Depression and physical activity
Depression : definition and symptoms
Depression is a leading cause of disability worldwide (1). It is defined as a state characterised by sadness, loss of interest and pleasure, feelings of guilt and low self-worth. Symptoms include sleep disturbances, loss or gain of appetite and fatigue (2). The WHO estimates that 4.3% of the European population suffers from depression (1). In adulthood, 9% of men and 17% of women will experience depression at least once in their lifetime in Europe (1). In Luxembourg, 21.6% of the population suffers from depression and 6% have moderate to severe symptoms (3). The main treatment options include antidepressant medication and psychotherapy, but other options such as physical activity are recommended (4).
The effects of physical activity on depression?
While the underlying mechanisms remain unclear (5), exercise prevents the occurrence or relapse of depression. It can be used as a stand-alone treatment or as an adjunct to other antidepressant treatments (medication or psychotherapy) (2,6). Physical activity has been demonstrated to reduce the symptoms of depression (5) and is recommended as a stand-alone treatment for mild-moderate depression and as an adjunct to usual care for major depression (2). A dose-response relation and reduction of symptoms is observed with greater frequency, intensity or volume of exercise (5). Moderate to high-intensity exercise has a significant impact on depression symptoms (2). However, lower-intensity exercise also provides benefits (5). There is evidence that exercise is also effective in the prevention of depression; one hour of exercise per week reduces the odds for future depression by 16% (4,5,7). Furthermore, 12 months after depression recovery, exercise reduces relapse rates compared to treatment based on medication alone (4).
What are the risks?
Practising physical activity goes hand in hand with a risk of somatic disorders (2). Excessive and compulsive exercising in underweighted patients with an eating disorder is associated with increased risk for medical complications, greater severity of eating disorders, longer treatment and quicker relapse (8). Therefore, exercising is not recommended in these populations without close medical supervision.
Even 20 minutes of physical activity per day reduce symptoms of depression, but longer durations and higher intensities may provide greater benefits (5). Moderate to vigorous physical activity is recommended to maximise the protective benefits of physical activity against depressive symptoms (9). The recommendations concerning the duration of physical activity remain the same as for the general population recommendations, i.e. 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week (2). The recommendations also include two sessions of strength exercises and one session of balancing per week. For depression treatment, the programme should last for at least 9 weeks (2) and preferably 12 weeks (5). Structured exercise completed under supervision may provide better results (4,10). It is important to establish realistic objectives and to ensure follow up with an exercise professional (4,10). Moreover, greater improvements may be observed when participants are involved in group-based exercise and when the activity is experienced as enjoyable (4,11).
- WHO Regional Office for Europe. Preventing depression in the WHO European Region [Internet]. World Health Organization; 2016 [cité 1 mars 2018]. Disponible sur: http://www.euro.who.int/__data/assets/pdf_file/0003/325947/New-Preventing-depression.pdf.
- Professional Associations for Physical Activity (Suède), Swedish National Insitute of Public Health. Physical activity in the prevention and treatment of disease [Internet]. Stockholm: Professional Associations for Physical Activity; 2010. Disponible sur: : https://www.folkhalsomyndigheten.se/contentassets/5de033c2c75a494a99cbba2407594c22/physical-activity-prevention-treatment-disease-webb.pdf.
- Ruiz-Castell M, Kandala N-B, Perquin M, Bocquet V, Kuemmerle A, Vögele C, et al. Depression burden in luxembourg: Individual risk factors, geographic variations and the role of migration, 2013–2015 European Health Examination Survey. J Affect Disord [Internet]. nov 2017 [cité 22 févr 2018];222:41‑8. Disponible sur: http://linkinghub.elsevier.com/retrieve/pii/S016503271730842X.
- Schuch FB, Stubbs B. Physical Activity, Physical Fitness, and Depression. In: Oxford research encyclopedias [Internet]. 2017 [cité 20 mars 2018]. (Oxford Research Encyclopedia of Psychology). Disponible sur: http://psychology.oxfordre.com/.
- 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services; 2018. Disponible sur: https://health.gov/paguidelines/second-edition/report.aspx.
- Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: A meta-analysis. J Affect Disord. 15 sept 2016;202:67‑86. Disponible sur: https://doi.org/10.1016/j.jad.2016.03.063.
- Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Ward PB, Silva ES, et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatry [Internet]. 25 avr 2018 [cité 17 mai 2018];appi.ajp.2018.1. Disponible sur: http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.17111194.
- El Ghoch M, Soave F, Calugi S, Dalle Grave R. Eating Disorders, Physical Fitness and Sport Performance: A Systematic Review. Nutrients [Internet]. 16 déc 2013 [cité 22 mai 2018];5(12):5140‑60. Disponible sur: http://www.mdpi.com/2072-6643/5/12/5140.
- Balchin R, Linde J, Blackhurst D, Rauch HL, Schönbächler G. Sweating away depression? The impact of intensive exercise on depression. J Affect Disord. août 2016;200:218‑21. Disponible sur: https://doi.org/10.1016/j.jad.2016.04.030.
- Catalan-Matamoros D, Gomez-Conesa A, Stubbs B, Vancampfort D. Exercise improves depressive symptoms in older adults: An umbrella review of systematic reviews and meta-analyses. Psychiatry Res. 30 oct 2016;244:202‑9. Disponible sur: https://doi.org/10.1016/j.psychres.2016.07.028.
- Schuch FB, Morres ID, Ekkekakis P, Rosenbaum S, Stubbs B. Exercise works for depression: bridging the implementation gap and making exercise a core component of treatment. Acta Neuropsychiatr [Internet]. avr 2017 [cité 22 mars 2018];29(02):124‑6. Disponible sur: https://www.cambridge.org/core/product/identifier/S0924270817000011/type/journal_article.
Authors & expert
Authors : Julia Ledien1, Alexis Lion2, 3, Simon Rosenbaum4, 5.
Expert : Claus Vögele6.
1 Luxembourg Institute of Health, Epidemiology and Public Health Research Unit, L-1445 Strassen, Luxembourg
2 Luxembourg Institute of Health, Sports Medicine Research Laboratory, L-1460 Luxembourg, Luxembourg
3 Fédération Luxembourgeoise des Associations de Sport de Santé
4 School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
5 Black Dog Institute, Sydney, Australia
6 Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
Year of publication