Walking, jogging, yoga and strength training ease depression

Even low intensity activities are beneficial, but the more vigorous the activity, the greater the benefits
Even low-intensity activities are beneficial, but the more vigorous the activity, the greater the benefits.

Walking or jogging, yoga and strength training seem to be the most effective exercises to ease depression, either alone or alongside established treatments such as psychotherapy and drugs, suggests an evidence review published by The BMJ today.

Even low-intensity activities such as walking or yoga are beneficial, but the results suggest that the more vigorous the activity, the greater the benefits are likely to be.

The authors stress that confidence in many of the findings remains low and more high-quality studies are needed, but they say these forms of exercise “could be considered alongside psychotherapy and drugs as core treatments for depression.”

The World Health Organization estimates that more than 300 million people worldwide have depression. Exercise is often recommended alongside psychotherapy and drugs, but treatment guidelines and previous evidence reviews disagree on how to prescribe exercise to treat depression best.

To address this uncertainty, researchers trawled databases looking for randomised trials that compared exercise as a treatment for depression with established treatments (eg, SSRI antidepressants, cognitive behavioural therapy), active controls (eg, usual care, placebo tablet), or untreated controls.



They found 218 relevant trials involving 14,170 participants with depression for analysis. Each trial was assessed for bias and the type, intensity and frequency of each exercise intervention was recorded.

Other potentially influential factors such as participants’ sex, age, baseline levels of depression, existing conditions, and differences between groups were also taken into account.

Compared with active controls, large reductions in depression were found for dance and moderate reductions for walking or jogging, yoga, strength training, mixed aerobic exercises and tai chi or qigong.

Moderate, clinically meaningful effects were also found when exercise was combined with SSRIs or aerobic exercise was combined with psychotherapy, suggesting that exercise could provide added benefit alongside these established treatments.

Although walking or jogging were effective for both men and women, strength training was more effective for women, and yoga or qigong was more effective for men. Yoga was also more effective among older adults, while strength training was more effective among younger people.

And while light physical activity such as walking and yoga still provided clinically meaningful effects, the benefits were greater for vigorous exercise such as running and interval training.

Exercise appeared equally effective for people with and without other health conditions and with different baseline levels of depression. Effects were also similar for individual and group exercise.

The authors acknowledge that the quality of evidence is low and very few trials monitored participants for one year or more. Many patients may also have physical, psychological, or social barriers to participation, they note.

Nevertheless, they suggest a combination of social interaction, mindfulness, and immersion in green spaces that may help explain the positive effects.

“Our findings support the inclusion of exercise as part of clinical practice guidelines for depression, particularly vigorous intensity exercise,” they say. “Health systems may want to provide these treatments as alternatives or adjuvants to other established interventions, while also attenuating risks to physical health associated with depression.”

“Primary care clinicians can now recommend exercise, psychotherapy, or antidepressants as standalone alternatives for adults with mild or moderate depression,” explains Juan Ángel Bellón at the University of Malaga in a linked editorial.

He points out that taking regular exercise can be challenging for people with depression and says studies using real world data are needed to evaluate physical activity programmes for people with depression.

He notes that the European Union has recently committed to promoting exercise across member states and urges health services and local and national administrations to “provide enough resources to make individualised and supervised exercise programmes accessible to the entire population.”

Find out about the benefits of resistance exercise training in treatment of anxiety and depression.

A new study by researchers at University of Limerick in Ireland and at Iowa State University has demonstrated the impact resistance exercise training can have in the treatment of anxiety and depressive symptoms.
A new study by researchers at the University of Limerick in Ireland and at Iowa State University has demonstrated the impact resistance exercise training can have in the treatment of anxiety and depressive symptoms.

A new study by researchers at the University of Limerick in Ireland and at Iowa State University has demonstrated the impact resistance exercise training can have in the treatment of anxiety and depressive symptoms.

The new study provides evidence to support the benefits resistance exercise training can have on anxiety and depression and offers an examination of possible underlying mechanisms.

The research, published in the Trends in Molecular Medicine journal, was carried out by Professor Matthew P Herring at the University of Limerick and Professor Jacob D Meyer at Iowa State University.

The researchers said there was “exciting evidence” that resistance exercise training may be an accessible alternative therapy to improve anxiety and depression-like more established therapies while also improving other important aspects of health.

