Exercise for Mood and Anxiety

Among the several treatment options for depression and anxiety, I find physical exercises to be the most underrated. People are always talking about how exercises help a multitude of physical conditions, but there is much less awareness of mental health outcomes. For the past few years, extensive research has been done about the impact of exercises on depression and anxiety, their mechanisms of action, ideal duration, intensity, type, and frequency.

An obvious mood-enhancement feeling is usually perceived within a few minutes of moderate exercises, and it turns out that it may last much longer than that. Study after study, both epidemiological and experimental, has shown the efficacy of exercises in the treatment of chronic depression and other mood and anxiety symptoms related to various women’s reproductive stages, such as pregnancy, postpartum and menopause. 

Regular workouts may also improve outcomes in women struggling with infertility. According to a study in Obstetrics & Gynecology,  “Women who exercised 30 minutes or more daily had a reduced risk of infertility due toovulation disorders”, says Robert Brzyski, MD, PhD, professor of obstetrics and gynecology at the University of Texas Health Science Center at San Antonio and chair of the ethics committee of the American Society of Reproductive Medicine (ASRM).

Dr. Madhukar Trivedi, MD, a psychiatrist at the University of Texas Southwestern Medical College, and colleagues studied exercise as a secondary treatment for patients with major depressive disorder who hadn't achieved remission through drugs alone. They evaluated two exercise doses: One group of patients burned four kilocalories per kilogram each week, while another burned 16 kilocalories per kilogram weekly. They found both exercise protocols led to significant improvements, though the higher-dose exercise program was more effective for most patients (Journal of Clinical Psychiatry, 2011).

During pregnancy, it’s been reported that about 20% of women meet criteria for major depression or generalized anxiety disorder, and those are linked to bad outcomes such as preterm birth and low birth weight. A recent study from Spain analyzed 167 healthy pregnant women- 90 were assigned to a supervised exercise program and 77 were in the control group. Significant differences were found between the two groups at the end of the study: the percentage of women who were depressed was much lower in the exercise group (12.2%) as compared to the control group (24.7%).

This is particularly relevant given that a lot of women feel even more anxious to take psychiatric medication during pregnancy, due to fears they might harm the fetus.

A study by Heh and colleagues (2008) randomly assigned 80 women with a 6-week postpartum EPDS score >10 (signifying postpartum depression) to one of two exercise groups: 3 exercise sessions/week, or the patient’s usual treatment (control group).  Women who were in the exercise group had a significant improvement in mood by five months postpartum when compared to the control group.

However, a lot of women worry that an exercise routine may be potentially harmful to their babies.

The same group analyzed 200 pregnant women and found out that regular and moderate exercise is safe throughout pregnancy and is not a risk to maternal and fetal well-being, and it helps to control excessive weight gain.

Additionally, they found that exercise throughout pregnancy does not cause preterm delivery. 

The American College of Obstetricians and Gynecologists advises pregnant women to participate in 30 minutes of moderate exercise on most days, unless other health conditions preclude this recommendation (Artal and O’Toole, 2003). Here you can find the complete guidelines for exercise during pregnancy and the postpartum period, including absolute and relative contraindications and warning signs to terminate exercises during pregnancy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724598/pdf/v037p00006.pdf

Other forms of mind-body interventions, such as yoga, have been gaining popularity during pregnancy and in the post-partum period and can be a wonderful way to substantially improve bonding/ attachment with your newborn! Several places are now offering Yoga and Pilates classes for mom & baby. If you’re unable to join one, there are great DVDs and YouTube videos and you can practice even at home.  ('Yoga for prenatal depression: a systematic review and meta-analysis'. Gong H et al (2015). BMC Psychiatry 15(1):14. [Pract Midwife. 2015])

Randomized controlled trials have also shown that exercise training is effective in alleviating vasomotor and other menopausal symptoms. Sternfeld and colleagues studied 248 women dividing them in an exercise group and a group that maintained their usual activity level. By 12 weeks, the exercise group reported greater improvement in insomnia, subjective sleep quality, and depressive symptoms. 

But how does it work in the brain? Biologically, exercises work by increasing serotonin (the neurotransmitter targeted by antidepressants) or brain-derived neurotrophic factor (which supports the growth of neurons), decreasing cortisol (a stress hormone) and regulating sleep, which is known to have protective effects on the brain,  helping with the fatigue and lack of motivation that are commonly seen in people with depression. Psychologically, they allow people to engage in a new meaningful activity and bring them the feeling that they’re taking good care of themselves, with consequent improvement on self-esteem and self-confidence. Socially, it makes one get out of the house and meet new people and sometimes engage in group sports and activities.

It's important that clinicians talk about the benefits of exercise with their patients, not only the physical ones, but the impact that exercise may have on mental health.  

So let’s sweat away the blues and take advantage of exercise's low cost, easy accessibility, minimal side effects, and extensive health benefits.  

Helpful links to some related studies:

Dunn, A.L., Trivedi, M.H., Kampert, J.B., Clark, C.G., Chambliss, H. G., 2005. Exercise treatment for depression: efficacy and dose response. Am. J. Prev. Med. 28: 1-8.

Koltyn, K.F., Schultes, S.S., 1997. Psychological effects of an aerobic exercise session and a rest session following pregnancy. J. Sports Med. Phys. Fitness 37 (4), 287-291.

Polman, R., Kaiseler, M, Borkoles, E., 2007. Effect of a single bout of exercise on the mood of pregnant women. J. Sports Med. Phys. Fitness 47 (1), 103-111.

Heh, S.S., Huang, L.H., Ho, S.M., Fu, Y.Y., Wano, L.L., 2008.  Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women. Birth . 35 (1), 60-65.

Artal, R., O’Toole, M., 2003. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br. J. Sports Med. 37 (1), 6-12

http://www.ncbi.nlm.nih.gov/pubmed/15626549?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

https://www.essa.org.au/wp/wp-content/uploads/Exercise-and-Mental-Health-An-Exercise-and-Sports-Science-Australia-Commissioned-Review.pdf