Exercise and Depression: It’s Complicated

By Neuroskeptic | November 30, 2010 6:25 pm

Some ideas seem so nice, so inoffensive and so harmless, that it seems a shame to criticize them.

Take the idea that exercise is a useful treatment for depression. It’s got something for everyone.

For doctors, it’s attractive because it means they can recommend exercise – which is free, quick, and easy, at least for them – instead of spending the time and money on drugs or therapy. Governments like it for the same reason, and because it’s another way of improving the nation’s fitness. For people who don’t much like psychiatry, exercise offers a lovely alternative to psych drugs – why take those nasty antidepressants if exercise will do just as well? And so on.

But this doesn’t mean it’s true. And a large observational study from Norway has just cast doubt on it: Physical activity and common mental disorders.

The authors took a large community sample of Norwegian people, the HUNT-2 study, which was done between 1995 and 1997. Over 90,000 people were invited to take part and full data were available from over 40,000.
What they found was that there was an association between taking part in physical exercise as a leisure activity, and lower self-reported symptoms of depression. It didn’t matter whether the activity was intense or mild, and it didn’t really matter how often you did it: so long as you did it, you got the benefit.
Crucially, however, the same was not true of physical exercise which was part of your job. That didn’t help at all, and indeed the most strenuous jobs were associated with more depression (but less anxiety, strangely).

How does this fit with the very popular idea that exercise helps in depression? Well, many randomized trials have indeed
shown exercise to be better than not-exercize for depression
, but the problem is that these trials are never really placebo controlled. You can usually tell whether or not you’re going jogging in the park every morning.
So the direct effects of exercise per se are hard to distinguish from the social and psychological meaning of “exercise”. Knowing that you’re starting a program of exercise could make you feel better: you’re taking positive action to improve your life, you’re not helpless in the face of your problems. By contrast, doing heavy work as part of your job, while physiologically beneficial, is unlikely to be so much fun.
This doesn’t mean that telling people to get more exercise isn’t a good idea, but if the meaning of exercise is more important than the physiology, that has some big implications for how it ought to be used.

It’s good news for people who just can’t take part in strenuous physical exercise because of physical illness or disability, something which is quite common in mental health. It suggests that these people could still get the benefits attributed to exercise even if they did less demanding forms of meaningful activity.

But it’s bad news for doctors tempted to default to “get out and go jogging” whenever they see a potentially depressed person. Because if it’s the meaning of exercise that counts, and you recommend exercise in a way which sounds like you’re dismissing their problems, the meaning will be anything but helpful.

In clinical trials of exercise, the exercise program has, almost by definition, a positive value: it’s the whole point of the trial. And the participants just wouldn’t have volunteered for the trial if they didn’t, on some level, think it would make them feel better.

But not everyone thinks that way. If you go to your doctor looking to get medication, or psychotherapy, or something like that, and you’re told that all you need to do is go and get more exercise, it would be easy to see that as a brush-off, especially if it’s done unsympathetically. The point is, if exercise doesn’t feel like a positive step, it probably won’t be one.

ResearchBlogging.orgHarvey SB, Hotopf M, Overland S, & Mykletun A (2010). Physical activity and common mental disorders. The British journal of psychiatry : the journal of mental science, 197, 357-64 PMID: 21037212

  • http://www.blogger.com/profile/08461338194309128443 Paul

    I think the push for exercise as a treatment for mental illness is so typical of biological approach we have to psychiatry. Patient's are told that it's all about the endorphins (the evidence is lacking there I'm afraid), and that there is a biological reason why exercise will help alleviate depression.

    I suffered considerable derealization, depression and anxiety for a number of years. It was only when I started to attend circuit training and spinning lessons at the gym that I found my symptoms lifted. I continued to take up sport, running the Edinburgh Marathon, and racing as a competitive cyclist, all the time my symptoms lifting.

