Is exercise always better for depression than therapy and medication? Not so fast, experts say

A new study suggests that exercise may work better than therapy or medication for treating mental health issues – but don’t give up on your therapist and your Zoloft just yet.

In a promising research review on “the effectiveness of physical activity interventions for improving depression, anxiety and distress” published late last month in the British Journal of Sports Medicine, researchers reported that the Physical activity can be up to “1.5 times more effective” than advanced counseling or medication for certain types of mental health conditions.

Yet, while this is another important validation, the research comes with caveats.

“Physical activity can significantly reduce symptoms of depression and anxiety in all clinical populations.”

The University of South Australia (UniSA) review, which Science Daily called “the most comprehensive to date”, looked at research on the effects of exercise on healthy people, those with mental health problems and those with chronic physical illnesses. And what’s exciting – if not downright surprising – is that, as UniSA lead researcher Dr. Ben Singh told Science Daily, “Our review shows that physical activity interventions can significantly reduce symptoms of depression and anxiety in all clinical populations, with some groups showing even more signs of improvement.”

That little word, “everything,” is the key here.

Singh further noted that “higher-intensity exercise had greater improvements for depression and anxiety,” but “all types of physical activity and exercise were beneficial, including aerobic exercise such as such as walking, resistance training, Pilates and yoga”.

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We instinctively know that moving is good for us; “An early morning walk is a blessing for the whole day,” wrote Henry David Thoreau. Scientific research on the benefits of physical fitness dates back decades: a 1978 study published in The Physician and Sports Medicine found management an “effective adjunct to psychotherapy for treating depressed patients”. And a 1985 study published in Public Health indicated that “physical activity and exercise may be a beneficial adjunct to alcohol and drug addiction programs.”

There are many reasons why exercise can be so powerful for our emotional health. Among the easiest to identify are immediate and external. Practiced regularly and safely, it can instill a sense of strength and achievement that builds confidence. “Exercise can help us develop a sense of purpose by providing structure and giving us something to strive for,” says Dr. Flora Sadri-Azarbayejani, medical director of Psyclarity Health in Boston. “This in turn can increase our sense of self-efficacy, the belief that we are capable of achieving our goals.”

Amid our national sleep deprivation epidemic, physical activity also helps us sleep better, which is a huge and often overlooked component of overall mental health.

There is more. Dr. Joseph Trunzo, professor and chair of the department of psychology at Bryant University and president-elect of the Rhode Island Psychological Association, notes the cathartic benefits. “Exercise can serve as a distraction, allowing you to find some peace and quiet to break the cycle of dark thoughts that promote depression.” He also observes that “you might vent your anger by exercising. Exercise can distract you from unpleasant thoughts.”

But science shows us that the benefits go even further. Exercise affects our stress hormones like adrenaline and cortisol. “It allows the body to physically expel stress and any trauma that may be stuck in our body,” says Katie McLaughlin, Professional Licensed Clinical Counselor and Owner of Cedar Rose Counseling & Wellness. “It also helps the nervous system learn to regulate itself, which means we can recover from stress faster.” There’s more – “Moving your body also produces a powerful neurochemical called brain-derived neurotropic factor. Without getting too scientific here,” she says, “BDNF makes it easier for us to think useful/positive thoughts by increasing the ability of our brain to create brand new neural pathways and neural connections.” And because creating these new thoughts and patterns is also the foundation of cognitive behavioral therapy, it’s easy to see how helpful exercise can be for people who are also good candidates for CBT, including including people with OCD, PTSD and anxiety.

The assumption that working out – or working out in a way that doesn’t work for everyone – is the cure for mental illness is an extremely disheartening message for a depressed person who is just struggling to get out of bed.

Some of the most fascinating work on this has linked the effects of exercise on the human endocannabinoid system, which plays a key role in emotional processing. Harvard Health explains, “We all have tiny cannabis-like molecules floating around in our brains.” And recent research from Wayne State demonstrates that “exercise reliably increases the body’s endocannabinoid levels.” In other words, the runner’s high seems to be real – and endorphins aren’t the only game in town.

But despite the encouraging benefits of physical activity, mental health is never a one-size-fits-all proposition. While exercise can be a part of a solid mental health plan, too much of it can also be a symptom of an underlying problem. Overtraining behavior often occurs in people with compulsive and addictive disorders, as well as those with body dysmorphia and eating disorders.

And Dr. Flora Sadri-Azarbayejani reminds that “there are certain risks associated with physical activity, such as injury or overtraining, which must be monitored and managed appropriately”. Sadri-Azarbayejani continues, “Some people may also find exercise difficult due to mental health issues, medical conditions, or physical impairments.”

The assumption that working out – or working out in a way that doesn’t work for everyone – is the cure for mental illness is an extremely disheartening message for a depressed person who is just struggling to get out of bed. Los Angeles clinical psychologist Dr Lauren Cook says: “While another person can go out for a run quite easily, it can be a monumental task when someone has mental health issues. Medication and therapy can provide that springboard for improvement when exercise is too difficult.”

And while exercise isn’t a replacement for other forms of mental health treatment and maintenance, it’s certainly effective enough to make you wonder why it isn’t more routinely brought into the conversation about it. A 2018 A Michigan State study found that “84% of respondents reported a link between (physical activity) and their mood or level of anxiety and 85% wanted to be more active”, but “only 37 % said their (mental health) providers regularly discussed (physical activity) with them.

This may be partly because exercise takes time and effort. While this should be a part of everyone’s life at their own level of ability, we live in a quick-fix culture in which Americans will literally spend thousands of dollars on a drug to keep them from eating. If we are serious about reaping the mental health benefits of physical activity, we need to realistically examine our commitment and consistency in making it a priority.

Mental health is never a one-size-fits-all proposition, and all those memes telling us that a walk in the woods is an antidepressant but drugs are kind of “shit” aren’t helping anyone. As Dr Raffaello Antonino, London-based counseling psychologist and founder of Therapy Central, says, “Exercise alone can rarely solve a mental health problem. Especially if the problem is quite serious and has a long history, exercise alone would hardly be able to remove them all. There are many people who are very physically active and still suffer from depression, anxiety or other problems.”

I know the effects of therapy and medication on life, and I have seen them firsthand in my family members and myself. I also know that when I regularly do practice jams and run in my park, I am less anxious throughout the day and sleep better at night.

It is not a competition; it’s a toolbox. We all just need to figure out the best ways to build our own, in conversation with our mental health providers, and without disparaging one aspect of treatment over another. Dr. Raffaello Antonino recalls: “The three – exercise, medication and psychotherapy are ways to treat mental health problems, and they are not mutually exclusive.”

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