In today's modern cities, the prevalence of so-called "wealthy diseases" is increasing. People are under immense pressure, both mentally and physically, leading to a sense of suffocation. Depression, once rare, is now becoming common among the wealthy, and it has become one of the most significant issues, even contributing to an increased tendency toward suicide. This has resulted in severe losses for families and society as a whole. From personal experience, the author of this article has discovered that exercise can be an effective way to prevent depression. Let us explore how movement can bring about a transformation.
As a child, my siblings and I often visited my father's sports lab on weekends. He was a cardiologist and exercise physiologist, and his lab was filled with treadmills and bicycle ergometers. When we rode bicycles or ran on imaginary mountains, he connected us to an electrocardiogram and had us breathe through a plastic tube to measure our oxygen consumption. From a young age, we were taught the importance of aerobic exercise, which helps prevent heart disease, high blood pressure, and stroke. These principles have always been central to medicine.
When I began studying psychiatry, I noticed that exercise was not considered a key part of treating depression or other mental illnesses. It was as if there was a clear separation between mind and body. At least in the early 1980s, psychiatric treatment focused mainly on the mind, with little attention given to the body and brain.
However, by the 1990s, exercise began to gain recognition as a potential aid in treating depression and anxiety. Psychiatrists and psychologists occasionally suggested their patients engage in more physical activity, such as running or going to the gym. While not harmful, it was believed that such activities could help those struggling with anxiety, stress, and physical tension. Some studies even indicated that regular exercise might improve symptoms of depression.
Now, with accumulating data, the benefits of exercise—such as yoga and meditation—are increasingly integrated into standard treatment plans. However, the best way to incorporate these practices into daily life remains unclear. For instance, what level of exercise is needed to help with depression? Is it a preferred treatment or an additional one? Who benefits the most? And what is the best way for those suffering from depression to maintain a consistent exercise routine?
Researchers at the University of Texas Southwestern Medical Center, Chad Rethorst and Madhukar Trivedi, reviewed the literature on exercise, analyzing factors such as dosage, duration, onset of action, possible side effects, and how to combine it with other treatments. They proposed structured exercise prescriptions that mental health professionals can use to guide their patients.
Can exercise help alleviate depression? The answer is encouraging. Exercise is a powerful antidepressant, with effects comparable to SSRIs (selective serotonin reuptake inhibitors). It can be an effective standalone treatment, helping those who only partially respond to SSRIs achieve better results and prevent relapse.
However, achieving full antidepressant effects through exercise requires a high level of commitment, often several times a week. Other therapies may take weeks to show full benefits. Additionally, motivating oneself to start and maintain an exercise program is challenging.
How long does it take for the effects of exercise to become noticeable? Studies like the TREAD trial suggest that higher levels of exercise, such as 16 kcal per week, yield better results than lower levels. Participants in high-intensity groups showed greater improvement in depression symptoms compared to those in low-intensity groups.
Despite the benefits, adherence to high-intensity programs remains a challenge. In the TREAD study, two-thirds of participants followed the program initially, but only about one-third maintained it after three months.
How intense should your workouts be? Before starting any exercise program, consult a doctor to ensure it’s safe for you. A general target is to reach 60-80% of your maximum heart rate, calculated as 220 minus your age. For example, a 30-year-old should aim for a heart rate of 114-162 beats per minute.
Another way to assess intensity is the RPE (Rating of Perceived Exertion) scale, ranging from 6 (rest) to 20 (maximum effort). Multiply the RPE by 10 to estimate your heart rate. For instance, an RPE of 12 corresponds to approximately 120 beats per minute.
Doctors can prescribe exercise as part of treatment, using resources like the PDF prescription available on Exerciseismedicine.org. Motivational interviews (MI) can also help people change behavior, guiding them through stages such as intention, thinking, preparation, action, and maintenance.
For those with depression, setting specific, achievable goals using SMART criteria (Specific, Measurable, Achievable, Relevant, Time-bound) can help integrate exercise into daily life. Even small amounts of exercise are better than none, and tools like pedometers, fitness trackers, and mobile apps can support tracking progress.
In summary, exercise has become a mainstream approach in treating depression and other mental illnesses. Although more research is needed, we already have effective tools to use exercise as a treatment. From the smoke-filled psychiatric clinics of the 1970s and 1980s to today, we’ve come a long way. Some researchers suggest that exercising in natural environments, like running in the forest instead of a gym, can offer additional benefits. Morning walks outside, where sunlight itself has a powerful antidepressant effect, can also be beneficial.
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