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Columns: Medical Report

Exercise for Persons with Depression and/or Anxiety Disorders

Rethorst, Chad D. Ph.D.

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ACSM's Health & Fitness Journal: 3/4 2019 - Volume 23 - Issue 2 - p 44-46
doi: 10.1249/FIT.0000000000000463
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BACKGROUND

Depression and anxiety are chronic mental health conditions. Annually, 19% of adults in the United States will be diagnosed with anxiety disorder and more than 30% will experience an anxiety disorder in their lifetime (1), whereas 6.7% will experience a depressive episode each year and approximately 20% will experience a depressive disorder in their lifetime (2).

Depression and anxiety are chronic mental health conditions. Annually, 19% of adults in the United States will be diagnosed with anxiety disorder and more than 30% will experience an anxiety disorder in their lifetime (1), whereas 6.7% will experience a depressive episode each year and approximately 20% will experience a depressive disorder in their lifetime (2).

These mental health disorders result in significant disease burden; in fact, depressive disorders are predicted to be the greatest contributor to health burden by 2030 (3). The burden of these disorders is due, in part, to the poor treatment response rates observed in these patients. Approximately one third of patients treated for anxiety and depressive disorders fail to achieve remission (4–6).

OVERVIEW OF DEPRESSION AND ANXIETY DISORDERS

Depressive disorders are characterized by a sad or irritable mood accompanied by somatic and cognitive changes that impair an individual’s functioning. Major depressive disorder (MDD) is the most common depressive disorder, with a lifetime prevalence of over 16% (7). The main symptom of MDD is mood and/or a loss of interest or pleasure in most activities for most days over at least a two-week period. Other symptoms of MDD include changes in weight or appetite, fatigue, slowed thought, speech, or movement, feelings of worthlessness or excessive guilt, changes in sleep, diminished ability to concentrate, and suicidality (8).

Anxiety disorders are characterized by excessive fear and anxiety and are differentiated by objects or situations that cause that fear and anxiety (i.e., specific phobias, social anxiety disorder, generalized anxiety disorder). These disorders result in behavioral disturbances such as avoidance and impairment in social and occupational functioning.

EVIDENCE

A number of randomized controlled trials have shown exercise to be effective in reducing the symptoms associated with anxiety and depressive disorders (9–13). When results of these studies have been compiled in meta-analyses, they indicate exercise might be as effective as other established treatments for depressive disorders, such as medication or psychotherapy (14). As a result of these research findings, the American Psychiatric Association’s Practice Guideline for the Treatment of Patients with Major Depressive Disorder supports exercise as a first-line treatment “provided the patient is sufficiently monitored” (15). This monitoring should include treatment supervision from a licensed mental health professional and ability of the exercise professional to handle mental health emergencies (described further in Special Considerations). Similarly, studies have shown exercise to be effective in reducing symptoms of generalized anxiety disorder, panic disorder, and social anxiety disorder. However, it should be noted that the evidence for exercise as a treatment for anxiety disorders is sparse (six studies included in a recent meta-analysis) (12) compared with the evidence supporting exercise as a treatment for depressive disorders (25 studies in a recent meta-analysis) [16]).

EXERCISE PRESCRIPTION FOR DEPRESSION AND ANXIETY DISORDERS

The existing evidence suggests exercise prescription for both depression and anxiety disorders should reflect current physical activity recommendations (10). Both aerobic and resistance training have proven effective in reducing symptoms of anxiety and depression. Beyond the content of the exercise prescription, individuals with these mental health disorders may have trouble staying motivated for exercise. In research studies, approximately 20% of participants with MDD drop out (17) and the dropout rate is likely to be much higher in real-world settings. Exercise professionals should be aware of these challenges and take time to implement effective behavioral strategies (i.e., goal-setting, intention planning, etc.) to help clients adhere to an exercise plan.

SPECIAL CONSIDERATIONS

A decision to use exercise as treatment for anxiety or depression should be made by a qualified mental health professional (i.e., psychiatrist, psychologist, counselor, etc.). In the event you suspect a client has an anxiety or depressive disorder or if the client discloses this information, you should not attempt to “treat” them with exercise. However, this is not to say that these individuals should not continue to exercise. They may benefit from an exercise program in ways beyond improvements in their mental health.

A decision to use exercise as treatment for anxiety or depression should be made by a qualified mental health professional (i.e., psychiatrist, psychologist, counselor, etc.). In the event you suspect a client has an anxiety or depressive disorder or if the client discloses this information, you should not attempt to “treat” them with exercise. However, this is not to say that these individuals should not continue to exercise. They may benefit from an exercise program in ways beyond improvements in their mental health.

Persons with depression and/or anxiety disorders typically engage in less physical activity (18–20), have lower cardiorespiratory fitness (21,22), and often have comorbid medical conditions such as hypertension, coronary heart disease, and type 2 diabetes (23,24).

Beyond the typical safety considerations for clients beginning an exercise program, exercise professionals must be prepared for mental health emergencies that may occur, namely the possibility of a client reporting suicidal thoughts. Ideally, exercise professionals will be in communication with a client’s mental health provider to establish a safety plan for these events. Otherwise, exercise professionals should have other resources available to them (i.e., phone numbers for suicide hotlines) and be prepared to contact emergency medical professionals if they are concerned for their client’s well-being.

References

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