In today's world, there is a growing prevalence of so-called "wealthy diseases" in urban areas. People are under immense pressure from both spiritual and material aspects, leading to a sense of suffocation. Depression, once rare, is now becoming more common among the wealthy, and it has become one of the most serious mental health issues. In some cases, this can even lead to suicidal tendencies.
This issue has caused severe losses at both the family and societal levels. The author of this article draws from personal experience to show that exercise is an effective way to prevent depression. Let us explore how movement can help people find a new beginning.
When I was a child, my siblings and I often visited my father’s sports laboratory on weekends. He is a cardiologist and exercise physiologist. His lab was filled with treadmills and bicycle ergometers. While we rode bicycles or ran on imaginary hills, my father connected us to an electrocardiogram and had us breathe through a plastic tube to measure our oxygen consumption. From an early age, we were taught the importance of aerobic exercise, which can help prevent heart disease, high blood pressure, and stroke. These principles have always been fundamental in medicine.
When I started studying psychiatry, I found that exercise was not given much attention in the treatment of depression or other mental illnesses. This separation seemed strange to me. At least in the early 1980s, psychiatric treatment was mostly focused on the mind, with little attention paid to the body and brain.
However, a decade later, in the 1990s, exercise began to be recognized as potentially beneficial for treating depression and anxiety. Psychiatrists and psychologists occasionally recommended that their patients engage in more physical activity, such as going for a run or joining a gym. It wasn't harmful, and we believed that this could help those struggling with anxiety, stress, and physical tension. Perhaps they would feel better if they could go outside for fresh air or sweat on an elliptical machine. Some studies even suggested that regular exercise might improve symptoms of depression.
Today, with accumulating data, the benefits of exercise—such as yoga and meditation—have become increasingly part of standard treatment. However, the best way to incorporate these into daily life is still unclear. For example, how much exercise is needed to help with depression? Is it a preferred treatment that can replace medication, or just an additional therapy? Who benefits the most? And what is the best way for depressed individuals to maintain a regular exercise routine?
Researchers at the University of Texas Southwestern Medical Center, Chad Rethorst and Madhukar Trivedi, reviewed the literature on exercise, evaluating factors such as dosage, duration, onset of action, possible side effects, and how to combine it with other treatments. They proposed exercise prescriptions that mental health professionals can use to guide their patients.
Can exercise help with depression? The answer is encouraging. Exercise is a powerful antidepressant, with effects comparable to SSRIs. It is an effective treatment on its own and can help those who only partially respond to SSRI medications achieve better results and prevent relapse.
However, achieving full antidepressant effects through exercise requires high-intensity workouts several times a week. Other therapies may take weeks to show full effects. Additionally, motivating oneself to start and maintain an exercise program can be challenging.
How long does it take for exercise to show effects? Studies like the TREAD trial showed that higher amounts of exercise led to better outcomes. For instance, 28% of participants in a high-intensity group experienced relief after three months, compared to 15% in a low-intensity group. Another study by Dunn and colleagues found similar results, with higher-intensity exercise showing better antidepressant responses.
But can people stick to high-intensity programs? In the TREAD study, about two-thirds of participants in the high-exercise group complied, but only one-third continued after three months.
How intense should your workout be? Before starting any program, consult a doctor. A general target is to reach 60-80% of your maximum heart rate, calculated as 220 minus your age. Alternatively, you can use the RPE scale (Rating of Perceived Exertion), where 6 is rest and 20 is maximum effort.
Doctors can prescribe exercise as part of treatment. Resources like Exerciseismedicine.org offer printable prescriptions.
If motivation is low, motivational interviewing can help. Prochaska and DiClemente identified five stages: precontemplation, contemplation, preparation, action, and maintenance. Support during the first six months is crucial for long-term success.
Depressed individuals can adapt these suggestions by setting SMART goals—specific, measurable, achievable, relevant, and time-bound. Even small steps matter, and tools like pedometers or fitness apps can track progress.
Is a small amount of exercise better than none? Definitely. Even 3-5 sessions per week for 45 minutes to an hour can provide significant benefits. Rethorst and Trivedi suggest that even less than current recommendations can still help most patients.
In summary, exercise has become a mainstream treatment for depression and other mental health conditions. Although more research is needed, we already have many tools to help treat depression through physical activity. From the smoke-filled psychiatric clinics of the 1970s and 1980s to today, we've come a long way.
Other suggestions include exercising in natural environments, such as running in the forest instead of a windowless gym. Morning walks in the sun can also have a strong antidepressant effect.
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