An Integrative Approach to Moving Away from Depression

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We are all aware that exercise is good for us. But is it possible that physical activity can also support mental well-being?

A recent article published in the American Journal of Psychiatry suggests that it might. It almost sounds cliché that a healthy body equates to a healthy mind. We know this is not always the case. For instance, professional athletes in pristine form are not immune to psychiatric illness. Still, there might be an inherent truth to the idea that physical activity serves as a protective factor for our mood. According to the CDC, almost half of adults aged 18 and over are not meeting the recommendations for aerobic physical activity and almost 80% do not meet recommendations for aerobic physical activity and muscle-strengthening activity combined. Considering depression is one of the leading causes of disability in the United States and around the world, and the fact that suicide (the 10th leading cause of death in the United States) is tightly associated with depression, this makes for an important discussion.

Felipe Schuch and colleagues performed a meta analysis of 49 studies that examined the relationship between physical activity and depression (Schuch). After rigorous analysis of the studies, their findings concluded that physical activity serves as a statistically significant protective factor by reducing the odds of developing depression regardless of age or geographic region (Schuch). Of course, more studies need to be performed, and there are inherent limitations to the study findings, but this is still a big step with regards to advocating for treatment that extends beyond medication management and conventional psychotherapy.

I recently sat down with Joel Homme, a seasoned yoga teacher with over 6,000 hours of teaching experience, to record an episode for the podcast, “This is Mental Health.” He spoke eloquently on the importance of movement, with the idea that physically moving our body may support vitality. As I have had time to reflect on this, I can appreciate how this idea plays beautifully with a recovery model in mental health. Whether it is writing something as basic as “yoga” on a prescription pad, or asking patients about ways they are using movement to support their own physical health, including a discussion on physical activity may provide more comprehensive and ultimately better care.

But why might exercise make us feel better from a mood standpoint? The simple answer is we don't know definitively, but there are several viable theories. The Monoamine Hypothesis suggests that exercise may serve to increase levels of serotonin, dopamine, and norepinephrine in the brain —central markers in depression and anxiety. Some have offered an alternative theory referred to as the Self-Efficacy Hypothesis, which I find particularly interesting (Craft). This hypothesis supports the notion that physical activity may serve to reverse a belief of “I can’t” to “I can, because I did.”

Aside from what we already know—that aerobic exercise helps support a healthy heart, fends off obesity, and reduces the risk for type two diabetes—it is now time to acknowledge its important role in the treatment of mood disorders. In a truly integrative approach, when discussing the benefits of exercise, even outside a clinical setting, reducing the risk of depression should be appropriately touted as a potential benefit. This is not only good for individual patients, but for mental health care in a broader sense. If we can work to extend these conversations beyond those working specifically in the mental health system not only to physicians in other fields, but to those outside the healthcare professions in general (chefs, coaches, and teachers for example), then mental wellness can become a part of any health-based discussion which may help improve discourse on mental health as a public health concern. This concept is a cornerstone of Green Psychiatry.

Earlier this week, NBA all-star LeBron James opened his signature I Promise school in his hometown of Akron, Ohio. James has spoken of his tumultuous childhood that consisted of growing up in a single parent home with a father who was largely absent. He has also discussed his belief that sports provided an outlet that averted him from entering into what could have been a life smeared by drugs, alcohol, and crime. When I consider James’ remarkable story, I speculate on the degree to which sports, physical activity, and being part of a team—a community—played to his own resiliency narrative. It is not a fallacy to offer the idea that movement fosters resiliency, and resiliency brings us one step closer to vitality and wellness. With this idea in mind, let’s keep moving.