The Role of Exercise in Preventing and Treating Depression

Original Editor - Andrea Sturm

Top Contributors - Simisola Ajeyalemi, Kim Jackson, Oyemi Sillo, Tarina van der Stockt, Jess Bell, Tony Lowe, Lucinda hampton and Robin Tacchetti  

Introduction

Depression is a leading cause of global burden. The mainstay of treatment is pharmacological and psychological interventions. While effective, not all people will respond to those treatments and alternative approaches for preventing and treating depression are required. Recent literature has demonstrated that higher physical activity (PA) levels and exercise confer protective effects on incident depression. Also, exercise has demonstrated efficacy on reducing symptoms for people with depression. Despite its effectiveness, similar to other treatments, some people may benefit more from exercise and identifying these potential predictors of response is necessary to deal with patients’ and professionals’ expectations. Dropout from exercise interventions is comparable to dropout from other treatments for depression and similar to dropout from exercise in other clinical populations. However, some strategies to increase adherence are important.

Major depressive disorder (MDD) is a highly prevalent disorder in most cultures across the world with a point prevalence ranging from 6% to 18% across different countries. When considering the prevalence of people with subsyndromal/subthreshold depression, or those that have significant depressive symptoms but do not meet the criteria for a formal diagnosis of MDD, the prevalence rate is approximately 15% to 20%. MDD is one of the top 10 causes of years lived with disability across the world and a leading global cause of burden, and the economic costs are considerable. For instance, the costs associated with the days lost of work due to depression and anxiety is estimated in US $ 1.15 trillion per year worldwide, and this amount is expected to increase twofold by 2030.

The core features of depression symptoms include low mood, decreased interest or pleasure in most or all activities of the day, decreased motivation, increases or decreases in appetite and weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, cognitive impairments, such as memory deficit, and suicidal thoughts with or without suicidal plans or attempts. In addition to the profound burden on mental health and well-being, there is a growing body of evidence to suggest that people with MDD experience substantially poorer physical health. For example, people with depression present increased prevalence of cardiometabolic disease, diabetes, and cardiovascular disease, and experience premature mortality by 10 yr compared with the general population. While suicide accounts for a part of the premature deaths among people with depression, it is well established that the higher levels of cardiovascular and metabolic disease when compared with the general population play a significant role to the premature mortality gap. 

The current focus of treatment for people with confirmed MDD consists of antidepressants and psychotherapies. While antidepressants are typically more efficacious than placebo, some evidence suggests that only about half of the people taking antidepressants achieve a clinically significant response (a decrease of 50% or more on depressive symptoms). Also, dropout rates are considerable, ranging from 15% to 132% higher than placebo. Another factor that influences adherence is the side effects of antidepressant medication which can include weight gain, increased diabetes risk, and sexual dysfunction among others. Psychological therapies, such as cognitive behavioral therapy, have a small-to-moderate effect for people with depression, the impact of psychotherapies on the poor physical health and premature-associated mortality is unclear. 

Given the considerable individual and societal burden of depression, there is a pressing need to identify modifiable risk factors which may be amenable to change. To this end, there is growing recognition that lifestyle behaviors, such as physical activity (PA) and exercise partially contribute to the risk of developing depression and can be useful strategies for treating depression, reducing depressive symptoms, improving quality of life, and improving physical health outcomes.

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