How to treat depression with physical exercise

The fact that physical exercise can treat depression is not news. Mental health researchers have actually known about this since the 1980s. Still, few health care providers prescribe movement with the same ease as they do antidepressants.

Perhaps it’s time to change that?

I hope so. However, I do realise it’s easier dreamt than done. Depression is often accompanied by a lack of energy and constant fatigue. And exercise treatment requires you to sweat and pant and jump yourself healthy.

Let’s face it, keeping up with an exercise routine is a challenge for most of us even when our minds are healthy. When depressed, leaving the house can feel like mountain climbing. So, how do we charge energy for such an expedition?

Organisational psychology offers a few tricks to help us create an exercise routine designed specifically for depression – one that we can implement with as little effort as possible. One that’s actually possible to maintain.

But first, let’s discover why exercise is even worth the effort. (Trust me, it is.)

How does exercise treat depression?

Scientists used to believe that the human brain would grow and change from the time we are born until around 20 years of age. After that, they believed the structure of the brain became “fixed”. And that the brain would just slowly lose cell after cell until it died.

Today, researchers have changed their minds about the brain’s ability to grow and change – a phenomenon called brain plasticity. Now we know that certain activities will significantly change the structure of the brain, regardless of age.

Well, you may have guessed that physical exercise is one of them.

As it turns out, exercise helps certain brain areas grow – areas which are responsible for memory, emotional regulation, concentration, abstract thinking, logical reasoning and a lot more.

But not only that. Exercise makes our brains more plastic – it enhances the brain’s ability to grow.

This short video summarises some of the most important changes that exercise triggers in our brains:

To quickly sum up: Physical exercise is the only antidepressant strategy that has an immediate effect on depressive symptoms. A power walk increases mood and concentration right away, whereas other treatments usually need several weeks to work. And with time, physical activity changes the structure of our brains.

Or, as Dr Jin-Lei Zhao and colleagues put it:

How much exercise is enough to treat depression?

Perhaps you’re wondering about the dosage? As it turns out, very little is enough to prevent depression.

In fact, a research team led by Dr Samuel B Harvey found that only one hour of physical activity per week could reduce the risk of becoming depressed by 12 %. The study included 33 908 people who were studied for 11 years.

And what is required to treat a current episode of depression?

Numerous research teams have investigated this question for decades. And in 2018, mental health scientist Ioannis D. Morres and his colleagues wanted to check, once and for all, if exercise was an effective depression treatment.

They examined a large pool of research trials to find the studies with the highest quality. Finally, they decided to include 11 Randomised Controlled Trials (RCTs – high quality studies including a control group) in their meta-analysis.

And the result of their analysis was clear and simple: exercise emerged as an effective antidepressant intervention. In fact, regular exercise was just as effective as antidepressant medication or psychotherapy.

Also, exercise proved to be effective across a variety of delivery formats and settings. It didn’t matter how severe the patients’ symptoms were – exercise was effective regardless of depression severity.

The exact dosage varied a bit between different studies, but on average the research participants exercised:

• ⏱ for approximately 45 minutes,
• 🏃‍♂️at moderate intensity,
• 3️⃣ 3 times a week
• 🗓 for about 9 weeks.

Other analyses indicate that 30-45 minutes of moderate exercise, 3-4 times a week can be equally effective.

So, what’s “moderate” intensity?

It means that you get your heart rate up and work up a sweat, but you don’t push yourself to the max. Here is a quick reference:

High intensity = Running as fast as you can
Moderate intensity = Jogging
Low intensity = Walking

So, it doesn’t have to be hard core training. And you can choose the type of exercise that appeals to you (or if you don’t like exercise at all – choose the lesser of evils).

But if you are a beginner, I recommend that you start with a much smaller dose (more on that later).

What type of exercise is the most effective against depression?

Actually, the type of exercise doesn’t matter as much as researchers once thought. Most studies have focused on aerobic exercise (cardio training that increases your heart rate). But in recent years, other activities have entered the research field.

According to a review article from 2020, high quality RCT studies have repeatedly shown that several forms of exercise can improve depression.

This is true for:

1. Aerobic exercise 🚴‍♀️ (such as cycling, jogging, dancing, swimming, playing ball games or other activities that increase your heart rate)
2. Resistance training 🏋️‍♂️(such as lifting weights, bodypump or using resistance bands)
3. and Mind-body exercise 🧘‍♂️🥋 (such as yoga and Tai Chi Chuan)

Simply put: It matters less what exact movements you choose as long as you regularly move your body.

