# Exercise as it relates to Disease/Kick the blues with exercise
## Kick The Blues With Exercise

          Using Exercise to Treat Depression

### Background

Depressive illness is a severe medical condition with individuals suffering from prolonged and persistent unhappiness, negativity and problems coping with daily life. No one is immune to depression and approximately 20% of people will experience it at some point in their lives.$^{1,2}$ For most people, a build up of stress is the precursor to depression, although some individuals are at a higher risk of suffering the disease, including people who:
* Are unable to communicate effectively with friends and family - about both everyday and serious issues
* Have multiple demands on their time - leaving little to no relaxation time
* Have certain personality traits - for example anxiety, prone to worry and a lack of self confidence
* Have fragile biochemistry - either due to illness, genetics or recent childbirth
* Imbibe in excessive amounts of alcohol or marijuana$^1$

### Signs & Symptoms

The signs and symptoms of depression will vary between individuals as depression will affect each person differently. However, some common symptoms may include:
* Lowering of mood - feeling sad and tearful almost every day
* Persistent negativity and pessimism - everything feels pointless even their lives
* Tiredness and fatigue - due to disturbances in normal sleeping patterns
* Loss of appetite and sex drive
* Loss of pleasure and motivation - in relation to normally enjoyable activities$^{1,2,3}$

### Common Treatments

* Anti-depressant prescription drugs - to restore chemical balance within the brain
* Therapy or cognitive training - to teach and encourage individuals to think and act in a more positive manner
* Community support programs - to assist with education, work placements and show community acceptance
EXERCISE AS TREATMENT
There is growing evidence to support the idea that physical exercise is an effective treatment for depression, with studies showing a decrease in signs and symptoms in exercise participants.$^{7,8}$ Exercise can:
* Regulate Mood - frequent exercise is seen to have an anti-depressant effect as it alters the neurochemistry of the brain in much the same way that anti-depressant drugs do. While anti-depressant drugs act to inhibit the re-uptake of serotonin in the brain exercise actually increases brain serotonin producing much the same effect.$^{4,7,8}$
* Decrease Negative Focus - exercise decreases the tendency to focus on perceived negative attributes while encouraging feelings of self-worth, perceived control and positive feedback.$^{4,5,8}$
* Break Stress Cycles - leisure time physical activity gives people a break from factors causing depression related stress. It also prevents the time stress associated with fitting an exercise program into busy schedules as it is done in designated down time and it may help to foster new social relationships further breaking down stress cycles.$^{5,6,7,8}$
* Boost Energy & Aid Sleep - exercise increases central endorphin concentration which provides a boost in energy and breaks the pattern of insomnia$^{5,6}$
* Teach Coping Mechanisms - exercise teaches how to deal with feelings of discomfort and exertion, sweating and heavy breathing, which can help in daily life when stressful situations mirror these feelings. Adaptation and a decrease in the feeling of discomfort generally occurs quite quickly in depressed individuals as depression is often associated with reduced levels of physical activity. $^{4,5}$
* Be Cost Effective and Relatively Side Effect Free $^8$
* Provide Other Health Benefits - including weight loss and reduced cardiovascular risk$^8$

### Recommendations

There is no specific exercise program to aid in the treatment of depression, however certain recommendations that do apply include:$^3$
* Setting realistic goals and beginning with a program appropriate to ones fitness level - unrealistic goals and training regimes can increase feelings of worthlessness when an individual fails to reach set targets, causing exercise adherence to be lost. It is important to remember that a simple walk is often enough for individuals with limited fitness.$^{3,4}$
* Exercise regularly - increased serotonin levels will not remain in the brain indefinitely, as such it is recommended that individuals participate in 3 - 5 sessions per week. $^4$
* Exercise at a moderate to vigorous intensity level for maximal benefit. $^{4,5,6}$
* Exercise aerobically - increasing endorphin concentration provides the greatest results in lowering depression. $^{4,5}$
* Working with an exercise professional - this will help with social support, program adherence and the development of a program suited to current fitness levels.

### Limitations

There are only a few limitations on exercise as a treatment for depression:
* Onset - it is incorrect to believe that there is a delay in the onset of exercise induced anti-depressant effects when compared with drug therapy; it is much the same for both at approximately 2 – 4 weeks with exercise adherence. $^4$
* Exercise intensity - beginning at an intensity above an individuals ability may cause a negative mood reaction. $^5$
* Level of depression - studies are inconclusive about whether severe depression can be treated by exercise alone or whether it may require a combination of exercise and drug therapy. $^{4,5,6,8}$

### Further reading

* Sane Australia - www.sane.org
* Professional Counselling - www.depression.com.au
* World Health Organisation - www.WHO.int
* Journal of Sport and Exercise Psychology - various articles

### References

* Hogan, D. (2009) Depression a Quick Summary www.depression.com.au
* Author Unknown (2010) Depression Sane Australia. www.sane.org
* Welch, L (2011) Fight depression with exercise Fawshaw Focus; 7:4
* Legrand, F et al (2007) Anti-Depressant Effects Associated With Different Exercise Conditions in Participants With Depression: A Pilot Study Journal of Sport and Exercise Psychology; 29: 348-364
* Francis, J et al (2010) The Role of Depression in Short-Term Mood and Fatigue Responses to Acute Exercise International Journal of Behavoural Medicine; 17:51-57
* Craike, M et al (2010) Direct and Buffering Effects of Physical Activity on Stress-Related Depression in Mothers of Infants Journal of Sport and Exercise Psychology; 32: 23-38
* Strohle, A (2009) Physical activity, exercise, depression and anxiety disorders Journal of Neural Transmission; 6: 777-784
* Daley, A (2008) Exercise and depression: a review of reviews Journal of clinical psychology in medical settings; 15:140-147