We were not able to locate a single published study that has examined the combined effect of varying intensity, duration, and frequency of exercise, although some studies have compared different intensities or different frequencies. With regard to intensity, Sexton et al. (45) examined reductions in depressive symptoms and anxiety in “neurotic” inpatients assigned to either a walking treatment or a more vigorous jogging treatment. Both groups showed equal reduction in their symptoms of anxiety and depression, but the jogging group had significantly more dropouts. Veale et al. (53), who compared aerobic exercise of low intensity with higher intensity, found similar results. Both groups decreased their depressive symptoms, but there was no significant difference between groups.
First, with regard to the question of whether the amounts of occupational and leisure time physical activity are linked to reductions in symptoms of depression and anxiety: This evidence is generally consistent for both cross-sectional and prospective studies and findings are similar across cultures; however, these studies are only observational. Also, only two of these observational studies presented data on anxiety symptoms. Second, with regard to the question of whether varying the intensity, frequency, and duration of the exercise prescription has a dose-response effect on depression and anxiety, there is evidence to suggest that both moderate and vigorous exercise can reduce symptoms of depression. No studies have varied frequency or duration or controlled for total energy expenditure. Third, with respect to resistance and aerobic exercise, there is evidence that both can reduce symptoms of depression. However, in the studies that compared aerobic versus resistance training, it is unknown if total energy expenditure was equivalent. Fourth, it is also not clear from the exercise training studies whether or not increases in cardiorespiratory fitness are necessary to reduce symptoms of depression. Also, with respect to all of these questions, there are more data examining depression disorders compared with anxiety disorders.
We thank Heather Kitzman, Melba Morrow, and Stephanie Parker for their assistance in preparing this manuscript.
Address for correspondence: Andrea L. Dunn, Ph.D., The Cooper Institute, 12330 Preston Road, Dallas, TX 75230; E-mail: firstname.lastname@example.org.
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders,
4th Ed. Washington, DC: American Psychiatric Association, 1994.
2. Asberg, M., C. Perris, D. Schalling, and G. Sedvall. The CPRS—development, and applications of a psychiatric rating scale. Acta Psychiatr. Scand.
Suppl. 271:1–27, 1978.
3. Babyak, M., J. A. Blumenthal, S. Herman, et al. Exercise treatment
for major depression: maintenance of therapeutic benefit at 10 months. Psychosom. Med. 62: 633–638, 2000.
4. Beck, A. T., C. H. Ward, M. Mendelson, J. Mock, and J. Ergaugh. An inventory for measuring depression. Arch. Gen. Psychiatry 4: 561–571, 1961.
5. Bhui, K., and A. Fletcher. Common mood and anxiety
states: gender differences in the protective effect of physical activity
. Soc. Psychiatry Psychiatr. Epidemiol. 35: 28–35, 2000.
6. Blumenthal, J. A., M. A. Babyak, K. A. Moore, et al. Effects of exercise
training on older patients with major depression. Arch. Intern. Med. 159: 2349–2356, 1999.
7. Broocks, A., B. Bandelow, G. Pekrun, et al. Comparison of aerobic exercise
, clomipramine, and placebo in the treatment
of panic disorder. Am. J. Psychiatry 155: 603–609, 1998.
8. Camacho, T. C., R. E. Roberts, N. B. Lazarus, G. A. Kaplan, and R. D. Cohen. Physical activity
and depression: evidence from the Alameda County Study. Am. J. Epidemiol. 134: 220–231, 1991.
9. Conroy, R. W., K. Smith, and A. R. Felthous. The value of exercise
on a psychiatric hospital unit. Hosp. Community Psychiatry 33: 641–645, 1982.
10. Cooper-Patrick, L., D. E. Ford, L. A. Mead, P. P. Chang, and M. J. Klag. Exercise
and depression in midlife: a prospective study. Am. J. Public Health 87: 670–673, 1997.
11. Demitrack, M. A., J. K. Dale, S. E. Straus, et al. Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. J. Clin. Endocrinol. Metab. 73: 1224–1234, 1991.
12. Doyne, E. J., D. L. Chambless, and L. E. Beutler. Aerobic exercise
as a treatment
for depression in women. Behav. Ther. 14: 434–440, 1983.
13. Doyne, E. J., D. J. Ossip-Klein, E. D. Bowman, K. M. Osborn, I. B. McDougall-Wilson,and R. A. Neimeyer. Running versus weight lifting in the treatment
of depression. J. Consult. Clin. Psychol. 55: 748–754, 1987.
