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Depression, mental health and activity

Nurturing

Health
Andrew O'Brien

It was Mental Health Awareness week recently, and Mental Health Ireland in their promotional material included the ‘Five Ways to Wellbeing’ guide. The ‘Five Ways to Wellbeing’ is based on research done by the New Economic Forum, a UK think-tank looking for ways to improve mental health and wellbeing.
The five ways referred to are: connect, be active, take notice, keep learning and, give. Evidence has shown that people who are engaged in these five areas have a lower risk of depression, and a better rate of recovery if they do develop depressive symptoms.
While each category is equally important, as a physiotherapist my job is to concentrate on the ‘be active’ one. Thankfully, a recent report published in the Current Sports Medicine Reports journal has shed some fascinating light on how important physical activity is in the prevention and treatment of depression.  
The report highlights the high prevalence and cost of depression around the world. Up to 18 percent of people have Major Depressive Disorder at any one time, and the estimated global cost of days lost to work due to depression and anxiety is US$1.15 trillion every year.
There is a growing body of evidence that people with depression have poorer physical health, including an increased prevalence of diabetes, heart disease and some cancers. People with Major Depressive Disorder also have a shorter life expectancy than the general population, and while suicide does account for a percentage of those premature deaths, the higher rates of illness is another significant contributing factor.
The study’s authors analysed data from 49 studies, including a total of 266,000 participants, and found that physical activity reduced the risk of a person experiencing depression by between 17 and 41 percent and that these effects were consistent across both sexes, different ages and countries. Thus, they found that physical activity doesn’t mean you will never experience depression, but certainly lowers the risk of that happening, regardless of who you are, how old you are and where you live.
When looking at exercise as a treatment for people with depression, the study looked at both short- and long-term results. They report an improvement in well-being after a 20-minute bout of cycling at any intensity – in other words a single short burst of exercise can help relieve depressive symptoms.
When analysing the results of 25 studies on the longer-term effect of exercise, they found that 40-50 percent of people with depression showed some response to exercise, a similar rate of effect as medication and psychological ‘talk’ therapies.
If treating depression was as simple as saying ‘just do some exercise’, the world would be a wonderful place. But we all know that it isn’t that easy and motivation to persist with exercise can be hard to maintain at the best of times, and is likely significantly more so during periods of depression.
This study reported that exercise therapy has a drop-out rate of 18 percent. Interestingly, this is actually lower than the drop-out rate for psychotherapies (19 percent) and medications (26-28 percent). It is suggested that drop-out rates are lower when people chose an exercise that they enjoy and perform it at their chosen intensity. Putting anyone in an environment they don’t like and demanding that they exercise at a level that is too high for their current level of fitness is a sure-fire way to make them drop out, depression or not.
It is also reported that supervised and social programmes maintain compliance better than setting a programme and expecting the individual to do it themselves.
It is worth pointing out that none of the three treatment options for depression – medication, psychotherapy and exercise – are mutually exclusive, and a combination of all three is most likely to result in the best outcome for a patient. It should also be remembered that the risk and severity of diabetes, heart disease and cancer, which are all more prevalent among people with depression, can be reduced by increasing physical activity.
Sadly, there is no silver bullet for depression or anxiety; anyone who has experienced either will tell you that. I am not trying to claim that exercise is a simple solution to a complex and debilitating problem. It is though, an extremely powerful weapon in the fight.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.