Depression: Exercise type and why it matters

Original Editor - Daniel Quinn

Top Contributors - Lucinda hampton, Daniel Quinn and Kim Jackson  

Introduction[edit | edit source]

Exercise photo.jpg

Depression in older adults is related to an array of negative health outcomes and is more chronic compared to that in younger adults. Physical activity has been regarded as a promising non-pharmaceutical method in treating and preventing depression in older adults. [1]Regular leisure-time exercise of any intensity provides protection against future depression. Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression[2].

Recent research presents evidence that exercise

  • Can help conditions that we previously thought were immune to the effects of exercise
  • The type, intensity and duration of this exercise can mean the difference between it being effective or ineffective. eg
    • walking and lifting weights are seen to be equally effective in decreasing depression symptoms.
    • For liver cirrhosis higher intensity interval training has shown to be required to improve health markers.
    • High intensity interval training is a workout consisting of alternating bouts of walking and running or cycling at a high heart rate separated by easier bouts at a lower heart rate.[3]

Secondary Depression[4]

  • Secondary depression generally accounts for 40% of depression diagnosis and is due to the psychological effects of living with a life threatening or limiting illness.
  • eg a person who has had a stroke and now has difficulty with speech, emotional expression or physical ability may develop depression or people who find themselves unable to live the life they want to due to heart, respiratory, rheumatological and orthopaedic conditions or cancer diagnosis.

Specific Examples[edit | edit source]

Knowing that following a specific, individually tailored exercise programme can increase quality of life and offer higher chances of survival can be emotionally empowering for a person.

  1. Coronary artery disease symptoms have shown greater improvement with resistance exercises than aerobic workouts alone. So, if we know that the onset of depression is caused by coronary artery disease, we can treat both the symptoms of heart condition and depression more effectively by incorporating resistance exercises into the program[5].
  2. In people diagnosed with breast or prostate cancer, survival rates are higher in patients who walk or take part in high intensity interval training for three hours per week, respectively. When we can efficiently increase the physical capacity of people with a diagnosis of cancer while also optimising their chance of survival through type of exercise, specific exercise prescription becomes highly important. Research cites that breast cancer mortality rates are decreased by 41% in people who exercise compared to those who don’t. In prostate cancer it is decreased by 61%[6].

Safety[edit | edit source]

Stress Test.jpg

Safety is extremely important when implementing an exercise programme with a person who has a serious physical condition. Heart conditions that are being managed with medication, without any form of surgery, will require a stress test prior to beginning any training program to ensure adequate blood supply to the heart. Prior to beginning an exercise program, you will need to find out the upper limits of the exercise that is suitable for you from your medical team. Once you know your maximum heart rate that you can exercise at, you can safely stay below it when exercising.

People who have been coping with serious physical limitations due to prolonged illness can experience a lower level of physical fitness. Due to this, certain types of exercises will be too demanding at the start of the exercise program. It’s important to break the exercise programme down in to achievable goals.

A long term goal may be to return to an old pastime, such as soccer. In the beginning, smaller realistic monthly goals may be needed to gradually increase fitness. This will give the body time to adjust, the heart and muscle time to get stronger and the fitness level time to improve at a steady rate allowing for consistent improvements in exercise intensity and duration.

This gradual increase in exercise intensity will progressively allow people to return to their chosen pastime in a safe and effective manner. This can have a significant positive effect on a person’s sense of wellbeing.

Tailored Exercise Program[edit | edit source]

Resistance exercise using resistance band.jpg

Exercise is a vital component of managing depression. For people who experience depression secondary to other health conditions, exercise prescription can be tailored to treat both the primary illness and the secondary depression.
If you are unsure of how to create smaller goals, or realistic time scales, consult a physiotherapist or doctor who specialises in the area of your illness or in exercise prescription for medical illnesses.

A simple one size fits all approach isn’t possible and each individual will experience exercise differently. Therefore exercise type and intensity will have to be customised to the person to ensure that it is physically suited to them and safe.

Once you start an exercise programme it is best to focus on your own goals, and how to attain them and not compare your progress to others. Appreciate that as each week passes you are getting fitter and healthier, but most of all you are now taking control over the parts of your healthcare plan that you can control. With exercise you will have a greater say in how your illness determines your life.

Note: Exercise programmes for heart and respiratory conditions are provided free-of-charge through the HSE’s cardiac and pulmonary rehab courses. You can be automatically referred to these courses by your primary health provider, or you can request a referral at your next appointment with your doctor or consultant. There are also private clinics that specialise in exercise prescription[7]

References[edit | edit source]

  1. Zhang S, Xiang K, Li S, Pan HF. Physical activity and depression in older adults: the knowns and unknowns. Psychiatry Research. 2021 Jan 18:113738.Available: https://pubmed.ncbi.nlm.nih.gov/33515871/ (accessed14.9.2021)
  2. Harvey SB, Øverland S, Hatch SL, Wessely S, Mykletun A, Hotopf M. Exercise and the prevention of depression: results of the HUNT cohort study. American Journal of Psychiatry. 2018 Jan 1;175(1):28-36.Available: https://pubmed.ncbi.nlm.nih.gov/28969440/ (accessed 14.9.2021)
  3. van der Windt DJ, Sud V, Zhang H, Tsung A, Huang H. The effects of physical exercise on fatty liver disease. Gene expression. 2018;18(2):89.
  4. The Significance of Secondary Depression. Clayton, P. and Lewis, C. (1981). Journal of Affective Disorders 1981: 3 25-35.
  5. Marzolini S, Oh PI, Brooks D. Effect of combined aerobic and resistance training versus aerobic training alone in individuals with coronary artery disease: a meta-analysis. European journal of preventive cardiology. 2012 Feb 1;19(1):81-94.
  6. Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML, Wactawski-Wende J, Craft L, Lane D, Martin LW, Chlebowski R. Physical activity and survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer prevention research. 2011 Apr 1;4(4):522-9.
  7. Craft LL, Perna FM. The benefits of exercise for the clinically depressed. Primary care companion to the Journal of clinical psychiatry. 2004;6(3):104.