Dr Herring explained: “Anxiety and depressive symptoms and disorders are prevalent and debilitating public health burdens for which successful treatment is limited.

“The healthful benefits of resistance exercise training, or muscle-strengthening exercise involving exerting force against a load repeatedly to generate a training response, are well-established,” said Dr Herring, Associate Professor in the Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences within the Faculty of Education and Health Sciences in UL.

“However, the potential impact of resistance exercise training in the treatment of anxiety and depressive symptoms and disorders remains relatively understudied. Moreover, the plausible psychobiological mechanisms that help us better understand how and why resistance exercise training may improve these mental health outcomes are poorly understood.”

The researchers argue that, while the available studies in this area are focused on relatively small sample sizes, there is sufficient evidence from previous and ongoing research at UL and the National Institute of Health-funded research with Dr Meyer and colleagues at Iowa State University to suggest that resistance exercise training does improve anxiety and depressive symptoms and disorders – though disorders themselves are scarcely studied.

“There is a critical need for confirmatory, definitive trials that adequately address limitations, including small sample sizes, but the limited evidence available to us provides initial support for the beneficial effects of resistance exercise training on these mental health outcomes, including increased insulin-like growth factor 1, cerebrovascular adaptations, and potential neural adaptations influenced by controlled breathing inherent to resistance exercise,” Dr Herring explained.

“We are tremendously excited to have what we expect to be a highly cited snapshot of the promising available literature that supports resistance exercise training in improving anxiety and depression. 

“Notwithstanding the limitations of the limited number of studies to date, there is exciting evidence, particularly from our previous and ongoing research of the available studies, that suggests that resistance exercise training may be an accessible alternative therapy to improve anxiety and depression.

“A more exciting aspect is that there is substantial promise in investigating the unknown mechanisms that may underlie these benefits to move us closer to maximizing benefits and to optimising the prescription of resistance exercise via precision medicine approaches,” Dr Herring added.

Professor Meyer, a co-author on the study, said: “The current research provides a foundation for testing if resistance training can be a key behavioural treatment approach for depression and anxiety.

“As resistance training likely works through both shared and distinct mechanisms to achieve its positive mood effects compared to aerobic exercise, it has the potential to be used in conjunction with aerobic exercise or as a standalone therapy for these debilitating conditions.

“Our research will use the platform established by current research as a springboard to comprehensively evaluate these potential benefits of resistance exercise in clinical populations while also identifying who would be the most likely to benefit from resistance exercise.”

Most people with arthritis and disabling chronic pain are in excellent mental health – is this true for you?

More than three quarters of Canadians living with arthritis and debilitating chronic pain are free of all psychiatric disorders, including depression, and more than half are happy and in excellent mental health
More than three quarters of Canadians living with arthritis and debilitating chronic pain are free of all psychiatric disorders, including depression, and more than half are happy and in excellent mental health

A new study published by researchers at the University of Toronto indicates a very high level of resilience among Canadians with arthritis whose activities were restricted due to pain.

The vast majority (76%) of these individuals were free of any mental illness in the past year, including depression.  The paper was published online this week in PLOS ONE.

More than half (56%) of the respondents went beyond just being free of psychiatric disorders to achieving excellent mental health.  The definition of excellent mental health sets a very high bar. To be defined in excellent mental health, respondents had to achieve three things: 1) almost daily happiness or life satisfaction in the past month, 2) high levels of social and psychological well-being in the past month, and 3) freedom from generalized anxiety disorder and depressive disorders, suicidal thoughts and substance dependence for at least the preceding full year.

“We were so encouraged to learn that the majority of older Canadians with arthritis who were in debilitating chronic pain had excellent mental health. These findings bring a hopeful message to those living with disabling pain and their families as well as to clinicians addressing their physical and mental health care needs,” says the study’s senior author, Esme Fuller-Thomson.  Fuller-Thomson is Director of the U of T Institute for Life Course and Aging and Professor at the Factor-Inwentash Faculty of Social Work (FIFSW) and the Department of Family & Community Medicine.

Consistent with earlier studies, this study found insomnia to be negatively associated with mental health.  

