Association between physical exercise and mental health: a cross-sectional study
thelancet.com
thelancet.com
> Testing Causality in the Association Between Regular Exercise and Symptoms of Anxiety and Depression
> Context: In the population at large, regular exercise is associated with reduced anxious and depressive symptoms. Results of experimental studies in clinical populations suggest a causal effect of exercise on anxiety and depression, but it is unclear whether such a causal effect also drives the population association. We cannot exclude the major contribution of a third underlying factor influencing exercise behavior and symptoms of anxiety and depression...
> Setting: Causal effects of exercise were tested by bivariate genetic modeling of the association between exercise and symptoms of anxiety and depression, correlation of intrapair differences in these traits among genetically identical twins, and longitudinal modeling of changes in exercise behavior and anxious and depressive symptoms.
> Results: Cross-sectional and longitudinal associations were small and were best explained by common genetic factors with opposite effects on exercise behavior and symptoms of anxiety and depression. In genetically identical twin pairs, the twin who exercised more did not display fewer anxious and depressive symptoms than the co-twin who exercised less. Longitudinal analyses showed that increases in exercise participation did not predict decreases in anxious and depressive symptoms.
> Conclusion: Regular exercise is associated with reduced anxious and depressive symptoms in the population at large, but the association is not because of causal effects of exercise.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
There's a huge bias in popular reporting toward studies concluding that interventions are helpful.
https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depr...
> Exercise is moderately more effective than no therapy for reducing symptoms of depression.
[...]
> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.
Let alone populations like the working poor who have little time in their lives for things like exercise, but growing mental illness issues.
> This outcome seems at odds with findings from randomized controlled trials in clinical and population samples indicating that regular exercise can relieve symptoms in subclinical individuals and in patients diagnosed as having an anxiety or depressive disorder. To understand the different outcomes of both types of study, it is crucial to make a distinction between the effects of prescribed and externally monitored exercise in selected subgroups and the effects of voluntary leisure-time exercise at the population level. Only voluntary leisure-time exercise is influenced by genetic factors, whereas the other type of exercise is environment driven. The absence of causal effects of voluntary exercise on symptoms of anxiety and depression does not imply that manipulation of exercise cannot be used to change such symptoms. It means that a population association, cross-sectional or longitudinal, cannot be used to justify exercise as a treatment without an actual randomized controlled trial. The possible difference in the antidepressant effects of prescribed vs voluntary exercise is consistent with findings from a recent study suggesting that the therapeutic effects of exercise are nonspecific to exercise. The antidepressant effects of exercise may only occur if the exercise is monitored and part of a therapeutic program.
So it sounds like among twins, if one twin naturally exercises more by their own volition, that twin doesn't in general show less depression/anxiety than the other twin, which is evidence against exercise causally reducing depression/anxiety. However it sounds like it may still be that prescribed exercise as an intervention, beyond what an individual would naturally choose to do, and maybe only in conjunction with therapy, could still benefit an individual (and perhaps then only individuals with clinical symptoms).
This study also does help by showing how the associative inverse relationship between exercise and depression in the general population seems to be from genetics influencing exercise, and not the other way around, and the important of a randomized control trial on exercise as an intervention.
The subtlety here is that this building resilience is not the same as fixing the causes of depression[3].
(I'm a bit surprised this research isn't mentioned in these papers)
http://science.sciencemag.org/content/357/6349/eaaf9794
[0] Skeletal Muscle PGC-1α1 Modulates Kynurenine Metabolism and Mediates Resilience to Stress-Induced Depression, https://www.cell.com/cell/abstract/S0092-8674(14)01049-6?cod...
[1] Kynurenines: Tryptophan’s metabolites in exercise, inflammation, and mental health, http://science.sciencemag.org/content/357/6349/eaaf9794
[2] https://ki.se/en/news/how-physical-exercise-protects-the-bra...
Both papers you cite are by the same group, and I don't think the results represent a consensus of the experts.
> Conclusions: Physical exercise positively affects mood and cardiovascular fitness, but does not lead to long-lasting changes in plasma levels of kynurenine and KYNA in patients affected by mild-to-moderate depression.
So that would suggest that the body just reaches a new equilibrium. Again, the point is that resilience does not fix causes - it could be that this is similar to trying to fix traffic jams with more roads; the only real fix is to get rid of the cars as much as you can (after which having an extra lane can make traffic go smoother).
> Both papers you cite are by the same group, and I don't think the results represent a consensus of the experts.
IIRC, that kynurenine does something is apparently well-established, and not just by this group. Also, that first paper has quite a few citations, you can check for follow-up research on Google Scholar[1]
[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384718/
[1] https://scholar.google.de/scholar?hl=en&as_sdt=0%2C5&q=Skele...
This is another degree of freedom in the theory, right?
I mean, this could all be true for all I know, but as an outsider I think this falls into the category of stuff I can't judge, and (like a thousand other theories investigated by experts and published in impressive places like Science) hasn't yet risen to the level of consensus.
