Exercise as a Treatment Option for Anxiety and Depression

“Mental health disorders are major contributors to sick leave and disability pensions”. (Martinsen, 2008, p. 25) “Anxiety and depression are among the most common mental health disorders”. (Martinsen, 2008, p. 25) As a result of this great cost to the public, researchers have set out to find alternate ways to effectively treat anxiety.

The effect of exercise on persons suffering from anxiety is continuously debated. “Early research was methodologically flawed and may have inhibited the use of exercise as a treatment option for those suffering from anxiety disorders.” (Strohle, 2008, p. 779) However, recent clinical studies have shown positive correlations between an exercise and a reduction in anxiety. “Aerobic exercise has been shown to be an effective and cost-efficient treatment alternative for a variety of anxiety and mood disorders, including panic disorder.” (Broman-Fulks and Storey, 2008, p. 117) When used in combination with pharmacological and psychological therapy, exercise can be a highly effective way to combat anxiety. (Martinsen, 2008, p. 26 and Strohle, 2008, p. 781)

The purpose of this paper is to document the benefits people who suffer from anxiety disorders can expect from exercise as a treatment option. Research supporting and opposing this theory, as well as a critical analysis of the reviewed research, are provided in the following paragraphs.

Research shows that a regular exercise regimen can have many positive effects for people who suffer from anxiety. Exercise has been proven to significantly reduce symptoms of anxiety and depression. Some studies have shown that intense exercise can even prevent symptoms of anxiety. The very first published study on exercise as a treatment for anxiety and depression produced positive results on severely depressed patients. Subsequent “studies have confirmed this observation, and demonstrated that exercise is associated with an antidepressant effect.” (Martinsen, 2008, p. 25) For example, runners have reported a feeling of euphoria and pain insensitivity. “The leading explanation for this phenomenon is an increase in endogenous opioids known as endorphins.” (Rot, Collins, and Fitterling, 2009, p. 207)

Runners have reported that they experience feelings of euphoria and pain insensitivity. This supports the theory that exercise improves mood. Evidence also suggests that exercise boosts the brains serotonin function. In experimental animals, physical activity has been shown to increase levels of tryptophan, to boost serotonin neurotransmission, to enhance serotonin metabolism, and to increase the production of various proteins involved in brain serotonin function. (Rot, Collins, and Fitterling, 2009, p. 208) Regular “exercise also increases levels of norepinephrine and its metabolites, and activates production of tyrosine hydroxylase, an enzyme involved in the production of norepinephrine. This correlates with norepinephrine’s positive effects on mood.” (Rot, Collins, and Fitterling, 2009, p. 208) Increases in dopamine after exercising have also been found.

Physical activity can also add to a positive self image. Depressed and anxious individuals typically are inactive and withdrawn. When these individuals are introduced to activities that can provide a sense of accomplishment and pleasure, such as exercise, they often experience more accomplishment and pleasure. This also teaches “depressed individuals that their behaviors affect feelings, and that they can influence how they think and feel by their own efforts.” (Martinsen, 2008, p. 28) “Studies have documented that exercise is associated with self-esteem and self-efficacy enhancement in a range of populations.” (Daley, 2008, p. 144) “Thus, it is possible that exercise counteracts symptoms of depression through enhancement of self-esteem.” (Daley, 2008, p. 144)

Some research opposes the use of exercise in treatment of anxiety. Studies have reported detrimental effects or no effects at all. There are many different variables, such as the type of anxiety disorder a person suffers from, that can affect the outcome of using exercise as a treatment for mental health disorders. People suffering from specific anxiety disorders, such as panic disorder, may have adverse affects with exercise therapy. “Exercise may induce acute panic attacks or increase subjective anxiety in patients with panic disorder.” (Strohle, 2008, p. 780) “In rare cases, exercise-associated bodily sensations may trigger panic attacks.” (Strohle, 2008, p. 781)

“Patients with social phobia experienced no significant changes in anxiety.” (Martinsen, 2008, p. 27) “Patients with agoraphobia and social phobia may experience anxiety symptoms when in a group or an outdoor facility, especially when they do not have quick access to an exit.” (Martinsen, 2008, p. 27) “Exercising in the outdoors or in large spaces may be anxiety provoking for others.” (Martinsen, 2008, p. 27)

Another drawback of exercise therapy is difficulty getting patients to adhere to an exercise regime. Depressed individuals tend to spend much of their time in an inactive state. (Martinsen, 2008, p. 28) Also, motivation for patients with major depressive disorder may be a limiting factor. (Rot, Collins, and Fitterling, 2009, p. 205) Finally, “adherence to a standardized exercise regimen during a randomized control trial may be problematic for many severely depressed patients”, thus making an accurate assessment of exercise as a treatment option difficult. (Rot, Collins, and Fitterling, 2009, p. 206)

Research is just beginning; long term effects have yet to be conclusive. A method for improving exercise consistency and devotion to a regular program has yet to be found, and researchers are continuing to look for methods of motivating people to exercise.

