Physical Activity and Depression

Ana Nicole Acevedo-Barga

Department of Psychology, Northeastern University, Boston, Massachusetts 02115
APA Citation
Word Count: 2186
Keywords:
Physical activity, exercise, depressive symptoms, modulator
Abstract:
Depression is a mood disorder marked by lack of motivation, anhedonia, and low self-esteem, and
annually affects 5% of people, worldwide (Zhang and Yen, 2015). This review examines the current
understanding and efficacy of physical activity as an adjunct therapy for depression. Additionally this
paper will examine areas in which the field of exercise psychology is still lacking and consider further
experimentation on this form of treatment.
Patients with depression tend to live more sedentary lifestyles than those who are not afflicted with the
disorder (Knepp, Yoza and Quandt, 2015). This lethargy can contribute to the negative symptoms of
depression such as lack of motivation, exhaustion, and low mood (Zhang and Yen, 2015). Research has
shown that exercise can counter act the risk of developing depression and assist in therapy as usual (TAU)
for individuals who are already Carter, Morres, Repper and Callaghan, 2015; Helgadttir, Forsell and
Ekblom, 2015; Ranoyen, Stenseng, Klockner, Wallander, and Jozefiak, 2015).
Despite these consistent and significant findings there is still discrepancy in the population that this
adjunct therapy can be helpful for, the amount of exercise required to induce results, and the level to
which one needs to exercise for it to have a significant effect (Carter, Morres, Repper, Callaghan, 2015).
There are few studies that use the same qualifications for regular exercise, which makes comparing the
data difficult (Ranoyen, Stenseng, Klockner, Wallander and Jozefiak, 2015). Additional, some studies
have found that prescribed exercise can actually worsen symptoms of depression in certain populations
(specifically in men) (Zhang, Yen, 2015).
Most depressed individuals both report more sedentary lifestyles & improvements in depressive
symptomology when implementing exercise into their routine (Ranoyen, Stenseng, Klockner, Wallander,
Jozefiak, 2015). Given that there has been little to no risk associated with exercise and increased
depressive symptoms, exercise should be implemented into the lives of children who are most at risk for
developing depression as a potential adjunct therapy and preventative measure.
Introduction:
Depression is a serious mental disorder that is estimated to annually affect 5% of people, worldwide
(Zhang and Yen, 2015). Low mood, little motivation, anhedonia, guilt or low self-esteem, irregular sleep
and eating patterns, exhaustion and poor concentration are all symptoms of mild to moderately sever
depression (Zhang and Yen, 2015). Its prevalence is anticipated to continue increasing which raises many
concerns regarding how to prevent, modulate, and treat depression. In recent years there has been a
growing amount of research on the impact of exercise for individuals suffering from this mood disorder
(Ranoyen, Stenseng, Klockner, Wallander, and Jozefiak, 2015). Literature suggests that depressed
individuals tend to live more sedentary lifestyles, which may contribute to their low energy, motivation,
and mood (Carter, Morres, Repper and Callaghan, 2015; Helgadttir, Forsell and Ekblom, 2015).
Interestingly, exercise can also be used to prevent and modulate depressive symptoms (Ranoyen,

