Is Exercise As Effective For Relieving Depression As Therapy and Medication?

Depression affects over 340 million people across the globe and here in the United States it is estimated that about 16% percent of the population will suffer from a major depressive disorder (MDD) during the course of their lives,  with women being almost twice as likely than their male counterparts to develop a disorder. ^1,2 With all the emphasis with regards to health care on obesity related illnesses it is often overlooked that depression is on track to become the second largest contributor to the global burden of disease by the year 2020.³ We know that physical inactivity increases the likelihood and duration of depression and that physical activity, whether it be work related, exercise or recreation significantly reduces the risk of developing a depressive disorder. This holds true across the board for people of all races and socio-ecomomic levels, but for those adverse to conventional therapeutic interventions, the question remains, can exercise be as effective as conventional therapy and medication in relieving depression?

Studies Find That Exercise Is A Strong Preventative Against Depression

In 2001 the British Medical Journal did a review of the antidepressant effects of exercise treatments. After looking at a total of fourteen randomized controlled trials they found that the positive effects of exercise treatment for depression when compared to no treatment at all was statistically significant. There were major reductions in depression ratings among those engaged in exercise programs as opposed to those who were inactive. There was some debate over the validity of this review as some of the participants in the studies may have had subclinical mood problems rather than fully diagnosed major depressive disorders. That being said the idea that exercise treatment is more effective than no treatment at all is supported by at least two other systematic reviews^{4, 5,6} and most of the systematic reviews find as well that ‘the antidepressant effect size of exercise can be comparable to that of psychotherapy and to that of pharmacotherapy.’ ^{7, 6, 8, 9}

The Anti-Depressant Effects Of Exercise May Be Comparable To Drug & Therapy Interventions

Does this mean that you should focus solely on exercise as a way to relieving depressive symptoms? Not at all, as there is a saying that in a battle one should always go down fighting with all swords drawn from their scabbards and the same applies to clinical depression. Given the effects of exercise on mood elevation, the combined use of therapy and drug interventions might result in faster onset of antidepressant action, so drug and therapy should not be instantly ruled out.10 More trials are needed before exercise can be recommended clinically as a prescription for dealing with depression, but if exercise could act as an immediate salve to the symptoms of depression given that antidepressant medications and therapy all take weeks to months before clinical improvements can be seen whereas the positive effects of exercise occur much faster. Most importantly, the use of exercise protocols are safe and do not interact negatively in any way with other drugs or therapeutic treatments.

Some experts argue that adherence to a standardized exercise program is the number one reason for failure among the general population and that it would be far more difficult for a severely depressed individual to find the motivation to exercise on a regular basis, but given the promising fairly recent results of brief high intensity weight training programs on relieving depressive symptoms¹¹ it might indeed be viable if the duration is considerably short especially as adherence to regularly taking anti-depressant drugs is equally a problem among individuals with depression. At the end of the day what these findings really highlight is that exercise and physical activity have a major role to play in our overall mental health and that more research should be done into its potential use as a clinical anti-depression prescription. In coming articles we will explore the relevance of short high intensity training on depression and how it might make getting the anti-depressive benefits of exercise far more attainable to those that find it hard to stick with an exercise program to being with.

References:

1.         Greden JF. The burden of recurrent depression: causes, consequences and future prospects
2.         Kessler RC, Berglund P, Demier O, et al. The epidemiology of major depressive disorder; results from the National Comorbidity Survey Replication- JAMA 2003
3.         Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med 1988
4.         Craft LL, Landers DM. The effect of exercise on clinical depression and depression resulting from mental illness: a meta analysis. J Sport Exerc Psychol 1998.
5.         Stathopoulou G, Powers MB, Berry AC, et al. Exercise interventions for mental health; a quantitative and qualitative review. Clin Psychol Sci Pract 2006.
6.         North TC, McCullagh P, Tran ZV. Effect of exercise on depression. Exerc Sport Sci Rev 1990.
7.         Lawlor DA, Hopker SW. The effectiveness of exercise as an intervention in the management of depression; systematic review and meta-regression analysis of randomized controlled trials. Br Med J 2001.
8.        Martinsen EW. Physical activity and depression: clinical experience. ACTA Psychiatr Scand Suppl 1994.
9.         Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med 1999
10.      Marije R, Collins K, Fitterling H. Physical exercise and depression. Mount Sinai School Of Medicine NY
11.      Singh, N, Stavrinos, TM, Scarbek Y, et al. A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. Journal of Gerontology 2005

Kevin Richardson is the creator of Naturally Intense High Intensity Training 10 Minute Workouts™ and one of the most sought after personal trainers in New York City. Get a copy of his free weight loss ebook here.

