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