Stenseng, Klockner, Wallander, and Jozefiak, 2015). This review examines the current understanding of
how physical activity can be used as an adjunct therapy for depression, and also discusses studies that
suggest exercise should not be prescribed for patients with depression. Finally we will examine areas in
which this field is still lacking and explore ways in which we can further experiment with this treatment.
Evidence For Physical Activity as a Modulator for Depression
Causes of depression have been widely studied and speculated. Some researchers argue that it is a genetic
predisposition that leads to the development of depression while others suggest that environmental
influences are the root causes of diagnosis. Regardless of the cause, increased physical activity in those at
risk for developing depression and among patients already diagnosed with depression seems to reduce
symptomology (Carter, Morres, Repper and Callaghan, 2015; Helgadttir, Forsell and Ekblom, 2015;
Ranoyen, Stenseng, Klockner, Wallander, and Jozefiak, 2015).
In a study conducted in 2015, 26 adolescents between the ages of 14-17 participated in a 12-session
preferred exercise intervention as an adjunct to normal therapy for depression (Carter, Morres, Repper,
and Callaghan, 2015). Treatment was offered twice weekly for six weeks resulting in up to 12 hours of
exercise (Carter, Morres, Repper, and Callaghan, 2015). Following the completion of the intervention
participants were interviewed and analyzed for perceived psychological improvements due to exercise
therapy. Results showed over 50% felt a sense of achievement and consequently felt better about
themselves, 50% reported the aspect of routine was beneficial, 50% reported increased energy levels,
66% reported increased motivation particularly in areas of social, educational and lifestyle changes, and
50% felt improvement in self-efficacy (Carter, Morres, Repper, and Callaghan, 2015). This study
exemplified the cycle of positive change that can be triggered by self-chosen exercise in patients with
depression.
In 2015 Swedish scientists collected data from 165 individuals suffering from depression (as scored by
the MINI and MADRS) (Helgadttir, Forsell and Ekblom, 2015). Participants ranged between the ages of
18-85. For one week participants were asked to wear triaxial accelerometers to monitor their levels of
activity and sedation (Helgadttir, Forsell and Ekblom, 2015). Analyses were conducted on participants
who wore their monitor for four or more days in the week and who had over 600 minutes of wear time
(Helgadttir, Forsell and Ekblom, 2015). Results showed that participants who were solely diagnosed
with depression exemplified more sedentary lifestyles and less physical activity. The majority of
participants wake time was spent in an inactive state (approximately 9.1 hours daily) which was
significantly higher than that reported by individuals with out depression (approximately 7.5 hours)
(Helgadttir, Forsell and Ekblom, 2015).
Not only does exercise have to power to reduce depressive symptoms after the fact, research shows that it
may also have the ability to decrease the likelihood of developing depression amongst risky and
predisposed populations (Ranoyen, Stenseng, Klockner, Wallander and Jozefiak, 2015). As depression is
known to have a genetic link, children of parents with anxiety and/or depression are at a higher risk of
developing depression themselves (Ranoyen, Stenseng, Klockner, Wallander and Jozefiak, 2015). In 2015
scientists collected data from over 5,000 adolescents (aged 13-18) via self-report questionnaires on selfesteem, physical activity, and depression (Ranoyen, Stenseng, Klockner, Wallander and Jozefiak, 2015).
Parents of these children were also asked to report their levels of anxiety and depression. Depression was
measured with the Symptom Checklist 5 (SCL- 5), self-esteem was measured using a four item version of
the Rosenberg Self Esteem Scale, and physical activity was measured using a single question form the
WHO-HBSC (Apart from school hours: How often do you usually exercise in your free time so much
that you get out of breath and/or sweat) (Ranoyen, Stenseng, Klockner, Wallander and Jozefiak, 2015).
Responses to the WHO-HBSC were divided into two categories. Children who exercised at least once
weekly were dichotomized to regular activity in comparison to children who exercised less than once
weekly who were dichotomized to low activity (Ranoyen, Stenseng, Klockner, Wallander and Jozefiak,

