Betty approached my office with a great deal of trepidation. "This isn't going to work," she said, "I've tried virtually everything and I don't see how a personal trainer can help me any more than my psychiatrist!"
Betty, a slender 52 year-old, had been suffering from clinical depression for the past eight years and had been undergoing intensive psychotherapy throughout this time. She had taken a variety of different prescription medications and had even tried several herbal remedies to cure her illness. Although her condition had improved, she still endured periods of severe despondency. She recently began seeing a new psychiatrist who recommended that she try exercise to supplement her therapy…
Clinical depression affects as much as 5% of the population and is especially prevalent in the elderly. In the past, traditional forms of anti-depressive treatment were limited to psychotherapy and medication. Although these remedies can be reasonably effective forms of treatment, they pose a tremendous financial burden to the healthcare system. According to the Presidents Council on Physical Fitness, those with depression spend over 50% more on healthcare than non-depressed individuals. Further, those being treated with anti-depressants spend three times as much on outpatient pharmacy costs than those not on drug therapy.
Moreover, there is a distinct risk of negative side effects associated with anti-depressant medication. Even the newer drugs such as Prozac and Zoloft, which are supposedly safer than previous medications, carry the potential for adverse reactions (including weight gain, drowsiness and sexual dysfunction). Thus, all factors considered, alternative, low-cost therapies are highly desirable, especially if they do not have any side effects.
In the 1990's, there have been at least five major research projects that have studied the effects of exercise on clinically depressed patients: all five concluded that exercise resulted in a significant reduction in depression. Most of the studies proved that exercise is at least as effective as drug therapy, perhaps even better. Furthermore, benefits even were seen in those with the most severe cases of depression, including those classified as mentally ill. The evidence is clear: exercise can be an effective means of combating this debilitating affliction.
In addition, exercise also can help to regulate sleeping patterns-a common outgrowth of depression that can often exacerbate mood disturbances and irritability. Exercise has been shown to significantly increase total sleep time and promote a more restful sleep. Ultimately, this can have a positive impact on enhancing state of mind.
Consequently, leading medical authorities are now beginning to prescribe exercise as the first course of action in the treatment of depression. This view is shared by the Surgeon General who, in their recent Report on Physical Activity and Health, proclaimed that physical activity helps relieve symptoms of depression and anxiety as well as improving overall mood. Across the board, there is a growing consensus that regimented workouts should be an integral part of any comprehensive treatment program.
In constructing an effective program, it is best to employ a combination of weight training and cardiovascular exercise. By integrating both of these facets into your routine, you will derive the greatest overall benefits on mental health. While it usually takes several weeks to see substantial results, anti-depressant effects can actually begin as early as the first session of exercise.
Ideally, exercise should be performed on three, non-consecutive days per week (i.e. Monday, Wednesday, Friday). The entire routine (weight training and cardiovascular exercise) should last about an hour with each component taking roughly an equal amount of time to complete. Since consistency breeds results, it is essential that you remain regimented in your endeavors. Try not to miss a session and, if you do, return to your routine as soon as possible.
The weight training portion of your program should incorporate a total body approach to training. This involves working each of the major muscle groups including your chest, back, shoulders, arms, legs and abdominals. Not only will this ensure that no structural imbalances are created between muscle groups, but it also will help to alleviate internal stress throughout your entire body.
Once your muscles are acclimated to this process, you should use weights that are heavy enough to make the last few repetitions of a set difficult to complete. Studies have shown that anti-depressant effects are greatest at high levels of intensity. Thus, you should try to push yourself as hard as possible during the workout. It really doesn't matter whether you use barbells, dumbbells or machines as long sufficient intensity is employed.
In the cardiovascular component of your routine, it is important to utilize a concept called cross training. Cross training dictates that you constantly vary your exercises amongst several different modalities (i.e. stairmaster, stationary bike, treadmill, etc.). This helps to reduce the boredom often associated with repetitive exercise, thereby improving adherence to your training routine. Furthermore, since different muscles and joints are involved in the performance of the movements, it reduces the possibility of overuse injuries such as shin splints, heel spurs and other related ailments.
For those who simply cannot tolerate the redundant nature of these movements, alternate forms of cardio such as dancing, swimming, hiking and other activities can provide acceptable substitutes. However, it is important to make sure that a high level of intensity is sustained regardless of the modality used. You should maintain a constant pace during the performance of the movement, striving to keep your heart rate elevated throughout the exercise.
Finally, in case you were wondering, Betty eventually became my client and, despite her initial reluctance, slowly began to embrace her workouts. She now is a fine testament as to the efficacy of exercise as an anti-depressant. After three months of working out, she has made terrific progress. In fact, after her last session she happily remarked, "Everyone keeps telling me how cheerful I seem lately. Even my husband says he's noticed a big difference-and that's really saying something!"
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