Exercise Therapy

Most of us have heard “exercise is good for us" but we tend to think this applies primarily to physical health. Actually, extensive research has demonstrated that exercise also has a direct beneficial effect on many aspects of mental health as well as indirect benefits.

For example, depression, the most common psychiatric affliction, is profoundly affected by exercise. One researcher commented that if exercise could be put into a pill and the public knew what a powerful antidepressant effect exercise had, everyone would be asking their doctor for "a prescription" for it. One study (by Dr James A Blumenthal and others from Duke University) even suggests that the effects of exercise on clinical depression is not only as effective as medication but may be longer lasting. In this study researchers followed 3 groups: medication only, exercise only, and medication plus exercise. All 3 groups showed significant improvement in their mood to about the same extent after 8 weeks of treatment.

One might have thought that if both exercise and medication are effective antidepressants, that the combination of the two would be even stronger but that's not what happened. In fact in a longer term follow up arm of the study turned out even more interesting: when subjects who had significant improvement in the first phase of their study were assessed after an 12 additional weeks, the “exercise only” group was least likely of the 3 groups to suffer a relapse of their depression.

We could speculate why the results turned to this way but the bottom line is that exercise clearly has an antidepressant effect which rivals that of medication and not only has few, if any, side effects but numerous "side benefits" as well. For more on that see below.

Readers should note that the "dose" of exercise required for an antidepressant effect is usually not trivial, i.e. we need to do more than just take a stroll around the block. The study mentioned above involved 30 minutes, 3-4 times per week of rather intense exercise: 80% of maximum effort on a treadmill. On the other hand, you shouldn’t let this level of intensity scare you away from starting an exercise program; anything is better than letting oneself become a “couch potato”. Just start from where you are and build your activity up slowly. Get moving!--you’ll be glad you did and your family will probably support you in the endeavor.

Depressed individuals often lack motivation and those in research studies exercise in a group, at least initially. If you or your friend or family member are suffering from depression, it may necessary to involve an exercise partner or join a class at the local gym. Also, its always best to check with your physician before starting on a rigorous exercise program and its also important to start at a comfortable level and gradually build up the intensity to avoid injury.

“Panacea” may be a bit of an overstatement, but in order to understand how many direct and indirect effects (“side benefits”) exercise can have, consider the hypothetical case of this 55 year old male---we’ll call him John. The case also illustrates how a more “holistic”, or natural approach to mental health care which includes exercise, can have wide-reaching benefits. John is typical of many patients these days with multiple complaints. He comes in for an initial consultation complaining of depression, insomnia with daytime fatigue, chronic low back pain and a 25lb weight gain in the last 4 months. In addition his primary care physician has just started him on medication for gastric acid reflux and the doctor also told him his labs show a ‘prediabetic condition’. All this is increasing his anxiety.

As a consulting psychiatrist, I could prescribe an antidepressant, possibly with an antianxiety agent and also a ‘sleeping pill’. Then, after setting another appointment, I could just send John on his way. It wouldn’t take long do this and few of my colleagues would question this strategy.

The risks of this “medication only” strategy deserves a discussion of its own but lets consider the potential benefits of a more holistic approach, in this case engaging John in a discussion about starting an exercise program. Here are some of the possible beneficial consequences in his case:

  1. the direct effect of exercise itself lessens John’s depressed mood within a few weeks;
  2. even before this direct physiologically-based effect, his anxiety level drops, he starts sleeping better and he finds he is no longer tired during the day; this allows him to accomplish during the day which in itself leads to better mood
  3. within a month he notices that he has lost 5 lbs and this boosts his self esteem.
  4. due to better digestion and elimination since starting to exercise, he no longer experiences gastric reflux; he also is pleasantly surprised to note that his back pain is better (the basis for this effect is that joints don’t get direct blood flow but benefit from increased indirect blood flow when we exercise; this allows more efficient delivery of nutrients as well removal of waste products from joints and thus decreased pain)
  5. when he meets with his primary care provider two months after starting his exercise program, to let him know he doesn’t need the medication of gastric reflux anymore the doctor also tells him his Hemaglobin A1c, (which estimates average blood sugar levels) has dropped into the normal range, i.e. he is no longer in the “at risk” category for diabetes.

This case, while hypothetical, is not unusual and many people have noticed at least some of these benefits once they start a regular exercise program. In this age of “direct to consumer” advertising for pharmaceuticals we are barraged with TV ads containing happy, healthy looking people associated with the use of various antidepressants and other drugs and which often end with the catch phrase “ask your doctor if [drug X] is right for you”. Wouldn’t it be refreshing to see an ad that showed a couple jogging or doing aerobics with the statement: ”ask your doctor if exercise is right for you”?

As a physician and a psychiatrist who has studied the effects of exercise and who also practices what he preaches on a daily basis, I can assure that at least some level of exercise IS right for you. And I encourage you to get started on a program of regular exercise today.

James L. Fleming, M.D.
Board Certified Psychiatrist