Whether advising our patients or in our own lives, we are familiar with the many physical benefits of exercise. We also know that during or after completing some physical activity, our mood is usually improved. But is exercise really so powerful that it can have impact on a clinical condition such as depression?

Over the past thirty years, research evidence has been accumulating about the importance of exercise as a method of treatment, even in some cases of severe depression. Exercise helps alleviate the immediate sense of distress – an acute impact. Over time, exercise also creates a general improvement in mood – a chronic impact.

Exercise has been compared to both psychotherapy and medication with regard to alleviating clinical depression, and it has been found equally effective. According to recent psychological research, evidence-based practice comprises relevant research, clinical knowledge and expertise, and the patient’s contextual culture, values and preferences. For any individual, the most helpful treatment may be exercise alone or in combination with psychotherapy and/or medication.

Exercise and Mood

Through research and clinical experience, we have much more information on the fact that exercise works than why it works. Exercise is one of the most effective ways of regulating mood, probably because it both increases energy and reduces tension. One theory is that an alteration in brain chemicals affects mood – and perhaps these are in fact the same brain chemicals that are targeted with psychotropic medication.

Other more psychological explanations abound as well. Exercise can provide distraction, time out from the normal preoccupations of everyday life. Exercise also affords a sense of mastery and accomplishment, which in turn influences self-esteem. Additionally, exercise is an excellent means of regulating social distance. It may be taking a spinning class at the gym with some buddies or riding through the autumn foliage, chatting with a close friend. Alternatively, particularly for overburdened, over-connected women, exercise may be a legitimate moment to have time to oneself.

What Works

What’s the best kind of exercise from a mental health perspective? Professor Bonnie Berger at Bowling Green State University has developed a taxonomy to describe types of exercise that are most effective. For mental benefits, the crucial elements are:

  • the activity is pleasing and enjoyable
  • the mode is aerobic or involves rhythmical abdominal breathing
  • the activity is predictable or spatially certain and without interpersonal competition
  • the exercise is of moderate intensity, lasts 20 to 30 minutes, and is part of the weekly schedule

Do these parameters mean we shouldn’t advise a fast game of tennis, or that your favourite pickup lunchtime basketball game down at the Y is off limits? Certainly not. However, if we are advising or doing something competitive, we must also find ways to be emotionally supportive of ourselves. Being self-critical about a lousy serve or negatively comparing oneself with teammates will improve neither the game nor one’s mood. The distraction of that type of activity will probably be strong, but the potential to tune out or contemplate will be less present. If competitive activity is enjoyable, it certainly shouldn’t be ruled out – and it’s definitely better for one’s mental health than not doing any activity at all.

That said, for the mental benefits, the types of exercise that are probably most effective are standard aerobic activities such as walking, running, biking, swimming or cross-country skiing. The Eastern arts, such as yoga, emphasize the value of diaphragmatic breathing, the integration of mind and body, mindfulness of the present moment, and a non-judgmental attitude, all of which are essential components for mental well-being.

Exercise and Other Emotional Problems

Although the most thorough research has been conducted on exercise in relation to depression, there is considerable research to suggest that exercise can have important positive effects on a number of mental health problems. Exercise is often recommended for the alleviation of stress. As with depression, it can help relieve symptoms of anxiety in the short term and decrease anxiety over the long haul. Exercise has also been associated with an increased ability to manage withdrawal from addictive substances. It is a key component in weight loss, and possibly even more important, in weight loss management.

The Body-Mind Connection

“A sound mind in a sound body” is not just a trite phrase. Physical activity is essential for our minds as much as our bodies. From a mental perspective, physical activity can serve a preventive as well as rehabilitative function. That’s pretty powerful medicine!