FITNESS MATTERS
Depressed? Then work out
DR. SHEELA NAMBIAR
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Exercise not only helps you stay fit physically but also helps improve your mood.
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Photo: V. SUBRAHMANYAM
It is well known and widely acknowledged that regular exercise relieves depression. A recent study published in Psychosomatic Medicine (2007; 69, 587-96) stated that patients who exercised in a group programme experienced relief in
symptoms compared to those taking treatment with conventional antidepressant medication. For those who exercised alone, without supervision, the symptomatic relief was somewhat less, due perhaps to lack of compliance with the exercise, but the home exercisers were still better than the ones who did not exercise at all but were given a placebo. The study was conducted by Duke University. There are several such studies done over the years that authenticate the importance of using exercise as a modality to treat depression.
According to Mayo Clinic, “Exercise is not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety.”
Just how much exercise is actually required to reduce symptoms of depression is not fully understood. Research studies show that it may require at least 30 minutes of exercise/day, 3-5 times/week. But as little as 15 minutes can improve the mood short-term.
Reasons
On trying to analyse the reasons why exercise could perhaps relieve symptoms of depression, there have been several findings. It is recognised that endorphins are released during exercise. Endorphins, which are mood-enhancing neurotransmitters (like opiates), improve mood and relieve depression chemically. Following a spell of vigorous exercise, most individuals will report an elevated mood, feel positive and energised. This happens even when they start the routine feeling tired or depressed. Exercise also reduces the levels of the stress hormone, Cortisol.
Almost 80 per cent of patients with depression have difficulty sleeping. Exercise regulates sleep patterns. This is an added benefit, combating the fatigue that accompanies sleep deprivation.
Physical activity, particularly when it is repetitive and structured, causes the mind to focus on the activity at hand, and not on the numerous negative thoughts that often cloud the mind of a depressed person. Their attention is diverted from their own misery to the simple act of walking/running or dancing. This is more pronounced when the activity becomes more intense as at that point when one is working at 70 per cent intensity; it is practically impossible to brood about one’s perceived misfortune.
When attending an aerobic class, for instance, the music, the other students, a motivating instructor and the exciting step learnt, tend to sidetrack the individual from one’s sadness and just stay in the moment, even if only for an hour or two.
Subsequently, the spill over of the endorphins into the next couple of hours, the anticipation of the next class, the weight loss and feel good factor keeps them going. When adhered to, exercise can be a crutch to lean on at these times. In association with regular exercise, if the individual is subjected to cognitive therapy, perhaps antidepressants if required and extensive counselling, the treatment can be complete and successful. The chances for recurrence of depression can be averted by persisting with regular structured exercise.
Disciplined routine
Exercise also lends a focus to your life. A disciplined routine, when maintained, can be an affirmation of one’s resolve and capability. This in itself is a great morale booster. The thought that one can subject oneself to a fitness routine (however distasteful one may find it initially) day after day is a great way to assert one’s self worth. Appropriate goals, which are both realistic and sensible, need to be set as part of the fitness training. On achieving those goals, once again, one’s sense of self worth is reaffirmed and self-confidence elevated.
Regular exercise aids weight loss. Being overweight has deleterious effects on one’s psyche. Beginning in childhood, an overweight individual faces some flak, which is carried over into adulthood as a reminder of inadequacies. On obtaining some degree of weight loss with regular exercise, the individual has a increased sense of self-esteem beneficial in someone who suffers feelings of self-doubt and uncertainty. Improved appearance does more to enhance confidence.
Connect to others
Attending a class or joining a gym is also a social activity that enables one to connect with other people doing the same thing. Depressed individuals often isolate themselves and, as a result, become more depressed as they wallow in self-pity and their mind goes through endless loops of melodrama, which is part of the disease.
A diversion with activity, other people (especially people they are not otherwise concerned or connected with), an instructor, trainer, music act as mood elevators and breaks this cycle of negative thought process and pessimism.
Many GPs and psychiatrists in the West practise “Exercise Referral” when they believe the patient would benefit from exercise as part of his therapy to treat depression and/or anxiety.
What kinds of exercise benefit depression? Aerobic activity is the most effective. Resistance training can help improve self-image, and group activities can help improve sociability and people skills besides aiding in eliminating symptoms of depression.
The keys to success in sticking with regular exercise at a time when motivation and enthusiasm for exercise may not be at an all time high are: Set simple, realistic goals initially, you don’t have to train for a marathon or the Olympics. Choose an activity you like and enjoy. Try and make it social. Set realistic goals and work towards them Go easy on yourself. You may not be able to do too much or exercise too hard initially. Work with your therapist; keep him/her involved with your progress so he/she can step in when required. Identify your barriers. You may be, for instance, self-conscious and uncomfortable working out with other people. You may then prefer to exercise in the privacy of your home. Your first goal should be just to stick with exercising 4-5 times/week irrespective of what you do or how intense the workout turns out to be.
Deal with setbacks
Finally prepare for setbacks. Everyone has them; the stale period, days when you are simply unable to workout, times when you gain back some of the weight lost, and days when exercise is just no fun. Depressed individuals tend to blame themselves for their apparent sense of failure. Avoid the blame game and focus instead on your successes and achievements.
Exercise can be an adjunct to therapy in the treatment of depression as has been shown by several studies. Although depression can be a debilitating disease, it can be treated successfully. Exercise is an inexpensive way to not only stay fit physically but emotionally as well.
The writer is a Practising Obgyn, Fitness and Lifestyle Consultant, NAFC (USA) and Director, TFL Fitness Studio, Chennai.
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