Exercise as a treatment for Depression: Hot idea or hot air?

It is very fashionable to include exercise as a complementary treatment in Depression.  In fact there are many studies that show that exercise has positive impacts on the brain.  And, in such as way as to possibly help improve depressive symptoms.  In addition, there are lots of studies that show a positive effect of exercise on depressive symptoms and even some systematic reviews that suggest exercise is a good addition to the usual treatment of Depression.  So there we have it – or do we?

A recent excellent research study reported in the British Medical Journal (2012: June 6) suggests that some of our enthusiasm may have been a bit over-extended.

This was a randomized controlled trial in over 350 adults with depression treated in primary care in the UK.  Everyone got the usual care but half received additional exercise coaching to encourage exercise in addition to their usual care.  The exercise group did show much more exercise (that is a good thing) than the treatment as usual group.  However there was no difference in any outcome measure of depression or its treatment over a period of one year!  Ouch!

Now, what does this mean?  Well, like any study this one was not perfect and the participants in the exercise group did not all achieve the recommended 150 minutes of vigorous exercise per week (at 30 minute per day aliquots).  So there may be been a dosing problem – not enough of a dose of exercise.  Or it may mean that exercise may be helpful for mild depressive symptoms – for psychological distress, but not for clinical depression.  Or, it may mean that the model used (an exercise coaching model) is not the best one by which to help people with Depression get the exercise that they need to help them get better faster or to a greater extent.  Or it may mean other things, too many to list.

So, does this mean we should not exercise to help us feel better?  Totally not!  Does this support using exercise as an alternative treatment for best evidence based care for Depression?  Totally not!  Should we keep suggesting patients exercise?  Totally yes – there are lots of other health benefits to exercise as we know.  Should we engage in more systematic study of this before we write the final chapter?  For sure we should!.

Oh well.  Enough reading about research and writing a blog.  I am off to walk quickly for 30 minutes followed by a nice relaxing summer drink.  It’s hot outside!

-- Stan