For many depressed people, exercise is excruciating. But it may be what they need to recover.

As many depression sufferers can attest, feeling down is likely to lead to slowing down. It’s not uncommon for once-active people to become couch potatoes when their mood turns blue.

The fatigue and low energy so often associated with depression are two of the biggest obstacles to exercising. And the idea of letting people see their out-of-shape body at the gym can be overwhelming for people who are struggling with feelings of worthlessness.

Because of these concerns and more, depression can significantly alter a person’s health and activity level—for the worse. But the mood disorder and poor physical fitness don’t have to go hand in hand; recent studies conducted at Duke University Medical Center in Durham, N.C., indicate that for some people, exercise may ease depression as well as medication does.

Working Exercise Into Your Life

  • Set tiny fitness goals.
  • Focus on success.
  • Take steps to avoid isolating yourself.
  • Do one new, nondiet-related activity each week.
  • Draw up a contract for fitness goals each month.

Exercise versus antidepressants

An initial study conducted in late 1999 found that 30 minutes of vigorous exercise three times a week was as effective in relieving short-term major depression as antidepressants. The study, which compared an exercise group with a group that took only medication and another group that combined both therapies, showed that the positive impact of exercise alone was comparable to the other two treatments.

A follow-up study that tracked the original participants for six months after the initial 16-week trial showed even better results. This study, which concluded in September 2000, found that the people who continued their exercise program were less prone to experiencing a relapse of depression. Findings showed that the more an individual exercised, the less likely she or he was to see symptoms of depression return.

Interestingly, patients who combined medication and exercise did not respond as well as those who simply worked out. Researchers say the result might be attributed to the more active role those in the exercise group were taking in their treatment. When participants began feeling better, they were more motivated to be active, making them feel even better and engaging them in a positive cycle.

While these preliminary findings are welcome news for depression sufferers, further research needs to take place to determine exactly why vigorous activity is effective and which types of depression can best be relieved by it.

Focused steps most effective

It’s tough to fight the initial urge to climb back into bed rather than get out and get moving, but taking that first step makes progress possible.

Teri Jo Oetting, a community dietitian at the University of Missouri Health and Sciences Center, helps her depressed patients make strides toward physical fitness by taking small, singularly focused steps.

Oetting recommends that her patients concentrate on one health and nutrition area at a time to keep themselves from becoming overwhelmed and frustrated. “Like getting at least five servings of vegetables and educating yourself on the benefits,” she says, “and keeping meal preparation as simple as possible.”

Since depression sufferers often isolate themselves, spending free time at home rather than out mixing with others, Oetting suggests easy but significant actions that point her patients in the direction of better habits.

“I might tell one person to walk outside at night, find the moon, and take three deep breaths,” she says.

In the beginning, patients may balk and find her suggestions silly, Oetting admits. But beyond those first steps, the door opens to a world of positive feelings that lead to bigger, brighter options. “Once outside, they end up doing more,” she explains. “Maybe 10 deep breaths in and out, telling themselves things like, ‘I walked outside. I’m getting better.’ Once they take that first step, they really feel good.” The bigger the steps, the more positive the feelings—leading to more activity and more success.

“Depressed patients who combined medication and exercise did not respond as well as those who simply worked out.”

Exercise as a gift to oneself

Several years ago, busy mother Julia Rosien was diagnosed with depression. Also dissatisfied with her body, she knew she needed to get back in shape. How did Rosien do it? “One step at a time.”

Now, with a healthy body and a happy outlook, she looks back and realizes, “It was about giving to myself. I didn’t have time to pee, never mind time to exercise,” she says. But by fitting a moment here or there into her already-too-full life, she found her way back to health.

She sat on the floor and did leg lifts while bouncing her toddler or playing patty-cake. “As my tummy went down, my self-esteem started to return,” says Rosien, who just a short time earlier couldn’t make it through a meal without crying. “I took charge of my life one stride at a time.”

A sense of control and participation in new activities can do wonders. That’s why Oetting’s recommendations don’t always involve diet and exercise. She gives her patients assignments that get them away from the dinner table and off the sofa, like potting plants during the week or going to a beautiful place and writing in a journal. She suggests her patients use the journal to record successes, so they have something they can refer to when they eat too much or don’t exercise.

Is weight gain inevitable?

Oetting sometimes sees weight gain as a side effect of antidepressants, usually three to four months into treatment. For that reason, she recommends seeing a dietician early and making lifestyle and diet changes before the effects occur.

Jeremy Kisch, PhD, senior director of Clinical Education for the National Mental Health Association, says patients shouldn’t accept weight gain as inevitable. “The older antidepressants are more associated with weight gain than the new ones,” he says. “But effects are individual. If you experience a problem, you need to let your doctor know, then work together to find an alternative.”