Exercise and Depression: Are you exercising enough? You have to get up off the couch and spend some time outside! You’ll be surprised how much better you’ll feel if you just move your body.
If you’ve experienced depression, there’s a decent chance a well-meaning friend or family member has given you some version of this advice. If you know someone with depressive disorder, you may have given this advice yourself.
With everything we now know about the mind-body connection, this advice makes sense.
If you nurture your body by following a nutritious eating plan and get an appropriate amount of exercise, the boost in your physical health should boost your mood and mindset, right?
On the other hand, depressive disorders are complex mental health conditions with myriad potential genetic and environmental risk factors, as well as the potential to disrupt virtually every part of your life.
Surely taking a few brisk walks around the block or finally scheduling time in the gym won’t be enough to make a meaningful difference, right?
Though this may come as a surprise to some, it turns out that exercise can have a beneficial effect on people with depression. And we’re not simply talking about minor improvements among individuals having a bad day or a temporary case of the blues.
Multiple studies show physical exercise can ease symptoms and improve quality of life among people with depressive disorders.
The Scope of the Problem
One reason why advances in depression treatment are newsworthy is that they can impact hundreds of millions of lives.
Depressive disorders are among the most common mental health issues in the U.S. and throughout the world:
- The World Health Association (WHO) reports that about 280 million people have depression. This is roughly 5% of all adults: 4% of men and 6% of women.
- WHO data also indicates that more than 10% of new mothers experience either peri- or post-partum depression
- The National Institute of Mental Health (NIMH) indicates the past-year prevalence of depression among adults in the United States is about 3%: 10.3% of women in the U.S. and 6.2% of men.
- The NIMH reports that 49% of adults and 59.4% of adolescents did not receive treatment for depression in the past year
The Benefits of Exercise on Depression
An important meta-analysis on exercise and depression appeared in the British Journal of Sports Medicine in September 2023:
- The analysis included an assessment of 97 previously published studies
- Researchers analyzed data from 128,000 participants ages 29-86.
- The clinical trials involved four types of activity: aerobic, resistance, mixed-mode exercise, and yoga.
Here’s what the research team found:
- All forms of physical activity had a positive effect on participants.
- Resistance exercises had the greatest impact on people with depression, while yoga and mixed-mode exercises were most beneficial for people with anxiety.
- Moderate to high intensity exercises were more effective than lower intensity workouts at easing symptoms of anxiety and depression.
- Activity sessions of all durations yielded mental health benefits, but results were best with sessions of less than 60 minutes.
The research team noted that regular physical activity should not be viewed merely as a way to overcome temporary periods of acute symptoms. Here’s how they characterized their results, and what they may mean for a wide variety of patients:
“While the benefit of exercise for depression and anxiety is generally recognized, it is often overlooked in the management of these conditions. Many people with depression and anxiety have comorbidities, and [physical activity] is beneficial for their mental health and disease management.”
In addition, the team found exercise improves mental health among participants with kidney disease, HIV, and chronic obstructive pulmonary disease (COPD), noting:
“This underscores the need for [physical activity] to be a mainstay approach for managing depression and anxiety.”
Exercise, Depression, and the Mortality Gap
In addition to improving quality of life, physical activity may also be able to extend the lifespan of people who have depressive disorders.
According to an October 2023 JAMA Open Network study, data shows anxiety disorders and depressive disorders can cause a 61% increase in mortality risk. In terms of depression alone, researchers found:
- Compared to people with no depressive symptoms, people with mild symptoms of depression showed:
- 35% higher risk of all-cause mortality
- 49% higher risk of death due to cardiovascular disease
- Compared to people with no depression, people with severe depressive symptoms showed:
- 62% higher risk of all-cause mortality
- 72% higher risk of cardiovascular-related fatality
- 121% greater likelihood of death due to ischemic heart disease
These findings, from a cohort study involving more than 23,000 adults in the U.S., align with prior studies from Canada, China, Central Europe, and Eastern Europe.
