Exercise for Mental Health: Depression and Anxiety

Regular exercise is fast becoming a safe, healthy and affordable way to manage and treat depression, anxiety and other mental health conditions. Whether it is used as an alternative to medication or as an adjunct to medication, a growing amount of evidence is showing strong correlations between exercise and lower symptoms of depression and anxiety (Brukner & Khan, 2012). 

Depression was ranked as the fourth largest health problem in the world by the World Health Organisation (WHO) in 2000 (Brukner & Khan, 2012). Since then, the number of people diagnosed with depression have continued to climb. For this reason, there has been a strong focus on finding safe, healthy and affordable ways to treat and manage depression. Over 100 cohort studies have found that regular exercise can reduce the onset of depression (Brukner & Khan, 2012). Regular exercise can also reduce symptoms of depression and help to reduce depressive episodes in people already diagnosed with depression (Brukner & Khan, 2012). 

When compared to antidepressant medication, exercise treatment is superior in the treatment of mild-moderate depression (Carek, Laibstain & Carek, 2011). Using exercise treatment in addition to antidepressants can be effective in further reducing depressive symptoms when compared to antidepressants alone (Carek at al, 2011). In addition to superior symptom management, exercise treatment can have far less negative side effects when compared to medical treatment of mental health conditions. 

Like depression, anxiety disorders are a cluster of highly prevalent mental health conditions in people around the world. It is estimated that close to 20% of people will experience an anxiety disorder at one point in their life (Brukner & Khan, 2012). Anxiety disorders can be transient or persistent and are twice as common in women as they are in men (Brukner & Khan, 2012). “Anxiety disorders broadly include phobias, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, as well as the generalized anxiety disorders” (Brukner & Khan, 2012). 

Regular exercise, keeping with WHO recommendations, has been shown to decrease likelihood of a diagnosis of an anxiety disorder and reduce symptoms of a previously diagnosed anxiety disorder. 

How does exercise treat mental health conditions?

The exact reason why exercise can be used so effectively to treat mental health conditions is not fully understood. It is believed to be a combination of changes in the brain’s neurotransmitters, release of endorphins that can make you feel good, increase in positive thoughts, emotions and self-confidence as well as the ability for people to take treatment into their own hands and have control over their mental health (Brukner & Khan, 2012). Furthermore, evidence shows that inactivity can actually lead to increased risk of developing a mental health condition (Carek at al, 2011). 

What type of exercise and how much?

Most studies have shown that keeping with the WHO recommendations for physical activity have been sufficient to treat mental health conditions. Based upon the WHO recommendations, Brukner and Khan (2012) recommend the following exercise guidelines for both preventive and rehabilitative management of depression and anxiety.

  • Aerobic Exercise: 150 minutes in 2 or more sessions per week.

  • Strength/resistance/weight training: 2 or more sessions per week, 30-60 minutes per session.

Aerobic exercise usually involves using large muscles repetitively in a way that increases your heart rate and aerobic endurance. Aerobic exercises can include:

  • Brisk walking, 

  • Hiking, 

  • Running, 

  • Cycling, 

  • Swimming, 

  • HIIT classes, 

  • Aerobic dancing such as Zumba, and

  • Cross-country skiing.

Strength/resistance/weight training involves contracting groups of muscles as well as specific muscles in isolation to increase lean muscle tissue. Specific strength and endurance parameters (frequency, intensity, duration, reps, sets and rest time) can be used in order to achieve the desired physiological effects and reduce risk of injury during this type of training. Strength/resistance training can include: 

  • Free weights, dumbbells, kettlebells and medicine ball training,

  • Circuit weight machines,

  • Resistance band training, and 

  • Clinical Pilates and reformer Pilates. 

Whilst starting a new exercise program can be fun and exciting, it is important to remember that sudden and uncontrolled increases in physical activity can be detrimental to muscles, tendons and ligaments and can lead to overuse injuries if not managed appropriately. It is important to consult with your physiotherapist, sports specialist or family doctor before making any big changes to physical activity levels to ensure you do so in a safe and healthy way. A physiotherapist can work with you to determine what type of exercise and exercise parameters will be best suited to your body. Together you and your physiotherapist can build safe exercise progressions to allow you to reach your exercise goals whilst minimizing your risk of overuse injuries. 

References:

Brukner, P., & Khan, K. (2012). Clinical Sports Medicine 4th Edition. Australia: McGraw-Hill Education Pty Ltd

Carek, P. J., Laibstain, S. E., & Carek S. M. (2011). Exercise for the treatment of depression and anxiety, PubMed 41(1). https://doi.org/10.2190/PM.41.1.c

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