Exercise works for depression – can we start implementing this now? (please?)

An impressive systematic review & network meta-analysis is out today in the BMJ. The conclusions and headlines are practically the same as over 100 reviews published in the past 10 years….that exercise is an effective treatment for depression.  The only difference in the review findings in recent past, including our own, is different analysis have been undertaken to provide arguments on the size of how effective exercise is. These subgroups are often based on the impact of risk of bias, type of exercise (e.g. resistance training, yoga), age group (e.g. young people). 

Note - I was contacted by the BMJ three weeks ago to write a commissioned editorial for this paper but declined as per their policy since I have worked with commercial companies.  Nonetheless, I thought I would share my views based on the whole evidence based. 

With that in mind, what did this review add to the burgeoning academic field? 

1. Greater intensity may equal greater effects (but the research shows this is harder for people with depression)

The paper provides some indication that there may be some evidence that exercise at a greater intensity result in better mental health improvement.  However, it should be noted that the authors also found that lower intensity exercises (e.g. walking, tai chi), also demonstrated a favourable effect (albeit smaller).  The challenge here from the research and real world is this – how is it possible to motivate and maintain engagement in higher intensity exercise in people whose motivation is typically impacted in depression?  We know from other research that higher intensity exercise results in more dropout for people with depression and higher intensity is a barrier to starting.  Anyone who has had or worked with people with depression knows that motivation is hard making the bar of effort needed higher does not seem logical as a blanket point to me.  Indeed, this to me seems a moot point in the real world (and off the whole data) –the key message I take is this do some exercise at an intensity you can do and be consistent at.

2. There may be some differences in the type of exercise

This is not novel to this paper, but it is probably the most comprehensive analysis.  The authors show that walking/jogging, yoga, aerobic and resistance exercise are the leading types of exercise that lead to improved mental health in people with depression.  Other types of exercise such as tai chi was also helpful.  My take home message is this – do an exercise you enjoy and can stick to. 

3. Group exercise is often better than going solo (in most cases)

This is a finding that many other reviews have found, but the authors suggest that group yoga was not better than individual yoga which is interesting.  We know that social support, community and belonging are important for us all and it is not surprising to see these findings replicated here. 

So where does that leave us?

I think we can safely state that exercise can be an effective treatment for people with depression now and it is included as a recommendation in treatment guidelines for this reason.  In my view, we do not need more research to answer the question “does exercise work for depression”.  We have hundreds of systematic reviews showing this.  We need to focus our attention on how to we take the findings from research and influence clinical pathways and sports/leisure/fitness facilities with the knowledge and confidence to offer exercise for people with depression? 

Do you agree?

If you would like to know the evidence of exercise and mental health, consider one of the courses I am pleased to now offer courses.