The 'Biggest Loser''s competitive weight loss approach may be entertaining, but it is certainly not a healthy precedent for weight loss.

The Biggest Loser- A Bad Example For Weight Loss

Over the past several years weight loss themed reality shows like ‘The Biggest Loser’ have become increasingly popular but are such shows really helping promote weight loss and a healthy lifestyle? In the ‘Biggest Loser’ the objective is of course to have the contestants lose as much weight as possible and has made these goals very much a matter of entertaining the public rather than trying to show healthy and realistic methods for long term weight loss that anyone can apply.

Weight Loss Is Only Effective When Done Slowly

The benchmarks are ridiculously unrealistic and for that matter, dangerous. Much is made over the fastest 100 pound weight loss- some poor soul lost that much in seven weeks, whereas in my two decades of helping people lose weight long term it takes at least nine to twelve months to lose that much weight safely and keep it off. The most weight lost in a week on the show was 34 pounds, which while may make for compelling television viewing, sends a really bad message to the public in terms of weight loss as studies have shown that individuals who lose weight quickly run the risk of gallstones, mineral deficiencies, loss of muscle tissue and reduced bone density. The safe rate of one to two pounds of weight loss per week might help someone stay healthy and keep the weight off long term, but it would only get them kicked off the show for not losing weight fast enough.

Competitive Weight Loss Sends A Potentially Harmful Message To The Public

Many of my colleagues in both the personal training, nutrition and medical fields agree that the idea of competitive weight loss is a dangerous one that does little to educate the public on how to lose weight safely and effectively. In my own personal training practice I have always been steadfastly against the use of Before and After photos in my marketing campaigns as it sets the stage for highlighting unrealistic weight loss figures and takes away the importance of the individual focusing on achieving their own goals through lifestyle modification rather than trying to make the numbers on the scale go down.

The Dangers Of Too Much Too Soon

Needless to say there have been hospitalizations on the show- and numerous instances where contestants suffer cramps, exhaustion and stress fractures from the high workloads. This type of programming isn’t inspirational, its voyeuristic- watching someone who is significantly obese try to complete strenuous exercise activities and work out five to six hours a day while following remarkably restrictive diets. It also sets the stage for the idea that to lose weight you need to do extreme things like exercise every day for hours on end while starving yourself while studies are increasingly showing that you can actually make more progress following low volume high intensity training which calls for no more than a half hour of exercise a week.

The Biggest Loser Is An Unrealistic Portrayal Of Weight Loss In Real Life

But there is another side of ‘The Biggest Loser’ that most viewers don’t see. The screening process alone requires that potential contestants camp out for hours on end in line for a chance to audition for the show. Being able to spend eight hours in line for anything is more than most would attempt but it ensures that the contestants, while obese are far more determined than most members of the general population. They are further screened to make sure that there is a ‘Wow factor’ by choosing contestants that are truly obese. It wouldn’t be half as entertaining to watch someone that was 10 or twenty pounds overweight on the show and so they opt for most of the contestants to be severely obese.

Fast Weight Loss Is Seldom Long Lasting & Potentially Dangerous

Research has shown definitively that if you lose weight and then regain it you significantly increase the risk of cardiovascular disease. Many former Biggest Loser contestants have regained some or all of their weight and it isn’t surprising given the unrealistic amount of exercise and the severity of the diets. No one takes into consideration the fact that these individuals actually made their health problems worse by going through such an extreme weight loss process as entertainment, cleverly packaged to look like it is meant to be some form of public service is the end goal at all cost.

