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At least one in ten people suffer from depression at some point in their lives, and some estimates are closer to one in four. It’s one of the worst things for a person’s well-being: worse than debt, divorce, or diabetes.
One in seven Australians takes antidepressants. Psychologists are in high demand. Still, only half of people with depression in high-income countries receive treatment.
Our new research shows that exercise should be considered alongside therapy and antidepressants. It can be as impactful in treating depression as it is in therapy, but it matters what type of exercise you do and how you do it.
Walk, run, lifting or dancing to relieve depression We found 218 randomized trials of exercise for depression, with 14,170 participants. We analyzed them using a method called network meta-analysis. This allowed us to see how different types of exercise compare, rather than lumping them all together.
We found that walking, running, strength training, yoga, and mixed aerobic exercise were as effective as cognitive behavioral therapy, one of the gold standard treatments for depression. The effects of the dance were also powerful. However, this was obtained by analyzing only five studies, mostly involving young women. Other types of exercises had more evidence to support them.
Walking, running, strength training, yoga, and mixed aerobic exercise appeared more effective than antidepressant medications alone, and were almost as effective as exercise along with antidepressants.
But of these exercises, people were most likely to stick with strength training and yoga.
Antidepressants certainly help some people. And, of course, anyone who is receiving treatment for depression should talk to their doctor before changing what they are doing.
Still, our evidence shows that if you have depression, you should see a psychologist and follow an exercise plan, whether you are taking antidepressants or not.
Join a program and work hard (with support)
Before analyzing the data, we thought that people with depression might need to “soothe the situation” with generic advice, such as “some physical activity is better than no physical activity.” But we found that it was much better to have a clear program that aimed to push yourself, at least a little. Programs with a clear structure worked better than those that gave people a lot of freedom. Exercising alone can also make it difficult to set the bar at the right level, since low self-esteem is a symptom of depression.
We also found that it didn’t matter how much exercise people did, in terms of sessions or minutes per week. It also didn’t matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.
Yes, it’s hard to stay motivated.
We must be careful when interpreting the findings. Unlike drug trials, participants in exercise trials know what “treatment” they have been randomly assigned to receive, so this can bias the results.
Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.
We also don’t yet know the best way to stay motivated to exercise, which can be even more difficult if you have depression.
Our study tried to find out if things like setting exercise goals helped, but we couldn’t get a clear result.
Other reviews found that it’s important to have a clear action plan (e.g., putting exercise on your calendar) and tracking your progress (e.g., using an app or smart watch). But predicting which of these interventions work is notoriously difficult.
A mega-study conducted in 2021 among more than 60,000 gym-goers found that experts had difficulty predicting which strategies might make people go to the gym more often. Even making the workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, something no expert predicted.
Still, we can be sure that people benefit from personalized support and accountability. Support helps you overcome the obstacles you are sure to face. Responsibility keeps people going even when their brain tells them to avoid it.
That’s why, when starting out, it seems wise to avoid doing it alone. Instead: — Join a fitness group or yoga studio.
— Get a trainer or exercise physiologist.
— Ask a friend or family member to go for a walk with you.
Taking some steps to get that support will make you more likely to continue exercising.
Let’s make this official
Some countries view exercise as a backup plan for treat depression. For example, the American Psychological Association only conditionally recommends exercise as “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is ineffective or unacceptable.”
According to our research, this recommendation prevents powerful treatment for many people who need it.
In contrast, the Royal Australian and New Zealand College of Psychiatrists recommends vigorous aerobic activity at least two to three times a week for all people with depression.
Given how common depression is and the number of people who do not receive care, other countries should follow suit and recommend exercise alongside first-line treatments for depression.