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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Focus on Fitness Focus on Fitness
 

Treating Depression With Exercise


July 09, 2013

By Howard LeWine M.D.

Brigham and Women's Hospital


Regular exercise enhances emotional well-being. Medical studies have shown that people who engage in a steady program of physical activity report a more cheerful mood, higher self-esteem, improved sleep and less stress. People who remain active and physically fit are less likely to develop clinical depression. So it's no surprise that exercise can be useful in the treatment of depression.

What Is Clinical Depression?

Clinical depression is more than just being sad and often includes other symptoms such as:

  • A change in appetite that sometimes leads to weight loss or gain
  • Difficulty sleeping
  • Loss of pleasure in activities that were previously enjoyable
  • Lack of energy or feeling tired much of the time
  • Problems concentrating or making decisions
  • Feelings of worthlessness or excessive, inappropriate guilt

The symptoms can be mild to very severe.

Mild depression: You have some symptoms and find it takes more effort than usual to accomplish what you need to do.

Moderate depression: You have many symptoms and find they often keep you from accomplishing what you need to do.

Severe depression: You have nearly all the symptoms and find they almost always keep you from accomplishing daily tasks. In addition, you may experience thoughts of suicide.

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How Does Exercise Improve Depression?

On a scientific level, exactly how exercise works to treat depression is unknown. One theory suggests that moderate and high intensity exercise increases brain levels of the chemicals known to reverse symptoms of depression. Serotonin (an antidepressant), norepinephrine (an adrenalin-like protein) and endorphins (natural pain killers) rise with sustained physical activity.

Other possible explanations include improved mood from enhanced body image, social support from exercise groups, and distraction from everyday worries. Meeting the challenge of continuing exercise may heighten self-confidence.

People who are very inactive with very low fitness levels are more likely to develop health problems, adding to any existing depression. If physical condition and depressive symptoms reinforce each other, treating one can improve the other.

Other factors incidentally associated with exercise may be just as important as the exercise itself, such as learning a new skill, socialization around a common theme and doing something new and different.

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Is Exercise Always Helpful?

Multiple studies have confirmed the effectiveness of regular exercise as a treatment for mild and moderate depression. In some studies, exercise has worked as well as medications and talk therapy. But like all depression treatments, it doesn't work for everyone. If mood does not improve soon after starting regular exercise — or if the person cannot sustain the will to work out — he or she needs to move quickly to additional treatments such as medication and psychotherapy.

For people with major depression, medication is almost always needed along with active involvement of a mental health professional. Exercise can be an excellent adjunct to these other therapies. Participating in a regular exercise program may speed up symptom improvement and help maintain a positive attitude.

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What Is the "Right" Exercise Dose?

There is no amount of exercise that is ideal for treating depressive symptoms. A good start is 30 minutes of aerobic activity (producing some heavy breathing and a light sweat) most days of the week. Then the intensity and duration of workouts can be gradually increased.

Choosing a program of exercise that you will do every day (or at least most days of the week) and sticking with it month after month is what matters the most. Higher intensity aerobic exercise may temporarily elevate your mood from the release of brain chemicals. However, maintaining a regular schedule of high intensity aerobic workouts over the long run can be very challenging.

No matter how much you do when you first get started in a new exercise program, you are likely to feel better about yourself. It is important to realize that many people experience a feeling of exhilaration at the immediate conclusion of an exercise session followed by a quick return to a sadder mood. Don't be discouraged; this is expected. Stick with your program. The longer lasting benefits of exercise for depression usually take a couple months. Studies suggest it takes an average of four months to get maximum benefit.

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Does the Type of Exercise Make a Difference?

Probably not. Aerobic exercise to treat depression has been studied more extensively than other forms of physical activities and has the most evidence to support it. Although there are fewer studies, weight training also has been shown to improve mild to moderate depression. With weight training, intensity does matter. In one study, the most improvement occurred among people who gradually increased their resistance over 10 weeks, doing three weight training sessions per week.

Scheduled physical activity that is not aerobic or related to resistance training also can be beneficial. The types of activities can be whatever is easiest for you. It may be walking, riding on a stationary bike or swimming. The sessions should be at least 30 minutes daily of real physical activity. It can vary from day to day, but you must be moving your body.

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Overcoming Inertia: How Do I Get Out of Bed?

For most people, not only those who are depressed, an exercise routine is difficult to start. In the midst of depression, this can seem like a giant task. Some ways to make that first move:

  • Set an initial goal of just putting on your walking shoes and getting out the door. Even if you walk just one block, it is the first step.
  • If you want company, ask a friend or family member to join you.
  • Group exercise is a great motivator. Hopefully someone you know will go with you until you get familiar with the group.

If it is too much of struggle to get started or if you have started exercising and stopped, speak with your doctor or mental health professional about other treatment options. You want to return to your goal of making exercise part of your daily routine.

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Exercise Is Always Worth a Try

Exercise will not have the same effect on everyone, and for most it will not be the only treatment needed for depression. There really is no down side. Exercise can be done at minimal or no financial cost, rarely has harmful side effects and almost always promotes physical health. Although exercise is no magic remedy for depression, there is little to lose and so much to gain by trying.

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Howard LeWine, M.D., is chief editor of Internet publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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