My thoughts on exercise and depression

There is a lot more to be said and I’m really aware of my own experience biasing my opinions so do add your comments and thoughts.

The headline is misleading

The main frustration is the misleading nature of the headline. If you read the article, what patients were actually given was “advice on up to 13 separate occasions on how to increase their level of activity. It was up to individual patients what activity they chose to increase and by how much.”. The report – which you can read in full here – is actually investigating one particular method (the TREAD method) of encouraging depressed patients to increase their activity. This is a very different study than the one the headlines lead you to believe.

“vigorous activity is almost always experienced as unpleasant while it is performed but there is improved affect and pleasure shortly after finishing, perhaps resulting from endogenous opioid activity, the “runner’s high.” This might explain why some participants in the trial reported that physical activity helped to improve their mood. Perhaps an intervention that focused only on vigorous physical activity might be more effective, although we suspect that this would be less acceptable to participants and difficult or even impossible to sustain. A better understanding of the underlying mechanisms that might link physical activity and mood could lead to new therapeutic opportunities.”

Going by the headlines, many people would probably assume that this is what is being looked at in this piece of research.

The headline is potentially damaging

In my experience, when someone is low, and on a particular track of behaviour, it takes a stronger push to get them to try things – and the tiniest of nudges to keep them more firmly on the same path. For someone depressed, whose mind is perhaps not as open to new, creative suggestions and solutions to help them, a headline like this could prevent them from giving exercise a go. As someone who uses exercise to manage depression a lot, you need to believe that it’s going to help raise your mood because, in the moments before hand, you can’t feel that it is going to. You have to take that on trust and just get out of the door.

In addition, the research was funded by the Department of Health who now have reason not to fund this particular sort of ‘facilitated physical exercise’ on the NHS. We just have to hope that, given how it is reported, it is not used to back up more wider reaching decisions about exercise and depression.

This study looks at a way of including an encouragement to exercise as a treatment to aid recovery.  The idea of recovery itself is a complex one (I write a bit more about it in the first part of this post) and, for a lot of people their experience of depression is, for a long time, one of ongoing management or ‘maintenance’ rather than just illness and treatment. I’m sure many people would agree that exercise can play a really important role in that ongoing management, by acting as a stress or anxiety relief, enhancing mood and, among other things, giving you that temporary endorphin high, by getting you outside and making you feel healthier. This study seems to be presented very much from within the model of ‘illness and treatment’ rather than taking into account the place of maintenance and management in living with depression. This wouldn’t necessarily be a problem if the headlines didn’t become ‘exercise doesn’t help with depression’.

I’m a big fan of the theory and practice of Mindfulness Based Cognitive therapy . MBCT teaches you skills and practices to help you manage your thoughts and moods to prevent relapse. One of it’s fundamental ideas is that moods influence thoughts – that those people who have experienced depression in the past have learned associations between sad moods and negative destructive thoughts. Moods, if not checked, can lead people, almost unaware into negative thought patterns, ruminations and so potentially to a relapse. Exercise can play a role in being an initial ‘reponse’ to a low mood, thus contributing to stopping this destructive downwards spiral. In addition, making a conscious decision to do something and gaining the personal satisfaction of achievement is also something MBCT suggests can be a positive response to low mood – and one that exercise can provide.

Finally, on a personal level, the report frustrates me because what it claims flies completely in the face of my own experience. Without regular running and swimming, I could not operate on a day to day basis as I am currently able – it is one of my most valued tools for managing my mind. I notice that depressive thoughts and ‘the fog’ become more prevalent and difficult to manage after a few days without exercise and, even after years of exercising in response to low mood, am still amazed at the enormous shift in my mind, a calming and lightening of the air and an opening up of the positive, that takes place after I have exercised. 

Of course, I am not expecting all of these varied and complex elements to be covered in one piece of scientific research, but it would be more helpful and honest if headlines did not claim that it has.