was repeated three times per week for 12 weeks in the evening.

The authors conclude that both groups saw improvements in their depression and reduced suicidal thoughts. However, the combined CBT and exercise group also improved their daily functioning and the combined treatment was superior than CBT alone at reducing depression and suicidal thoughts.

Using exercise as an adjunct to traditional therapy provides a low-cost, safe, easily accessible way to improve the effectiveness of standard treatment that has the added benefit of improving physical health too. This work adds further support to the importance approaching mental health from a whole-body perspective.

Reference

Abdollahi, A., LeBouthillier, D. M., Najafi, M., Asmundson, G. J. G., Hosseinian, S., Shahidi, S., Carlbring, P., Kalhori, A., Sadeghi, H. & Jalili, M. (2017). Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression. Journal of Affective Disorders, https://doi.org/10.1016/j.jad.2017.05.012

Many people will have heard that there are mood benefits of exercise. This is often linked to the ‘runners high’; the body’s release of endorphins and other ‘feel good’ chemicals during and just after exercise. There are also other neurological benefits of exercise that are linked to improved mood and wellbeing. For example, aerobic exercise increases the production of a protein called Brain Derived Neurotrophic Factor (BDNF). BDNF promotes the growth of new brain cells and is associated with improved memory, executive function and mood. Several studies and meta-analyses have demonstrated a positive effect of exercise on the symptoms of depression that are comparable to psychotherapy and antidepressant medication, and a new meta-analysis published last month, looking specifically at Quality of Life (QoL) adds to this body of research. QoL differs from illness symptoms in that it relates to a more global sense of wellbeing or satisfaction with life including where one perceives oneself to be in relation to peers or cultural expectations.

In this review the researchers collated exercise trials that assessed QoL in people with a diagnosis of Major Depressive Disorder (MDD). All trials included in this review had to include a non-exercise control group so that the effect of exercise could be established (as opposed to some other factor). The results indicated that moderate aerobic exercise, performed three times per week (the average across the studies) was associated with improved overall QoL for people with MDD. In addition, there were specific improvements in the psychological domain. The psychological domain (compared to the physical and social domains) has been shown have the greatest effect on overall QoL in long-term illness. There was no change in QoL in the non-exercising (control) groups. The authors state that exercise can be used as an effective treatment strategy for depression especially since antidepressant medication alone tends not to improve QoL even when depressive symptoms improve.

The evidence for the benefits of exercise in treating depression is robust and established. Regular exercisers have up to 30% reduced risk of developing the illness. Of course, the experience of depression can make it difficult to find the motivation to exercise in the first place. For some people it may be important to start with smaller exercise goals such as a five minute walk three times a week to help build a sense of achievement and consistency. Walking with a friend or a group could potentially enhance the social domain of QoL as well as helping you to stay committed. Exercise can be a very effective, accessible, low-cost, low-risk (of side effects) weapon in the arsenal against depression.

Schuch, F. B., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P. B. & Stubbs, B. (2016). Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response. Psychiatry Research, 241, 47-54.

Arnold, R., Ranchor, A. V., Sanderman, R., Kempen, G. I., Ormel, J. & Suurmeijer, T. P. (2004). The relative contributions of domains of quality of life to overall quality of life for different chronic diseases. Quality of Life Research, 13, 883-896.

http://www.nhs.uk/Livewell/fitness/Pages/Whybeactive.aspx

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine.

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