At least one in ten people have depression sooner or later of their lives, with some estimates closer to at least one in 4. It’s considered one of the worst things for somebody’s wellbeing – worse than debt, divorce or diabetes.
One in seven Australians take antidepressants. Psychologists are in high demand. Still, only half of individuals with depression in high-income countries get treatment.
Our latest research shows that exercise needs to be considered alongside therapy and antidepressants. It will be just as impactful in treating depression as therapy, nevertheless it matters what style of exercise you do and the way you do it.
We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a way called a network meta-analysis. This allowed us to see how several types of exercise compared, as an alternative of lumping all sorts together.
We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as cognitive behaviour therapy – considered one of the gold-standard treatments for depression. The effects of dancing were also powerful. However, this got here from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.
Walking, running, strength training, yoga and mixed aerobic exercise seemed simpler than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.
But of those exercises, people were more than likely to persist with strength training and yoga.
Antidepressants definitely help some people. And in fact, anyone getting treatment for depression should seek advice from their doctor before changing what they’re doing.
Still, our evidence shows that if you’ve got depression, it’s best to get a psychologist an exercise plan, whether or not you’re taking antidepressants.
Before we analysed the information, we thought individuals with depression might must “ease into it” with generic advice, reminiscent of “some physical activity is healthier than doing none.”
But we found it was much better to have a transparent program that aimed to push you, at the very least somewhat. Programs with clear structure worked higher, compared with people who gave people a number of freedom. Exercising by yourself may also make it hard to set the bar at the proper level, given low self-esteem is a symptom of depression.
We also found it didn’t matter how much people exercised, when it comes to sessions or minutes every week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the upper the intensity, the higher the outcomes.
We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this will likely skew the outcomes.
Many individuals with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.
We also still don’t know the perfect method to stay motivated to exercise, which will be even harder if you’ve got depression.
Our study tried to search out out whether things like setting exercise goals helped, but we couldn’t get a transparent result.
Other reviews found it’s necessary to have a clear motion plan (for instance, putting exercise in your calendar) and to track your progress (for instance, using an app or smartwatch). But predicting which of those interventions work is notoriously difficult.
A 2021 mega-study of greater than 60,000 gym-goers found experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t appear to motivate people. However, listening to audiobooks while exercising helped rather a lot, which no experts predicted.
Still, we will be confident that individuals profit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.
So, when starting out, it seems sensible to avoid going it alone. Instead:
Taking a number of steps towards getting that support makes it more likely you’ll keep exercising.
Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only conditionally recommends exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”.
Based on our research, this advice is withholding a potent treatment from many individuals who need it.
In contrast, The Royal Australian and New Zealand College of Psychiatrists recommends vigorous aerobic activity at the very least two to thrice every week for all individuals with depression.
Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.
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