# Exercise as it relates to Disease/Exercise in the Treatment of Depression
## Background of Exercise and Depression

Depression is a common and debilitating mental disease that can have a devastating effect on the individual and those close to them. Depression is characterized by prolonged feelings of sadness, dejection and hopelessness.
The World Health Organisation International Classification of Disease classifies depression as:
* 2 weeks of abnormal depressed mood
* Loss of interest and decreased energy
* Loss of confidence
* Excessive guilt
* Recurrent thoughts of death
* Poor concentration
* Sleep disturbance
* Change in appetite.
Two symptoms of depression are quite recognizable, lack of motivation and fatigue resulting in exercise not being a priority. Depressed patients are often physically sedentary. Which can cause a reduction in physical work capacity. This indicates that the reduced fitness level is caused by physical inactivity and is a strong argument for integrating physical fitness training into comprehensive treatment programmes for depression.

## Exercise effects on Depression

Regular exercise can be an effective treatment by itself for mild depression (particularly for people who were previously sedentary). For more severe depression, exercise can be a helpful addition alongside other treatments (e.g. medication or psychological therapies).
Benefits of regular exercise may help depression by improving:
* Self-esteem and confidence
* Energy levels
* Social aspects (especially in group exercise situations)
* Sleeping patterns
* Distraction from areas of worry, concern and guilt
* increased levels of brain neurotransmitter serotonin

## Exercise Recommendations

When designing an exercise prescription for patients who have depression the individual circumstances of each patient must be considered. Hopelessness and fatigue can make exercise difficult, and some individuals are vmay feel guilt and self-blame if they fail to stick with a regimen. A realistic, flexible, and pleasurable program has the best chance for success.
| Frequency | 2-5 times a week |
| Intensity | Whatever the individual feels up to |
| Time | 30+ minutes a day overall |
| Type | Aerobic or resistance |
The National Physical Activity Guidelines for Australians recommend:
* A minimum of 30 minutes of moderate intensity exercise on most, preferably all, days of the week (an example of ‘moderate intensity’ exercise is brisk walking where you notice a slight increase in breathing and heart rate) .
* Exercising for at least 10 minutes at a time - the 30-minutes total does not need to be continuous you can combine short sessions of different activities to a total of 30 minutes or more each day.
* Being active in as many ways you can each day (e.g. use the stairs).
* Both aerobic exercise (e.g. brisk walking, cycling or jogging) and resistance or strength training (e.g. weight-lifting) have been found to be beneficial for depression.
The National Physical Activity Guidelines for Australians recommend:
* A minimum of 30 minutes of moderate intensity exercise on most, preferably all, days of the week (an example of ‘moderate intensity’ exercise is brisk walking where you notice a slight increase in breathing and heart rate)
* Exercising for at least 10 minutes at a time - the 30-minutes total does not need to be continuous -you can combine short sessions of different activities to a total of 30 minutes or more each day.
* Being active in as many ways you can each day (e.g. use the stairs).
* Both aerobic exercise (e.g. brisk walking, cycling or jogging) and resistance or strength training (e.g. weight-lifting) have been found to be beneficial for depression.

## Further Information and Support

* General Practitioner
* Psychologists/ Clinical psychologists
* Hypnotherapy
For further readings or information go to:
* http://www.beyondblue.org.au/ Or Call 1300 22 4636
* http://www.lifeline.org.au/ Or Call 13 11 14

## Research Based Evidence

Numerous studies have shown that people who exercise regularly experience fewer symptoms of depression and anxiety than those who do not exercise regularly.
* Several trials have shown that regular exercise of moderate intensity can be an effective treatment by itself for mild to moderate depression.
* Two trials have found that 16 weeks of regular exercise is equally effective as an SSRI antidepressant medication in the treatment of mild to moderate depression in older adults who have been inactive.
* Research also suggests that exercise can further assist depression in individuals with depression who have responded only partially to an antidepressant medication.
Studies include:

## References

* ↑ DepressioNet.org.au (2011). "What is Depression". http://depressionet.org.au/what-is-depression/ ?open
* 1 2 Benefits of exercise for the treatment of depression (1990). “Sports Med”. http://www.ncbi.nlm.nih.gov/pubmed/2192427?open
* 1 2 3 Exercise and Depression (2011). “Black Dog Institute Australia”. http://www.blackdoginstitute.org.au/docs/ExerciseandDepression.pdf
* ↑ Exercise in the treatment of depression (2011). “Current Psychiatry Reports Volume 11, Number 6, 466-472”?open
* ↑ Running versus weight lifting in the treatment of depression (1987). "PubMed”. http://www.ncbi.nlm.nih.gov/pubmed/3454786?open
* ↑ Exercise intensity and reduction in neurotic symptoms: a controlled follow-up study (1989). “Pub Med” 1989;80(3):231-235. http://www.ncbi.nlm.nih.gov/pubmed/2816466
* ↑ Influence of aerobic exercise training and relaxation training on physical and psychological health following stressful life events (1987). “Psychosom Med” 1987;49(4):355-365. http://www.ncbi.nlm.nih.gov/pubmed/3303097