Exercise and Depression: Recommendations from the research

Directly affecting approximately 10% of the population during their lifetime, major depressive disorder (MDD) causes a significant impact on the individuals affected and their families.  Just over half of the people who live with MDD seek assistance, and of those a smaller number receive evidence-based treatment options.5002869_orig

Treatment options for MDD vary, including:

  • anti-depressants
  • psychotherapy
  • neurostimulation (electroconvulsive therapy), andMHT036_man-biking-exercise-depression_FS
  • repetitive transcranial magnetic stimulation

Despite the evidence that these treatment options do work, their suitability for any given individual should be carefully considered due to possible side-effects, cost and accessibility.  In addition to these options, alternative economical treatments should be considered.

Exercise and physical activity as an alternative treatment option for MDD has delivered positive outcomes.  The American Psychiatric Association has taken to including exercise as a option in it’s most recent guidelines for treatment.

So what do we know about the relationship between exercise and MDD?1234

Both aerobic exercise and resistance training can be beneficial.
Aerobic exercise is essentially exercise that causes shortness of breath.  Running, swimming, cycling and walking are all examples of aerobic exercise that has been shown to be beneficial in reducing symptoms for people with MDD.
Resistance training involves such exercise as lifting weights, walking with hand weights, and other exercise that requires you to ‘work against gravity’ (hence the name resistance).  Less research has been conducted with resistance training exercise, however the results suggesting its benefits in reducing the symptoms of depression are optimistic.

How often?  Ideally exercise 3 times per week for 45-60 minutes each time.
Recommendations for how often to exercise and duration can vary considerably.  The reasons for the variation can be dependent upon the desired outcome of the exercise (for example improving diabetic control, increasing fitness levels, weight-loss).  In the instance of reducing symptoms of depression, studies have compared 2-5 sessions per week at 30-60 minutes per session.  The guidelines for optimally assisting with depression are to participate for 3 sessions per week for a duration of 45-60 minutes each time.

How hard?  What should be the exercise intensity?
How ‘hard’ to exert yourself when exercising is an important consideration when planning an exercise routine.  The guidelines for aerobic exercises (walking, swimming, running etc) are based upon your heart rate.  Keeping your heart rate elevated within the range of 50-85% of its maximum capabilities.  exercise-beats-depression
In a laboratory this is tested by conducting a VO2 max test.  A VO2 max test requires a period of time spent on a treadmill or rowing machine with various breathing apparatus attached.  Most of us don”t have the opportunity to complete this rather unpleasant task, so as a rough guideline if you subtract your age (in years) from 220, aim to work at 50-85% of this number.
So, a 50 year old person should approximate their maximum heart rate at 170 bpm (beats per minute) and to benefit from the anti-depressant effects of aerobic exercise, be exercising somewhere between 85-145 beats per minute.  This is most easily kept track of with a heart rate monitor.  However if you want to quickly (and cheaply) gauge your heart rate, simply hold two fingers to your neck or your wrist until you can feel your pulse.  Count the number of beats over a 6 second period and add a 0, this will give you an approximation of your heart rate for 60 seconds.

The guidelines for resistance training is to repeat an exercise 8 times, briefly rest and then repeat two more times (resulting in 24 repetitions of the exercise).  The weight of the resistance should be 80% of the heaviest weight you can complete by yourself.  So, for example if the heaviest single bicep curl you can complete (with good form)  is 10kg, then the weight you lift for your 3 sets of 8 repetitions is approximately 8kg.

For how long?  Keep exercising for at least 10 weeks.
Some studies have shown significant improvement in depression symptoms in as short as 4 weeks.  Most studies are supportive of a continuation of the exercise program for at least 10 weeks.  When focusing from a lifestyle perspective, the recommendation would be to make exercise a life-long pursuit. However, from the perspective of reducing depressive symptoms at least 10 weeks is the recommendation.

Can I make it easier to achieve?  Using psychology to maintain exercising.
Maintaining an exercise regime is not always easy.  Maintaining an exercise regime when you are experiencing depression can be even less so.  Understanding some of the factors that help to maintain exercise can help to make the change easier.

Experience tells me that people find it challenging when life feels out of control or unpredictable, it is harder to cope.  Engaging in an exercise regime is best assisted when the opportunity of choice is offered.  Choosing the type of exercise, the location, and frequency will increase the perceived level of control over the activity and consequently increase involvement and adherence.

Choosing and maintaining an exercise regime can often be challenging initially.  For some people, seeking the support of a health professional (such as exercise physiologist or psychologist) may help to overcome some of the barriers to change.