This reminds me of the Iron Law of Evaluation:
https://www.gwern.net/docs/sociology/1987-rossi
The Iron Law refers social program interventions but I think it is applicable to a lot of health interventions too.
So, one option is to ignore depression and look at other things.
They did not establish causality in the study and they also said that inactivity might be a symptom of poor mental health. The people who had less mental health days might not be physically ill, but rather, socially ill. If you read the full study and some of the interesting demographics you will see what I mean.
It really tells us nothing but puts more stigma on people who are ill making it seem like it is their fault they are sick.
In that sense, if feeling too depressed for extreme sport, maybe a walk ever now and then should at least not be neglected.
I’m sure most people have a pretty good idea exercise can help with mental health. I think the next thing that needs to happen is a broader awareness of just how effective exercise can be, and that it should be one of the very first thing tried to improve mental health. I think this should happen along with a general increase in mental health awareness (you can’t use exercise to help with your depression if you don’t recognize you’re depressed).
My completely anecdotal example... it kept me from starting crazy meds for at least an extra year or two (by the time I was up to 1-2 hours, 7d/week, it was time to bite the bullet.. though at lower doses than I likely would have otherwise needed.
First step would be "get some evidence it does anything at all". We're not even at that point yet.
Almost everyone in this thread talking about exercise as a treatment for depression is failing to correct for cuasality, or for sponteneous remission.
> (you can’t use exercise to help with your depression if you don’t recognize you’re depressed)
More like you can't use exercise to treat depression because it doesn't work. There's no clear difference between treating depression with nothing or treating it with exercise.
And so we end up with a group of people being given bad advice, trying to follow it, and then when it doesn't work (because it won't work for most of them) being blamed for doing the wrong type of exercise or not doing enough.
What they should be thinking is: going for a walk around the block, not getting the car for close by errands, not taking the elevator, going for a bike ride, etc
Likewise for diets. Those who spend their New Years resolution momentum eating baked chicken and broccoli for a week or completely cutting out carbs will shortly find themselves failing completely and binging ice cream or whatever. Rarely do you see sensible advice like "keep your same diet habits, but cut out soft drinks", or "if you engage in late night boredom-eating, try binging vegetables instead."
Unfortunately, humble and incremental changes in habit seem antithetical to our society's affection for (unrealistic) sweeping, dramatic transformations.
I honestly have done this for the endorphine boost, but overall I’ve lost just under 11kg in about 10 months and I’ve really started to notice my belly go down, and I can actually see muscle building now... which I’ll be honest and say surprised me (why I have no idea). This is great, but I did exercise to deal with some pretty appalling trauma I experienced - everything else is nice but for me, not essential.
People start way too intense, spending hours in the gym, and burn out all their enthusiasm in the first weeks or two before they realize that their efforts are unsustainable. Really, start with a plan on what do to, go in and do it. If it's a half hour that's perfectly fine. My sessions, depending on the day, last anywhere from half an hour to 3 based upon my mood and the workload for that particular session - but you gotta keep the mandatory work to a reasonable amount - everything else should be treated as icing on the fitness cake.
I'm sure to go with the 11 kg there has been significant body composition changes to make it count for more as well.
Yet I'll walk to anywhere within a half an hour's walk. I'll do that daily. Grocery store? walk. I'll go longer at times. I'll take the stairs. I'll go out hiking and walking to see something or do something.
Unfortunately, if I have nothing to see or do - no work or lack the means to do something - I rarely do these things. These have generally been the times when my mental health is worst as well (though that trend has changed the last few years). It makes me despise these sorts of reports.
For me, it just took having the self-control to commit to an exercise regime. Eventually it became easier because I track my exercise and having a break in it (even if I am traveling or on vacation) feels really bad.
I doubt it would work for everyone, but I think it was necessary for me because I live in a city and even if I walked everywhere (which I do), I would never get enough exercise to offset 8-hour days of sitting at a computer desk writing software.
Also sometimes when I've spent time indoors on the PC/internet I realize that sitting outside with a book would have been better.
I s'pose that access to nearby walking routes and some sort of garden can be a big help here and I'm lucky in that respect.
Or it could theoretically be like trying to treat muscular dystrophy via 100 lb bench presses - the system is too far gone for it to help.
C'mon, no shaming the 100 lbs bench press - I absolutely encourage someone whose benching 100 lbs to bench, because if they work hard pretty quickly it won't be 100 lbs any more.
And you raise an excellent point - is exercising the thing boosting the mood, or is the exercising the result of a mood boost.
No, it isn't. It's in the folk remedy, but there's not much evidence to support exercise as a treatment for depression.
This is _my own analysis and experience_, of course, so YMMV. There are additional important approaches to anxiety, like identifying stressors that need to be addressed (situations, goals, relationships, etc.) and attending to various facets that contribute to a feeling of purpose and promise. But after learning to look at my symptoms through the lens of "exhaustion" (whether it be productivity exhaustion or fitness-induced) I no longer suffer from chronic severe anxiety and depression, and my psychiatrist long ago pronounced me cured. Some people here may benefit so I share this in case it helps.