“These findings underscore the importance of health professionals asking about sleep problems, particularly as chronic pain can undermine the quality of sleep,” says co-author Denise Marshall, a recent graduate of U of T’s FIFSW. “Among individuals with chronic pain, cognitive behavioral therapy or CBT has been shown to significantly reduce insomnia. CBT is an already established effective and relatively rapid treatment for depression and anxiety in the general population, and among those with chronic pain.”

Those with a confidant were much more likely to be in complete mental health than those without a confidant (60% vs 8%, respectively).

“Confidants are an important source of emotional and instrumental support,” says co-author Matthew Moses, also a recent graduate of the U of T’s FIFSW. “Although the exact mechanisms by which a confidant supports mental health are not fully understood, we hypothesize that the provision of emotional support can help enhance self-esteem and help the individual buffer general stress associated with the chronic pain.”  

Other factors associated with excellent mental health in the year preceding the survey included having no previous history of major depressive disorder and/or generalized anxiety disorder.

“The current research shifts away from a deficit-focused approach to mental health among individuals with arthritis, and instead uses a strengths-based perspective to explore factors associated with resilience in individuals with arthritis who are experiencing chronic and disabling pain.” says co-author Sally Abudiab, who also recently graduated from U of T’s FIFSW.

The study investigated factors associated with mental flourishing in a nationally representative sample of 620 Canadian adults drawn from the Canadian Community Health Survey-Mental Health who had been diagnosed with arthritis who are living with disabling chronic pain.

How parents’ work stress affects family mealtimes and children’s development

Sehyun Ju, Qiujie Gong, and Karen Kramer.

(L to R): Sehyun Ju, Qiujie Gong, and Karen Kramer.< College of ACES

 Family mealtimes are important for parents and children as a space to communicate, socialize, and build attachment relationships. But it can be difficult for busy parents to balance family and work life. A new study from the University of Illinois Urbana-Champaign explores how parents’ job stress influences their attendance at family mealtimes, and in turn, children’s socioemotional development.

“We all struggle to maintain the balance between work life and family life. But this might be especially challenging for parents, who are engaging in childcare after a busy and stressful day at work. And when it comes to co-parenting in dual-earner families, which comprises 65% of families with children in United States, we do not know much about how mothers and fathers share caregiving roles under work stress,” said lead author Sehyun Ju, doctoral student in the Department of Human Development and Family Studies (HDFS) in the College of Agricultural, Consumer and Environmental Sciences (ACES) at U. of I.

The study included data from more than 1,400 dual-earner families, consisting of heterosexual married couples with children, in a nationally representative survey that traced children’s development across family, home, child care, and school environments from 9 months to kindergarten. The researchers focused on the interplay of child characteristics, family mealtimes, and parents’ job and financial dissatisfaction.

“We found that children of parents who expressed higher work-related stress when the children were 2 years old had lower socioemotional competency at age 4 to 5, measured by lower positive and higher negative social behaviors,” Ju explained. 

There were significant differences regarding the impact of mothers’ and fathers’ work stress. For mothers, higher job dissatisfaction did not impact frequency of family mealtimes; however, it was directly associated with lower socioemotional competency in their children. 

On the other hand, fathers who had higher job and financial dissatisfaction were less likely to attend family mealtimes with their children, and this in turn resulted in the children having lower socioemotional competency at age 4 to 5. 

“Even when the mother increased her mealtime presence to compensate for the father’s absence, the child’s socioemotional development was still negatively impacted. This indicates fathers may have a unique influence that cannot be replaced by the mother. Future intervention programs should help both parents obtain a better balance between work and family, and highlight the importance of family routines to promote healthy child development,” stated co-author Qiujie Gong, a doctoral student in HDFS.

The findings speak to the pervasiveness of traditional gender roles, added Karen Kramer, associate professor in HDFS and co-author on the study. “Mothers are considered primary caregivers, and they are expected to be present and feed their children no matter what. The study showed they didn’t adjust their mealtime frequencies in response to job dissatisfaction as fathers did.”

Kramer notes the study is unique in combining topics from different disciplines, including psychology, sociology, economics, and nutrition, and connecting them in a holistic way that provides insights for policy measures.

“We have to acknowledge the challenges that families face in creating consistent routines. It’s not just an outcome of individual influences. Outside factors, such as parents’ work environment and financial situation can affect their interactions, mealtimes, and child development. For example, dinner time for young kids is typically around five or six o’clock, but the expectation that parents are home early in the day doesn’t align with being an ideal worker. Policy initiatives to help provide a work environment and community support that facilitate family mealtimes would be important,” Kramer concluded.