    Now, I could say it's all about endorphins, but that negates the positive psychological and social aspects of me taking up sport. For example, I lost the weight I put on through taking Olanzapine – I look great! I was spending less time just sat at the computer at home, ruminating. I was meeting new friends – a whole new social world revealed to me. I achieved some amazing things which I am very proud of.

    I can understand why this would exercise would not work for many people, but through taking up other activities, sufferers can experience many of the positive outcomes of exercise that I experienced.

  • http://www.blogger.com/profile/02512695249235770799 michaelgrayer

    Just skimmed through this article and it looks interesting, though a few potential pitfalls jump out at me.

    One more thing to look out for: are the four groups defined in the “leisure exercise” arm comparable to the four groups in the “work activity” arm? I mean both in terms of the types of people in each group, and also conceptually in terms of how much exercise is done. This may show simply a quadratic relationship between the amount of physical activity a person does and depression, as the groups don't overlap exactly. In other words, there's an optimum amount of physical activity to be had.

    I would expect this phenomenon anyway, since a person who has time to spend on leisure sporting activity is unlikely to be also working strenuous shifts – the groupings will to some extent be the complement of each other.

    There may also be some selectivity going on here, particular with respect to leisure exercise: those who are depressed may be less likely to engage in sporting or athletic activities. Indeed, employees who suffer from depression may also be less likely to have the confidence to move from a strenuous job if it's taking its toll.

    I'm not sure that this study really undermines the idea of advising someone to engage in leisure physical activity to assist with combating depression. Not to a large extent anyway.

  • ex-hedgehog freak


    I think that, if one were to try and compare a 40-hour per week heavy labor job with more than 3 hours per week of leisure-based physical activity, you would come up kind of short – so I think that you are right. Even in the extremes of leisure activity, folks who do a lot of jogging/hiking etc per week are not going to experience the comparable level of physical exertion/activity as say a coal miner or lumberjack.

    I think the key through all of these treatments (both pharm and nonpharm) is choice; people don't necessarily want to choose to do heavy physical labor for 40 hours a week, but they do choose to play football, walk, jog, etc, and therein lies the possible benefits for depression. The open-label trial format has the benefit of choice, and yes, there'll be a big old placebo effect, but in the clinic its results that matter. There's also some data out there that if patients choose their own antidepressant, it can benefit response – it will certainly benefit adherence, which is a step in the right direction.

    I think psychotherapy operates much the same way – people need to choose psychotherapy actively (or at least buy into the concept) to obtain its full benefit. At the end, it comes down to what we say time and time again – it's all in your head.

  • http://www.blogger.com/profile/10860246538349067232 Lindsay

    My experiences with exercise and depression are sort of the reverse of Paul's — when I became depressed, I had already been in the habit of exercising every day for many years, and for a couple years had ramped up my activity level even more, since I was in college and could work out *whenever I wanted*, rather than having to wait for gym classes or school-sponsored activities. I enjoyed exercise, which is why I did so much of it. (I also enjoyed the results of exercise, but I don't think I could've kept up such a strenuous regimen if I didn't also enjoy the activity itself). But I still ended up with severe depression, which after a while would keep me out of the gym for weeks at a time. So, for me, there's kind of a bitter edge to all the hype around exercise as preventative and cure-all for depression: it functioned as neither for me, even though I'd been a serious exerciser before my depression and continued to be one for at least a year and a half after it, and saw no benefit. (I still liked to exercise, but it didn't make me feel better overall, and sometimes I just felt so overwhelmed that I couldn't even move, let alone run or lift weights like the maniac I used to be. Some days maybe I'd *try* to get into the gym, but find I'd just sit down on a bench and cry rather than get any lifting done. So that sucked).

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Paul: Exactly. I had a similar experience…although I've only managed a half marathon so far ­čśŤ

    I do think that exercise makes you “feel better” as a direct physiological effect, but not really in the sense of making you feel less depressed or anxious. Although I guess it depends how you define “depressed”.

    ex-hedgehog freak: Right. If you want to exercise, and you do, that's great. But then it's got a meaning for you, over and above the exercise itself.

