Study details which exercises fight depression

In the past decade, research has shown the benefits that exercise has for patients with major depressive disorder. A new study helps physicians prescribe the right dose.

“The current understanding of this is that exercise has been helpful for depression as a stand-alone treatment or as an augmentation with medication, but what exercise and how much and for how often do you have to use it?” said Madhukar H. Trivedi, MD, a co-author of the study that appeared in the May Journal of Psychiatric Practice.

After reviewing data from nine randomized controlled trials that evaluated the link between exercise and mood enhancement, the study offers these recommendations:

• Aerobic exercise is best; resistance training also has benefits.
• Three to five exercise sessions weekly are needed.
• Each session should be 45 to 60 minutes.
• Intensity needs to reach 50% to 85% of the maximum heart rate for aerobic exercise. For resistance training, patients need to do 80% of one repetition maximum, which is the maximum weight that can be lifted at a single time.
• At least 10 weeks of training are needed.

But just telling patients to exercise is not enough. Physicians need to help patients identify barriers to exercise, as well as monitor patients to make sure they are following the recommended path.

Karen Cassiday, PhD, board member and secretary of the Anxiety and Depression Assn. of America, said it helps to warn patients that it can be difficult to get started exercising.

“Discuss with them how you can pair exercise with something fun­ — audio books, podcasts, music,” she said. “Suggest that they exercise with other people. If you are meeting someone, you are more likely to do it.”

Patients should chart progress

Dr. Trivedi suggests that patients log their activity — through a diary or an electronic monitoring device — and that they bring in the electronic or paper log to share with their physician.

“You should monitor every two weeks, if not once a week,” said Dr. Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas.

Cassiday suggested having patients record how they feel after exercising, because things tend to look better.

“You can have them list what they see around them. For example, what do the trees look like?” she said. “Or, you can ask them to record what the best thing that happened to them that day.”

Dr. Trivedi hopes the guidance for prescribing exercise will help time-pressed physicians make this something they can easily incorporate into their practices.

Finding time to fit everything into a patient visit “is the health care dilemma of our times,” Dr. Trivedi said. “It shouldn't take more than two or three minutes” to incorporate this discussion.

In addition to enhancing one's mood, exercise helps depressed patients lose weight and lower their cholesterol, Dr. Trivedi said.

“As we get into the new health care system, exercise provides a very good tool,” he said. “There is real value to think about because of the many benefits of exercise.”