Depression: Sport and exercise can help to get up off the mat

Depression is a common mental disorder. Some 300 million people in the world have it, or an estimated 3.8% of the population, according to the World Health Organization (WHO). Treatments include medications, psychotherapy - and exercise.

Yes, exercise. It and physical activity in general can ease symptoms of depression - it's scientifically proven.

The problem is that being active is extremely difficult for most people suffering from depression. After all, listlessness is a major symptom. But doing nothing won't help.

Sport and exercise are often an integral part of both inpatient and outpatient depression therapy, notes Jens Kleinert, professor of sport and health psychology at the Cologne-based German Sport University, and director of its Institute of Psychology.

Among the benefits, he says, are an improved mood and self-concept along with an increase in social interaction and activation of the immune system, skeletal muscles, etc. Sport and regular exercise also help to lessen tiredness and lack of energy.

"Depressive people then feel more vigorous, alert and active," he says - and better able to manage everyday tasks. And while they often feel an emotional void, "sport can frequently break through it, at least partly," with emotional moments such as winning, losing, improved performance and, above all, shared experience.

They also have problems with their self-esteem and body awareness, and sport and exercise can help here too: "They learn new things or improve their abilities, for example in strength, agility or endurance. They experience their body positively, its positive development, which boosts their self-esteem."

Many depression sufferers withdraw from others and feel isolated. Doing sport or exercise in a group can help to draw them out of their shell. "It doesn't have to be team sport," Kleinert says. "A yoga course or joint fitness training can also allow them to experience fellowship."

Bringing yourself to do such activities may be hard. But doing just about any sport or exercise can be very beneficial.

"Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense," write the authors of an Australia-led meta-analysis of 218 randomized controlled trials.

The objective of the meta-analysis, recently published in the British Medical Journal (BMJ), was to identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. The trials involved 14,170 participants.

According to Kleinert, endurance training was long thought to be especially effective for depression due to its positive influence on the neural changes associated with the disorder.

Strength and fitness training are effective as well, he says, because they bolster patients' self-concept and manifest patients' progress in development. "Strength training, in particular, quickly results in small successes that positively impact their self-concept," remarks Kleinert.

The WHO recommends that healthy adults do at least 150 minutes of moderate exercise a week, or at least 75 minutes of vigorous exercise. This can also be a guideline in depression treatment, say the authors of an article translating as "Enjoyment From Sport and Exercise in Mental Illnesses" in the German trade journal Praxis Magazin, directed at naturopathy practitioners.

"The key is to find a sport or form of exercise that you enjoy and, above all, do regularly and stick to over the long term," advises Kleinert, adding that being in a group and having fixed times can help.