Dr Richard Harvey
Aboriginal Health
Health
Treating the Cause of Obesity, not the Effect
Exercise - the Nature Fix
Health Promotion Through Cycling
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Using exercise to ward off anxiety and depression
Recent evidence has shown that exercise is as effective as psychotherapy and anti-depressant drug therapy in treating mild to moderate depression, and even more effective when used in conjunction with the conventional therapies.
Depression is the most common primary care psychiatric diagnosis, with a lifetime of prevalence of major depression being about five per cent of men and 10 per cent of women. These rates seem to be on the rise, which is alarming, as about 15 per cent of people suffering from severe major depressive disorders will die by suicide.
Depressed people can have symptoms ranging from mild to severe. These include a depressed mood, loss of ability to experience pleasure, a loss of interest in usually enjoyable activities, a loss of motivation, changes in sleep, appetite, weight, energy and motor activity.
Other dysfunction includes concentration problems, self deprecation and suicidal thoughts. Appropriate treatment may include psychotherapy, anti-depressant medication and/or electro convulsant therapy. However, physicians are now using exercise as an important adjunct treatment for their depressed (and anxious) patients.
Researchers found significantly reduced depression scores in severe and moderately depressed persons, following a six week aerobic exercise program. They found also elevated moods in non-depressed people.
These improvements were even more marked at a six month follow up for those persons who continued to perform aerobic exercise. It was found that the increased physical fitness levels of the participants led to less physical health problems and less depression. Thus, they concluded that exercise protected the participants from developing depressive symptoms. Studies also showed reduced anxiety levels in those people who exercised regularly.
There have been conflicting reports about what kind of exercise is most helpful for depressed persons. Recent studies suggest low intensity aerobic exercise, such as walking, is as beneficial psychologically as the more intense aerobic exercises, such as jogging/running, which are more likely to cause injury.
The exercise program must be fun, convenient and varied. These factors are associated with increased compliance.
Exercise guidelines for an aerobic program would include
- a frequency of two to five times per week
- for a duration of 30-40 minutes
- plus five to 10 minutes (each) of warm up and cool-down (with stretching) at each session.
How does aerobic exercise work?
Psychological theories:
- Distraction from stressful stimuli.
- Exercise as a way of regaining control of one's body and life (as depression can be a person's response to loss of control).
- Improved social interaction that often accompanies participation in sports.
Biological mechanisms:
- Alterations of chemical substances in the brain (usually an increase), which can reverse the low levels found in persons who are depressed.
- Another mechanism proposed is the thermogenic effect of exercise (elevation of body temperature) that could have antidepressant effects.
Risks of overdoing it
Even though exercise has many physical and psychological benefits, negative consequences can result from excess.Overdoing it may lead to overtraining or staleness - a response to high volume, high intensity training with inadequate rest and recovery periods. Symptoms are similar to those of depression: fatigue, loss of sense of purpose, decreased energy levels, feelings of helplessness, hopelessness and incompetence, etc. Therefore, whilst exercise can alleviate depression - too much can lead to depression.
Exercise, thus, has been shown to provide psychological gains for depressed and anxious people. The mechanisms for achieving this are uncertain. Exercise is most beneficial in the depressed person when combined with psychotherapy and/or medication. Exercise should be prescribed in an individualised manner, ensuring that intensity and duration are not excessive. At the extremes of too little or too much exercise, people may become depressed, whereas with a moderate exercise program, their moods may become elevated.
As with many aspects of a healthy lifestyle - moderation is the key to success.
Get your fix - get healthy - safely!
Richard Harvey
Reference: The Physician and Sports Medicine - September 1995.
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