The myths of exercise and depression

Earlier this week, the BBC News site reported on a study into exercise and depressionwritten up in the British Medical Journal. “Exercise ‘no help for depression’” is how the BBC summed up the study. Immediately, Twitter went wild, with countless sufferers of mental health conditions chipping in to say that they were a firm fan of exercise as a means of coping with their problems.

But what does this study really tell us? That the particular intervention – face to face and telephone coaching to encourage people to use what facilities are available to them locally – did not make any noticeable difference to the participants’ level of depression in comparison with people with similar symptoms who did not receive the intervention.

The intervention was specifically designed to be something that could be easily carried out in primary care, in other words it was designed to meet the needs/limitations of treating depression in primary care. It was not designed around what people with depression or in a specific local area thought might be helpful.

So maybe this study just wasn’t measuring the right things, or offering the right intervention. I certainly don’t think we should chuck exercise on the scrapheap just yet.

But, equally, let’s not become uncritical about its benefits either. There seemed to be a bit of evangelising going on, and I am sometimes concerned that those who do find exercise beneficial make assumptions about its efficacy and appropriateness across the board. We need to be wary, for example, of the following myths:

Anyone can do a little bit of exercise.

While exercise seems highly likely to help with conditions such as mild-moderate anxiety and depression, anyone who is in a really severe, deep depression is likely to have genuine difficulties getting out of bed, washing, dressing, etc. They are not being lazy, they are suffering from “psychomotor retardation”, a well known effect of severe depression which can make people move, speak or even think more slowly.

Exercise proponents may mean well, but encouraging someone in this state to exercise will feel as impossible as asking them to flap their arms and fly to the moon. We also need to consider that many people have other illnesses or disabilities in addition to mental health problems. Suggestions like “anyone can run in the park for free” wrongly assume that we are all equally physically able.

Exercise will stop you from relapsing.

Exercise may help you keep well. But if you relapse, it’s highly unlikely to be simply because you stopped swimming twice a week! Recovery and relapse are complex and multifaceted, and it’s simply not possible to be sure of a causal link between exercise and continued wellness.

If you exercise, you won’t need medication/therapy.

For some people that’s true, but again they are likely to be the people towards the milder end of the clinical spectrum. If some people can tackle their depression or anxiety through exercise, without needing drugs, great! But no-one should feel that they “should” be able to run the blues away. For people with longer-term and harder to treat conditions such as bipolar, schizophrenia or personality disorders, exercise may be one tool that people use to pursue recovery or maintain wellness in periods of remission, but that’s going to be it – one tool from a kit of many, with more traditional tools such as drugs or therapy likely to be at the forefront.

Exercise is always good for mental health problems.

Usually, maybe; always? Definitely not. For example, I know that I am far from the only bipolar person who over-exercises in a high, sometimes to the point that I injure myself. If I am feeling a little elated, I can naughtily develop my hypomania, by undertaking repetitive exercise. Running is especially powerful, particularly if I listen to fast music on headphones as I run. There is a lot of counting involved in many forms of exercise – reps, lengths, laps – which can feed into obsessive traits, and over-exercising can be an integral part of eating disorders.

So let’s celebrate when we find exercise helpful! Whether you believe today’s reports, or have faith in previous studies recommending exercise for mental distress, what ultimately matters is whether it works for you. And if you are depressed but exercise is beyond you right now, please don’t feel guilty. We can only do what we can do.