Much of the information included in this blog is based on the meta analysis written by Rethorst and Trivodi on the prescription of exercise for people with a major depressive disorder.   A meta-analysis is a research paper that summarises key findings of a multitude of research papers on a particular topic.

Information provided in this piece are general in nature.  People experiencing depression should seek advice from their treating professionals to determine the appropriate course of action for themselves.  People who have not exercised recently should seek approval by their medical practitioner to commence an exercise program.  An exercise physiologist is an appropriately qualified health professional to assist you in planning an exercise program.

Don’t act on NY Resolutions until you’ve read this!

2011-year-resolution-400x400The temptation will be strong over the next week to join in with others and declare your New Years resolutions for 2013.  An admirable gesture for sure, however the reality is that the majority of people leave their resolutions long behind by March.  So how can you be different? What can turn your good intentions into sustainable long-term behaviours?

The truth is that whatever the new behaviour is (eg. Starting to exercise, stop smoking, flossing your teeth) it’s something that you are currently NOT doing as you would wish …. hence the need for the resolution!  So, whatever it is there are reasons you aren’t doing it.  Unless you know what they are and have strategies to overcome them, you are wasting your time declaring your upcoming change.

The well known phrase fail to plan, plan to fail’ is 100% correct.  Most psychologists view behaviour change as occurring through a series of steps or stages.  We may initially be resistant to change, then we contemplate doing things differently and many people make some quick plans and then launch themselves into whatever the new behaviour is.

STOP.

You rushed it and that’s why so often it doesn’t work.  Successful behaviour change comes about when you think and plan, then think some more, and then do some more planning!

Let me illustrate two quick examples of how you can considerably increase your chances of changing your behaviour.  I’ll use examples of both starting a new behaviour and stopping an existing one.

Starting a new behaviour – Going to the gym

Why do I want to start exercising at the gym?

  1. It will improve my cardiovascular fitness and strength
  2. It will help me to lose weight
  3. it will help my confidence?

So why haven’t I been going to the gym?

  1. I haven’t been prioritising it into my weekly schedule.
  2. When I have the opportunity to go, I do something else, for example when the alarm goes off in the morning, I roll over and go back to sleep.
  3. I think about going to the gym and then I tell myself it’s going to be hard, and I will be sore, and I’ll probably make a fool of myself.

What do I need to do differently to overcome these obstacles?

  1. Prioritising – Get out my diary and make an appointment with myself to go to the gym. Decide whether mornings or evenings will suit me and the family better.
  2. Not seizing the opportunity – go anyway! I know I don’t feel like it, but I know it will feel good once I’m done.  I also need to have my clothes out ready to make it easier. So I’ll lay them out the night before for a morning session. Or I’ll put them in a bag in the back of my car in the morning so I can go straight from work.
  3. Negative self-talk – challenge the helpfulness of what I’ve been saying to myself.  “Yes, it will be physically uncomfortable at first and I might be sore, but long term it will be really good for me to go”.  “I might feel self-conscious, but I’m a long way in front of all the people who stayed home in bed!”  “That’s why I’m going to get a trainer to plan out a program for me initially, so I can learn what to do”.

What resources do I need to change my behaviour?

  1. sandshoes,
  2. gym shorts and a tshirt
  3. a gym membership,
  4. access to a personal trainer to design my initial training program.

When will I start?

I’l ring the gym now and schedule to get a program from a trainer.

How will I know when I’m successful?

I’ll be regularly going to the gym 3 times a week and I’ll notice a difference in my appearance and how my body feels.

What if I relapse and stop going?

  1. I’ll first forgive myself!
  2. I’ll then review why I haven’t been going and make plans to overcome those obstacles.

Behaviour 2 – Stop eating high sugar and high fat desserts every night.

Why do I want to stop eating the desserts?

  1. They are calories I don’t really need.
  2. I’ve just started my gym program and this isn’t helping my efforts.
  3. I don’t feel good after I’ve eaten them.

Why do I currently eat desserts every night?

  1. They are in the freezer!
  2. Habit
  3. My partner eats them with me
  4. It’s what I do when I watch tv to relax.

What do I need to do to overcome these obstacles?

  1. In the freezer – throw them out and don’t buy any more!
  2. Habit– Change the habit, think about something I would rather eat instead like a piece of fruit or some yoghurt and have those foods available.  Remember you don’t need to totally abstain!  Perhaps you might have your treat dessert twice a week.  Plan which nights that will be and have that then.  Reducing your intake from 7 nights a week to 2 will make a big difference.
  3. My partner eats them too– talk to your partner about your decision to make a change and see if your partner would like to make the change too.  It will be easier if they do, but if they don’t, make the commitment to do this for yourself.
  4. It’s what I do to relax– Remind yourself why you are making this change.  Enjoy the fruit or whatever alternative you go with.

