Mental Health Awareness Week, observed in mid-May, highlights the ongoing importance of addressing mental health issues. As we move into July and enjoy better weather, the seasonal depression that affects many during the winter months often lifts. However, it's important to remember that mental health issues do not simply disappear with the arrival of summer. Among the many factors that influence mental health, exercise stands out due to its significant and well-documented benefits. This blog explores the neuroscience behind how physical activity can enhance mental well-being, providing insights into the mechanisms that make exercise a potent tool for mental health improvement.
Exercise as a Primary Treatment for Depression
A comprehensive study conducted by researchers at the University of South Australia has emphasised the potential of exercise as a primary treatment for depression. Published in the British Journal of Sports Medicine, this meta-review is the most extensive to date, analysing data from 97 reviews, encompassing 1,039 trials and 128,119 participants. The findings are striking: physical activity is 1.5 times more effective than traditional treatments, such as counselling or leading medications, in alleviating symptoms of depression.
The meta-review reveals that short-term exercise interventions, lasting 12 weeks or less, are particularly effective. This highlights the rapid impact physical activity can have on mental health, offering a promising alternative or complement to conventional treatments. Notably, substantial benefits were observed in diverse groups, including individuals with depression, pregnant and postpartum women, healthy individuals, and those diagnosed with HIV or kidney disease. This suggests that exercise can be beneficial across a wide range of demographics and health conditions.
"(...) Strength training was more effective for women, and yoga or qigong was particularly effective for men."
Types and Intensity of Exercise
The type and intensity of exercise play crucial roles in its effectiveness. This study found that all forms of physical activity—ranging from aerobic exercises and resistance training, to mixed-mode exercise and yoga—were effective in improving mental health. However, moderate-to-high-intensity exercise was more effective than low-intensity exercise, likely due to the greater physiological and neurochemical changes induced by higher-intensity workouts.
Another systematic review and meta-analysis conducted by Noetel et al. in 2024 corroborates these findings. This analysis examined the impact of various exercise modalities on depression and found that walking, jogging, yoga, strength training, and dancing significantly alleviate depressive symptoms. Interestingly, the review highlighted differences in effectiveness based on gender and age. For instance, walking and jogging benefited both genders, whereas strength training was more effective for women, and yoga or qigong was particularly effective for men. Additionally, yoga showed greater benefits for older adults, while strength training was more beneficial for younger individuals.
Neurological Mechanisms
Understanding the neurological mechanisms behind the mental health benefits of exercise is essential. The University of South Australia study points to several key neurobiological changes induced by physical activity. Exercise boosts the expression of brain-derived neurotrophic factor (BDNF), enhances the availability of serotonin and norepinephrine, regulates hypothalamic-pituitary-adrenal (HPA) axis activity, and reduces systemic inflammation. These changes contribute to improved mood and reduced anxiety, supporting the therapeutic benefits of physical activity.
Noetel et al. also propose several mechanisms based on trends observed in their data. They suggest that social interaction in group exercises can enhance social connectivity, reducing feelings of isolation and depression. Practices like yoga promote mindfulness and experiential acceptance, which are beneficial for mental health. Activities with immediate feedback, such as strength training, can boost self-confidence and perceived competence. Furthermore, exposure to green spaces during outdoor activities provides additional environmental and psychological benefits. Collectively, these factors contribute to the mental health benefits associated with exercise.
"(...) Physical activity is 1.5x more effective than traditional treatments, such as counselling or medication, in alleviating symptoms of depression.
Implications for Mental Health Treatment
Despite the strong evidence supporting the benefits of exercise, it remains underutilised in clinical practice for several reasons. Patients may be reluctant to adopt exercise routines, particularly if they are experiencing severe depressive symptoms. Additionally, prescribing and monitoring exercise can be challenging in clinical settings, and there is a lack of standardised protocols for integrating exercise into mental health treatment plans.
Clinical guidelines also vary across countries. While some, like Australia, recommend lifestyle management, including exercise, as a first-line treatment, others view it as a complementary approach when psychotherapy or pharmacotherapy is ineffective. The meta-analysis by Noetel et al. advocates for the integration of exercise into primary treatment protocols for depression, tailored to individual patient characteristics. They propose that structured programs and group exercises can provide additional support and enhance adherence, leading to better outcomes. Exercise should be recommended as a primary treatment for depression, rather than merely as a supplementary option.
Conclusion
The evidence strongly supports the incorporation of physical activity as a primary treatment for depression and anxiety. Both studies highlight the significant mental health benefits, lower costs, and fewer side effects of exercise compared to traditional treatments. Given these advantages, exercise should be more widely adopted in therapeutic settings. Future research should focus on optimising exercise prescriptions and integrating physical activity into standard mental health care practices to enhance patient outcomes.
This article was written by Rebecca Parker and edited by Julia Dabrowska, with graphics produced by Lilly Green. If you enjoyed this article, be the first to be notified about new posts by signing up to become a WiNUK member (top right of this page)! Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch.
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