Depression Treatment: Treatment - Exercise

Overview.

Many people are familiar with the idea that exercise is good for health. The benefits of exercise for heart health, maintaining a healthy weight and managing diabetes are well established. What some people may not know is that exercise is also good for the brain and can help improve mood. Exercise can have antidepressant effects. In fact, certain kinds of exercise are as effective as antidepressant medication (Blumenthal et al., 1999) and cognitive therapy (Lawlor & Hopker, 2001) in reducing symptoms of depression.

How Does Exercise Work to Treat Depression?

Even in people who are not depressed, exercising can feel good and stimulate a release of endorphins, the natural feel-good chemicals in the body. Thus, exercise can be a good stress-buster. In depression, it may function the same way. There are also additional ideas about why exercise is helpful for depression. On a biological level, there is evidence that depression is caused or maintained by inflammation in the brain and exercise can reduce that inflammation. In addition, a chemical in the body called Brain Derived Neurotrophic Factor (BDNF) appears to be important for brain functioning including thinking, memory and mood. Although it is not possible to increase BDNF in the body through diet, aerobic exercise stimulates the body to make BDNF, which may in turn improve thinking and mood. The active ingredients in exercise may also overlap with another treatment, Behavioral Activation, in that exercising creates opportunities to feel positive about oneself and increase social activities. 

What Does Exercise for Depression Look Like in Action?

Much of the research looking at exercise has focused on aerobic exercise, meaning activities that increase heart rate to 60-90% of maximum heart rate and keep it up for a period of time. Some common ways of getting aerobic exercise include jogging, using a climber or elliptical machine at the gym or hiking. Because people have different levels of fitness, what is “aerobic” and elevates heart rate for one person may not do so for someone else. In many cases, brisk walking may be an aerobic activity. Research suggests that a good guideline for antidepressant “dosage” of exercise is 30 minutes of aerobic exercise three times per week (Blumenthal et al., 1999).

Engaging in regular exercise is difficult for many people even when they are not depressed. With the added burden of depression, which can create extreme fatigue and decreased motivation, exercise may seem impossible. Thus, more important than the type of exercise a person does, is how a person approaches getting into an exercise routine. This is especially true if regular exercise has not been part of life recently. The best advice is to start small. Really small.  When beginning exercise, taking a 5-minute walk can sound far less daunting than a 30-minute run. Over time, the amount and intensity of exercise can be increased. Some people also find that having an exercise buddy or making a public commitment to a loved one is helpful in establishing accountability.

Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., . . . Krishnan, K. R. (1999). Effects of exercise training on older patients with major depression. Arch Intern Med, 159(19), 2349-2356.

Lawlor, D. A., & Hopker, S. W. (2001). The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. Bmj, 322(7289), 763-767.