    As you say, in the clinic, it's the results that matter but this is my worry. If you tell everyone to go out and exercise, some people will find that annoying or patronizing, and I suspect they're not going to do well (even if they do adhere to it, which they probably wouldn't).

    I'm worried by any “one size fits all” approach.

  • http://www.blogger.com/profile/08461338194309128443 Paul

    For myself at least, it is true that after exercise, particularly immediately after it, I do feel good. I was talking about this to some friends on the Sunday cycling club run. We'll all get home, barely able to move and keep our eyes open, but we feel relaxed – chilled even – inside. I liken it to the way I feel after taking diazepam, which may suggest there is something in the endorphin theory after all!

    A half marathon is nothing to scoff at 'skepty. A huge well done. Have you thought about taking up cycling? One problem I had with running was the lack of a 'scene'. The cycling 'scene' is huge and quite varied. I found it really increased the social aspect of exercise in a way running never did.

  • Anonymous

    I read a research article a few years ago that where a session of exercise led to a mood boost in the immediate aftermath, but when tested the next day the depressed people's mood was in many cases actually LOWER than it had been prior to the exercise session. Bit like a drug come-down I guess.

  • MikeS

    Looking at depression outcomes based on physical activity at work seems to be confounded by too many other variables; you really can't conclude that physical activity is the only thing mediating that relationship. You're comparing people with very different jobs, which contributes to their depression. Also, people who work in manual labor tend to be more often lower SES, minority status, and live in urban environments, all of which contribute to the prevalence rates of anxiety and depression. Essentially their comparing apples to oranges.

  • RatWheelUK

    Could you run those findings over to Public Health England fast as looks like they're bent on transforming us into a nation of happified gym rats.

  • http://www.blogger.com/profile/12170572784481628483 Craig

    I've read recently of the importance of exercise in immune response, with one study showing that colds and flu symptoms were significantly less likely with regular exercise, so I'm sure there are benefits.

    I know these benefits can be true for exercise because I have a slightly obsessive friend that became depressed while out of work that always talked about going to the gym but never did because of his self-image. I encouraging him to go and do regular exercise, go to the gym, and now that he does his mood (and whining) has improved significantly.

    However there was a time when I was depressed and I'd go cycling in an attempt to be proactive, only to get a short distance and return home feeling worse. So being depressed and heading out exercising often exposes one to situations or memories which can have detrimental psychological effects.

    Yesterday I read how some people respond to stress differently than others in dissed and victimised, and how genetics may play an important roll.

    From my experience it's getting over the hurdles in maintaining the motivation to do regular exercise or social activity that is more important than the exercise itself, but that it's a feedback cycle that can be much harder for some than others.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    MikeS: It's true that this is an observational study so there are lots of confounding variables.

    However, it fits with other evidence. If you read the Cochrane review of exercise for depression (linked to in the post), it found that the duration of the study had no impact on how beneficial the exercise was on depression symptoms.

    But as we all know, the physiological benefits of exercise, increased fitness etc, are proportional to how long it is, and its intensity.

  • Anonymous

    I get clinically depressed when I exercise. That's because I look at all the young hard-bodied folks zipping along on the treadmills and ellipticals at the health club and I realize how old, fat, and out of shape I am! Why, it drives me to drink too! Say NO to exercise — it is bad for your mental health!

  • ex-hedgehog freak

    @Neuro (11/30 post):

    My sense here in the US is that the vast majority of psychs look at exercise as a second- or third-line choice if someone is not ready to accept (or maybe doesn't think they have time for) psychosocial approaches such as CBT, IPT etc. It's not a route that most of them actively seek to go down, unless the primary (and some would argue more evidence-based) forms of nonpharm approaches are off the table for the patient. So I feel less concerned about the notion that people may find this annoying or patronizing.

