Physical Activity and Depression

Ana Nicole Acevedo-Barga

Department of Psychology, Northeastern University, Boston, Massachusetts 02115
APA Citation
Word Count
Keywords
Physical activity, exercise, depressive symptoms, modulator,
Abstract
Introduction:
Depression is a serious mental disorder that is estimated to affect 5% of people
annually, worldwide [4]. Low mood, little motivation, anhedonia, guilt or low self-esteem,
irregular sleep and eating patterns, exhaustion and poor concentration are all symptoms
of mild-moderately sever depression [4]. 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 depression [3]. Literature suggests that
individuals suffering from depression tend to live more sedentary lifestyles, which may
contribute to their low energy, motivation, and mood [1,2]. Interestingly, exercise can
also be used to prevent and modulate depressive symptoms [3]. 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. Finaly 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 environment 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 and
modulate the disorders affects [1,2,3].
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. Treatment was offered twice weekly for six weeks resulting in up to 12 hours
of exercise. 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 else, 66% reported increase in motivation particularly in areas of
social, educational and lifestyle changes, 50% felt improvement in self-efficacy. This
study exemplified the cycle of positive change that can be triggered by self-chosen
exercise in patients with depression. (Carter, Morres, Repper, Callaghan, 2015).

In 2015 Swedish scientists collected data from 165 individuals suffering from depression
(as scores by the MINI and MADRS). Participants ranged between the aged of 18-85.
For one week participants were asked to wear triaxial accelerometers to montor their
levels of activity and sedation. 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.
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 a sedentary state (approximately 9.1 hours daily) which is significantly
higher than that reported by individuals with out depression (approximately 7.5 hours).
(Helgadttir, Forsell, 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/predisposed populations. As depression is known to have a
genetic link, children of parents with anxiety an/or depression are at a higher risk of
developing depression themselves. In 2015 scientists collected data from over 5,000
adolescents (aged 13-18) via self-report questionnaires on self-esteem, physical activity,
and depression. Parents of these children were also asked to report their levels of
anxiety and depression. Depression was measured with the Symptom Checklist 5 (SCL5), 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 and/or sweat). 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. Parent depression was measured with the CONOR-MHI.
Interestingly children who exercise on a regular basis are less likely to be impacted by
depression of 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,
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. Participants underwent the Patient Health Questionnaire
Depression Scale (PHQ-8), which was divided into 5 sub categories. This survey
excluded 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. The question posed asked How
many past month?. 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). 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. 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, 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. What is causing this discrepancy in research? (Carter,
Morres, Repper, Callaghan, 2015).
Once again this article argues that regular activity is necessary to have modulatory
affects on depression (described by the WHO-HBSC question) but doesnt recognize
(did it even analyze?) the effects of low activity maybe their definition of the two are
just different? (Ranoyen, Stenseng, Klockner, Wallander, Jozefiak, 2015).
In some studies, Males 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 (does it describe the
intensity?), 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).
Areas That Remain a Mystery
Why is exercise a more effective treatment for women? Why is there discrepancy in the
prescribed amount of exercise needed to have a significant change. We could look at
neuronal mechanism differences between men and women when they exercise and
focus on altering these mechanisms in women to see if it treats depression. ?
Future Directions and Conclusion
Depressed individuals both report more sedentary lifestyles & improvements in
depressive symptomology when implementing exercise into their routine. 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.
Exercise could be implemented into the lives of children who are most at risk for
developing depression (Ranoyen, Stenseng, Klockner, Wallander, Jozefiak, 2015).
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 Mussleman 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
Carter, T., Morres, I., Repper, J., Callaghan, P. (2015). Exercise for Adolescents with
depression: Valued aspects and perceived change. Journal of Psychiatric and Mental
Health Nursing, 23 (1), 37-44. Retrieved February 20, 2016. DOI:10.1111/jpm.12261
Helgadttir, B., Forsell, Y., Ekblom, O. (2015). Physical activity patterns of people
affected by depressive and anxiety disorders as measured by accelerometers: A crosssectional study. Plos One. Retrieved February 20,2016. DOI:
10.1371/journal.pone.0115894
Prakash, R. S., Voss, M. W., Erickson, K. I., Kramer, A. F. (2015). Physical activity and
cognitive vitality. Annual Review of Psychology 66, 769-797. Retrieved February 20,
2016. DOI: 10.1146/annurev-psych-010814-015249
Ranoyen, I., Stenseng, F., Klockner, C. A., Wallander, J., Jozefiak, T. (2015). Familial
aggregation of anxiety and depression in the community: The role of adolescents selfesteem and physical activity level (the HUNT study). BMC Public Health, 15. Retrieved
February 20, 2016. DOI:10.1186/s12889-015-1431-0
Zhang, J., Yen, S. T., (2015). Physical activity, gender difference and depressive
symptoms. Health Services Research 50 (5), 1550-1573. Retrieved February 20, 2016.
DOI: 10.1111/1475-6773.12285
Knepp, M. M., Yoza, J., Quandt, E. A. (2015). Higher modifies beck depression inventory
scores are associated with body, eating, and exercise comparisons but decreased
exercise amounts. Perceptual and Motor Skills 120 (3), 945-959. Retrieved February 20,
2016. DOI: 10.2466/15.29.PMS.120v14x8