I have seen for myself more and more people feeling like they are failures since their weight loss isn’t as fast or as spectacular as the contestants on the ‘Biggest Loser’ and I have to constantly remind them that weight loss more of a marathon than a sprint and that their modest losses of one to two pounds a week is not only phenomenal but safe, healthy and more likely to be permanent. If you want information on weight loss, you don’t turn on the television in prime time and you have to keep in mind that entertainment is just that no matter how well packaged it is. At the end of the day slow and steady wins the race, without starvation diets and without spending hours every day exercising to exhaustion.

Kevin Richardson is the creator of the Naturally Intense High Intensity 10 Minute Workouts and one of the most sought after personal trainers in New York City and the founder of the Naturally Intense System of Diet & Exercise™. Get a copy of his free weight loss ebook here!

Why don't more overweight people go to the gym to lose weight?

The Real Reasons Overweight People Don’t Join Gyms

According to the numbers from the Center of Disease Control, two thirds of Americans are overweight and even more fall into the category of being obese. We know conclusively that being over one’s ideal weight increases the risk of everything from heart disease to Type II diabetes, not to mention the potential mental anguish from a negative body image. We also know that exercise can be a major force in helping people get into better shape and to improving their health, so why don’t more people join gyms and start exercising? It sounds like a simple solution yet only a third of people who are overweight meet the National Institute of Health’s exercise recommendations. Given these facts one has to assume that there are other issues stopping more people from joining gyms that we are not bringing into focus.

Often I hear people who already have made exercise a part of their lives talk about how easy it is for America to reverse the obesity epidemic. In a very shallow and unsympathetic manner they will proclaim that people are just lazy and too set on sitting in front of a television with a remote control and a bag of chips to do anything about their weight problem. If you have a poor body image, all you need to do is to get off of your behind and hit the gym- that simple. I hear such ignorance so often that is sickens me and from people in the industry that should really know better. I don’t think that you need to have a degree in behavioral sciences to understand that simple black and white approaches to real human problems ignore the basic truth that our actions are based on emotions, not on logic. We are not machines and thus for there to be a real solution to a problem, it must come from an understanding of the emotions that those problems can bring about. Any other approach simply will not work and while the gym industry is indeed a multi-billion dollar enterprise, the overwhelming majority of Americans that really need their services do not have a membership. Let’s take a real hard look at why that is.

Fallacy: People Who Are Overweight Don’t Know That Exercise Is Important

Even if you live in a small cave, I am pretty sure that you, like the rest of the world are aware that exercise is not only important but that it can help you lose weight and live longer. It’s no secret and pouring more money solely into increased health and fitness education is not the answer. People who are overweight or obese actually are stronger believers in the importance of exercise than their regular weight counterparts. According to a survey of over 1,500 men and women done by researchers at the Washington Medical Center soon to be published in the Journal of Nutrition Education and Behavior, people that have weight issues are well aware that exercise is a key factor in improving their body image and their overall health. With the constant cues from the media and their physicians this should not come as a surprise to anyone although recent studies have called into question the effectiveness of conventional exercise programs for weight loss, (and with good reason- See my post: Is Exercise Effective) it is still medically accepted that exercise does reduce the health risks associated with being overweight and improves self esteem.

Truth: People Who Are Overweight Don’t Join Gyms Because They Are Self Conscious

 
Stop and think for a minute, if you were overweight, obese, or simply didn’t feel that great about your body, how would you feel about going into a hip sports club advertised on television and flyers as being filled with fit and trim beautiful men and women? If you felt some degree of trepidation then you would begin to understand what so many really feel. The study found that most overweight men and women dislike the idea of sweating and exerting themselves in front of younger and more svelte gym-goers, and this was their primary reason for not joining a health club. This feeling of self consciousness is obviously even more prevalent in women than with men. Women are far more likely to feel pressured to wear trendy and sexy clothes while in the gym and to feel embarrassed about training in front of members of the opposite sex. They also are far less likely to try to use a complicated piece of machinery for fear of looking ridiculous if they use it incorrectly. These fears are very real and can do quite a lot to stop someone from making positive steps towards improving their health.

