By Dr Michael Noetel, senior lecturer in psychology
At least听听have depression at some point in their lives, with some estimates听. It鈥檚 one of the worst things for someone鈥檚 wellbeing 鈥� worse than听.
听Australians take antidepressants. Psychologists are in听. Still, only听听of people with depression in high-income countries get treatment.
翱耻谤听听shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it.
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Walk, run, lift, or dance away depression
We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together.
We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as听听鈥� one of the听听for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.
Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.
But of these exercises, people were most likely to stick with strength training and yoga.
Antidepressants certainly help听. And of course, anyone getting treatment for depression should talk to their doctor听听what they are doing.
Still, our evidence shows that if you have depression, you should get a psychologist听and听an exercise plan, whether or not you鈥檙e taking antidepressants.
Join a program and go hard (with support)
Before we analysed the data, we thought people with depression might need to 鈥渆ase into it鈥� with generic advice,听听鈥渟ome physical activity is better than doing none.鈥�
But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression.
We also found it didn鈥檛 matter how much people exercised, in terms of sessions or minutes a week. It also didn鈥檛 really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.
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Yes, it鈥檚 hard to keep motivated
We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which 鈥渢reatment鈥� they鈥檝e been randomised to receive, so this may skew the results.
Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn鈥檛 free.
We also still don鈥檛 know the best way to stay motivated to exercise, which can be even harder if you have depression.
Our study tried to find out whether things like setting exercise goals helped, but we couldn鈥檛 get a clear result.
Other reviews found it鈥檚 important to have a听听(for example, putting exercise in your calendar) and to听听(for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult.
A听听of more than 60,000 gym-goers听听experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn鈥檛 seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted.
Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they鈥檙e sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.
So, when starting out, it seems wise to avoid going it alone. Instead:
join a fitness group or yoga studio
get a trainer or an exercise physiologist
ask a friend or family member to go for a walk with you.
Taking a few steps towards getting that support makes it more likely you鈥檒l keep exercising.
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Let鈥檚 make this official
Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only听听exercise as a 鈥渃omplementary and alternative treatment鈥� when 鈥減sychotherapy or pharmacotherapy is either ineffective or unacceptable鈥�.
Based on our research, this recommendation is withholding a potent treatment from many people who need it.
In contrast, The Royal Australian and New Zealand College of Psychiatrists听听vigorous aerobic activity at least two to three times a week for all people with depression.
Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.
I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based.
If this article has raised issues for you, or if you鈥檙e concerned about someone you know, call Lifeline on 13 11 14.
This article was republished from The Conversation under a Creative Commons license. Read the听.
