Exercise must be ‘core treatment’ for depression: Study

‘If exercise was a pill, it would fly off the shelves.’
 
That is according to University of Queensland researchers who say exercise should be routinely prescribed as part of a patient’s depression treatment plan.
 
Published in The BMJ, the paper reviewed more than 200 studies with the aim of finding the optimal dose and type of exercise for treating depression, compared with psychotherapy and antidepressants.
 
It found different exercises were more beneficial for different people, but overall, patients benefited from the change.
 
‘No matter how often people exercised, whether they had other health issues or how severe their depression was, in all scenarios, exercise had a meaningful impact on their depression,’ report author Dr Michael Noetel said.
 
‘We found exercise should be considered alongside traditional interventions as a core treatment for depression.
 
‘Anyone getting treatment for depression should talk to their doctor before changing what they are doing, but most people can start walking without many barriers.’
 
Activities including walking, jogging, yoga, and strength training in particular were found to be ‘extremely beneficial’ for treating depression.
 
For younger women, strength training was especially effective, while older men can benefit the most from yoga.
 
Depression continues to be a significant burden within Australia, with one in seven people experiencing the illness in their lifetime.
 
It also remains a leading cause of disability worldwide and has been proven to lead to lower life satisfaction more than divorce, debt, or diabetes.
 
Author of the RACGP’s Handbook of Non-Drug Interventions (HANDI) Dr David King welcomed the research and said it is not just exercise that can improve mental health, but also the social interaction that often comes with it.
 
‘If you give a tablet, you don’t get people into a healthy routine and get them socialising,’ he told newsGP.
 
‘If we do non-drug treatments, the extra benefits or co-benefits are there on top, so if you need a medicine and exercise, you’re getting the best of both worlds.
 
‘People with mental health problems often are not as physically well and we need to make sure we concentrate on their overall health, not just medicalising and treating depression, but the socialisation as well.’
 
According to the HANDI, ‘any exercise is better than no exercise … [and] more exercise sessions have a greater effect on mood than fewer sessions’, when it comes to treating depression.
 
However, it also warns exercise programs alone are not a treatment for those suffering poor mental health, and that depression may impact a patient’s ability to participate or complete everyday activities.
 
Dr King said it is important for GPs to remember depression is a chronic disease, and that it takes a lot of work to change someone’s trajectory.
 
‘People come to me depressed and they say, “I’ve exercised, I’ve done sleep hygiene, and I’m still depressed”, but some people take antidepressants and they’re still depressed too,’ he said.
 
‘We need to use a combination of treatments and treat the person holistically, and realise that it can take time, and exercise is good, but it might not necessarily fix everything.
 
‘Depression is a chronic disease if it’s been there for more than six months, so you can use the chronic disease management approach and get an exercise physiologist.’
 
The study’s researchers said further high-quality research is needed to discover the correlation between exercise and depression.
 
But Dr Noetel said it is clear that when patients are given an easy to understand and structured program for physical activity, they are more responsive.
 
‘More support is needed to help people get going with physical activity, and to keep going,’ he said.
 
‘Prescriptions for exercise for those with depression also need to be personalised and take into consideration the individual’s circumstances, to ensure it’s the most effective plan for them.’
 
Dr King echoed this advice, saying GPs need to help their patients find an enjoyable and sustainable exercise regime, as well as one that keeps than accountable, if they are going to reap the rewards.
 
‘Exercise works better if people can either join a class or have instructions if they’re not very good at it, or they might need help or actually have a commitment to turn up and see allied health specialists to help them develop an appropriate exercise program for them,’ he said.
 
‘Just saying to people, “you need to exercise” doesn’t really work, we need to be aware of that because it’s easy to write a prescription and go to the chemist.
 
‘And although exercise is very effective, we need to help people to launch a type of exercise program that is sustainable, which means it’s got to suit them, and they’ve got to enjoy it.’
 
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