Exercise does not improve depression

I never thought that such a statement could cause so many people to be up in arms but it seems people reading the Guardian were just that and all because of an article in the British medical journal. http://www.bmj.com/content/344/bmj.e2758 Facilitated physical activity as a treatment for depressed adults: randomised controlled trial’ that concluded:

The main implication of our results is that advice and encouragement to increase physical activity is not an effective strategy for reducing symptoms of depression.

It is odd that there were people arguing both for and against this conclusion with such passion that it became quite heated. In fact the original article (http://www.guardian.co.uk/society/2012/jun/06/exercise-doesnt-help-depression-study) about this was then quickly followed by a few short pieces on the same subject (http://www.guardian.co.uk/commentisfree/2012/jun/06/exercise-depression-research-misses-point, http://www.guardian.co.uk/lifeandstyle/shortcuts/2012/jun/06/exercise-beat-depression-research, http://www.guardian.co.uk/lifeandstyle/shortcuts/2012/jun/06/how-exercise-deal-with-depression)

Part way down one of the debates I felt compelled to ask myself why it was such a big deal? It’s just one piece of research about one type of physical activity intervention for the treatment of depression.

I mean really it wasn’t asking the question of whether doing exercise could make you feel better which is what seemed to be being debated. It was asking whether this intervention would affect the level of depression. It seemed that so many people were jumping to a lot of conclusions about the research and the conclusions that it came to, without really taking the time to consider why the intervention might not have had the desired affect. Significantly to my mind it was people who also felt better from exercising that were so against it and looking at the quotes it brought to mind the same attitude that I have heard from GP’s, CPN’s (country psychiatric nurse), OT’s (occupational therapist) and several other types medical professionals who seem to think that one thing will help everyone.

In my humble opinion to think that everyone with the same mental health issue could be helped by the same intervention is ludicrous. And I’m not talking cured here, I’m talking helped. It seems to me that there are a multitude of things that contribute to someone becoming unwell and some of them could be associated with exercise, or the lack of it. I have met far too many people to not be aware that peoples feelings about exercise, participating in it or their own ability to do it are affected by their past experiences and these may have led them to avoid doing it entirely. For others it may have been their escape, time to themselves, a way to get rid of anger or to just obliterate the world. The point is that for some it is not going to work at all, in fact it may make things worse and for others it will make them feel better. That some of the test subjects in this research reported that they felt better with increased exercise adds weight to this.

 It was noted that it seemed the people who took part in more vigorous exercise seemed to get more benefit, which incidentally is what the other articles in the guardian also said. The fact is that for them it’s a way to express some of the feelings, frustrations and anger that they are carrying around with them and when they have pushed themselves or scored that goal or run that marathon they feel better but it’s not about just being physically active it’s about what they are putting into the sport emotionally or about them being able to extinquish all feelings and focus just on the sport. And that for me is the point that actually these people who are gaining from it have found an outlet for some of their pent up emotions, to find a sense if achievement from it or an escape from the world. Even if it’s just looking around and saying it’s a beautiful world out here.

However I don’t think the research was about that. It wasn’t about them getting anything out of it except being more physically active and for some that’s all they did achieve, for others they put something into it that gave them something else and I think that’s why it helped some but not all.

In fact I am very impressed that the intervention was as successful in increasing peoples activity levels as they claim and I think if they could employ it to people who’s level of exercise is a problem then it will really help them. The fact that this exert is part of one of the articles does not dissuade me of it either.

Perhaps the most patronising thing about this research is the suggestion that while it might be useless for depression, exercise might well help the obese and diabetic and those with dodgy tickers, and that those conditions might contribute to depression http://www.guardian.co.uk/commentisfree/2012/jun/06/exercise-depression-research-misses-point

I do not find it patronising to suggest that this would work for others and I feel very much that he has misquoted the research paper dreadfully. It was not exercise that they were so quick to advocate the use of but the intervention which produced lasting increased exercise levels in it’s participants.

In fact it is this comment and many others like it that reminds me of a saying that’s been used on me frequently

Don’t take it so personally it wasn’t meant that way!

If exercise is helping you then go for it but if you really think that insisting that everyone who is depressed needs to do more exercise and that will make them feel better in the long term then you might want to remind yourself that professional sportsmen and women also suffer from depression and it would be churlish in the extreme to have their doctors turn around and say here take more exercise. Now don’t get me wrong I am not suggesting that the research was looking at increasing exercise as all that was needed to help people with this mental health issue but that when people write such pieces they seem to have missed what I think of as the big picture, that the range of problems within any diagnosis is enormous and that the number of causes for them are even bigger. What helps one person may not help someone else who appears to have the exact same symptoms because the cause is different.

Unfortunately when research is being done to assess whether to implement a strategy they don’t usually have the ability to choose a more people focussed approach. They are trying to find something that does work for all and that they could roll out to everyone. I have a lot of sympathy for the people who are trying to find the answers however I think they might consider using a people focussed approach as it would give them more positive results but don’t trash the results because it found that it didn’t work for everyone. They didn’t once suggest that people should stop exercising if it gave them some peace, some sense of achievement, some positive outcome. They just said that this intervention didn’t significantly improve the level of depression for the total population, not that it didn’t improve the level of depression for any one person with in it.