If you’ve ever heard anyone say ‘training is my therapy’, they might not be exaggerating.
More is being understood about the power of exercise on positive mental well-being, to the point where some researchers now believe it may be at least as effective as other common treatment approaches for conditions such as major depressive disorder.
Originally, the advice around exercise and mental health suggested it was just good practise and a nice compliment to traditional treatment modalities. Now, it’s moving into the realms of legitimate treatment approach.
In fact, researchers more recently hypothesised that exercise even holds promise as an option in those that are resistant to other forms of treatment, like medication and psychotherapies.
If exercise can be deemed an effective treatment option for mental health issues like major depressive disorder, then it stands to reason that an understanding of which exercise approaches and in what doses needs to be established.
Background
Till recently, Western health guidelines around exercise for mental health appeared not to take exercise as seriously as a treatment option for depression as it should have.
For example, British guidelines recommend ‘group exercise programmes’ and offer general recommendations to increase any form of physical activity. The American Psychiatric Association recommends any dose of aerobic exercise or resistance training. Australian and New Zealand guidelines at least suggest a combination of strength and vigorous aerobic exercises, with at least two or three bouts weekly.
Not a great deal of specificity and direction there, but encouraging to see Australian and New Zealand guidelines offering more specificity in terms of weekly expectations.
In order to move the understanding around fitness and mental health, research has needed to dig deeper and uncover the specific connections between the two domains, and the treatment potential of exercise and its positive impact on mood.
A recent Australian-based systematic review sought to determine the specific exercise modalities, but also the doses that are best for treating depression. Even the language around those measures shows a theoretical shift in the thinking around exercise as treatment.
Further to this, they explored exercise’s potential as a treatment for major depressive disorder — again, not just about mood in a general sense but depression in a clinical setting. They also compared bouts of specific training types to the measurable effects of psychoanalysis, antidepressant medication, as well controls.
The Study and its Findings
To be eligible for inclusion, previous studies had to be randomised controlled trials that included exercise as a treatment for depression and included participants who met the criteria for major depressive disorder, either clinician diagnosed or identified through participant self-report as exceeding established clinical thresholds.
The results were quite significant. The study showed reductions in depressive symptoms for walking/jogging, yoga, and strength training. The impacts of the activity on mood increased as the intensity of the exercise increased, with strength training and yoga showing strong outcomes in this regard.
Interestingly there were both age and sex differences in the results also, with women showing greater positive impacts from strength training, while men saw more pronounced impacts from yoga. Strength training also appeared more effective in younger age groups, and aerobic exercise saw its greatest impact when paired with psychotherapies in older demographics.
The Takeaways
There are a number of key takeaways from the results, and as always, more research is required to gain a better understanding.
The outcomes would suggest that any gender biases around specific training modalities could be to the detriment of population mental health. It would appear that more men should be attending yoga classes and more women should get out on the gym floor.
Intensity also appears to be another key metric. Regardless of whether you are going for a walk and free squatting, ensure you’re upping your effort markers.
One of the interesting findings from the recent ACSM Industry Trends report was there appears to be a movement within the fitness industry calling for governments to subsidise exercise and personal training as part of its spending on health. And based on this study’s findings, perhaps this view has merit.
In Australia, the government has been subsidizing psychological counselling sessions for some time. The demand for psychological treatment is as high as it’s ever been, with some reports stating that people are waiting months to see a therapist under the scheme.
Could a subsidised exercise program which includes personal training help alleviate the pressure on the mental health system, while delivering even better results for sufferers? It’s a view that is certainly gaining momentum.
But what is clear is that training, and likely a combination of aerobic, strength and yoga is the magic mix for maximising its mental health boosting properties.
So the next time you hit the gym for a weights session or cardio, maybe check out the yoga classes as well. And if you’ve ever been heading into a yoga class and you’ve looked out over the gym floor and wondered what it would be like to give the weights a go, it could be time to have a chat with one of the resident PTs.
And if you’re thinking about signing up at a new gym, ensure they have a range of offerings, from classes to a well-appointed gym floor. Your mental health might depend on it.
Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, del Pozo Cruz B, van den Hoek D et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials BMJ 2024; 384 :e075847 doi:10.1136/bmj-2023-075847