14. Dunn, A. L., and R. K. Dishman. Exercise
and the neurobiology of depression. Exerc. Sport Sci. Rev. 19: 41–98, 1991.
15. Endicott, J., and R. L. Spitzer. A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch. Gen. Psychiatry 35: 837–844, 1978.
16. Farmer, M. E., B. Z. Locke, E. K. Moscicki, A. L. Dannenberg, D. B. Larson, and L. S. Radloff. Physical activity
and depressive symptoms: the NHANES I Epidemiologic Follow-up Study. Am. J. Epidemiol. 128: 1340–1351, 1988.
17. Folstein, M. F., S. E. Folstein, and P. R. McHugh. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.
18. Foreyt, J. P., R. L. Brunner, G. K. Goodrick, S. T. St. Joer, and G. D. Miller. Psychological correlates of reported physical activity
in normal-weight and obese adults: the Reno diet-heart study. Int. J. Obes. Relat. Metab. Disord. 19: S69–S72, 1995.
19. Fremont, J., and L. W. Craighead. Aerobic exercise
and cognitive therapy in the treatment
of dysphoric moods. Cognitive Ther. Res. 11: 241–251, 1987.
20. Gershon, E. S. Bipolar illness and schizophrenia as oligogenic diseases: implications for the future. Biol. Psychiatry 47: 240–244, 2000.
21. Greist, J. H., M. H. Klein, R. R. Eischens, J. Faris, A. S. Gurman, and W. P. Morgan. Running through your mind. J. Psychosom. Res. 22: 259–294, 1978.
22. Haskell, W. L. Dose-response issues from a biological perspective. In:Physical Activity, Fitness, and Health
, C. Bouchard, R. Shephard, and T. Stephens (Eds.). Champaign, IL: Human Kinetics, 1994, pp. 1030–1039.
23. Hassmén, P., N. Koivula, and A. Uutela. Physical exercise
and psychological well-being: a population study in Finland. Prev. Med. 30: 17–25, 2000.
24. Khantzian, E. J. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am. J. Psychiatry 42: 1259–1264, 1985.
25. Kivelä, S.-L., and K. Pahkala. Relationships between health behaviour and depression in the aged. Aging (Milano) 3: 153–159, 1991.
26. Klein, M. H., J. H. Greist, A. S. Gurman, et al. A comparative outcome study group psychotherapy vs. exercise
treatments for depression. Int. J. Ment. Health 13: 148–177, 1985.
27. Krause, N., L. Goldenhar, J. Liang, G. Jay, and D. Maeda. Stress and exercise
among the Japanese elderly. Soc. Sci. Med. 36: 1429–1441, 1993.
28. Kupfer, D. J. Recurrent depression: challenges and solutions. J. Clin. Psychiatry 52: 28–34, 1991.
29. Lampinen, P., R.-L. Heikkinen, and I. Ruoppila. Changes in intensity of physical exercise
as predictors of depressive symptoms among older adults: an eight-year follow-up. Prev. Med. 30: 371–380, 2000.
30. Martinsen, E. W., A. Hoffart, and O. Y. Solberg. Aerobic and non-aerobic forms of exercise
in the treatment
disorders. Stress Med. 5: 115–120, 1989.
31. Martinsen, E. W., and A. Medhus. Adherence to exercise
and patients’ evaluation of physical exercise
in a comprehensive treatment
programme for depression. Nord. Psykiatr. Tidsskr. 43: 411–415, 1989.
32. Martinsen, E. W., A. Medhus, and L. Sandvik. Effects of aerobic exercise
on depression: a controlled study. Br. Med. J. (Clin. Res. Ed.) 291: 109, 1985.
33. McNeil, J. K., E. M. Leblanc, and M. Joyner. The effect of exercise
on depressive symptoms in the moderately depressed elderly. Psychol. Aging 6: 487–488, 1991.
34. Meador-Woodruff, J. H., J. F. Greden, L. Grunhaus, and R. F. Haskett. Severity of depression and hypothalamic-pituitary-adrenal axis dysregulation: identification of contributing factors. Acta Psychiatr. Scand. 81: 364–371, 1990.
