Regular exercise can have a profoundly positive effect on your mental health. In fact, a recent study found that running therapy had effects on depression and anxiety similar to those of antidepressants.
The scientific work, presented at the European College of Neuropsychopharmacology (ECNP) Congress in Barcelona in October 2023, found that an exercise programme also led to more favourable physical outcomes – although the results indicated that sticking to regular activity was a challenge.
“Antidepressants work for most people – we know that not treating depression at all leads to worse outcomes, so antidepressants are generally a good choice,” said lead study author Dr Brenda Penninx, professor of psychiatric epidemiology at Vrije University in Amsterdam. “But this study shows that running therapy can reduce depressive symptoms, at least in some depressed people. The effects on mental health outcomes were similar to those seen in the group taking antidepressants”.
Dr Penninx emphasises that an exercise programme should not replace medication, but should be offered as an additional treatment option, well supervised by trained staff.
A comparison between running and medication for depression
The researchers followed 141 people with depression, anxiety or both. Participants could choose to be treated with medication only (and no running) or with running therapy (and no medication).
Over the course of 16 weeks, 45 people were treated with a selective serotonin reuptake inhibitor (SSRI) and 96 followed a running programme.
Participants in the medication group received escitalopram (Lexapro and Cipralex) at an initial dose of 10 milligrams (mg) per day. Medication was managed by a psychiatrist who could decide if the dose needed to be increased. If escitalopram was ineffective or poorly tolerated, patients were switched to a second SSRI, sertraline (Zoloft).
Running therapy consisted of supervised 45-minute outdoor running sessions, with a target of two to three sessions per week, in line with public health recommendations from the Centers for Disease Control and Prevention (CDC).
Similar results for mental but not physical health
At the end of the study, about 44 percent of each group showed remission of their symptoms of depression and anxiety, but the authors noted that the symptoms were still “substantial”.
When it came to physical health, however, the changes were more favourable for the runners, who saw a reduction in heart rate, blood pressure and waist circumference, as well as an increase in lung function. On the other hand, the antidepressant group experienced signs of physical decline, with weight, blood pressure and triglycerides increasing and heart rate variability decreasing (a sign of less resilience), according to the Cleveland Clinic.
The research team emphasised that exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging people to get outside, set personal goals, improve their fitness and participate in a group activity.
However, sticking to an exercise programme can be a challenge. Only 52 per cent of the running group adhered to the protocol, while 82 per cent of the drug group were able to keep up with their medication.
“It’s harder to change your behaviour than it is to take a drug,” says Dr. Eric Ruhe, a psychiatrist at the University Medical Center Amsterdam who specialises in the treatment of depressive disorders.
Dr Ruhe, who was not involved in the research, advises that an antidepressant should be accompanied by increased physical activity, and would like to see future research looking at the outcomes of taking antidepressants and running together.
Encouraging lifestyle changes
The study authors recognise that motivating people to exercise is not an easy task. Ruhe points out that changing lifestyles and starting to run regularly can be particularly difficult for depressed people, whose mental health severely interferes with motivation.
To be effective, running therapy needs to go beyond simply telling a person to “go run” – it’s important to provide adequate supervision and coaching, says Penninx.
She adds that running may not be for everyone and that depressed people may get similar benefits from other activities they prefer, such as cycling, swimming or playing a sport like football or tennis. Exercising with other people can also help with motivation.
The research presented at ECNP (originally published in the Journal of Affective Disorders in May 2023) builds on previous research demonstrating the mental health benefits of exercise. An analysis of 21 randomised trials of exercise and depression, published in the British Journal of Sports Medicine in September 2022, found no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression. For someone with severe depression, exercise alone may not be enough.
Because this trial was relatively small and not fully randomised (participants chose their therapy), Penninx would like to conduct a larger, multi-site trial with more rigorous randomisation and evaluate the combination of running therapy and antidepressant medication.
“There is no ‘magic bullet’ for depression that works for everyone,” says Penninx. “If we have more choices in our treatment armamentarium, patients will have choices, and treatments can also be combined to achieve the best outcome.”
