Changing the conversation about health

BEYOND PILLS CAMPAIGN: Exercise should be a core treatment for depression, research suggests

An evidence review of the benefits of exercise for depression, published in the BMJ, found that some types of exercise proved more effective than psychotherapy and antidepressants, writes Sarah Stacey.

Latest NHS figures show that 8.6 million people in England take antidepressants but, according to a University of Queensland Australia review, which looked at 218 studies of 14,170 participants with depression, they could be better off taking aerobic exercise, joining a yoga, walking or dancing group and getting out in nature. 

All types of physical exercise brighten the mood but dancing topped the bill for clinically important mental health benefits, followed by jogging, both with a bigger impact than CBT and medication. Combining exercise with socialising gave a double whammy. 

“Based on our findings, dance appears to be a promising treatment for depression, with large effects found compared with other interventions in our review,” say the authors. Though they caveat the small number of studies, low number of participants (mostly young women, average age 31) and biases in the study.

Research conducted by the University of Queensland Australia found exercise can have a significant positive impact on mental health, with dancing particularly ‘promising’ in the treatment of depression (Pic: janeb13/pixabay)

However, other research, including with older people, confirms the mental as well as physical benefits of dancing to music, allowing people to free their minds of distressing thoughts.

Although this review looked at patients with major depression, exercise appeared equally effective for people with different baseline levels of depression and with or without other health conditions. Dialling up the intensity – running, say, or interval training – gave extra benefits, according to lead author Dr Michael Noetel, who said that patients who can do more intense exercise in a structured environment could further decrease depressive symptoms. Interestingly, yoga proved particularly helpful for depression in older men and strength training most helpful for younger women.

Even a gentle walk can have benefits on mood, says GP Dr William Bird (Pic: MabelAmber/Pixabay)

Consultant psychiatrist Dr Paul Keedwell, a fellow of the Royal College of Psychiatrists, said: “The power of exercise to lift mood is often overlooked. Social interaction might be almost as important as the physiological effects, with additional benefits to be gained in green and natural environments.”

Physical activity is currently included in the NICE guidelines for depression but, according to Professor Jonathan Roiser, mental health group leader at University College London: “unfortunately, [exercise] is rarely prescribed in practice even though we know it works.” 

The authors say that, while more high-quality studies are needed, exercise could be considered alongside psychotherapy and drugs as core treatments for depression. “The effect size of exercise was comparable to that of cognitive behavioural therapy, but the quality of evidence supporting such therapy was higher.

“The effect of exercise appeared superior to antidepressants, although when exercise was combined with antidepressants, the effect of the drugs improved,” wrote Professor Juan Ángel Bellón of the University of Malaga in an Editorial for the BMJ.

However, telling people they should take more exercise can be off-putting, particularly for those who are feeling depressed. “Depression is an evolutionary sickness behaviour so we are designed to keep our calories for recovery. That’s why it’s hard to be motivated to exercise,” explains GP Dr William Bird.

“But it is the best treatment for depression so people should start slowly doing something they enjoy, like a gentle walk in the fresh air with a friend – even better in nature which is good for depression on its own. Don’t worry if it’s just doing a little at a time; the important thing is to do something and slowly do a bit more.”

Even the word ‘exercise’ can be a deterrent for people unused to it. Instead, Kate Green, a Somerset-based Senior Physiotherapist in Community Rehabilitation, suggests patients be “more active”. 

“Physical activity is vital for everyone’s health at all ages from childhood on,” says Sir Muir Gray from Oxford University, Director of The Optimal Ageing Programme and an authority on healthcare systems. In the year to November 2022, 63.1% of people in England aged 16 and over were classed as physically active, meaning they did 150 minutes or more of moderate intensity physical activity a week. That leaves three to four in ten people doing less. One way to increase this number, Sir Muir says, is ‘simply to issue an activity prescription with every drug prescription’. He recommends the NHS Active 10 website and app.

In 2015, the Academy of Medical Royal Colleges published a review entitled Exercise: the miracle cure. Professor Dame Sue Bailey, then Chair of the Academy, wrote: “I believe that if physical activity was a drug, it would be classed as a wonder drug, which is why I would encourage everyone to get up and be active.” Whether we join a Scottish dancing group, bend our bodies and minds to yoga in the park, or join a walking group, it’s one of the best things we can do for our health.