Exercise Does Not Make You Less Depressed
bmj.comThe title of this post does not match the title of the paper.
The report does not say "exercise does not make you less depressed".
The report mentions some of the weaknesses; some comments to the article do a good job at pointing out other weaknesses.
Exercise is not just pushed at people with depression to treat that depression; it's to help with other stuff too:-
* medication side effects (sometimes include weight gain or overeating)
* improving social life
* improving general health
The title matches the results though...
"Results: There was no evidence that participants offered the physical activity intervention reported improvement in mood by the four month follow-up point compared with those in the usual care group; adjusted between group difference in mean Beck depression inventory score −0.54 (95% confidence interval −3.06 to 1.99; P=0.68). Similarly, there was no evidence that the intervention group reported a change in mood by the eight and 12 month follow-up points. Nor was there evidence that the intervention reduced antidepressant use compared with usual care (adjusted odds ratio 0.63, 95% confidence interval 0.19 to 2.06; P=0.44) over the duration of the trial. However, participants allocated to the intervention group reported more physical activity during the follow-up period than those allocated to the usual care group (adjusted odds ratio 2.27, 95% confidence interval 1.32 to 3.89; P=0.003)."
re exercise not being perscribed for depression. Current belief in Positive Pyschology circles (the founder of which invented the above mentioned Beck depression inventory) includes exercise acting as a treatment for depression.
"Besides training new habits and antidepressants, getting better exercise and a healthier diet have proven to have strong effects on mood. In fact, exercise is sometimes called the "miracle" or "wonder" drug - alluding to the wide variety of proven benefits that it provides.[55][56]" -- http://en.wikipedia.org/wiki/Positive_psychology
>* The title matches the results though...*
And it disagrees with the results of many, many other studies, some of which even quantify the exercise done instead of just relying on self-reported number of days of exercise.
http://scholar.google.com/scholar?q=exercise+and+depression&...
It doesn't match the results though. The title is it doesn't work for "you". "You" may not be above 14 on the depression scale. "You" may get more than three sessions with a trainer. "You" may be in the part of the sample that did improve their mood.
It's always a stretch to over-generalize to "everyone", or the more annoying "you", from the results of a study when the effect on all people is not going to be the same.
It's not clear from the report whether they're talking about people who had the intervention and who did exercise, or if they're talking about people who had the intervention but who didn't do the exercise. (Or maybe it is and I just missed it?)
> Nor was there evidence that the intervention reduced antidepressant use
People are recommended to stay on anti-depressants for at least 6 months after feeling well, and for at least two years if they're at risk of relapse.
(http://publications.nice.org.uk/depression-in-adults-quality...)
So it's difficult to use antidepressant use as a guide to whether people feel recovered or not.
It's also unclear whether the intervention offered matches current NICE guidelines, which says
> 1.4.2.4 Physical activity programmes for people with persistent subthreshold depressive symptoms or mild to moderate depression should:
> * be delivered in groups with support from a competent practitioner
> *consist typically of three sessions per week of moderate duration (45 minutes to 1 hour) over 10 to 14 weeks (average 12 weeks).
About prescription: Yes, some people think exercise is a wonder drug. I'm not interested in those people unless they're treating patients. Your wikipedia article says:
> While positive psychology can inform clinical psychology, it is not helpful to stretch beyond this point
I live in the UK. Clinicians should refer to the NICE guidance. The NICE guidance is pretty specific about what constitutes physical exercise. That's because the evidence for exercise isn't great. The Cochrane review (http://summaries.cochrane.org/CD004366/exercise-for-depressi...) has a good summary of the evidence - when you only include high quality reviews there's only small benefits from exercise.
But, even if the benefit for depression from exercise is slim there are other reasons to do exercise, and it's important that people are helped to exercise, especially if they're at risk of self-neglect.
More research is needed. It's great that this study has been done. But it's incredibly frustrating that this one study is reported in terms such as "Exercise does not help depression".
To me, more interesting than the study itself was the rather brutal criticism it got from the scientific community posted on the same website.
In my own experience, diet had a much more dramatic effect on my day-to-day mood. Switching to basically a slow carb diet helped my mood and outlook tremendously.
EDIT: I wanted to add that exercise also has a great effect on my mood, but only temporarily. By following a consistent diet that (in my case) is low glycemic and high in protein, the stability of my mood was much greater than exercise alone.
I do not have time to read the whole paper right now, but one question I have about the results is the prescribed exercise. In my experience, the type of exercise I do can have very different affects in how it makes me feel afterwards. For example, my mood is stabilized for much longer if I do 15 minutes of interval sprints rather than a 30 minute run. Cycling will also make me feel much different than high-weight/low-rep weightlifting.
What I am getting at is that if the "exercise" routine was run for 30 minutes 2 time a week, I could easily see how that would not affect depression. However, if it was a regime of HIIT or heavy compound exercises (squat/deadlift/bench), I would be very surprised if people didn't see long term mood benefits.
On the diet angle, I noticed a dramatic improvement when I drank tea as opposed to coffee. YMMV of course, but in my case drinking coffee even in the morning kept me up later at night.
I do notice however, that regular exercise helps with my stress-coping ability.
this is the wrong crowd to be advocating tea over coffee!