Breathe! The shape-shifting ball that supports mental health

Alexz Farrall and his PAWS ball

Alexz Farrall demonstrating the use of PAWS CREDIT Vittoria D’Alessio, University of Bath

A soft ball that ‘personifies’ breath, expanding and contracting in synchronicity with a person’s inhalations and exhalations, has been invented by a PhD student at the University of Bath in the UK. The ball is designed to support mental health, giving users a tangible representation of their breath to keep them focused and to help them regulate their emotions.

Alexz Farrall, the student in the Department of Computer Science who invented the device, said: “By giving breath physical form, the ball enhances self-awareness and engagement, fostering positive mental health outcomes.”

Generally, breathing is an ignored activity, yet when done deeply and with focus, it’s known to alleviate anxiety and foster wellbeing. Measured breathing is highly rated by mental health practitioners both for its ability to lower the temperature in emotionally charged situations and to increase a person’s receptivity to more demanding mental-health interventions.

Disciplines that frequently include mindful breathing include Cognitive Behavioural Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), Dialectical Behaviour Therapy (DBT) and trauma-focused therapies.

Most people, however, struggle to sustain attention on their breathing. Once disengaged from the process, they are likely to return to thinking mode and be less receptive to mental-health interventions that require concentration.

“I hope this device will be part of the solution for many people with problems relating to their mental wellbeing,” said Mr Farrall.

Focus lowers anxiety

Recent research led by Mr Farrall shows a significant improvement in people’s ability to focus on their breathing when they use his shape-shifting ball. With their attention heightened, study participants were then able to pay closer attention to a guided audio recording from a meditation app.

Among those who used the ball, there was an average 75% reduction in anxiety and a 56% increase in protection against worry-induced thoughts. In contrast, those relying only on the audio recordings experienced a 31% reduction in anxiety (recording 44% more anxiety than their counterparts).

Additionally, those accessing the ball alongside audio guidance showed significantly higher Heart Rate Variability (indicative of better stress resilience and emotional regulation) than those using only audio, demonstrating the superior calming effect of a combined ball+audio approach.

The study’s results were presented earlier this year at the CHI Conference on Human Factors in Computing Systems – the premier international conference of human-computer interaction.

Stop the drop out

Explaining how the device supports a user, Mr Farrall said: “When an individual holds the ball, their breath becomes a physical thing between their hands. They can feel and see the flow of air as the object expands and contracts.

“This allows them to become more aware of their own internal sensations and more receptive to psychological change. It gives a personalised and engaging experience, and is accessible to everyone.”

Mental health issues costs the NHS around £118 billion annually, yet the demand for services significantly exceeds supply, leaving many unable to access mental health support. While digital technologies like apps have emerged to bridge this gap, many people don’t use them for long enough to enjoy the promised benefits, with one study showing that only 3.9% of users stick with an app programme over a 15-day period.

Mr Farrall’s interactive ball – named the Physical Artefact for Well-being Support (PAWS) – offers a potential solution by giving people an extra incentive to actively participate in managing their mental health. In time, Mr Farrall hopes his ball will be a tool used both by mental-health professionals and private individuals.

“I want this device to be a genuine catalyst for mental health improvement, not just in clinical settings but also for home users,” he said.

Professor Jason Alexander, who supervises Mr Farrall’s project from the Department of Computer Science at Bath, said: “The beauty of PAWS is that the concept is so simple – letting someone ‘feel’ their breath – yet it has the potential to revolutionise the delivery and outcomes of mental health support not only in the UK but worldwide.”

Haptic feedback

The ball works through haptic feedback, where sensors attached to the user’s body transmit data about their respiration patterns to the ball via a computer.

In the Bath study, the PAWS prototype used an electronic and pneumatic circuit to convert pulmonary activity to pneumatic activation. Future versions, however, will leverage Bluetooth technology and smart geometric structures to eliminate the need for wires, and make the device easier and more comfortable to use.

Plans for a larger study are underway to delve deeper into the potential benefits of PAWS. This next study will incorporate insights from mental health experts and people who have spent some time using the ball.