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In recent years, reports of celebrities being hindered by depression have been common, and even some people have ended their lives, and related news has attracted widespread attention. The state's investment in this field has also been increasing, and extensive science popularization has been carried out on various platforms. Depression has also gradually been faced by the public from being originally regarded as "correctional".
We've briefly introduced exercise therapy for depression before (can exercise also treat depression?). --Talking about the role of exercise therapy in depression), for mild to moderate depression, exercise therapy is equivalent to drug therapy and psychotherapy; the NICE guidelines give specific recommendations for exercise therapy to treat depression, including the combination of aerobic exercise and strength training, which needs to be achieved with a certain frequency and for sufficient duration. Today, let's explore more topics of exercise therapy.
Several concepts about exercise therapy
and its significance
Exercise refers to "one or more components of a planned, organized, and repetitive body movement to improve or maintain good health." "Exercise includes cardio and strength training.
Studies have shown that regardless of the type of exercise, people who exercise a lot have a low chance of developing depressive symptoms. This simple conclusion suggests that by reducing sedentary confinement and increasing exercise as much as possible, you are already preventing depression.
For exercise therapy to work better, a certain frequency and intensity needs to be achieved, that is, exercise prescription. Exercise prescriptions are at the heart of exercise therapy. The complete exercise prescription includes: exercise form, exercise intensity, exercise time and frequency of exercise. Exercise prescriptions for depression are: at least 3 times a week for 45 to 60 minutes each time, moderate-intensity aerobic exercise for at least 10 weeks.
Supervised exercise: Exercise under the supervision of a trained professional, including a sports coach, physical therapist or exercise physiologist. Studies have found that supervised exercise has a better antidepressant effect. Therefore, when you want to regulate mood or improve depression through exercise therapy, finding a fitness instructor to guide you will produce better antidepressant results.
Which exercise therapy is suitable for
Type or symptom of depression
There are many types of depression, such as endogenous depression, agitative depression, postpartum depression, etc., and the effect of exercise therapy on different types of depression varies.
Exercise therapy is more effective for patients with depression with prominent physiological symptoms such as decreased appetite, sleep disturbances, and decreased libido. The study found that exercise had a definite improvement in the sleep problems associated with depression, and high-intensity exercise could improve the quality of sleep in depressed patients.
Anhedonia and lack of motivation are core symptoms of depression, and exercise therapy has improved this well. In the Emotion Regulation Skills module of Dialectical Behavior Therapy, there is a technique called "opposite behavior", that is, to induce the brain to regulate emotions by exhibiting behaviors that are opposite to emotions. Specifically, when patients are depressed, they lack motivation, lack of interest, and do not want to move, and if we follow this impulse, our mood will not improve. On the contrary, exercise can improve the symptoms of anhedonia and lack of motivation.
Patients with depression may experience cognitive function abnormalities such as attention span and memory decline. Working memory refers to the ability of individuals to temporarily store and manipulate information in the performance of cognitive tasks, which is equivalent to the "cache" of the brain. Studies have confirmed that aerobic exercise has significant improvements in working memory in depressed patients.
How exercise therapy is used clinically
As a protective factor, exercise can prevent depression from occurring.
As a form of treatment, exercise therapy can make drug therapy more effective.
Doctors may be concerned about whether adding exercise therapy to drug therapy will increase the burden on patients. Don't worry. Studies have shown that increasing exercise on top of conventional drug therapy does not reduce the acceptability of both interventions. Patients who also receive exercise therapy have higher adherence to antidepressant medications. Foreign studies have also found that patients who receive combined sports and psychological therapy have higher adherence to treatment options; while patients who receive psychotherapy alone have low compliance.
Patients often ask, which exercise style is more effective for improving mood? I will give patients a list of possible options and let them choose the sport they are interested in. Because only then is it more likely to stick to it, and exercise prescriptions work.
The use of exercise prescriptions in specific groups
Patients with depression during pregnancy
When pregnant women suffer from depression, patients have limited treatment options, and psychotherapy is a first-line treatment, taking into account the possible effects of the drug on the fetus. Now, this group has one more option.
Previous clinical studies have shown that exercise prescriptions for women with depression during pregnancy are: under the supervision of a professional, 30-60 minutes of moderate-intensity exercise 3 times a week for 4-31 weeks. Exercise arrangements can be: 10 minutes of walking + 30 minutes of aerobic exercise + 10 minutes of stretching + 10 minutes of relaxation. Exercises may produce better results if performed in conjunction with music therapy.
Elderly patients with depression
Studies have mentioned that exercise prescriptions for elderly depressed patients should be: under the supervision of a professional, do at least 30 minutes of routine, moderate intensity activities a day, including aerobic exercise, muscle strengthening, flexibility and balance strengthening exercise, for 6 months. There is also good news that the preventive effect of exercise on depression in the elderly population is more obvious than the therapeutic effect of depression.
Patients with comorbid depression with Parkinson's disease
The comorbidity rate of Parkinson's disease with depression is as high as 50%. Mental distress due to depression is an important factor in the impaired quality of life of patients with Parkinson's disease. Parkinson's disease itself can lead to impaired motor function in patients. Exercise therapy under supervision can improve symptoms in both aspects at the same time, significantly improving the quality of life of patients.
Exercise prescription tips
Usually reduce sedentary, increase exercise, choose the exercise you like, in the case of physical tolerance, the greater the intensity, the better. Just move and you're preventing depression.
When you develop depressive symptoms, you can try an exercise prescription, and if there is no significant improvement in 1-2 months, it is recommended to go to a psychiatric clinic as soon as possible.
Even if you are already receiving medication and psychotherapy, you can cooperate with exercise therapy, which will not only enhance the efficacy, but also improve the adherence to treatment.
Find a professional to do supervised sports and get better results.
Social support, which is also a booster of exercise therapy's onset of action, may increase the chances of treatment success by exercising with friends or family.
Let's cherish health together, starting with the embrace movement!
bibliography
1. Huang, Y., et al., Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry, 2019. 6(3): p. 211-224.
2. Axelsdóttir, B., et al., Review: Exercise for depression in children and adolescents - a systematic review and meta-analysis. Child Adolesc Ment Health, 2021. 26(4): p. 347-356.
3. Teychenne, M., K. Ball, and J. Salmon, Physical activity and likelihood of depression in adults: a review. Prev Med, 2008. 46(5): p. 397-411.
4. Russo-Neustadt, A.A., et al., Physical activity and antidepressant treatment potentiate the expression of specific brain-derived neurotrophic factor transcripts in the rat hippocampus. Neuroscience, 2000. 101(2): p. 305-12.
5. Garza, A.A., et al., Exercise, antidepressant treatment, and BDNF mRNA expression in the aging brain. Pharmacol Biochem Behav, 2004. 77(2): p. 209-20.
6. Trivedi, M.H., et al., Exercise as an augmentation treatment for nonremitted major depressive disorder: a randomized, parallel dose comparison. J Clin Psychiatry, 2011. 72(5): p. 677-84.
Note: The pictures in the text are from the Internet, and the invasion and deletion are apologetic.
Author: Chen Chao
Peking University Sixth Hospital
Edit the || He Yingying
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Dear friends, the mental health answering game is officially online, let's play it!
Department of Public Affairs, Peking University Sixth Hospital
National Mental Health Program Office