Exercise should be ‘core treatment’ for depression – study

Exercise should be a “core treatment” for people with depression, academics have said, after a new study suggested that some forms of exercise were just as good as therapy and even better than anti-depressants.

Walking, jogging, yoga and strength training appeared to be more effective than other types of exercises, according to a major new analysis.

And the more vigorous the exercise, the better, according to a research team led by academics in Australia.

But even low intensity exercises such as walking and yoga had meaningful benefit.

The effect of exercise appeared superior to antidepressants, according to the study which has been published in The BMJ.

But when exercise was combined with antidepressants, this improved the effect of the drugs.

They also found that the benefit of exercise was comparable with that of cognitive behavioural therapy, but the quality of evidence supporting therapy was higher.

Researchers drew their findings from 218 clinical trials involving more than 14,000 people from multiple countries.

“Exercise is an effective treatment for depression, with walking or jogging, yoga and strength training more effective than other exercises, particularly when intense.

“Yoga and strength training were well tolerated compared with other treatments.

“Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression.”

They added: “These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.”

In a linked editorial, Professor Juan Angel Bellon from the University of Malaga, Spain, wrote: “Primary care clinicians can now recommend exercise, psychotherapy or antidepressants as standalone alternatives for adults with mild or moderate depression.

“The final choice depends on patient preference and other considerations, including any barriers to access.

“For adults with severe or treatment-resistant depression, the available evidence currently favours combined psychological and drug treatment.”

Dr Paul Keedwell, consultant psychiatrist and fellow of the Royal College of Psychiatrists, said: “This is a welcome review of the evidence supporting exercise as part of a holistic programme of treatment for depression. The power of exercise to lift mood is often overlooked.

“Social interaction might be almost as important as the physiological effects of exercise (with group activities such as yoga, dance and walking groups being particularly helpful), and context is probably important too, with additional benefits to be gained in green and natural environments.

“Many depressed individuals find exercise very challenging. But, taken together, the evidence supports exercise being an important part of a package of treatments for depression, and it will help with physical health too.”

Prof David Curtis, honorary professor at University College London (UCL), added: “Even moderate forms of exercise, such as walking, produced benefits, although the effects do seem to be stronger with more vigorous exercise.

“Overall, the effects of exercise seem as strong or stronger than for antidepressants or standard psychological treatments. Thus, the authors’ suggestion that exercise should always be recommended as part of the treatment package seems sensible.”

But Professor Michael Bloomfield, consultant psychiatrist at UCL, added: “Whilst this paper adds to the evidence that exercise is good for you, it is not possible to say at this stage that exercise on its own is better than existing treatments including medication and psychological therapies.

“When people experience more severe forms of depression simply offering exercise may not be completely helpful, for example, when someone is struggling to get out of bed let alone get to the gym.

“Depression is often caused by a range of factors and it is more helpful to think about the pros and cons of a range of treatments including medication, talking therapy and exercise, that can be offered to patients, rather than an unhelpful division of medication vs. talking therapy vs. exercise.”