35. Meyer, T., A. Broocks, B. Bandelow, U. Hillmer-Vogel, and E. Rüther. Endurance training in panic patients: spiroergometric and clinical effects. Int. J. Sports Med. 19: 496–502, 1998.
36. Mobily, K. E., L. M. Rubenstein, J. H. Lemke, M. W. O’Hara,and R. B. Wallace. Walking and depression in a cohort of older adults: the Iowa 65+ Rural Health Study. J. Aging Phys. Act. 4: 119–135, 1996.
37. Morgan, K., and P. A. Bath. Customary physical activity
and psychological wellbeing: a longitudinal study. Age Ageing 27: 35–40, 1998.
38. Morgan, W. P., J. A. Roberts, F. R. Brand, and A. D. Feinerman. Psychological effect of chronic physical activity
. Med. Sci. Sports 2: 213–217, 1970.
39. Paffenbarger, R. S., Jr., I.-M. Lee, and R. Leung. Physical activity
and personal characteristics associated with depression and suicide in American college men. Acta Psychiatr. Scand. 377: 16–22, 1994.
40. Penninx, B. W. J. H., S. Leveille, L. Ferrucci, J. T. M. Van Eijk, and J. M. Guralnik. Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. Am. J. Public Health 89: 1346–1352, 1999.
41. Petruzzello, S. J., D. M. Landers, D. B. Hatfield, K. A. Kubitz, and W. Salazar. A meta-analysis on the anxiety
reducing effects of acute and chronic exercise
: outcomes and mechanisms. Sports Med. 11: 142–182, 1991.
42. Rajala, U., A. Uusimäki, S. Keinämen-Kiukaanniemi,and S.-L. Kivelä. Prevalence of depression in a 55-year-old Finnish population. Soc. Psychiatry Psychiatr. Epidemiol. 29: 126–130, 1994.
43. Rush, A. J., M. Trivedi, D. Schriger, and F. Petty. The development of clinical practice guidelines for the diagnosis and treatment
of depression. Gen. Hosp. Psychiatry 14: 230–236, 1992.
44. Ruuskanen, J. M., and I. Ruoppila. Physical activity
and psychological well-being among people aged 65 to 84 years. Age Ageing 24: 292–296, 1995.
45. Sexton, H., A. Maere, and N. H. Dahl. Exercise
intensity and reduction of neurotic symptoms: a controlled follow-up study. Acta Psychiatr. Scand. 80: 231–235, 1989.
46. Sime, W. E. Exercise
in the prevention and treatment
of depression. In:Exercise and Mental Health
, S. E. Golston (Ed.). Washington, DC: Hemisphere Publishing Corporation, 1987, pp. 145–152.
47. Singh, N. A., K. M. Clements, and M. A. Fiatarone. A randomized controlled trial of progressive resistance training in depressed elders. J. Gerontol. A Biol. Sci. Med. Sci.
48. Spitzer, R. L., J. Endicott, and E. Robins. Research diagnostic criteria: rationale and reliability. Arch. Gen. Psychiatry 35: 773–782, 1978.
49. Stephens, T. Physical activity
and mental health in the United States and Canada: evidence from four population surveys. Prev. Med. 17: 35–47, 1988.
50. Steptoe, A., S. Edwards, J. Moses, and A. Mathews. The effects of exercise
training on mood and perceived coping ability in anxious adults from the general population. J. Psychosom. Res. 33: 537–547, 1989.
51. Stewart, A. L., R. D. Hays, K. B. Wells, W. H. Rogers, K. L. Spritzer, and S. Greenfield. Long-term functioning and well-being outcomes associated with physical activity
in patients with chronic conditions in the Medical Outcomes Study. J. Clin. Epidemiol. 47: 719–730, 1994.
52. U.S. Department of Health, and Human Services. Mental Health: A Report of the Surgeon General.
Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999, pp. 1–278.
53. Veale, D., K. Le Fevre, C. Pantelis, V. De Souza, A. Mann, and A. Sargeant. Aerobic exercise
in the adjunctive treatment
of depression: a randomized controlled trial. J. R. Soc. Med. 85: 541–544, 1992.
54. Weyerer, S. Physical inactivity and depression in the community. Evidence from the Upper Bavarian Field Study. Int. J. Sports Med. 13: 492–496, 1992.
55. Yesavage, J. A., and T. L. Brink. Development and validation of a geriatric depression screening scale: a preliminary report. J. Psychiatr. Res. 17: 37–49, 1983.