What resources do I need to change my behaviour?

  1. A dessert alternative

When will I start?  

I’ll go grocery shopping this afternoon and buy some fruit alternatives.  When I get home I’ll throw the old desserts out (or put them to the back of the freezer for my two allocated nights).

How will I know when I am successful?

When I have been regularly eating healthy options for my dessert.

What if I relapse and stop going?

  1. I’ll first forgive myself!
  2. I’ll then review why I haven’t been going and make plans to overcome those obstacles.

SO WHERE DO YOU START?

First I’d like you to copy the questions I have listed below and put them into a word Healthprocessing document.  Take the time to go through the questions and answer them for yourself.  Print the answers off and put them somewhere where you’ll see them and start moving towards change.

  1. Why do I want to stop/start                               ?
  2. Why do I currently                          (insert the current barrier here)?
  3. What do I need to do to overcome these obstacles?
  4. What resources do I need to change my behaviour?
  5. When will I start?  
  6. How will I know when I am successful?
  7. What if I relapse and stop going?

The psychological benefits of breakfast

This post was first written on Inshape News in July 2012.

The nutritional benefits of breakfast in relation to weight loss are well established and I’m sure will be well described by my fellow writers.  It is also important to consider the psychological benefits that can be gained when you sit down in the morning and tuck into a bowl of something healthy.

Consistently, studies demonstrate that memory, creativity, processing and other brain functioning are all enhanced following consumption of breakfast. Further, your morning meal can boost your energy levels and leave you feeling more alert and ready for your day.

One advantage of regularly eating breakfast is the discipline activated and required to maintain the routine. Self-discipline (or self-regulation) is the process of consciously managing your health. Whilst challenging for many, the decision to make proactive steps towards your health will have far reaching benefits. When we self-regulate we are likely to feel more in control of ourselves, and our tendency for impulsive behaviour decreases.

People who self-regulate are able to plan and set goals, reflect on their own behaviour and organize themselves appropriately. Other things we know about those who self-regulate are that they are more likely to seek out information and advice, will try harder and persevere for longer. These qualities are beneficial in all aspects of our health and well-being. So the habit of eating breakfast will provide more than just nutrition for your body and have an impact on your metabolic rate. Eating breakfast will set you up to increase the likelihood of making better health choices through the rest of your day – impacting on your long-term weight and health.

Self-regulating to ensure you eat breakfast is made easier with some planning and organization, however it is worth the effort. Also make sure you add some variety. Perhaps have a few cereals to choose from or cook some eggs in different ways. Creativity in our lives is helpful for our motivation levels. Ultimately, treat self-regulation like a muscle — the more you work it the stronger it gets. Self-regulation gets easier with time and its benefits to your waistline will be worth it.

Facing depression

This post was first written on Inshape News in July 2012.

Depression can be experienced in many forms and with varying severity, from mild to severe or psychotic. However, there are a number of strategies that a person can adopt which will assist with their functioning and general well-being.

These are as follows:

1.  Enhance the positive areas of your life. Engaging in activities that you enjoy is a helpful step towards overcoming depression.  Ask yourself, “What have I stopped doing that I used to enjoy?”

Perhaps it is:

  • Reading a book.
  • Catching up with friends for a coffee or meal.
  • Exercising.
  • Going to the park.

To overcome depression, spend some time reflecting on the positive aspects of those activities and remember times when you did them.

Try to increase the number of positive activities and events in your daily routine.

2.  The way you think. One role for our mind is to generate our everyday thoughts. The way we think directly influences our mood and therefore our resulting behaviours. For example, if we think we are lazy, we may feel sad, which may result in us not being physically active. How we interpret our lives can be constructive and helpful or negative and harmful. How we think is an active choice. Negative thinking is an unhelpful habit that we can overcome with practise and persistence.

Just because we think something, doesn’t necessarily make it true. When you feel depressed negative thoughts can weigh on your mind. You may doubt yourself, wonder if you can cope, or feel like it’s all too hard. To overcome this, start by listening to that inner voice. Ask yourself, “What are you saying to yourself?”

Being aware of your negative thinking serves two purposes:

  1. Knowing your internal ‘chatter’ can act as an early warning sign that your thinking is not being helpful.
  2. Knowing your internal ‘chatter’ allows you to take action towards more helpful thinking.

