by G. John Mullen | mullen@myhousecallmd.com
Go
to any gym across the country and you’re likely to find quite the
variety of folks “getting their workout on.” You may notice a couple
Tara Reid doppelgangers on the stair stepper who appear to have been
there for the past 12 hours, a cluster of guys wearing 1980’s style
muscle shirts swarming around the bench press, a few big-boned
characters “jogging” on the treadmill and, last but not least, a
smattering of normal folk trying to stay in shape. You can’t help but
wonder, “What motivates these people to exercise day in and day out?”
Is it pure physical gains? Psychological? Neuro-chemical? Social? The
answer is probably a combination of all of the above. Of note,
however, is the psychological effect of exercise. We’ve all experienced
the endorphin-rich high after a good workout. What if we harnessed
that positive feeling…could it help with depression? This simplistic
yet promising thought has to have crossed the mind of a psychiatrist
somewhere.in the world. Well, it turns out is has. We decided to hit
the textbooks and scientific journals to get to the bottom of the issue.
Stat Fact: Depression affects 1 in 5 people during their lifetime.
After pouring through a pile of research
the size of the Sears Tower, this is what we found (feel free to skip
ahead of the stats if numbers are not your cup of tea) (IMAGE 2):
- Exercise is better than not exercising: Exercise has a large positive effect on people clinically diagnosed with depression when compared with no treatment.
- Exercise is equally as effective as Cognitive Behavioural Therapy and Anti-Depressants: When compared to typical depression treatment (cognitive behavioural therapy and anti-depressants), there was no difference between the two test groups.
- The beneficial effects of exercise are long-lasting: One study found 6 months after exercise nearly 90 percent of people with major depressive disorders maintained benefits.
- Correction: The beneficial effects of exercise are long-lasting ONLY if you continue to exercise: The benefits of exercise decreased following the intervention of exercise. In other words, the positive effects only last if you consistently exercise.
- Structured exercise seems to do the trick: All except one of the studies used supervised exercise, suggesting perhaps having someone to dictate a workout plays a role in the positive benefits.
- Combining resistance and aerobic exercise is better than only one type of exercise: Most improvement was noted in groups that combined aerobic and resistance training, compared to aerobic training alone.
- One study suggests that 45 minute sessions consisting of a 10 minute warm-up, 30 minutes of continuous aerobic exercise and 5 minutes of cool-down demonstrated greater improvements compared to medication and medication combined with exercise.
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We still don’t know the most effective approach to exercise: The frequency, duration, intensity and type of exercise are poorly understood in the equation.
These are some bold findings that are
seldom discussed in a psychiatrist’s office. In today’s medicine, you
rarely hear someone being prescribed “exercise” to treat anything but
obesity (which is not the best method to lose weight, by the way…think
diet) but as any regular exerciser knows, there is more to exercise than
controlling your weight. Are these neuro-chemical responses the
answer? People without depression benefit greatly from the
neuro-chemical response stimulated by exercise and many believe this has
a great deal to do with the positive benefits seen with depressed
people.
You may have heard of the post-exercise
euphoria referred to as an “endorphin rush” or “runner’s high.” This
term stems from the chemical believed to be responsible for that
characteristic feeling, the endorphin (short for endogenous morphine).
Endorphins are released from the pituitary gland and hypothalamus in
the brain in response to pain, exercise, excitement, love and orgasm.
Endorphins
are chemically similar to opiates and subsequently produce similar
effects including analgesia and a generalized feeling of well-being.
When released, endorphins bind to opioid receptors blocking the release
of specific neurotransmitters that are associated with pain. A German
study in 2008 found that endorphins concentrate in the limbic and
prefrontal region of the brains of runners (these areas are specifically
associated with emotion) following vigorous exercise. Endorphins
levels peak 30 minutes after the start of aerobic exercise at which
point you experience the classic euphoric sensation. While opiates
(think morphine and heroine) are extremely addictive, we have to
question the addictive nature of endorphins given that only about 15% of
Americans exercise regularly. If it was truly addictive, would you be
able to quit so easily?
While exercise is attractive in theory,
it can often be rather painful in actuality, especially for the
newcomers in the room. The discomfort of exercise is felt more
immediately than its benefits leading to poor compliance. The delayed
release of endorphins creates a lapse between the pain and the pleasure
elements of physical
activity. In a society raised on immediate gratification, it’s easy to
see why such a small percentage of Americans exercise regularly.
Now let’s get back to depression.
Depression causes individuals to feel lethargic and unmotivated. How on
earth do you convince this population to exercise even if it will
elevate their mood? The answer lies in the quick results they will
see. Anti-depressant medications can take weeks to months to take full
effect while the euphoria of exercise occurs 30 minutes into a training
session. As with any other population, if they receive positive
results, they are more likely to continue to exercise. At the same
time, we have to remember that compliance is the biggest issue with any
population when trying to implement an exercise program. It is naïve
to believe a depressed person will be more compliant because they know
the benefits of exercising. For this reason, a novel and more
regimented approach may be necessary. Exercising with a personal
trainer, attending regular group fitness classes or joining a
recreational fitness group are all ways to create accountability in your
fitness routine and increase the likelihood that you stick with a new
exercise program. The key here is to find a program you enjoy and then
create a strong sense of accountability so you stick with the program.
The Take Home Message:
A recent extensive review of literature
regarding exercise left health care professionals with this message,
“There is not accurate information about how effective exercise might
be, nor can recommendations be made about the relative benefits of
aerobic exercise, resistance exercise or mixed exercise, whether group
or individual exercises are better, nor about the optimum duration of
exercise. Given that the dropout rates from exercise can be substantial,
a pragmatic approach would be to recommend that patients choose a form
of exercise which they will enjoy; this may improve adherence and
increase the likelihood that people will continue exercise long-term.”
In layman’s terms, researchers do not know how much or what kind of
exercise to do for best results. They also don’t know what results to
expect when you do exercise. We do know, however, that exercise has a positive effect on depression and therefore should be a part of the treatment of all depressed individuals.
If you suffer from depression, talk to your psychiatrist, psychologist
or therapist about incorporating exercise into your treatment and let
the endorphins roll!
Questions? E-mail the Author: mullen@myhousecallmd.com
References
- Babyak M, Blumenthal J, Herman S, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000 Sep-Oct 2000;62(5):633-638.
- McGovern, MK. The Effects of Exercise on the Brain. Serendip.2002. Accessed: http://serendip.brynmawr.edu/bb/neuro/neuro05/web2/mmcgovern.html
- Mead G, Morley W, Campbell P, Greig C, McMurdo M, Lawlor D. Exercise for depression. Cochrane Database Syst Rev. 2009(3):CD004366.
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