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Exercise and Depression

Exercise can help your clients with depression, but know your professional boundaries.

Research continues to support the positive emotional health benefits of exercise for reducing symptoms of depression.2,4 Regular physical activity may promote a more positive mood and better energy level, and increase a person's resistance to stress. Best of all, exercise may prevent relapse into another round of depression for people prone to this disorder.

In one study,1 subjects suffering from depression were divided into three groups: aerobic exercise only, medication only, and combination of exercise and medication. Symptom improvement was similar for all three groups. This means that exercise was as effective as medication for the treatment of depression.

But after 10 months, the results became even more interesting. The subjects who exercised, with or without medication, experienced significantly lower rates of symptom recurrence. This is especially good news, since depression recurs for many people.

What is depression?

Depression is a mental health disorder marked by both mental and physical symptoms. Symptoms of depression vary from person to person. In general, depression is diagnosed when people experience a number of symptoms, including prolonged feelings of sadness, anxiety, hopelessness, guilt or worthlessness; loss of interest or pleasure in activities once enjoyed; and unexplained changes in sleep, appetite and weight. Depression may be severe or mild, and last for weeks or years.

Depression is a debilitating disease that interferes with every aspect of a person's life. The combination of fatigue, negative mood and inability to feel pleasure result in a downward spiral of doing less and feeling worse. The best thing for people who are depressed is to get out and do things, but people with depression often have difficulty summoning the desire or energy to do the things that might help them feel better - like exercise. While regular physical activity helps reduce symptoms of depression, people with depression face huge emotional hurdles when attempting to stick to an exercise program.

What kind of exercise is best?

Aerobic exercise is generally recommended for the relief of depression, but almost any type of physical activity can be helpful. If clients have specific recommendations from their healthcare providers, help them follow their doctor's orders. As usual, adherence is more important than an ideal exercise program that is not followed. Help your clients begin slowly and build gradually. The general recommendation of 30 minutes of aerobic activity per day most days of the week appears to be effective.4

A comprehensive treatment program

Clients exercising to relieve depression may also be taking medications and following other therapeutic recommendations. Never suggest that medications are not needed! If discontinuing or reducing medication becomes a treatment goal, then your client must work closely with his or her physician on this process.

Your scope of practice

While it is appropriate for fitness professionals to promote the positive emotional health benefits of physical activity, make sure you do not slip into the role of therapist. Personal trainers are especially likely to be invited into their clients' personal lives, as conversation develops during workouts. But always maintain your professional distance, and monitor your level of involvement; never diagnose illness or recommend treatment.

When clients complain, you can certainly listen with a sympathetic ear. Clients may even share the fact that they are exercising with you because they hope to reduce symptoms of depression. That is fine. You may discuss with them how studies have found that exercise may help reduce feelings of stress, anxiety and depression for many people, keeping the focus on general research findings. If clients convey that depression is interfering with their ability to function, suggest that they seek professional psychological guidance.

Many trainers have had the sense that certain clients were beginning to lean too heavily on them. Some have even gradually fallen into a "helping" relationship, where clients call them at all hours when they feel stressed or lonely. It is natural to want to be helpful, but realize that you are not helping if you keep clients from getting professional aid. Talk the situation over with your manager, if you work at a fitness center. And don't be afraid to discontinue your relationship with a troubled client if you are getting in over your head.

References
1. Babyak, M., J.A. Blumenthal, S. Herman, et al. Exercise treatment for major depression: Maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine 62: 633-638, 2000.
2. Martinsen, E.W., and J.S. Raglin. Themed review: Anxiety/depression: Lifestyle medicine approaches. American Journal of Lifestyle Medicine 1: 159-166, 2007.
3. National Institute of Mental Health. Depression. www.nimh.nih.gov/ healthinformation/depressionmenu.cfm
4. Stein, M.B. Sweating away the blues: Can exercise treat depression? American Journal of Preventive Medicine 28: 140-141, 2005.
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