However I'd say that "laying down because it's all I can do" and "laying down as a conscious way of attending to my personal exhaustion" are two different states of being, with an important difference. The first could easily raise one's anxiety if it seems counter to "what needs to be done" while the second approach is part of a more analytical process (at least in my case) which is hopefully accompanied by fail-overs and follow-ons, like addressing stressors, mentioned above.
On the flip-side, I personally experienced some serious post-binge depression after playing Talos Principle VR for a few hours. It's not very physically engaging, with a somber atmosphere throughout. I felt so weird taking off the headset and jumping back into reality.
Though I think both scenarios just go to show how powerful VR could potentially be in the medical field.
That weird not-quite-real feeling you get after a lot of VR seems to be a thing though. If you're playing something engaging and emotionally heavy I imagine it'd be even stronger.
Hire a tax preparer. It costs more than doing it yourself, but I find we often discount the cognitive cost of just doing a thing when considering whether to outsource stuff.
In other words, build / use systems to minimize the impact of your own limitations on your responsibilities.
However, if you are finding this to be a consistent and long term issue please see a councilor. They can help and diagnose far better than you will find here. If you find that gets put off as well, ask a friend or family member to help you make and keep the initial appointments. You may be surprised by the number of people that are willing to help free of judgement if you will let them.
Also sorry about the paywall - you can get the article either through sci-hub here http://sci-hub.tw/10.1016/S2215-0366(18)30227-X or you can email me and i'll send you a copy direct!
Question:
Why are you wasting your time?
Do you wish to apply a blanket cure for the unknown multitude causes of mental health issues?
Why do you think reductions in the self reported “mental health” of the general population is useful for people who have been hospitalized with mood disorders?
Don’t you think that people who lie about how much exercise they do also might be lieing to themselves about their mental health?
2- nope, and actually my entire research agenda has been around helping people find a treatment that is most likely to work for them specifically! (we also founded a company to bring the research to market- springhealth.com)
3- that is beyond the scope of the paper, and we didnt use the word hospitalized once
4- yep, and thats a good example of one of the pitfalls of self-reported surveys. in general, i am a bit less cynical and in our experience, most people aren't filling out surveys to intentionally lie or sabotage.
hope this helps!
You want to bring the research to market, not help the mentally ill. You goal is profit.
For the 20 I have been “cared for” by people like you it took my own ingenuity and relentless pressure on a psychiatric system that thinks there is never a nutritional cause to mood disorders to have them test me for a biotinidase deficiency which turned up positive. My mood issues were cured by 15 grams of biotin a day.
Researched and doctors like you were so certain what caused my depression and anxiety you filled me with pills that rarely worked and diabled me with side effects. It took 15 years to even test me for a B12 or iron deficiency.
So sorry, but your study does not help the mentally ill. Maybe it helps people who are stressed from the everclenching fist of capitalism, but that’s about it.
we've had a wonderful positive response to this article, and people are overwhelmingly excited and motivated to try and exercise more because of it (even at relatively lower intensities or volumes -- every little helps). even if we are extremely cynical and say theres zero benefit of exercise for mental health, then people will still be getting known improvements regarding diabetes, stroke, cardiovascular disease. Nobody is advocating for exercise at the expense of alternative treatments like meds or therapy, this really is just a (potentially large) extra benefit.
:/
You established ZERO causality in your study! How can you even say you are a scientist and say this has a (potentially) large benefit?!
And you did not even distinguish between mental health and mental illness.
The fact that you are excited that you got a “positive response” from this article just tells me you are a neoliberal shill.
It also relied on self reported physical activity! Ha!
It is worthless to extract anything regarding mental heath and exercise from this study.
In other words, would I put the overview on the coffee table in my wife's office (she's a psychiatrist) for her patients to see? Yes.
Are you a sadist?
Let me give you a personal anecdote. I suffered depression and anxiety and fatigue for years. I tried to be active but it made me feel worse. Turns out I had late onset partial biotinidase deficiency. I take biotin, my depression and anxiety are gone and now I can work out like a normal person.
What good does this study do for people like me and the probably hundreds of thousands of people like me? I would in fact it harms people like me because it lays a simple cure over a complex and diverse issue.
Almost without exception, the people she sees are looking for ways to help move themselves forward. By the time they get here, they realize (and it's part of the education that goes with the practice) that mental illness is extremely complex, not every treatment helps everyone, and there's no single magic bullet. And yes, serious metabolic workups are a big part of the practice.
So while I appreciate your perspective, I take issue with the claim that (in this context) it is suggesting laziness as a cause for their illness, or sadism on my part.
I am telling you, as a person who suffered from suicidal depression, that seeing a pamphlet like that in the past would make me feel worse, not better. But why listen to me? I am only the patient.