The Surprising Results of Exercise for Depression

By: Len Lantz M.D.

How can I exercise if I’m already depressed and tired?

When you are depressed, you often feel stuck. People with major depression frequently don’t exercise because their energy and motivation already are low. Just brushing your teeth can feel like a major chore. However, there is hope. Most people do not understand how much they can benefit from a small amount of exercise.

If your idea of exercise is going to a gym, jogging down the road, picking up a new sport or restarting an old one, then it is no surprise that exercise seems daunting. It’s not your fault. For most of us, exercise has been defined by advertising. Think of all the gym advertisements, infomercials and images you’ve seen on social media, and you will be demoralized in a heartbeat.

Exercise can be simple

It can be incredibly easy to enjoy the physical and mental health benefits of exercise. Federal guidelines for exercise show how straightforward exercise can be. Walking, dancing, playing and running all count. Moderate-intensity exercise means anything that gets your heart beating faster, and muscle-strengthening activity means that you are making your muscles “work harder than usual.” That’s it! Exercise need not be demanding. It does not require a tennis racket, mountain bike or gym membership. Here are the federally recommended amounts of exercise:

 Preschool children (age 3-5): These children are to be “physically active throughout the day.”

Children and Adolescents (age 6-17): “60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily” that includes:

• Aerobic: 3 days per week
• Muscle and bone strengthening: 3 days per week

Adults: 2.5-5 hours of moderate-intensity or 1.25-2.5 hours of vigorous-intensity aerobic physical activity per week

• Muscle strengthening: two days per week
• Additional health benefits are seen with more than five hours per week of moderate intensity.

Older adults: As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.

The researchers who proved that exercise helps depression

There are dozens of research studies showing that exercise exerts a positive effect on major depression, however, the medical community has been slow to embrace exercise as a treatment for depression. One of the major battles to prove that exercise treats depression was fought and won by lead researcher James A. Blumenthal, Ph.D., at Duke University School of Medicine and his colleagues, many of whom are distinguished researchers at other top universities.

In 1999, the research study, “Effects of exercise training on older patients with major depression,” was published in the Archives of Internal Medicine. The results showed that 16 weeks of exercise produced similar benefit as the antidepressant Zoloft for people with major depression ranging from mild to severe intensity. The people in the exercise arm of the study just needed to walk or jog 3 times per week for 45 minutes for 16 weeks. The study showed that people reached remission (i.e., fully free of depression) 60% of the time in the exercise group, 65.5% of the time in the Zoloft group and 69% percent of the time in the combined group (medication and exercise).

Most of the researchers continued the study for 6 months and they had another amazing finding. If patients from the 1999 study continued to exercise for another 6 months, they were half as likely to relapse back into depression. The benefits of exercise stop when you stop exercising.

Exercise was shown to help depression and the entire field of medicine erupted in celebration, right? Wrong.

These incredible researchers were met with skepticism and denial. The larger medical community could not believe the enormity of their results. Essentially, the medical community said, “Exercise is as good as Zoloft? No way!” They raised objections about how accurate the diagnoses of depression were, how the study was not blinded and that there was no placebo arm in the study.

So, the same lead researcher and his esteemed colleagues put together the more rigorous SMILE study which was published in 2007. The average patient had moderately severe Major Depressive Disorder The exercise was the same (walking or jogging 3 times per week for 45 minutes for 16 weeks) and they compared the exercise group to Zoloft and placebo (sugar pill) groups. The researchers found that the “unadjusted remission rates were: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; and placebo = 31%.”

Did you catch that? The effects of exercise were similar to that of Zoloft. Both exercise and Zoloft beat the placebo. Exercise clearly helps major depression!

A one-year continuation study showed that continuing the treatment for another year resulted in 67% remission in the exercise groups and 63% remission in the Zoloft group. The longer you exercise, the greater the benefit.

Why don’t we exercise?

Our brain tells us a number of lies to trick us into not exercising. It tells us about a problem we have and then convinces us that if we exercise, the problem will worsen. Our sneaky brain might tell us:

• You are tired enough already
• You already have aches and pains
• You need to rest
• Exercise will make you feel worse
• You will have even less energy after you exercise
• The weather is bad
• You can exercise later
• You exercised yesterday

Here is the reality: most people feel better mid-exercise or post-exercise than they do before they started exercising. Try it out for yourself. Assess your energy level pre- and post-exercise. The vast majority of people feel better with exercise. For the small percentage of people who feel mid- and post-exercise worse, here is the cure: back off the intensity of your workout until you feel at least as good as when you started, and then exercise will feel better to you over time as you begin to build your endurance.

A patient story on exercise

“John” was horribly depressed. He was on leave from work because his depression was so severe. He just couldn’t function. He was on an antidepressant and that helped some, but the reality was that he wished he could just sleep for a few weeks, wake up, and find that his depression was gone. Both his therapist and his psychiatrist told him that this was not how it worked. They encouraged him to move his body and fill his day with meaningful activities.

Exercise seemed absolutely impossible to John in his depressed state. When his doctor and therapist encouraged him to exercise, all he could think about was an infomercial and a ripped dude on the machine. John told himself that he would never be able to afford the machine or look like the guy in the ad.

He finally broke down in therapy after his therapist, Joelle, recommended – for the thousandth time – that he start exercising. “I can’t do it!”, John yelled, “I’m too freaking tired and I don’t want to join a gym!” Joelle was stunned but then started smiling. “She said, “Thank you for bringing this up to me. I’m sorry I didn’t explain what I meant by exercise. I just wanted you to walk a few laps around the town square. That’s it. You don’t have to pump iron and look like Dwayne ‘The Rock’ Johnson. Let’s talk about realistic exercise that will actually charge up your batteries.”

John and Joelle came up with a plan that he liked. He would wake up by 7 am, take 3 laps around the town square (he would take 4 laps if he was feeling really good after the 3rd) and then he would take care of his hygiene and eat a healthy breakfast. John felt better and better each week. He continued to meet with his psychiatrist and take his antidepressant. Within a few months, he started to notice that his depression was going away, and he was starting to enjoy life again.

How to start exercising today

It is easy to start exercising today. Pick an activity that increases your heart rate and do that regularly each week until you are exercising for at least 2 1/2 hours per week. Here is a reasonable strategy:

• Check with your doctor first if you have a health condition
• Start slow and build your stamina (you don’t need to overdo it)

+ Start walking every morning before breakfast

+ After lunch go for a brief walk

+ Avoid exercising near bedtime, as this can disrupt your sleep and digestion

• Buy a Fitbit or keep a paper Exercise Log

+ Keep track of your energy and how you feel pre- and post-exercise

+ Monitor your mood

+ Record the days and amount of time you exercised

+ List the type of exercise

• Write down your plan for bad weather days
• List your top excuses for not exercising and your replies to your

tricky brain

Imagine living life with a better mood, a healthier body and more energy

If you are willing to make changes in your life to increase your exercise, you are likely to become less depressed. Even if you do not have depression, exercise is good for your emotional well-being and physical health. Think about how satisfying it would feel at the end of the day to know that your exercise has helped your body and your brain. Taking care of yourself through regular, moderate exercise is a proven strategy for helping your depression and enhancing your mental and physical health. You can do it today and you can do it for free!