Exercise is even more effective than counseling or medication for depression. But how much do you need? | Fitness

TThe world is currently grappling with a mental health crisis, with millions of people reporting depression, anxiety and other mental illnesses. According to recent estimates, nearly half of all Australians will experience a mental health disorder at some point in their lives.

Mental disorders have a high cost to both the individual and society, with depression and anxiety being among the leading causes of health-related disease burden. The Covid pandemic is exacerbating the situation, with a significant rise in mental health complaints affecting a third of people.

While traditional treatments such as therapy and medication can be effective, our new research highlights the importance of exercise in managing these conditions.

Our recent study published in the British Journal of Sports Medicine reviewed more than 1000 studies on the effects of physical activity on depression, anxiety and mental health problems. It showed that exercise is an effective way to treat mental health problems – and can be even more effective than medication or counseling.

Harder, faster, stronger

We reviewed 97 review papers, involving 1,039 trials and 128,119 participants. We found that 150 minutes a week of various types of physical activity (such as brisk walking, weight lifting, and yoga) significantly reduced depression, anxiety, and mental health problems compared to usual care (such as medications).

The greatest improvements (as self-reported by participants) were seen in people with depression, HIV, kidney disease, in pregnant and postpartum women, and in healthy individuals, although clear benefits were seen across all populations.

We found that the higher the exercise intensity, the more beneficial it is. For example, walking at a brisk pace, instead of walking at the usual pace. And six to 12 weeks of training has the greatest benefits, rather than shorter periods. Long-term exercise is important for maintaining improvements in mental health.

How much more effective?

When comparing the magnitude of the benefits of exercise with other common treatments for mental illness from previous systematic reviews, our findings suggest that exercise is approximately 1.5 times more effective than medication or cognitive behavioral therapy.

In addition, exercise has additional benefits compared to drugs, such as a lower cost, fewer side effects, and bonus physical health gains such as a healthier body weight, improved cardiovascular and bone health, and cognitive benefits.

Exercise is cheaper than medication, with fewer side effects.

Why it works

Exercise is believed to affect mental health through multiple pathways and with short- and long-term effects. Immediately after exercise, endorphins and dopamine are released in the brain.

In the short term, this helps improve mood and buffer stress. In the long term, the release of neurotransmitters in response to exercise promotes changes in the brain that help with mood and cognition, reduce inflammation and boost immune function, all of which affect our brain function and mental health.

Regular exercise can lead to better sleep, which plays a vital role in depression and anxiety. It also has psychological benefits such as increased self-esteem and a sense of accomplishment, all of which are beneficial for those struggling with depression.

Not such an ‘alternative’ treatment

The findings underline the critical role of exercise in managing depression, anxiety and mental health problems.

Some clinical guidelines already recognize the role of exercise – for example, the Australian and New Zealand clinical guidelines suggest medication, psychotherapy and lifestyle changes such as exercise.

However, other leading bodies, such as the American Psychological Association Clinical Practice Guidelines, only emphasize medication and psychotherapy and list exercise as an “alternative” treatment – in the same category as treatments such as acupuncture. While the label “alternative” can mean many things when it comes to treatment, it often suggests that it falls outside conventional medicine or lacks a clear evidence base. None of these things are true in the case of exercise for mental health.

Even in Australia, medication and psychotherapy are more often prescribed than exercise. This may be because exercise is difficult to prescribe and monitor in clinical settings. And patients can be resistant because they have little energy or motivation.

But don’t do it alone

It is important to note that while exercise can be an effective tool for managing mental illness, people with mental illness should work with a health professional to develop a comprehensive treatment plan – rather than going alone with a new training regimen.

A treatment plan may include a combination of lifestyle approaches, such as exercising regularly, eating a balanced diet, and maintaining social contacts, in addition to treatments such as psychotherapy and medication.

But exercise should not be viewed as a “nice to have” option. It’s a powerful and accessible tool for managing mental illness – and the best part is that it’s free and offers many additional health benefits.

• Ben Singh is a research fellow at the University of South Australia. prof. Carol Maher is an emerging leader of a future fund for medical research at the University of South Australia. Jacinta Brinsley is a postdoctoral fellow at the University of South Australia

• This article originally appeared on The Conversation