Mental health claims have grown more than 75% since 2019, with Canadian insurers paying out nearly 600 million in 2021 for mental health counselling and therapies.   This doesn’t even include mental health’s substantial proportion of the 12 billion in total claims paid for pharmaceutical interventions.  

 

It is no secret that COVID has put a strain on our collective mental health.  And while we all may have different theories and explanations for why our mental health has deteriorated, instead of focusing on the “why”, we need action now.  We need cost-effective, broad application, and efficacious solutions, not more political posturing or academic discussions.

 

A recent network meta-analysis published in the British Journal of Sports Medicine compared treatment of either exercise alone, anti-depressants alone or exercise + anti-depressants versus a control for mild to moderate depression.  They reviewed and pooled data from 21 randomized controlled trials (including a total of 2551 patients) and concluded that exercise alleviates symptoms of depression to a similar degree as antidepressants alone or in combination with exercise.  

 

The exercise plus anti-depressants arm did not perform better than exercise alone.  So some experts who claim exercise works synergistically with antidepressants would have to put a pause on that theory after this review.    

 

The authors note that the exercise group may have higher drop out rates, subjects that for a variety of reasons chose not to complete the intervention period.  However that finding was heavily influenced by one single paper, so the validity of that claim needs further evaluation.  

 

There was a clear reduction in side effects with 22% of subjects in the antidepressant group reporting side effects versus only 9% in the exercise group reporting side effects.  The authors note that pharmacologic treatment is associated with higher adverse events, higher costs and social stigma.  

 

Why does exercise help with depression?

The immediate effects of exercise occur with the release of feel good hormones, endorphins, which some will describe as a “natural high” or “runner’s high” feeling.  Endorphins have a broad scope of effects that help improve your sense of well being.

 

Over the longer term regular exercise releases proteins called neurotropics or growth factors, which helps nerve cell growth in the brain.  Specifically scientists have found that the mood centre of your brain, the hippocampus, is smaller in those who are depressed.  Improving cellular connections and growth in this part of the brain seems to help relieve depression. https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression  

 

What type of exercise should I be doing and how often?

General guidelines from CANMAT recommend 30-60 minutes sessions at a moderate intensity performed 2-3 times weekly for 9-12 weeks.  This allows for a significant amount of personal preference, which is good, but the recommendation is almost too vague and lacks practical specificity.    

 

In a meta-analysis review comparing strength versus cardio, strength training demonstrated a large effect size, versus a moderate treatment effect size for cardio or endurance training.  This review also found exercise intensity mattered, with higher intensity work garnering greater results.  As well, the duration of the aerobic exercise mattered, with longer sessions generating greater results.

 

The exercise prescription details are far from being fully established.  And it’s unlikely a cookie cutter protocol with ever be established.  And although some academic experts and medical professionals may view this as a limitation for wide spread implementation it is in fact the opposite, it is an opportunity to use the ancient power of human movement in the way that suits your needs, your goals and your overall mental health.  

 

Our primary mental health resources need an update

The DSM-5 (diagnostic and statistical manual of mental disorders), the “bible” of mental health resources for health care professionals, supports exercise therapy only when anti-depressants or psychotherapy treatments are ineffective or unacceptable.  DSM-5 says there is a lack of evidence to recommend exercise as an official treatment.  And although our Canadian Guidelines (CANMAT) are slightly more positive in their recommendation for including exercise, it does not specifically outline exercise as a primary intervention tool.

 

So although the evidence for exercise as a treatment for non-severe depression isn’t new, it does seem to run into some resistance getting the recognition it deserves.  Is this medical turf wars?  Medical professions jockeying to best position themselves to provide all the prescriptions needed to treat depression.  No (powerful) medical profession is well positioned to benefit from an uptick in personal training or supervised exercise…except of course, the most important person, the patient!!!