Exercise Does Not Make You Less Depressed
bmj.com
bmj.com
The report does not say "exercise does not make you less depressed".
The report mentions some of the weaknesses; some comments to the article do a good job at pointing out other weaknesses.
Exercise is not just pushed at people with depression to treat that depression; it's to help with other stuff too:-
* medication side effects (sometimes include weight gain or overeating)
* improving social life
* improving general health
"Results: There was no evidence that participants offered the physical activity intervention reported improvement in mood by the four month follow-up point compared with those in the usual care group; adjusted between group difference in mean Beck depression inventory score −0.54 (95% confidence interval −3.06 to 1.99; P=0.68). Similarly, there was no evidence that the intervention group reported a change in mood by the eight and 12 month follow-up points. Nor was there evidence that the intervention reduced antidepressant use compared with usual care (adjusted odds ratio 0.63, 95% confidence interval 0.19 to 2.06; P=0.44) over the duration of the trial. However, participants allocated to the intervention group reported more physical activity during the follow-up period than those allocated to the usual care group (adjusted odds ratio 2.27, 95% confidence interval 1.32 to 3.89; P=0.003)."
re exercise not being perscribed for depression. Current belief in Positive Pyschology circles (the founder of which invented the above mentioned Beck depression inventory) includes exercise acting as a treatment for depression.
"Besides training new habits and antidepressants, getting better exercise and a healthier diet have proven to have strong effects on mood. In fact, exercise is sometimes called the "miracle" or "wonder" drug - alluding to the wide variety of proven benefits that it provides.[55][56]" -- http://en.wikipedia.org/wiki/Positive_psychology
And it disagrees with the results of many, many other studies, some of which even quantify the exercise done instead of just relying on self-reported number of days of exercise.
http://scholar.google.com/scholar?q=exercise+and+depression&...
It's always a stretch to over-generalize to "everyone", or the more annoying "you", from the results of a study when the effect on all people is not going to be the same.
> Nor was there evidence that the intervention reduced antidepressant use
People are recommended to stay on anti-depressants for at least 6 months after feeling well, and for at least two years if they're at risk of relapse.
(http://publications.nice.org.uk/depression-in-adults-quality...)
So it's difficult to use antidepressant use as a guide to whether people feel recovered or not.
It's also unclear whether the intervention offered matches current NICE guidelines, which says
> 1.4.2.4 Physical activity programmes for people with persistent subthreshold depressive symptoms or mild to moderate depression should:
> * be delivered in groups with support from a competent practitioner
> *consist typically of three sessions per week of moderate duration (45 minutes to 1 hour) over 10 to 14 weeks (average 12 weeks).
About prescription: Yes, some people think exercise is a wonder drug. I'm not interested in those people unless they're treating patients. Your wikipedia article says:
> While positive psychology can inform clinical psychology, it is not helpful to stretch beyond this point
I live in the UK. Clinicians should refer to the NICE guidance. The NICE guidance is pretty specific about what constitutes physical exercise. That's because the evidence for exercise isn't great. The Cochrane review (http://summaries.cochrane.org/CD004366/exercise-for-depressi...) has a good summary of the evidence - when you only include high quality reviews there's only small benefits from exercise.
But, even if the benefit for depression from exercise is slim there are other reasons to do exercise, and it's important that people are helped to exercise, especially if they're at risk of self-neglect.
More research is needed. It's great that this study has been done. But it's incredibly frustrating that this one study is reported in terms such as "Exercise does not help depression".
EDIT: I wanted to add that exercise also has a great effect on my mood, but only temporarily. By following a consistent diet that (in my case) is low glycemic and high in protein, the stability of my mood was much greater than exercise alone.
I do not have time to read the whole paper right now, but one question I have about the results is the prescribed exercise. In my experience, the type of exercise I do can have very different affects in how it makes me feel afterwards. For example, my mood is stabilized for much longer if I do 15 minutes of interval sprints rather than a 30 minute run. Cycling will also make me feel much different than high-weight/low-rep weightlifting.
What I am getting at is that if the "exercise" routine was run for 30 minutes 2 time a week, I could easily see how that would not affect depression. However, if it was a regime of HIIT or heavy compound exercises (squat/deadlift/bench), I would be very surprised if people didn't see long term mood benefits.
I do notice however, that regular exercise helps with my stress-coping ability.
I think you imply in your comment that "self-motivated exercise" is better than "externally facilitated". If that is true then we can start worrying less about selling the idea of exercising and more about thinking how to motivate a depressed individual.
On the other hand, if both cases of exercising offered the same results then we could say that it's not the motivation but the exercise itself who's helping us.
But going hard, and really pushing my body and pushing myself beyond my preconceived limits has done wonders. There have been times when getting that "runner's high" feeling has completely sidelined the depressive state I've been in. When it happens, I'm still astonished at how much that endorphin release can really make a difference to my mental well being. I realise this is all only anecdotal, with a sample size of one! But I believe runner's high is a recognised phenomenon:
Some stuff happened that made me stop exercising. It's been several months. I am generally kind of mopey, lethargic, and unhappy with myself. And putting on weight, which only makes me grumpier.
YMMV.
I just made sure I was going for at least 30 mins and just listening to some music with no real goal in terms of fitness.
Eventually I just got to the point while walking that I would get little energy bursts and turn it into a jog instead of a walk. Now I'm working my way through one of the couch to 5K style apps and loving it.
Forcing myself out the door the first few times was really key though (regular times I could stick to easily was great as well)
> The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone.
I wonder, did they think this was a good idea, or did they see no other way for the clinician to increase the incentive to do physical activity?
Any depressed entrepreneur out there: if you're thinking about exercise, do it! Outdoors if you can, but by any means, listen to Nike: just do it!
Anecdotally speaking, lifting heavy weights vastly improves my mood. This is in contrast to, say, cardio, which simply makes me feel tired. I wish the study had accounted for this too.