Exercise and Depression: Additional Studies and Data
An article published January 2019 noted that, when excluding deaths by suicide, people diagnosed with major depressive disorder (MDD) die an average of 10 years earlier than people with no MDD diagnosis.
Researchers identified several factors that may contribute to increased risk of premature mortality. Compared to people without MDD, people with MDD:
- Are more likely to be sedentary
- Are less likely to be physically fit
- Report higher rates of:
- Cigarette use
- Alcohol consumption
- Obesity a
- Show dysregulation in key physiological systems:
- Hypothalamic–pituitary–adrenocortical (HPA) axis
- Immune system
- Autonomic nervous system.
- Are less likely to adhere to medication protocols and more likely to engage in other problematic behaviors.
- Show higher death rates from diabetes and stroke
However, when people who have depression engage in appropriate physical activity on a regular basis, they can experience improvements in their physical health and lifespan, as well as a reduction of their mental health symptoms.
The research team reported that people who exercise three times per week for 12-24 weeks show a 22% higher likelihood of remission from depression symptoms. They also link exercise with the following outcomes:
- Elevated mood
- Decreased anhedonia
- Reduction in suicidal ideation
- Improved neuroplasticity
- Correction of autonomic and immune imbalances
Studies also suggest that exercise can lead to the following improvements among people who have depression:
- Enhanced regulation of appetite hormones
- Increased metabolism
- Better quality and duration of sleep
- Improved cardiorespiratory fitness
- Cessation of smoking
- Reduced alcohol intake
- Minimized use of illegal drugs
Here’s how the researchers describe their findings:
“First, exercise offers numerous physical benefits, which can counteract several mechanisms postulated to increase mortality risk in depression. Second, if prescribed and delivered correctly, exercise can be as effective as other first-line treatments, while being mostly free of adverse side-effects.”
How Does Exercise Help?
Studies confirm certain approaches or techniques can have a beneficial impact on mental health, but researchers don’t always fully understand how or why they work. That’s the case with the relationship between exercise and mental health.
The studies in the previous two sections clearly indicate that physical activity relieves some depressive symptoms – that’s not up for debate. But how, exactly, this occurs remains up for debate.
In the article “The Benefits of Exercise for the Clinically Depressed,” authors Lynette L. Craft, PhD, and Frank M. Perna, EdD, PhD, describe five common hypotheses that attempt to explain how physical activity can alleviate depressive symptoms:
Distraction
Engaging in physical activity temporarily takes the mind off worries, which helps some people more than introspective practices such as journaling.
Endorphins
After physical activity, the body releases β-endorphins. These interact with opioid receptors in the central nervous system and may contribute to the euphoric feelings associated with exercise
Monoamines
Exercise increases the availability of serotonin, dopamine, and norepinephrine in the central nervous system, which influence mood, energy, pleasure, satisfaction, and motivation.
Thermogenic Increase
During exercise, core body temperature increases. This can affect the functioning of several areas of the brain, including the brain stem, which is involved in mood, judgment, and motivation.
Self-Efficacy
Depression can reduce belief in the potential for positive change. When exercise improves mood and wellbeing, this belief can return, and have a positive impact on depressive symptoms and quality of life.
Also, exercise can improve self-confidence, increase opportunities for social interactions, and give people something to look forward to. This underscores the importance of finding activities that are fun during treatment.
People who associate exercise with physical pain and mental duress are far less likely to make physical activity a regular part of their regular schedule. But when people find something they love to do, they’re far more likely to make it a recurring activity.
Of course, before beginning any exercise regimen, it’s important to consult with a doctor or another qualified healthcare provider. In addition to identifying any physical health risks to avoid, they can suggest activities best suited to individual needs.
Also, please note that most experts view physical activity as a complement to, not a replacement for, traditional interventions such as medication and therapy. Depending on the nature and severity of depressive symptoms, seeking professional mental health care can be an essential step on the path toward a healthier and more hopeful future.
Gianna Melendez
Jodie Dahl, CpHT