    There is also the augmentation study (Trivedi et al – Exercise as an augmentation strategy for treatment of major depression. J Psychiatr Pract. 2006;12(4):205-213) which shows some benefit for exercise when added on to an AD. I get the sense from studies like this that psychs are looking at exercise as simply another choice for the nonpharm approach area, in which case they are relying on the fact that, as with CBT and others, the patient has to buy into it in order for it to really have benefit. I don't think this is a case of a one-size-fits-all, more of a be-open-to-all-the-options for any individual patient, and use patient prefs as a starting point. If someone is open to the idea of some lifestyle changes, particularly if, like Paul, they have gained some weight on an SSRI or SGA, then you can get some benefit for the depression AND work on a side effect at the same time.

  • Anonymous

    Oh great so you get to work your arse off exercising just to try to get back to where you were before you were prescribed so-called antidepressants that made you fatter

  • Anonymous

    so-called antidepressants/antipsychotics

  • http://www.blogger.com/profile/00926204336056169207 Disgruntled PhD

    On the meaning of exercise point, Crum and Langer (2007) carried out an interesting study.

    They randomised hotels to either treatment or no treatment. The treatment was to be told how many caloires per week they burned as the result of their work cleaning hotel rooms. They found at one and three months follow up that those informed of the health benefits of their work had lost more weight and reported better psychological and physical outcomes.

    Reference here: http://www.ncbi.nlm.nih.gov/pubmed/17425538

  • http://www.blogger.com/profile/05660407099521700995 petrossa
  • Anonymous

    Could you please put your links inside an HTML A tag (especially the lengthy ones).

    name/title of the link here

  • veri

    Copy and paste you lazy fruit. Can't even exercise your finger. When I broke up one time with the love of my life, instead of pigging out I woke up 5am every morning and jogged my heart out listening to Boyz 2 Men. Weeping and jogging. First I sang but the kookaburras fell off the fence. Felt great afterwards.

  • http://www.blogger.com/profile/02219505720807067694 NeuroK├╝z

    Indeed, it's complicated. I don't think it hurts to encourage someone to exercise, as long as it's done in a way that isn't demeaning (although arguably, certain people might always interpret it that way). I've always found associations between physical activity and cognitive ability to be interesting. It makes sense that humans would have evolved, as hunter-gatherers, in such a way that physical activity is intricately linked with intelligence/survival ability. Exercise might be better at benefiting cognitive rather than affective aspects of psychiatric disorders.

  • ex-hedgehog freak

    Totally off subject I know, but veri just posted something that I actually understood when I read it…. :)

  • http://evidencechart.com veri

    Thank-you Freak :) your validation means the world to me. Were you a hedgehog in a past life? I bet you still enjoy tickling. I'm re-training my mental faculties thanks to evidencechart.com. Now I have hope, for a better future. A world without war, famine, poverty, where peace, love, unity reigns: evidencechart.com

  • Anonymous

    I find it a bit of a leap to assert or postulate a relationship between no benefit from exercise done as part of one's job and questionable benefit from exercise as prescribed by a practitioner. In the former, one may have little choice about the effort involved in the work. That kind of added psychological stress could negate some of the benefits of physical activity. In the latter, one would in theory have choice about the kind of exercise, the duration and the intensity.

    Even though there are days I don't want to and may not fully enjoy the experience of strength and resistance training, there is absolutely no question that it has a lightening impact on the corrosive symptoms of depression and on anxiety–whatever biopsychosocial reasons happen to be.

    Even on days when exercise feels like work rather than pleasure–and those days are not few and far between–there is a very beneficial and lasting effect.

    Regular exercise does seem to have an immunizing effect on depression and anxiety.

