By: Meike de Jong

Introduction

Almost everyone knows someone who is suffering from a mild or more serious form of depression. A depression is a serious psychological mood disorder which is characterised by insomnia, fatigue, change in appetite and a state of low mood.¹ Unfortunately the number of people suffering from depression is expected to increase by as much as 10%.² Treatment of depression usually consists of medication (antidepressants) and psychotherapy. In addition other therapy forms such as light therapy and alternative treatments are often used.³

Physical activity and depression

There is some evidence for physical activity as a preventive measure against depression. Research performed on non-clinically depressed patients showed a decrease of 27% in relative risk of developing depression for men that exercise 3 hours per week or more compared to less active persons. People with a sedentary lifestyle are more vulnerable to depression than people living active lifestyles.⁴ Physical activity, according to Knapen et al. (1999), or rather the lack thereof, is a central factor in developing depression or increase the severity of its symptoms. This is depicted more clearly in Figure 1.

Figure 1

The most researched form of depression therapy is cognitive behavioural therapy, however there are some studies that exercise is equally effective.⁵

Which forms of training are effective for people suffering from depression?

Resistance exercise

In a study performed by Singh et al. (1997) resistance exercise was proven an effective antidepressant in depressed elderly. In addition it improved strength, morale and quality of life.⁶ Another study performed by Craft & Perna (2004) showed that resistance exercise is as effective in running therapy and easier to perform for some patients. In general a training program lasting 9-12 weeks is advised consisting of three training sessions of at least 30 minutes.⁷

Cardiovascular training

Research has shown that 16 weeks of aerobic cardiovascular training or medication were equally effective in decreasing symptoms of depression.⁸ These findings are supported by two different studies which required the participants to perform cardiovascular training for 12 weeks. In these studies depressive symptoms decreased as well. ^9,10 In addition Salmon (2001) concludes in his review that aerobic training has a strong stress reducing and antidepressant effect, which can further improve a depressive patients’ condition.¹⁰

Other forms of training

The results of a study performed by Chou et al (2004) proved that Tai Chi training for 45 minutes three times a week during a period of three months was effective in reducing the score on the Center for Epidemiological Studies Depression Scale. On average the patients in this study reduced their symptoms by such an extent that they did not fulfil the criteria for depression anymore on this scale.¹¹

Discussion

From the results of the studies described above can be concluded that different forms of physical training are effective methods to treat depression, but the question remains how these form of training can be applied most effectively. According to Dunn et al. (2005), Training three times per week is just as effective as five times per week in treating the symptoms of depression.⁹ Research has shown that performing resistance or cardiovascular exercise on higher intensities is more effective than training on lower intensities. This means that cardiovascular exercise should be performed at an intensity between 70-85% of maximum heart frequency.⁸ Resistance exercise has been proven more effective when exercise intensity is around 80% of the 1 Repetition Maximum (1RM) in decreasing symptoms of depression than training at an intensity of 20% 1RM.12

The aforementioned forms of exercise have both been proven effective but which is most applicable or most effective? Martinsen et al. (1989) compared cardiovascular training and resistance exercise in depressive patients. They found that depression scores had decreased similarly after a period of training.¹³ From this it can be concluded that it does not make much difference which form of training is chosen, only that it is performed regularly and at a high enough intensity. Because depression is accompanied by decreased social functioning, exercise is often performed in groups. However research has shown that there is little difference training alone or in groups and personal preference is most important in choosing training in a group or alone.¹⁴

Conclusion

Based on the literature described above it can be concluded that physical training is an effective method in the treatment of depression. The following guidelines can be applied to develop an effective training regimen for patients with depression.

Firstly the patients’ preferred training modality, such as cardiovascular or resistance exercise or a combination should be determined, and whether the patient wants to train in a group or individually.

Cardiovascular training should be performed at an intensity 80-85% of Maximum Heart Frequency, for at least 30 minutes continuously three times per week.

