A recent systematic review of randomized clinical trials indicates that aerobic exercise has significantly large antidepressant treatment effects for patients with clinical depression. This paper, “Aerobic Exercise for Adult Patients with Major Depressive Disorder in Mental Health Services: A Systematic Review and Meta‐Analysis,” was published October 18 in the journal Depression and Anxiety.
Anyone who breaks a sweat via physical activity on a regular basis knows from first-hand experience that aerobic exercise makes us feel good. As the author of The Athlete’s Way: Sweat and the Biology of Bliss, my mission in life is to motivate people to seek regular aerobic exercise as a way to improve their mental health. In my opinion, the physical health benefits of aerobic exercise are secondary to the cognitive and psychological benefits of moderate-to-vigorous physical activity (MVPA).
My passion for promoting aerobic exercise as a prescriptive tool for combating clinical depression is personal. In the winter of 1983, when I was 16, I suffered a major depressive episode (MDE) that pushed me to the brink of suicide. Luckily, that summer, I discovered the antidepressant power of running. Aerobic exercise pulled me out of my clinical depression and turned my life around. (See "Growth Mindset Advice: Take Your Passion and Make it Happen.")
My late father (Richard Bergland) was a neuroscientist who studied the impact of daily activities on neurophysiology in a laboratory using animal models and wrote a book called The Fabric of Mind. As a teen, based on my childhood exposure to his research, I made myself a human guinea pig and tried to figure out how various "doses" of exercise made me feel. It became clear to me that daily sessions of vigorous aerobic exercise throughout that summer of 1983 (while blasting "Flashdance (What a Feeling)" and "Holiday" on my Walkman) had transformed my brain and how my mind worked. But I realized by the winter of 1984 that if I didn't exercise a few times a week, my depression would creep back. Through trial-and-error, I was able to pinpoint a “tonic level” of weekly aerobic exercise that was "just right" for my mental health and acted like an antidepressant prophylactic that prevented me from slipping back into depression.
Over the past decade, I’ve kept my antennae up for empirical evidence to support my anecdotal experience. That said, there remains a heated, ongoing debate about the ideal duration and intensity of aerobic exercise that someone should do on a daily/weekly basis to optimize mental health.
The million-dollar questions remain: What intensity of aerobic exercise (e.g., light, moderate, vigorous, or intense) is best for combating anxiety and depression? How many minutes per day and hours per week of physical activity are necessary to trigger antidepressant effects?
The latest systematic review and meta-analysis of clinical trials involved 11 eligible studies and 455 adult patients (18-65 years old) with major depressive disorder (MDD). Instead of taking antidepressants, these patients were treated with supervised aerobic exercise for an average of 45 minutes at moderate intensity, three times per week, for 9.2 weeks. The review also found that aerobic exercise has moderate-to-large antidepressant effects in trials for those with a lower risk of clinical depression, as well as large antidepressant effects among trials with short-term interventions (up to 4 weeks).
The systematic review and meta-analysis concluded that there is a significantly large overall antidepressant effect of aerobic exercise compared with antidepressant medication and/or psychological therapies. "Collectively, this study has found that supervised aerobic exercise can significantly support major depression treatment in mental health services," lead author Ioannis Morres of the University of Thessaly said in a statement.
In addition to providing empirical evidence that aerobic exercise has powerful antidepressant effects, this meta-analysis also advances our understanding of a specific dose-response. Based on this systematic review, it appears that three 45-minute sessions of moderate-intensity aerobic exercise per week is associated with depression relief in adult patients with major depressive disorder.
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Ioannis D. Morres, Antonis Hatzigeorgiadis, Afroditi Stathi, Nikos Comoutos, Chantal Arpin‐Cribbie, Charalampos Krommidas, Yannis Theodorakis. "Aerobic Exercise for Adult Patients with Major Depressive Disorder in Mental Health Services: A Systematic Review and Meta‐Analysis." Depression and Anxiety (First published: October 18, 2018) DOI: 10.1002/da.22842