Listen to your self-talk. Ask yourself, “Is it positive? Is it helpful? Would you speak to others the way you are speaking to yourself?”  If the answer is no, then challenge these negative unhelpful thoughts and replace them with something more beneficial. There are various self-help books that can assist you to do this or you may wish to seek guidance from a counselor.

Replace negative thoughts with positive, helpful thinking. Challenge yourself to think differently and create new positive thinking habits.

3.  Make positive choices. Often when we are feeling depressed we turn to food, alcohol, and cigarettes, as well as being inactive or reducing our social contact as a way of coping. Unfortunately these strategies may have negative consequences for us, especially if they are over used, particularly in the long term.

Broadening your decisions and considering the range of options you have may help you to consider other behaviours or actions that will benefit you.

If you’re feeling down perhaps you could go for a walk or if you find yourself seeking solace in the fridge choose fruit or another healthy choice.

Depression is a serious condition affecting a large proportion of the population. It is important that in cases of a depressive disorder — particularly a severe one — that a person seek assistance from an appropriate health practitioner. Psychology offers a number of therapeutic approaches and strategies to assist people in facing depression. It is important that you take steps that will best benefit you. Seeking help and adopting some of the strategies mentioned in this article may be helpful for you.

 

Mental strength and weight loss

This post was first written on Inshape News in June 2012.

Whilst losing and maintaining weight loss requires physical actions (what you choose to eat, whether or not you exercise), much of your success of comes down to overcoming the associated mental challenges (feeling tired, losing motivation or losing confidence).

There are five key areas you can focus on that will greatly enhance your chances of success in being the person you want to be and achieving your goals.

Set Goals – If you don’t know where you are going, how will you know when you get there?  Research consistently shows that goal setting is a key component of success.  Begin with the end in mind. Ask yourself, “What would you like to achieve in ‘x’ months time?”  Once you know this, then you can ask yourself, “What can you do TODAY to contribute towards the final goal?”  Remember that small and regular steps are the key to achieving your goals.

Be Positive – How you talk to yourself is ‘crucial’ in determining whether you make positive decisions.  Our brain is specifically designed to offer us a constant stream of thoughts.  Over time and through habit, we determine whether these thoughts are optimistic and helpful or pessimistic and unhelpful.  Optimism has been repeatedly shown to be a determining factor for success.  So you could ask yourself, “Would I ever speak to someone else, the way I speak to myself?”  If, like many people the answer for you is NO, then work towards changing your thinking.  If your thinking is negative, challenge yourself – is what you’re saying even true?  Are you catastrophising?  Will the thing that’s worrying you even be an issue next week?  Next month?  Next year?  Replace pessimistic unhelpful thoughts with those that will move you forward in your goals.

Take …… And replace it with ……
“I ate junk food for lunch. I’m never   going to get on top of this. I’m hopeless.” “I ate junk food for lunch. Oh well, it   was just today and tomorrow I will have a chance to have something healthier   that I’ll enjoy.”
“I’ve only lost 330g this week. This is   too slow. I’m never going to get there.” “I didn’t lose a lot of weight this week,   but I didn’t gain any either!  Slow and   steady wins the race. It will be worth it in the end.”

Be Resilient – Challenges will come along. You’ll miss an exercise session or you’ll eat something unplanned that you wish you hadn’t.  Remind yourself it’s okay.  It’s not the challenges in life that we experience, but rather, how we respond to these and deal with them.  Chin up and face the world – you will be okay and you can survive whatever you face.  The sooner you can bounce back, the sooner you can make more positive steps to enhance your well-being.

Be Creative – Novelty is a great way to spark our interest and keep us motivated.  Perhaps there is a new healthy dish you could try or you could change the location of your regular walk?  Routine is important, however sprinkling in some creativity every now and again stops us from becoming stagnant and gives us a reason to move forward.

Know Your Recipe – Not just for the foods you eat, but for the life you want to live!  We all have things that when we do them regularly greatly increases our chance of success.  The more mindful you are of what helps you to stay healthy and make great choices, the more likely you will continue to do them.  So, if you know that staying hydrated, going to be before 10pm, putting your exercise clothes out before you go to bed, taking a container of almonds to work to snack on are all things that help you to make positive choices, then include these in your recipe.  Your recipe for success that is.

Maintaining a healthy weight is a work in progress for many people, for all of their lives.  Approaching it optimistically, with a plan, being able to bounce back when something goes wrong, including novelty and knowing what you do that makes a difference are all key factors is maintaining your mental strength.

Hmmm, whether to turn left or right?

