If you are feeling depressed or anxious, you might want to consider adding some physical activity to your daily routine. Sports Management magazine recently featured a research study by the University of South Australia, published in the British Journal of Sports Medicine, which has found that exercise is 1.5 times more effective than counselling or leading medications in reducing symptoms of depression and anxiety. These articles can be accessed from the links below.
The global prevalence of mental health disorders is significant. In 2019, the World Health Organisation estimated that 1 in every 8 people, or 970 million people around the world were living with a mental disorder, with anxiety and depressive disorders being the most common. However, these are widely believed to be underestimates due to poor diagnosis and low reporting rates. Actual lifetime prevalence rates for mental disorders are estimated to be between 65 and 85%.
In the UK, Mind report that approximately 1 in 4 people will experience a mental health problem each year. In any given week, 1 in 6 people report experiencing a common mental health problem (like anxiety or depression).
The current annual costs of mental health disorders are substantial. Globally, the economic value associated with this burden was estimated at about USD $5 trillion in 2019. In the UK, mental health problems cost the economy at least £117.9 billion annually.
Looking ahead, the projected costs of mental health disorders are expected to rise. It is estimated that mental disorders could cost the global economy USD $16 trillion by 2030. The costs are primarily due to early onset of mental illness and lost productivity, with an estimated 12 billion working days lost due to mental illness every year.
In the landscape of mental health treatment, lifestyle management approaches, such as exercise, sleep hygiene, and a balanced diet, have become integral alongside traditional interventions like psychotherapy and pharmacotherapy. However, the adoption and prioritisation of these approaches varies across countries. For example, in the United States, the authors of the featured research state that clinical guidelines lean towards prioritising psychotherapy and pharmacotherapy, with lifestyle approaches considered as complementary treatments. In stark contrast, the most recent guidelines from England’s National Institute for Health and Care Excellence (NICE), released in 2022, present a different perspective, at least for depression. For cases of less severe depression, NICE recommends group exercise following guided self-help and group and individual therapies. Psychotherapy and pharmacotherapy find themselves further down the list of recommendations, with the order based on considerations of clinical effectiveness and cost. The treatment recommendations differ for more severe depression, with group exercise taking bottom position in the hierarchy of suggested interventions. There are great resources showing recommendations for less severe and more severe depression which you can access using the links below.
When it comes to anxiety, however, the NICE guidelines offer less far less information. In both their quality standards and guidelines for anxiety disorders [QS53] and Generalised Anxiety Disorder and Panic Disorder [CG113], available using the links below, exercise is not explicitly mentioned. The guidance on physical activity is limited, acknowledging it as an option. The guidelines highlight that the evidence base for physical activity in managing anxiety is smaller compared to that for depression but does indicate its potential in reducing anxiety symptoms.
Back to the featured research now. This meta-analysis examined the effects of all modes of physical activity on depression, anxiety, and psychological distress in adult populations, analysing 97 systematic reviews, encompassing 1039 trials and involving 128,119 participants.
The researchers found that physical activity was linked to a 43 per cent reduction in mental health symptoms, compared with usual care. The benefits were similar across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. All modes of physical activity, including aerobic, resistance, mixed-mode exercise, and yoga, demonstrate effectiveness, with higher intensity exercises showing greater improvements.
The underlying mechanisms of physical activity’s positive effects on mental health are multifaceted, involving psychological, neurophysiological, and social factors. Different modes of activity stimulate varied physiological and psychosocial responses, with moderate and high-intensity exercises proving more effective than lower intensities.
The findings also challenge the conventional wisdom about intervention duration. While longer interventions generally yield smaller effects, shorter, more frequent interventions demonstrate larger benefits. This counters the dose-benefit relationship observed in physical health outcomes, suggesting that high doses of physical activity may not be essential for improvements in depression.
Despite the encouraging results, this review acknowledges limitations, particularly the focus on mild-to-moderate depression and the scarcity of evidence for anxiety and psychological distress. As the latest NICE guidelines indicate, the effectiveness of physical activity and exercise differs based on the severity of the depression. Nevertheless, the overall message is clear – physical activity is a potent tool for managing symptoms of depression and anxiety.
In conclusion, this research reinforces the important role of physical activity in managing depression and anxiety. It not only underscores the need for physical activity as a primary approach but also challenges preconceived notions about intervention duration and intensity. As we navigate the complex landscape of mental health, the evidence strongly advocates for the integration of physical activity into the holistic management of depression and anxiety, offering a beacon of hope for individuals, clinicians, and policymakers alike.
References
Sports Management article
BJSM full article
WHO factsheet on metal disorders
MIND mental health facts and statistics
Harvard Center for Health Decision Science, quantifying the global cost of mental disorders
Mental Health Foundation, how much mental health problems cost the UK economy
Psychiatric Times, projected costs of mental illness
NICE, resource showing treatment options for less severe depression
NICE, resource showing treatment options for more severe depression
NICE, anxiety disorders
NICE, generalised anxiety disorders and panic disorders
