“When we compare exercise with other treatments for depression and anxiety, we get a tie,” says Michael Otto, professor of psychology and brain sciences at Boston University. “But unlike medication, with exercise you get only positive side effects.”
Some antidepressant medication can cause side effects that include blurred vision, insomnia, weight gain and decreased sex drive. Exercise, on the other hand, has been shown to reduce blood pressure, improve cognitive function, maintain or reduce body weight, regulate blood sugar and improve sleep, says Otto, co-author of “Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being.” “Imagine if we could put all that into a pill. It would be a blockbuster,” Otto says.
“Exercise is not what every primary care [doctor] prescribes for depression. But it should be,” says Annie Way, a primary care physician who incorporates integrative medicine in her family medicine practice at the University of Virginia Health System. (Definitions of integrative medicine vary; her practice’s website defines it as care that “takes into consideration all factors influencing health, including mind, spirit, and community as well as the body.”) “Exercise is a key component for every depressed patient,” she added
Prescribing exercise to treat depression is not as easy as it might sound, however, according to Jasper Smits, a psychology professor at the University of Texas at Austin and a spokesman for the Anxiety and Depression Association of America. “Most physicians and counselors are not trained in exercise intervention,” says Smits, co-author of “Exercise for Mood and Anxiety.” “Plus, it’s a lot more challenging to exercise than it is to take medication.” After all, exercising takes more time and effort than swallowing a pill.
So what kind of exercise are we talking about, and how long do you have to do it? Most research regarding mood and exercise has involved moderate aerobic exercise (e.g., walking fast), finding a benefit at 30- to 40-minute sessions conducted four or five times a week. (A moderate level of activity is when you can talk while exercising.) But there is some indication that more vigorous workouts — such as interval training, which alternates periods of high-intensity exercise with recovery periods — are better suited for people with anxiety, Smits says. “High-intensity workouts create responses in the body that mimic the symptoms of anxiety,” says Smits. This is key, he says, because instead of thinking you’re having a heart attack next time you are experiencing severe anxiety (which often causes heart rate spikes) you start associating your symptoms with something healthy — exercising.
If walking 30 to 40 minutes four times a week, much less running intervals, sounds like a tall order, don’t fret. No one is expecting you to get off the couch and start sprinting. In fact, that would be inadvisable. “Patients need to set realistic goals,” Wray says. “Just start doing something. Walk out to the mailbox and see if you can keep walking a bit more. Take the stairs at work. Get up from your desk every 30 minutes and walk around.” Gradually increase the duration and intensity until you get to 150 minutes a week or more, which has the added benefit of being close to the government recommendation for weekly exercise to improve physical health (maintaining weight and preventing diabetes and high blood pressure).
To keep the momentum going, “Find what motivates you,” Otto suggests. “Maybe pulling on the spandex makes you feel like an athlete. Or go out for a walk with friends. Play basketball.” Adding community — the social element — can help you stay motivated and also counteract the tendency to isolate, which is a common trait in people with depression and other mood disorders. A personal trainer can also help by becoming a type of exercise interventionist at least until the exercise habit is fully formed. “Exercise should be prescribed with support,” Smits says.
Along with building tolerance for anxiety symptoms, creating community and countering isolation, exercise provides a sense of achievement and self-confidence. Exercise also strengthens a person’s ability to cope positively with life issues (instead of negatively such as overeating or drinking alcohol) and releases endorphins. And it contributes to mindfulness: When we exercise, our brain refocuses, especially if the workout is strenuous and requires concentration. “You have to pay full attention to what is going on right now,” says Smits, “and that helps you stay away from the future and the past which is where anxiety and depression stay alive.”
While exercise for mood may sound like a long, uphill road, there is a bright spot that all three experts are eager to share: Quick results. “I usually see changes in mood the same week someone starts exercising,” Way says. Otto agrees. Results can take “a really long time if your goal is to look buff,” he says. “But the benefits of exercise for mood show up almost right away.”