Depression, exercise, research and the media

A recent study on treating depression with exercise encouragement and advice has caused quite a stir. Check out the headlines.

But the paper itself says the following:

The main implication of our results is that advice and encouragement to increase physical activity is not an effective strategy for reducing symptoms of depression. Although our intervention increased physical activity, the increase may not have been sufficiently large to influence depression outcomes.

An article tackling the coverage of the study quotes the pay-walled editorial from the same issue of the medical journal:

Or, as the BMJ’s own editorial points out: “Patients in both groups therefore already received high quality care, and 57% were taking antidepressants at recruitment. It may have been difficult for the addition of a physical activity intervention to make an appreciable difference.” Further, about 25 per cent were already meeting Government exercise guidelines, so there may have been “little room for the intervention to make a difference”. The BMJ says that there has still been insufficient research.

I think that this is a very important point. It would be interesting to compare the following groups:

  1. exercise/no medication
  2. exercise/medication
  3. no exercise/medication
  4. no exercise/no medication

Further, look at the effect of exercise rather than the effect of advice and support. AND, follow them for at least a year. Then, if we establish exercise is helpful, we can look at whether it helps some but not others, what dose and frequency is needed, whether it’s helpful as an adjunct to other treatments, and THEN explore strategies for getting patients to exercise.

Another blog summarizes the study this way:

So, what did the study actually find? Two groups of depressed individuals were kept on their standard treatment plan and one of those groups was mildly encouraged to do more exercise through a few short telephone calls and a couple of face to face meetings. There was no minimum amount of exercise required for inclusion in the study, nor were any facilities for exercise provided. Over half of the participants were on anti-depressant medication that may provide some of the benefits of exercise alone, thus negating the benefit of exercise on self reported happiness.

At the four month follow up, exactly the same number of people in the treatment group had participated in physical activity as had done so in the control group (though it should be noted that there were seventeen more people in the control group than in the treatment group). Over the course of the study there was only a fifteen percent difference in the amount of exercise between the two groups! This study shows that the current exercise based treatment plan of telling people to exercise is not effective. It does not assess the outcomes of enabling people to exercise, or indeed of actually exercising.

“EXERCISE DOES NOT HELP DEPRESSION” is a good headline, but it’s not that simple and it’s not true.

How Exercise Can Prime the Brain for Addiction

 

This makes sense, but is a weird thing to think about. Drug addiction may be more difficult to kick if it became habitual while exercise if part of your routine:

 

It does indicate that shedding an addiction acquired when a person has been exercising could be extra challenging, he says.

“But, really, what the study shows,” he continues, “is how profoundly exercise affects learning.”

When the brains of the mice were examined, he points out, the runners had about twice as many new brain cells as the animals that had remained sedentary, a finding confirmed by earlier studies. These cells were centered in each animal’s hippocampus, a portion of the brain critical for associative learning, or the ability to associate a new thought with its context.

So, the researchers propose, the animals that had been running before they were introduced to cocaine had a plentiful supply of new brain cells primed to learn. And what they learned was to crave the drug. Consequently, they had much more difficulty forgetting what they’d learned and moving on from their addiction.

That same mechanism appeared to benefit animals that had started running after becoming addicted. Their new brain cells helped them to rapidly learn to stop associating drug and place, once the cocaine was taken away, and start adjusting to sobriety.

“Fundamentally, the results are encouraging,” Dr. Rhodes says. They show that by doubling the production of robust, young neurons, “exercise improves associative learning.”

But the findings also underscore that these new cells are indiscriminate and don’t care what you learn. They will amplify the process, whether you’re memorizing Shakespeare or growing dependent on nicotine.

 

Less effective and focused on only one problem

Some friends shared this video about the benefits of exercise:

At about 7:00, he says:

So a German researcher named Rainer Hambrecht looked at this with about 100 cardiac patients He got the group to exercise, and by that I mean 20 minutes a day in an exercise bicycle and once a week a 60 minute aerobics class, and the other half got the high tech stent and just did their normal activity, and after one year 88% of the exercise group were event free, compared to 70% of the people who got a Stent. So both worked, but I find it sort of incredible that the low tech made a bigger difference and you have to remember that the Stent just fixes one part of the heart.

Earlier, he outlined the diverse benefits of physical activity in various populations, including:

  • [in knee arthritis patients, it] reduced rates of pain and disability by 47%
  • reduced progression to dementia and Alzheimer’s by around 50%
  • reduced progression to frank diabetes by 58%
  • 41% reduction on the risk of hip fracture
  • reduced anxiety by 48%
  • 23% lower risk of death
  • number one treatment of fatigue
  • shown again and again to improve qualty of life

This got me thinking about whether12 step recovery is to addiction what exercise is to heart disease.

Preventing heart attacks is a very good thing. That stents exist and are readily available is a very good thing. This sounds like a very strange thing to wonder, but would we be better off it cardiac care was a little less medicalized? If there was a little more parity in research and resources invested in helping people be more physically active? I know that there are some efforts in this direction, but is the medical system missing the boat?

In the same way we have interventions (like medications) that can prevent overdose and reduce drug use. But, these offer none of the other benefits. Further, the damage done by addiction is often pretty global—physical, emotional, social, familial, spiritual, occupational, educational, etc. So…an intervention narrowly focused on drug use is, at best, a start on the path to wellness and recovery.

Of course we can’t make cardiac patients exercise and we shouldn’t withhold care to patients who do not exercise or give them second class care. But, maybe, the medical system should be more focused on “recovery” rather than just harm reduction?

The addiction treatment system did a lousy with people who didn’t engage in our version of exercise, we didn’t do a good job supporting it beyond a period of a few weeks or months, we sometimes used some dubious and even harmful methods to get people to do it. (We’re not alone in this. Medical history is full of dubious and harmful methods.) But…there’s been a lot of improvement, a lot of success and it offers global benefits that go well beyond abstinence or reduced drug use. So…why are so many people in a hurry to abandon and dismantle this system?