Exercise Therapy To Prevent And Treat Depression

Research supports exercise for major depression. It may be an effective alternative for patients resistant to the currently available medications.

A comprehensive review of all the available therapies suggests that exercise is an effective intervention in  reducing depressive symptoms in patients with major depressive disorder (MDD), on its own and in conjunction with other treatments, such as antidepressant medication and psychotherapy.

The review in the May 2013 Journal of Psychiatric Practice, offers evidence-based recommendations for prescribing exercise, and addresses practical issues related to prescribing exercise in real-world treatment settings .

"Despite the substantial evidence supporting the use of exercise in the treatment of MDD, previous studies have not provided a clear indication of the proper dose of exercise needed to elicit an antidepressant effect," write Chad Rethorst, PhD, and Madhukar Trivedi, MD, of the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas. The authors therefore, sought to fill the void by reviewing the available data from controlled clinical trials. The goal was to formulate specific and detailed recommendations for clinicians on how to prescribe exercise for their patients with MDD.

What is the Evidence?

The available evidence suggests that aerobic exercise is preferable for patients with MDD. However, there is evidence for resistance training as well.

Recommendations for patients include: Three to five exercise sessions per week, for 45 to 60 minutes per session.

Aerobic exercise should be done to achieve a target heart rate that is 50 to 85 percent of the individual's maximum heart rate.

Resistance training recommendations include a range of upper and lower body exercises — three sets of eight repetitions at 80 percent of 1-repetition maximum, ie, 80 percent of the maximum weight that the person can lift in one go.

The experts provide data suggesting that health benefits are apparent in four weeks after initiating the exercise regimen. The patients noticed a distinct improvement in depressive symptoms. However, there is no room for complacency: for the greatest degree of benefit in terms of antidepressant effect, the exercise program should be continued for at least ten to twelve weeks.

Compliance is pretty high, as the reviewers note, stating that among "the studies they reviewed, only about 15 percent of patients dropped out of exercise programs; they are comparable to dropout rates in studies of medications and psychotherapy."

Strategies that may help improve adherence to exercise programs are quite a few: the choice of exercise is varied and consulting patients about what interests them and tailoring individualized educational and exercise regimen helps. Practical tips for clinicians on exercise intervention are always a boon, especially if it helps patient adherence.

"These findings suggest that exercise doses below the current recommendations may still be beneficial for patients with MDD," the authors write. They suggest that clinicians should encourage patients to proactively take to some  form exercise "even if they do not exercise enough to meet current public health recommendations."

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