Truth: Lack of Motivation Isn’t Why Most People Don’t Exercise

So in the end laziness and lack of motivation really are not as much a part of the equation as some would think. Many people don’t join health clubs because they hate the idea of going into an environment where they would feel out of place, and understandably so. In the study only about 18 percent were members of a health club. That means that a full 82 percent were not going to a gym because of their negative feelings towards their perception of what a health club environment would be, and I can say with authority that you don’t necessarily have to be overweight or obese to be intimidated by going to a gym. Of all the clients that I have trained over the course of almost two decades, most of them who had never worked out in a gym before expressed some trepidation about going there for the first time. This negative feeling towards health clubs held true whether they saw themselves as being overweight or underweight and is one that I think most people can relate to feeling at some point, but what are some solutions?

One Solution: Independent Hardcore Gyms Over Health Club Chains

When started training some twenty-one years ago I was a scrawny teenager. At almost six feet and weighing 125lbs soaking wet, to say that I was self conscious about my appearance would be a serious understatement. At the time the idea of joining a gym filled me with a genuine sense of terror. I was so certain that I would be ridiculed that I started lifting weights in earnest at home in order to get into decent enough shape to be able to go to the gym!
It took two months before I mustered the courage to join a hardcore gym not too far away from where I lived and it was one of the best decisions of my life. Everyone there was so focused on their training that no one even noticed that I was there. There was also a real sense of community and the regulars took it upon themselves to take me under their wings and teach me the ropes. The rest you could say is history and I owe my successful career as a natural bodybuilder and personal trainer to the support I got in the gym during those early years.

Many tell similar stories at neighborhood independent gyms across the country. You would think that in such hardcore places would be the last place where someone who was overweight would not fit in, but nothing could be further from the truth. In a spandex free environment where everyone is focused on achieving their goals you don’t feel like you have to be part of a scene the way you would at some of the commercial health club chains. To this day I have never had a membership at a commercial health club chain and I have always based my personal training service out of more hardcore independent gyms. With the high intensity training that I do an environment where everyone else is serious as well is extremely important and my clients have always done exceptionally well in these settings and felt more comfortable regardless of how they look. Commercial gyms have a lot that needs to change if they wish to reach out to the majority of the population, and from a business world perspective it would also make them more profitable (although to be honest people waste millions of dollars every year on gym memberships that they never really use, but that’s material for another article.)

Other Solutions: Less Judgement More Action

 Society as a whole has to stop equating people’s character with their weight or activity levels- it isn’t always as simple as joining a gym and people in the industry also have to be more understanding just how difficult it can be to join a gym. Hiring a personal trainer can be a great way to be introduced to the gym environment without feeling like you are going in all by yourself. True the prospect of working with someone that looks just like the people that you might find intimidating at the gym can be a daunting one, but there are a lot of trainers out there like myself who do understand the issues, and as a rule hiring an out of shape trainer is seldom ever a good idea.

Some in the industry think that by lowering the bar it will help more people feel comfortable about working with a trainer, but all it does in the end is make it less likely for the client to be successful. If you are drowning you wouldn’t turn to someone that was having difficulty in the water as well for help, you would look to a strong swimmer and the same applies to personal training. Every trainer is different, though and you may have to shop around to find one that is both understanding and knowledgeable.

Another great idea is starting with a partner or a group of people you know that are already working out. In any case starting an exercise program can be as exhilarating as it is frightening, so the next time you see someone starting out in your gym, take the headphones off for a second and make them feel welcome, it does make a difference.

NYC Personal Trainer Kevin Richardson is the most sought after personal trainers in New York City, a lifetime drug free bodybuilding champion and the founder of the Naturally Intense System of Diet & Exercise™. His high intensity 10 minute workouts have been helping people get better results in less time for the past 19 years! Get a copy of his free weight loss e-book here!

The worst thing to say is that I want to look like this person or that person. In doing so you limit yourself to being only as excellent as they may be and in so doing prevent yourself from realizing a higher level of accomplishment that you never knew possible. One that far surpasses that of whom you admire. Let others be guides, not goals.

Warmest regards,

Kevin Richardson

Founder, Naturally Intense System of Diet & Exercise™

Naturally Intense Personal Training NYC

www.naturallyintense.net