2015). Parent depression was measured with the CONOR-MHI. Interestingly children who exercise on a
regular basis are less likely to be impacted by their mothers depression. Children who exercise on a
regular basis are also more likely to report higher levels of self-esteem, which, as mentioned before,
contributes to a positive cycle of change. (Ranoyen, Stenseng, Klockner, Wallander and Jozefiak, 2015).
Another study compared the effects of Physical Activity as treatment for depression between men and
women. 4,798 males and 6,762 females between the ages of 18-99 participated in this study (Knepp, Yoza
and Quandt, 2015). Participants underwent the Patient Health Questionnaire Depression Scale (PHQ-8),
which was divided into 5 sub categories (Knepp, Yoza and Quandt, 2015). This survey disregarded
questions regarding suicidal behavior because individuals with this level of depression were excluded
from the study. Participants also reported their exercise levels by answering an item from the BRFSS
questionnaire (Knepp, Yoza and Quandt, 2015). Those who recorded exercising at least 15 times in the
past month were categorized to be regular exercisers and those who recorded exercising less than 15 times
per month were categorized as seldom exercisers. Results showed that regular physical activity did
ameliorate depressive symptoms among mildly-moderately depressed individuals and was particularly
effective among women (although both men and women showed significant improvements in their
depressive symptoms when regularly exercising) (Knepp, Yoza and Quandt, 2015). This further supports
the theory that exercise can be used as an adjunct therapy to TAU amongst depressed individuals (Zhang,
Yen, 2015). The relationship between exercise and depressive symptoms is further supported in a study in
which 120 college students were given a multitude of surveys measuring their depression level, and their
exercise routine. This survey included a m Beck Depression Inventory, the Montgomery-Asberg
Depression Scale, an Obligatory Exercise Questionnaire, a Body, Eating, Exercise comparison measure
(BEECOM), the Godin Leisure-Time Exercise Questionnaire, and Design Fluency Tasks (Knepp, Yoza
and Quandt, 2015). Individuals who had higher scores on the mBDI (translating to higher levels of
depression) reported lower OEQ scores, significantly lower DFT scores, and significantly higher
BEECOM scores suggesting that higher levels of depression can induce a more sedentary lifestyle, which
in turn perpetuates the disorder (Knepp, Yoza and Quandt, 2015).
Evidence Against Physical Activity as a Modulator for Depression
Other studies have contradicted these findings, expressing the necessity for moderate to high levels of
physical activity in order to produce positive psychological changes in individuals with depression.
(Carter, Morres, Repper, Callaghan, 2015). This discrepancy is mimicked in a secondary study that argues
regular activity is necessary to have modulatory affects on depression (described by the WHO-HBSC
question) but doesnt recognize the effects of low activity (Ranoyen, Stenseng, Klockner, Wallander and
Jozefiak, 2015).
In some studies, men being treated for moderately sever depression showed a positive relationship
between exercise and their symptoms. This means that, in some cases, regular exercise can worsen
symptoms of depression. These results may be due to the small sample size, however this contradictory
data needs to be further investigated to ensure PA isnt an exacerbating treatment (Zhang, Yen, 2015).
This study defined regular exercise as 15 times in a month, which is a stricter criteria than those in other
studies that also showed improvements in depressive symptoms with less regular exercise (but still
intentional exercise) (Zhang, Yen, 2015).
Other studies have failed to find significant improvement in depressive symptoms after being prescribed
exercise compared to patients given TAU. In 2012, 273 patients diagnosed with Major Depressive
Disorder were recruited to test the efficacy of lifestyle change therapy (Serrano, Olivan-Blazquez,
Vicens-Pons, Roca, Gili, Leiva, Garcia-Campayo, Demarzo, and Garcia-Toro, 2015). Participants were
required to be 18 or older, score greater than an 11 on the Beck Depression Inventory, and to have been
experiencing depressive symptoms over the past two months (Serrano, Olivan-Blazquez, Vicens-Pons,
Roca, Gili, Leiva, Garcia-Campayo, Demarzo, and Garcia-Toro, 2015). Individuals with confounding

conditions such as suffering any other neurological disease that impairs the Central Nervous system, were
excluded from the study in addition to patients with delusions, hallucinations, suicidal risk, or who were
currently pregnant or lactating. The Active intervention and the Control differed on the following
recommendations (See Figure 1).

Fig.1highlights the difference between the active and control intervention in the Serrano et. al study
(Serrano Ripoll, M J; Olivan-Blazquez, B; Vicens-Pons, E; Roca, M; Gili, M; Leiva, A; Garcia-Campayo,
J; Demarzo, M P; Garcia-Toro, M (2015). Lifestyle change recommendations in major depression: Do
they work? Journal of Affective Disorders 183, 221-228. DOI: 10.1016/j.jad.2015.04.059)
At 12 month follow up to the intervention, results showed that although both groups improved, there was
no significant difference in the group who received more detailed directions on how to implement
exercise into their lifestyle. This suggests that although helpful, exercise cannot be a solitary treatment for
depression (Serrano, Olivan-Blazquez, Vicens-Pons, Roca, Gili, Leiva, Garcia-Campayo, Demarzo, and
Garcia-Toro, 2015).
Future Directions and Conclusion
Depressed individuals both report more sedentary lifestyles & improvements in depressive symptomology
when implementing exercise into their routine (Ranoyen, Stenseng, Klockner, Wallander, Jozefiak, 2015).
This suggests that some neurological interaction that is influenced by exercise may also be able to
modulate depression. Further research is necessary to determine these exact neural mechanisms and how
the can be altered as a form of treatment. The discrepancy in prescribed amount of exercise and its
variable effectiveness based on gender also needs in depth investigation. Given that there has been little to
no risk associated with exercise and increased depressive symptoms, exercise should be implemented into
the lives of children who are most at risk for developing depression as a potential adjunct therapy and
preventative measure.
Disclosure Statement

The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be
perceived as affecting the objectivity of this review.
Acknowledgments
Special thanks to Cecilia Musselman for instructing me how to adequately use the Northeastern
Universitys online library resources. My understanding of our database system has expanded immensely
and your help aided in the efficiency in finding relevant resources for this Literature Review. Additional
thanks to Daphne Hubbard for encouraging me to take breaks to move my body when my writing
attempts were no longer productive.
Literature Cited
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