Merely staying on any kind of feeding schedule while including any amount of food-pyramid thinking has had the most dramatic effect for me.
Exercise for exercise alone is reason enough to keep doing it.
Would anyone be surprised to find out that externally facilitated exercise, as offered in the study, has different emotional effects than self-motivated exercise?
Yes! Common knowledge says that exercise helps you fight depression. If we see that some class of exercise is not as effective as another one (or is not effective at all) then we can start to ask ourselves how they differ.
I think you imply in your comment that "self-motivated exercise" is better than "externally facilitated". If that is true then we can start worrying less about selling the idea of exercising and more about thinking how to motivate a depressed individual.
On the other hand, if both cases of exercising offered the same results then we could say that it's not the motivation but the exercise itself who's helping us.
http://curetogether.com/blog/2011/05/03/23-surprisingly-effe... I'm not using the curetogether survey to argue against the results from a peer-reviewed scientific study. But, if you look at the top-right corner, I think the survey "kinda" reveals "self-motivation" played a big part in fighting against depression.
Rhino55 - your account appears to be banned, your comment is showing as dead.
In my own experience, casual or minimal exercise has done little to affect my mood and since my early twenties depressive periods have been a very real problem, even effecting my employment at one point.
But going hard, and really pushing my body and pushing myself beyond my preconceived limits has done wonders. There have been times when getting that "runner's high" feeling has completely sidelined the depressive state I've been in. When it happens, I'm still astonished at how much that endorphin release can really make a difference to my mental well being. I realise this is all only anecdotal, with a sample size of one! But I believe runner's high is a recognised phenomenon:
Anecdata: Earlier this year, I was exercising regularly. I had a lot of energy and felt great about my body and my brain.
Some stuff happened that made me stop exercising. It's been several months. I am generally kind of mopey, lethargic, and unhappy with myself. And putting on weight, which only makes me grumpier.
YMMV.
I found myself in a similar situation and decided to just 'walk' to get my mind out of the funk.
I just made sure I was going for at least 30 mins and just listening to some music with no real goal in terms of fitness.
Eventually I just got to the point while walking that I would get little energy bursts and turn it into a jog instead of a walk. Now I'm working my way through one of the couch to 5K style apps and loving it.
Forcing myself out the door the first few times was really key though (regular times I could stick to easily was great as well)
I almost wonder if the authors didn't read the analytic-rheumination hypothesis. Adding another thing to a depressed person's plate, and then hounding them when they don't do it, is exactly what they don't need.
> The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone.
I wonder, did they think this was a good idea, or did they see no other way for the clinician to increase the incentive to do physical activity?
Any depressed entrepreneur out there: if you're thinking about exercise, do it! Outdoors if you can, but by any means, listen to Nike: just do it!
I'm annoyed that the study does not go into details about what the "physical activity" consisted of. The only thing it says is "self reported level of physical activity (≤1, 2-3, ≥4 days per week, with at least 30 minutes of moderate or vigorous intensity physical activity)" which does not mean much.
Anecdotally speaking, lifting heavy weights vastly improves my mood. This is in contrast to, say, cardio, which simply makes me feel tired. I wish the study had accounted for this too.
I agree. I always feel great after a heavy set of power cleans or deadlift.
Interesting; I usually feel tired after a bunch of weight-lifting but invigorated after a long hard run.
The key, I find, is that you have to be on a schedule of lifting; for the first few times, you feel pretty crummy after.
having a schedule and pushing yourself as hard as you can is probably the point. When you lift you are pushing yourself. When I run hard for 30 minutes I am pushing myself. It is pure self motivation. Why would you not feel good after that? At the very minimum you are helping to sustain a certain mental focus. Additionally, if you think about CBT and how that is used to treat depression it is easy, in my mind, to glean how thinking about your thinking for good, particularly during exercise can be a positive on your mental health. I know when I am 22 minutes I am thinking a lot of positive thoughts about making it to the end and that I am strong enough to finish. This shit is CBT.
Right, once I got on a schedule I felt pretty bad when I didn't get in my daily lift.
This is all my personal experience, but while struggling with emotional problems I tried exercise (cardio/weight lifting at the gym) for a period of 6 months. Although the exercise itself was not helpful in lifting my mood, having something to do (a routine if you would) helped me keep my mind off the "bad stuff". That itself was a plus but I could have easily replaced exercise with WoW, gambling or piano lessons and the result might've been the same.
Note this study was targeted towards clinically depressed people. Whether or not it relieves stress in non-depressed people is a different topic.
This study is not about 'making you feel good', it' about improving cases of clinical depression. If this study is sound, it would generalize to saying "exercise in addition to usual care is no more effective than usual care alone at reducing self-reported levels of depression measured by standard means".
I've often wondered about this. I've been through a couple major depressive episodes even as I was in peak physical condition. I was doing high-intensity boot camps 4-5 days per week.
"three face to face sessions and 10 telephone calls with a trained physical activity facilitator over eight months" does not make you less depressed.
yes. it seems that this detail has been missed by many.
Exercise does relieve, at least, some stress, but that does not mean that it will make you less depressed in the long run. I think these are somewhat different things, the depression being a more complex issue that seems to depend on more factors than stress.