Resistance exercise should target major muscle groups (chest, back, legs, shoulders, arms and abdomen) on three non-consecutive days per week. Each exercise consists of three series of 8-10 repetitions at 80% of 1RM.

Tai Chi is effective when three sessions per week are performed of 45 minutes each.

To achieve optimal results it is important that the training programme, regardless of training modality, is performed for at least 12 weeks. It is recommended that the training sessions are supervised, to motivate the patient, make sure exercises are performed correctly and reduce the chance of skipping training or quitting altogether.¹⁴

References

1. Bear, M.F., Connors, B.W., Paradiso, M. A. Introduction to neuroscience. In: Neuroscience exploring the brain 2nd edition. USA Lippincott Williams & Wilkins.
2. Schoemaker, C. , Poos, M.J.J.C., Spijker, J., Gool, C.H. van. Neemt het aantal mensen met depressie toe of af? In: Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. URL: http://www.nationaalkompas.nl> Nationaal Kompas Volksgezondheid\Gezondheid en ziekte\Ziekten en aandoeningen\Psychische stoornissen\Depressie, 22 maart 2010.
3. Velde, V., van der. (2005). Samenvatting Multidisciplinaire richtlijn Depressie Richtlijn voor de diagnostiek en behandeling van volwassen cliënten met een depressie.
4. Knapen,, J., Vliet, P., van de, Coppenolle, H., Van, Pieters, G., Peuskens, J. Psychomotorische therapie en depressie: een paradox? (1999). Psychopraxis, 1, 157-162.
5. Cuijpers, P., Dekker, J. Psychologische behandeling van depressie; een systematisch overzicht van meta-analysen. (2005). Nederlands Tijdschrift voor Geneeskunde, 149, 1892-1897.
6. Singh, N.A., Clements, K.M., Fiatatrone, M.A. A Randomized Controlled Trial of Progressive Resistance Training in Depressed Elders. (1997). The Journal of Gerontology Medical Sciences, 52a, 1, M27-M35.
7. Craft, L.L., Perna, F.M. The Benefits of Exercise for the Clinically Depressed. (2004). The Primary Care Companion to the Journal of Clinical Psychiatry, 6, 3, 104, 111.
8. Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, W.E., Herman, S., Khatri, P., Waugh, R., Napolitano, M.A., Forman, L.M., Appelbaum, M., Doraiswamy, M., Krishnan, R. Effects of Exercise Training on Older Patients with Major Depression. (1999). Archives of Internal Medicine, 159, 2349-2356.
9. Dunn, A.L., Trivedi, M.H., Kampert, J.B., Clark, C.G., Chambliss, H.O. Exercise Treatment for Depression. Efficacy and Dose Response. (2005) American Journal of Preventive Medicine, 28, 1, 1-8.
10. Salmon,P. Effects of Physical Exercise on Anxiety, Depression , and Sensitivity to Stress: a Unifying Theory. (2001). Clinical Psychology Review, 21, 1, 33-61.
11. Chou, K.L., Lee, P.W.H., Yu, E.C.S., Macfarlane, D., Cheng, Y.H., Chan, S.S.C., Chi, I. Effect of Tai Chi on depressive symptoms amongst Chinese older patients with depressive disorders: a randomized clinical trial (2004). International Journal of Geriatric Psychiatry, 19, 1105-1107.
12. Singh, N.A. Stavrinos, T.M., Scarbek, Y., Galambos, G., Liber, C., Fiatarone Singh, M.A. A randomized Controlled Trial of High Versus Low Intensity Weight Training Versus General Practitioner Care for Clinical Depression in Older Adults. (2005). Journal of Gerontology: Medical Sciences, 60A, 6, 768-776.
13. Martinsen, E.W., Hoffart, A., Solberg, O. Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial.(1989). Comprehensive Psychiatry, 4,324-31.
14. Stammes, R., Spijker, J. Fysieke training bij depressie. (2011). Nederlands Tijdschrift voor Evidence Based Practice, 1, 15-18.