However, if you choose aerobic exercise or resistance training as your depression treatment, it’s important to work up a sweat and get your heart rate up for at least 30 minutes at a time. In most studies, exercise with high or moderate intensity has proven to be more effective than low intensity training. Also, it’s more powerful to do a full 30-minute workout than to split your exercise into three 10-minute sessions.

Simply put: 30 minutes of jogging tends to be more effective than a 30-minute walk. But remember, the walk is also antidepressant! Some people recover from depression just by implementing 20- or 30-minute walks into their daily routine.

How can yoga and Tai Chi Chuan treat depression?

Now, perhaps you’re wondering about yoga… If it’s true that high intensity training is better than low intensity, how is it possible that slow movements like yoga poses are effective against depression?

Well, mind-body practices such as yoga and Tai Chi Chuan (or Taijiquan) offer something in addition to the movements. Instead of focusing on fitness, they aim to integrate body, spirit and external environment to improve overall health. Also, they include elements of deep breathing and meditation, which can help explain the antidepressant effects.

Read more about yoga for depression here.

What type of exercise is right for me?

There are benefits with all forms of physical exercise.

Aerobic exercise can:

• Protect against a myriad of diseases, such as Alzheimers, diabetes and cancer
• Increase your ability to manage strong emotions
• Improve concentration
• Improve memory
• Improve sleep quality

Resistance training can:

• Delay muscular degeneration
• Promote healthy metabolism
• Alleviate anxiety and feelings of inferiority
• Improve mood

Yoga and Tai Chi Chuan can:

• Reduce negative emotion
• Improve sleep quality
• Relieve fatigue
• Prevent cardiovascular and cerebrovascular diseases

My advice is to choose the form of exercise that seems most appealing to you. After that, we can start building your new exercise routine.

6 exercise hacks for depressed people

In your mind, what is your biggest challenge when it comes to regular exercise? (Getting started, keeping up the habit, fatigue, forgetfulness, negative thoughts about your body…)

Well hopefully, the following 6 pieces of advice (or exercise hacks) can spare you some frustration when building your new routine.

#1 Keep it short

Exercising with depression is different from exercising without it. When depressed, we tend to compare ourselves to the non-depressed version of us. And we sometimes criticise ourselves harshly if we fail to live up to our expectations:

“I should be able to do better”

“This is not good enough”

“Why can’t I do this?! There’s something wrong with me”

“This is just another failure”

Critical thoughts make us set inappropriate goals – goals that are way too challenging for a depressed body. For example, we may be tempted to schedule a 90-minute spin class when a 20-minute walk would be more appropriate.

So, take your depression into account when building your exercise routine. It’s completely natural to not be able to work as hard as before your depression. Perhaps begin with short walks or light jogging. And as you get the habit going, add a few minutes to your routine every time you do it.

#2 Specify your goals

Common symptoms of depression include a loss of interest in daily activities, reduced motivation, unusual fatigue and difficulties making decisions. This means it will be challenging to spontaneously schedule a workout or decide on the spot when and how to exercise.

The solution is to decide in advance exactly when and how to move your body. Try to make your goals as specific as possible. After all, the biggest mistake people make when building a new routine is to leave it unspecified. Here are a few examples of vague goals:

“Be healthier”

“Go jogging twice a week”

“Start power walking next Monday”

If too many variables are left unspecified, it’s easier to push our exercise session into the future.

Here are a few examples of specific goals:

“Take a 20-minute walk around the lake on Thursday the 7th at 9 am.”

“Attend the 7 pm dance class at The Studio on Pretend Street on Monday the 1st.”

“Do 3x20 sit ups and 3x10 burpees on Wednesday the 28th at noon.”

A specific goal tells you exactly what to do to accomplish it and when to do it.

#3 Keep it simple

A common mistake people make when starting their exercise routine is to overcomplicate it. And to make decisions based on motivation.

Motivation is fleeting. And it’s usually highest during the first week of a new routine. This is probably why the gym tends to be packed with people in January, but echoing empty in March.

The solution is to avoid making decisions based on motivation. Instead, reflect on what seems realistic. What type of workouts can you manage to complete even when fatigued, sad or lonely?

Then, set long-term goals and break them down into smaller goals. For example, if your wish is to be able to take go jogging for 40 minutes every Monday, Thursday and Saturday, your first week of exercise might look something like this (note, this is just an example):

Week 1

Monday: 20-minute walk at 9 am.

