We live in depressed and anxious world today. With the increasing isolation and abounding fear intensified with the events of 2020, more and more are facing depression and anxiety as a part of daily life. The hope of recovery in conventional medicine has long resorted to either medications or admonitions to pull oneself by their bootstraps. The increasing recognition that the most common medications, SSRI’s or selective serotonin reuptake inhibitors, are not always successful in restoring mood balance has made the situation even more depressing for many. More emphasis needs to be placed on natural or lifestyle interventions like this study in which they evaluated the effects of exercise on depression and anxiety.
A group of researchers from the University of South Australia reviewed the medical literature to gather the available date for an answer to whether physical activity, in other words exercise, would benefit patients with mild to moderate depression and anxiety. They included 1039 different trial that had been previously grouped into 97 reviews. This included in total over 128,000 different individual patients. With so many different studies using a variety of physical activity interventions as well as different outcome measurement, this was not a simple task. Despite the challenge, they did find that physical activity showed a positive benefit across the board for types of exercise. The reported benefits were in line with the benefits found in studies of medications typically used for these conditions.
Several finer points were worth noting. “The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals.” The benefits seemed to lessen in the longer duration studies prompting these researchers to consider why shorter interventions seemed more impactful. They also found that moderate to high intensity exercise showed higher benefits than low intensity ones. The researchers thought that a threshold effect might be in place in which the activity had to be of sufficient intensity to trigger hormonal or neurotransmitter changes needed to improve moods.
From a functional medicine viewpoint, this study has upsides and downsides. On the upside, it confirms that our emphasis on lifestyle interventions do produce measurable benefits in patients. Encouraging our patients to increase physical activity to appropriate levels have benefits in their reported improvement at subsequent visits. On the downside, with any intervention whether lifestyle or supplement or medication, there is an art to timing and coaching to proper implementation. A severely depressed patient is unlikely to have as much motivation to start exercising as one who is only mildly to moderately symptomatic.
A patient with a debilitating medical condition may also be depressed, but exercise may be a bad idea if implemented before they are physically capable of the added activity. Just like with someone recovering from an entirely physical illness, helping the patient to appropriately dose the exercise is critical. Too much activity, too soon may actually not only worsen symptoms but set the medical condition back a step or two. Thus, timing and dosing of activity needs to be guided by an experienced clinician just as much as dosing a blood pressure medicine or a vitamin.
Helping our patients restore healthier more abundant lives means the wise and methodical application of both science and the art of medicine. Setting up sufficient time with our patients to provide this type of guidance means we work outside of the insurance model where they do not pay for this type of care.
Singh B, Olds T, Curtis R, et al., Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine Published Online First: 16 February 2023. doi: 10.1136/bjsports-2022-106195
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.