“Go out for a walk; you’ll feel better.”
That’s long been a trusty bit of wisdom for relieving stress and lightening mood. But now that there’s a persuasive body of hard science to back up the antidepressant function of exercise, Michael Otto, a College of Arts & Sciences professor of psychology, says clinicians should consider physical activity as important and valid a treatment for depression as antidepressant drugs and talk therapies. Otto argues that numerous clinical trials have shown that people with major depression who embrace routine exercise get better at the same rate as they do with antidepressants.
Depression is a fierce adversary for clinicians; according to the National Institute of Mental Health, it affects nearly 15 million Americans over 18 and is the leading cause of disability for those ages 15 to 44. A significant percentage of them could improve dramatically with exercise alone, and for patients who still require medication, it can increase the benefit, says Otto, one of a group of researchers calling for psychologists to include exercise programs in treating not just depressives, but people with anxiety and eating disorders. Otto, coauthor, with Jasper A. J. Smits of Southern Methodist University, of the clinical guide Exercise for Mood and Anxiety Disorders (Oxford University Press), is working on a book about exercising for improved mental health for lay readers. BU Today spoke with him about the antidepressant effects of exercise and the challenge of motivating people who may be immobilized by sadness.
BU Today: It’s long been known that exercising makes us feel better. What’s new about the link between physical activity and depression?
Otto: In recent years there are more findings documenting just how effective exercise is. Its effects rival antidepressants in head-to-head studies. Another new thing is the potential adoption of exercise as a part of clinical practice. We thought, how come we don’t see this connection in the hard literature? We decided to make the strength of these findings clear to people in mental health circles. There were no treatment manuals until ours to help clinical practitioners incorporate exercise programs. It’s time to attend to this.
Isn’t the link between exercise and mood intuitive? Most of us exercise because it makes us feel good.
A lot of intuitive things just aren’t true. There’s no scientific evidence for a lot of the stuff that goes around in the popular culture, like the merits of magnets or the belief that vitamin C helps you not get a cold. People like me tend to distrust popular opinion. If you go for a run you may be less stressed, but research showing it can treat something like major depression — a bad, debilitating disorder — that’s where the news is.
Is there a bias among clinical psychologists against prescribing exercise as being too simple?
The beauty of exercise is that it appeals to holistic thinking and there’s evidence. Those two things don’t often go together. Our manuals help clinicians get comfortable with the exercise prescription and support treatment by giving information to patients, helping them adopt the intervention themselves.
How does exercise for health or anti-aging differ from exercise for improving mood?
The problem with exercise for health is you have to wait nine months to a year for results, before your abs and your hips look better. It’s a tremendous commitment. The beauty of exercising for mood is you get the payoff right now. The other kicker is, being in a bad mood is why a lot of people don’t exercise, and this becomes precisely the reason to exercise.
Severely depressed people often have trouble just getting out of bed. How can a therapist get patients to take those first steps?
What’s important is that we can add exercise to the treatments that work, such as cognitive and interpersonal therapy and antidepressants. We now know that exercise works, but getting people to exercise is an art. Let’s be frank — Americans are abysmal at adopting exercise. So our approach is to use cognitive behavior therapy to target exercise adoption and help people really stick with it.
My colleague Jasper Smits and I have devised a number of activity-based treatments that break exercise up into small, useful steps. When you’re on your couch, there may be no way you’re going to get up and go running. But if you get up and put on your workout clothes, you’ll feel, I may as well move a bit, and then decide just to go outside. These small gains keep a person going, which is important because we’re working against poor motivation and the feeling that nothing matters. We prepare people for the kind of thoughts you have when you wake up in the morning — like, I really should exercise but don’t. We tell patients they need to make decisions with their awake mind, not their asleep mind.
How much exercise should depressed people do for sustained results?
We think that bouts of exercise are important, not just random physical activity during the day. We’re talking about half-hour chunks, the time necessary to get people past ruminative thinking. For me, for example, my brain shuts off at around 22 minutes into a run. And we know what’s worked in the trials is getting the heart rate up for 20 to 45 minutes of sustained activity. We’re staying where the research is.
Taking pills to feel better seems to be a powerful force in our culture. Will exercise be a hard sell for clinicians treating depressed or anxious people?
My colleagues who have med-based practices don’t talk about exercise. In my practice, people want to avoid taking medicines, or patients are struggling with just meds or therapy and not getting better. They want more active components. For all those therapists who are not offering drug or cognitive therapy, this provides a new choice. We have to change everybody’s biases — both doctors’ and patients’.
Is there any concern that if exercise proves to be a cure, it will put Ph.D.s out of business?
We’d be so lucky to run out of cases. A few more people might go for care who otherwise don’t go. Conventional treatment for depression works about half the time no matter what the therapy is. Smits and I are writing a book so depressed people can pick up the exercise program by themselves.
How important is the social aspect of exercise?
Depression is an isolating force, and once you’re isolated with a bad mood, it feeds on itself. Exercise returns you out into the world. It feeds you in ways over and above the health benefits.
What are the limitations of exercise therapy? Is it effective for thought disorders like schizophrenia?
Depression is where the bulk of the findings are. Second are anxiety and panic disorders, and there are new exercise applications for substance dependence. But there’s no evidence that exercise can treat thought disorders or delusions.
Can anything be psychologically bad about exercise?
Any behavior can be overdone. With exercise, you can overdo it and get injuries or overdo it so it crowds out other aspects of your life. There’s the risk of exhibiting that uniquely human ability to redefine success in a way that you’re failing all day long: I ran three miles — I could’ve run five.
Susan Seligson can be reached at firstname.lastname@example.org.