In 1998 I watched the movie ‘Sliding doors’ and it’s underlying question has remained with me: how different might your life be dependent upon even the small decisions you make?

The movie follows lead character Gwyneth Paltrow’s life according to whether she does or doesn’t catch the train home after being unfairly sacked from her job. The movie shows in parallel the very different lives that would follow based upon that one small event.

Every day we are faced with hundreds of decisions: from what to have for breakfast, which route to travel to work, and whether or not to ask for that promotion.  The thought that every fork in the road could lead to very different destinies could feel immobilising as we consider every possibility and outcome.

However there may also be times that by following our usual course of action our routines limit and preclude us from taking a risk with the opportunity in front of us.

The truth is that without a crystal ball we can never be 100% confident of the consequences of our decisions or how another decision may have turned out. So the lesson then is to move forward with confidence, knowing that at the time of our decision we did the best we could with the information and options we had in front of us.

When making a decision these general guidelines may be helpful:

1. List your options.  Very few situations have only one possibility – brainstorm all the possibilities, even the seemingly unrealistic or ‘silly’ ones.

2. Consider the advantages and disadvantages of the options – what will be the likely outcomes? what is the ‘cost’ to you and others of the action? which outcome is likely to receive the most resistance?  why? and how could you overcome it?

3. Visualise the outcome.  Take the options you have considered and see in your mind what that decision may look like.  Consider that decision in future terms – how may you feel down the track if that was the decision you made?

4. Listen to yourself.  So often people tell me of times when they didn’t listen to their ‘gut reaction’ and regret their decision.  Whilst intuition isn’t always right for us, it is certainly can be a good starting point.

5. Implement your decision.  Here’s your opportunity to take action.  With energy and enthusiasm, take action on your decision.  Be committed to the choice you have made.

6. Evaluate your decision. This is your opportunity for learning and growth.  Was the outcome what you expected?  Would you do anything differently next time?  What would you do next time?

Clinical experience tells me that time spent in the past, in the land of regret and ‘what if’ only facilitates guilt, disappointment and depression.  You made a decision and whether or not you achieved what you hoped for, the question is: what are you going to do now? All you control is in the present.  The past is for our memories and the future is for our aspirations.

The wonder of life is that it is filled with opportunities and decisions to be made.  The doors will continue to ‘slide’, the journey is deciding which ones you will step through.

 

Achieving those new year resolutions (in June)!

Around December 28 each year I receive phone calls from journalists seeking comments regarding New Years Eve.  In particular, New Years Resolutions and why we are not successful in keeping them!  Each year my answer is the same, most people don’t spend enough time planning for the changes they intend to make.

Behaviour change can be tricky – it isn’t just a case of deciding you’d like to start something new or tweak something you’ve been doing and then it just happening.  The reality is that for behaviour change to stick it requires thought and planning.

You want to start or change the way you currently do something, perhaps you want to start exercising or improve your food choices.  Your first consideration needs to be:  Why haven’t I been doing that behaviour prior to now?  The answers are crucial, because in part they will help you to understand your barriers to change.

When we know our barriers to change, we can plan ways in which we will overcome them.  Consider the barriers below and some possible solutions.

Barrier Solution
I don’t like exercising in the mornings Exercise in the afternoons or evening
The morning is the only time I have to exercise, and I don’t like exercising in the mornings – it’s hard to get up! Lay your clothes out the night before.  Set the alarm and remind yourself that once your feet touch the floor, the hardest part is done!
I don’t know what exercises I should do, I’m not even sure where to start See a qualified professional and have them design and teach you an exercise regime that will work for you
I’m not ready to start exercising, but I want to some day. Perhaps start by increasing your incidental exercise – park further away at the shopping centre, hop off the bus one stop earlier, take the stairs rather than the lift or escalator.
I feel tired and sluggish in the afternoons and a chocolate bar always makes me feel better. The sugar hit from the chocolate bar will be short lived – perhaps take some nuts or fruit or a yoghurt to work ready for your afternoon snack.
Once I start a packet of biscuits, I can’t stop If you’re going to have a biscuit, take what you want to have out of the packet and put the remainder away in a slightly inconvenient spot – the harder you have to work to get to it, the more time you have to think about it and may change your mind.

Do you make new year resolutions in 2011?  I wonder what you were determined to do 6 months ago?  Did you do it – for a while?  Are you still doing it?  The more time you can spend planning for how to make change work, the more likely you’ll achieve your goal.

And of course the good news is that change can start as soon as you’re ready … no need to wait until December 31 to start planning!

Next week we’ll discuss the language around change.  With a few simple phrases you can significantly increase the chances that you will make those changes.