Even when unsupervised, exercise can have long-term benefits—as was shown in a randomized, blinded, controlled study of 32 elderly subjects.29 An active treatment group underwent 10 weeks of supervised weight lifting, followed by 10 weeks of unsupervised exercise. Controls received no active treatment. Depression scores as measured by BDI were significantly lower at 20 weeks and 26 months in exercisers compared with controls. An antidepressant effect was seen in 73% of exercisers vs 36% of controls at 20 weeks of treatment.
Comment. These studies show that exercise can maintain an anti depressant effect for 10 to 26 months, but additional randomized controlled studies are needed.
Preventing depression? Inactive nondepressed individuals may be at greater risk to develop depression compared with active individuals, according to a 29-year longitudinal study of Californians age 17 to 94. This association was somewhat diminished when findings were adjusted for the Alameda County residents’ physical health, socioeconomic status, social supports, life events, and other health habits.30 The authors recommended that exercise programs be offered in community mental health programs.
Box 4
Simple steps to build physical activity into daily life
| The American Heart Association offers helpful tips for increasing daily exercise at home, at work, and at play. For additional suggestions, go to www.americanheart.org. | ||
|---|---|---|
| At home | At the office | At play |
| Do housework yourself instead of hiring someone else to do it | Brainstorm project ideas with a coworker while taking a walk | Plan family outings and vacations that include physical |
| Work in the garden or mow the grass (using a riding mower doesn’t count); rake leaves, prune, dig, and pick up trash | Stand while talking on the telephone | activity (hiking, backpacking, swimming, etc.) |
| Go out for a short walk before breakfast, after dinner or both; start with 5 to 10 minutes and work up to 30 minutes | Walk down the hall to speak with someone rather than using the telephone | See the sights in new cities by walking, jogging, or bicycling |
| Walk or bike to the corner store instead of driving | Take the stairs instead of the elevator, or get off a few floors early and take the stairs the rest of the way | Make a date with a friend to enjoy your favorite physical activities, and do them regularly |
| When walking, increase the pace from leisurely to brisk; choose a hilly route | Schedule exercise time on your business calendar, and treat it as any other important appointment | Play your favorite music while exercising, something that motivates you |
| Dance with someone or by yourself; take dancing lessons | ||
| Join a recreational club that emphasizes physical activity | ||
| When golfing, walk the course instead of using a cart | ||
CASE CONTINUED: Removing barriers to exercise
The resident psychiatrist treating Mrs. S encourages her to join an aerobic exercise class at the nearby fitness facility. Because cost is a potential barrier, he helps her negotiate a discount for the first 6 months of membership. Her husband agrees in a joint counseling session to help more with the care of their children so that she can attend the classes.
With continued sertraline, 200 mg/d, and aerobic exercise, Mrs. S’s residual depressive symptoms gradually improve. She still has days when she is unable to attend the exercise classes, but she benefits from the program and is functioning better at work and home.
Getting started
We recommend that psychiatrists inquire about physical activity at every visit to gauge patients’ perception and motivation to exercise. Find ways to overcome patients’ fears and negative experiences with exercise. Provide information to help increase physical activity among patients with depressive symptoms10 (see Related Resources).
Encourage patients to take steps each day to increase their physical activity (Box 3). Depending on the severity of the individual’s depression and inactivity, a realistic starting point may be to take the stairs instead of an elevator, play with children and pets, or take short brisk walks in the yard or neighborhood (Box 4). Consider stationary bikes or swimming as alternatives for physically handicapped individuals and patients who have undergone knee replacements.
- 2008 physical activity guidelines for Americans. U.S. Department of Health and Human Services; 2008:vi-viii. www.health.gov/paguidelines.
- American College of Sports Medicine/American Health Association physical activity guidelines and keys to exercise success. www.acsm.org.
- American Heart Association. www.americanheart.org.
- U.S. Department of Health and Human Services. Quick Guide for Healthy Living. Get Active. www.healthfinder.gov/prevention/ViewTopic.aspx?topicID=22.