Thursday: 20-minute jog at 9 am.

Saturday: 20-minute walk at 9 am.

Depending on how the first week goes, you may want to adjust your goals.

If too challenging: reduce the duration or the number of days.

If accomplished with ease: try to increase the duration or the intensity.

If challenging but achievable: repeat the same goal for two-three weeks until you can accomplish it with more ease. Then, increase the intensity or duration.

#4 Set one goal at a time

Doing too many things at once is another common mistake people make when they want to start exercising. When motivation hits us, we build up an image in our minds about what a healthy life looks like and we try to do it all at once. But that usually ends in disappointment. Such a strategy is based on motivation. And (as mentioned earlier) motivation quickly wanes.

A long-lasting way to create a healthy life is to take one small step at a time.

#5 Include your friends and family

Have you ever heard of the observer effect? It means that we usually perform better when we are being observed by others. Also, we are less likely to cancel plans after making a commitment to a friend or a family member.

So, one of the most powerful strategies you can use is to schedule your workouts together with somebody you like. If that doesn’t appeal to you, sign up for a group class. Exercising with other people means socialising, which is also an antidepressant – two birds with one stone.

#6 Reward yourself every step of the way

Give yourself small rewards or words of encouragement every time you take a step on the path towards healthy exercise. Post on social media, give someone a high-five, tell yourself how impressed you are for starting something new, cook your favourite food or read a fun magazine… And remember that every step counts. No achievement is too small to celebrate.

How to create an exercise plan for depression

So, how do we make a long-term exercise plan that’s actually reasonable and attainable? Well, this process can be a bit more complicated than we think. Setting goals is easy. But setting achievable goals is a different story.

Human beings are emotionally driven creatures. And we need special tools to keep us on the right track (pun intended 🏃‍♂️) when motivation wanes.

Most long-term goals are left unmet for these reasons:

• They are too vague
• They are not important enough
• They don’t include a measurement of success

It’s important to counter those issues. The following video presents a powerful technique for creating achievable goals:

So, this is basically how it’s done:

1. Look into the future (a few months ahead)
2. Set a specific, measurable and time bound goal for that future
3. Take a small step today, towards that future goal

Let’s begin.

What is the first step towards antidepressant exercise?

The first step on the road to your new exercise routine is something to achieve today or within the next few days – a short-term goal.

Take a look at your first milestone (the one that you created under #TIMEBOUND). What action can you take today or within the next few days to get closer to it?

For example, if your first milestone is to take a 30-minute walk every Monday and Wednesday, your short-term goal might simply be to take a 30-minute walk.

Or, if your first milestone is to attend a group workout once a week, your short-term goal might be to sign up for a class. Or to attend your first class.

You decide what is reasonably challenging this week. You can even choose such goals as power cleaning, power gardening or playing with animals.

So, what action can you take today or within the next few days to get closer to your milestone?
Write down your answer.

Okay, now let me ask you 9 important questions to make this short-term goal both SPECIFIC and MEASURABLE.

1. Where will you do it? (For example, where do you go for a walk?)
Write down your answer.

2. When will you do it? (As soon as possible is recommended. Maybe today or tomorrow?)
Write down your answer. Mark your calendar. And set a reminder.

3. And for how long?
Write down your answer.

4. Are you doing this alone or with a friend? With whom? When will you ask them to participate?
Write down your answer.

5. What could stop you from doing this? Do you see any potential obstacles on the horizon? (For example, thoughts, work assignments, kids, anxiety, fatigue etc.)
Write down your answer.

6. Can you think of possible solutions? What can you do to remove or manage those obstacles? (For example prepare your family, mark the calendar, do a quick meditation, call a friend for support etc.)
Write down your answer.

7. Even though we prepare for obstacles, unexpected barriers can arise and keep us from reaching our short-term goals. If that should happen, what’s plan B? (For example schedule a backup workout)
Write down your answer.

8. To commit to this first step, I suggest you tell an important person in your life about your goal. It could be anybody: a friend, relative, teacher or doctor. Whom can you tell about this goal?
Write down your answer.

9. And how will you reward yourself after completing your first step? (Cooking your favourite meal, hugging someone, posting on social media, telling yourself something encouraging, shouting from the rooftops, taking a hot bath, playing a video game…)
Write down your answer.

And there you go. You have created a SMART goal and the first step on the road to a healthier life – both physically and mentally. Don’t forget to evaluate your plan as you go along. And set a ton of reminders.

Hope this helps.