  • Jude

    Exercise didn't cure my major clinical depression. It took some powerfully stupid drugs to do that. But it helps me keep from regressing. I have agoraphobia, so I didn't exercise until I took care of a friend's dog for 2.5 months. The dog insisted that it must be walked outside, so we went at 3 a.m. or 4 a.m. or 5 a.m., so I can handle my anxiety. After I gave him the dog, I kept up the exercise. In winter, I switch to a stair climber, and then I almost forget how to go outside again without anxiety. However, it's also true that there is almost *no* exercise available in mental hospitals. You're stuck in there without shoes (you might use laces to hang yourself) and you can walk up and down the halls. In half-way houses, they might take a group 1/2 mile walk once a week. It's stultifyingly boring and does nothing for your attitude. Exercise may not improve one's depression–it didn't help mine–but without it, I'm much worse. Every day, stairclimber or outside, 1 to 4 miles. Maybe it's my anxiety that it helps.

  • Anonymous

    I am doing a project in school about healthy eating and exercising, would you allow me to use your picture. Here is the link for the picture. http://neuroskeptic.blogspot.com/2010/11/exercise-and-depression-its-complicated.html I go to Crown Hills Community College,Leicester, and I would really appreciate if you grant me permission to use your picture. Thank You Saarah.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Er, well, I actually 'borrowed' the picture myself, so it's not my permission to give.

  • Anonymous

    Okay, thanks for replying back, I really appreciate it. Thank You, Saarah.

  • http://www.squidoo.com/coping-resources-for-depression Beating Depression

    I speak from experience when I say that exercise is the most important source of help for depression. You don't have to run marathons or swim until you drown to see the benefits. Just a simple run or walk every few days can really kick depression in the teeth!

    Sure, depression is a mental condition but it's been proved time after time that exercise is the best form of help for depression.

  • Anonymous

    The reasoning in this article is quite poor IMO. Sorry.

    Many athletes actually know that overexercising is not good for you and infact can CAUSE depression in particular when nutrition and proper rest is not paid attention to.

    Exercise is not a well defined term: It matters how much you do, how often you do it and what you do.

    Hard physical exhausting work is not the same as 30-60 minute workouts 2-4 times a week. It does not equal exercise in moderation.

    It's like saying that alcohol in moderation has horrible effects on the heart because alcoholics and heavy drinkers are more likely to suffer from heart disease.

    In addition saying the placebo effect could be responsible for all the improvements is quite unreasonable as well.

    Actually it has been reported countless times that people who exercise regularily feel worse emotionally and have more stress related symptoms once they quit their exercise routine.

    There are infact many depressed individuals who are using exercise to reduce stress and depressive symptoms as well who promptly have a relapse once they stop. Don't tell me that this is the nocebo effect or the absence of a placebo effect or due some other hidden variable.

    In addition even moderate exercise can reduce stress levels quickly and improve brain circulation and many other stuff.

    Then correlation is not the same as causation. There could be countless other reasons why people in those jobs are more likely to be depressed.

    Then the article is relying on one single study to make the argument and saying it fits in with an other study. Well there are countless studies on this and similiar subjects it's really easy to cherry pick one or two (even if the majority of the available studies contradicts the claim) and argue this to be proof of something.

    At best this study could be viewed as a starting point for further research but i think no one could view this proof or significant evidence that exercise worsens depression or that it is ineffective if you subtract the placebo effect.

    I think excercise has been hyped a bit as depression treatment, it's not a miracle treatment but it does have some benefits in some or even many.

  • Anonymous

    Regular vigourous exercise has been a miracle cure for me.

    I find it SOOOO much better than antidepressants and sobbing to shrinks.

    It's kept me right for years now…

  • Anonymous

    If you've ever been part of a group of obsessed marathoners you will see that sometimes the exercise just creates a new problem. It's like using heroin as an antidepressant, it might make you feel better for a while but it never lasts, you keep needing more, and it can have a detrimental effect on all of your social relationships.

    Exercise taken to an extreme can be quite self-destructive.



No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.


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