The following conditions have been associated with successful use of exercise as a treatment option for anxiety and depressing disorders:

• Well informed and highly monitored patients
• Exercise professionals who have knowledge of mental health disorders. (Martinsen, 2008, p. 27)
• Exercise prescriptions tailored to each individual and regular follow-ups to monitor progress.
• “A multidisciplinary approach involving scientists and practitioners in psychiatry, psychology, sport medicine and health care providers.” (Strohle, 2008, p. 781)

Exercise has been proven to have wide range of health benefits. “The current weekly recommendation by the US Department of Human and Health Services (2.5 hours of moderate aerobic physical activity, 1.25 hours of vigorous aerobic activity, or an equivalent combination of moderate and vigorous aerobic activity plus additional muscle strengthening activities on two or more days) has increased since the 1995 recommendation issued by the American College of Sports medicine and Centers for Disease Control and Prevention of at least thirty minutes of moderate physical activity on most days of the week.” (Rot, Collins, and Fitterling, 2009, p. 204) “The Mayo clinic lists several medical benefits of regular physical activity on its Web site, including weight management, increased cardiovascular function, prevention and control of chronic diseases, and improvement in sleep.” (Rot, Collins, and Fitterling, 2009, p. 204) “The self-efficacy theory, originally proposed by Bandura in 1977, postulates that confidence in one’s ability to exercise is very much related to a person’s actual ability to exercise.” (Rot, Collins, and Fitterling, 2009, p. 209)

The absence of physical activity, however, “can have harmful effects on health and well- being including; increasing the risk for coronary heart disease, diabetes, certain cancers, obesity, hypertension, and all cause mortality.” (Strohle, 2008, p. 777) “Physical inactivity may also contribute to the development or worsening of mental disorders.” (Strohle, 2008, p. 777)

Recent studies have shown positive results in the use of exercise training in the treatment of depression and anxiety disorders. “Following samples of non-depressed subjects over time, the general finding is that physically active people have a reduced tendency to develop depression.” (Martinsen, 2008, p. 25) By implementing a regular exercise regime, people suffering from depression and anxiety disorders have more tools available to them cope with the symptoms.

“Anxiety and depressive disorders are major public health problems, and their costs to both the individual and society are enormous.” (Martinsen, 2008, p. 28) Alternative methods to traditional therapy, such as psychotherapy and antidepressants, in the treatment of these disorders are necessary for more well-rounded management. Exercise has been found to have immediate physical and psychological effects. Antidepressants sometimes have to be taken regularly for weeks before a noticeable change takes effect. “Furthermore, some symptoms of depression remain despite antidepressant treatment, for example, fatigue and reduced cognitive function and evidence had shown that exercise can improve these symptoms.” (Daley, 2008, p. 143)

In one meta-analysis, “exercise was as effective as cognitive therapy.” (Daley, 2008, p. 143) In another study, exercise was no different in treatment of depression than psychotherapy, or other types of behavioral and pharmacological interventions. (Daley, 2008, p. 143) These studies are promising because many patients would prefer an alternative to taking medication to treat their anxiety symptoms. Compared to pharmaceutical treatment options, “exercise is relatively side effect free, a comparatively cheap alternative, and can be performed at the convenience of the individual, in contrast to antidepressants or psychotherapy, which is reliant on a visit to a physician or therapist.” (Daley, 2008, p. 143) Also, “a large proportion of patients who receive antidepressant medication do not respond adequately.” (Martinsen, 2008, p. 26) These patients “were randomly assigned to exercise and health education classes, exercise was significantly more effective.” (Martinsen, 2008, p. 26)

No notable differences in effectiveness have been found between aerobic and non-aerobic exercise. A patient’s participation in an exercise trial may make them more likely to continue to regularly exercise after the trial is done. This supports the theory that exercise has some long term “feel good” effects, and that “exercisers gain a sense of confidence as they become more skillful and that this feeling of mastery is translated into other areas of their lives, including management of their depressive symptoms and adherence to their exercise programs.” (Rot, Collins, and Fitterling, 2009, p. 209) These factors create a positive environment that encourages patient’s use of exercise therapy. “For example, while exercise may improve mood by increasing one’s self-worth, mood improvement might in turn increase the likelihood that someone exercises again through its impact on self-worth.” (Rot, Collins, and Fitterling, 2009, p. 210)

I am personally interested in this research because I believe it will be beneficial to my own experience with anxiety. I have had experience with pharmacological treatment as well as cognitive therapy. While there are definitely situations that require medication and other therapy or treatment, I don’t think that it is always necessary or appropriate. I believe that some forms of anxiety, especially mild anxiety, can strongly benefit from using exercise as a treatment option. The feeling of having some control over my own treatment of anxiety has a “feel good” effect all on its own.

Exercise has been the method of therapy that has consistently, and most successfully, helped my anxiety. The beauty of exercise is that it is always available and can be done almost anywhere and at anytime. In doing this research, have learned that people suffering from depression and anxiety can only benefit from implementing an exercise program. I believe the positives heavily outweigh the negatives when it comes to implementing a regular exercise program to enhance well-being.

In conclusion, mental disorders are costly to individuals and society. Anxiety and depression are some of the most common mental health disorders. Exercise significantly reduces anxiety and depression symptoms and should be included in their treatment. Research supporting this theory includes; exercising produces effects similar to antidepressants, increases the production of endorphins and other “feel-good” chemicals, and boosts self-esteem. While there are negative aspects of utilizing exercise therapy, the positives heavily outweigh the negative. In conducting more long-term studies, researchers will continue to enhance the use of physical activity as a treatment option for anxiety and depression. Keeping patients well informed, educating exercise professionals in mental health, tailoring programs for each individual, and using a multidisciplinary approach involving a variety of health professionals can lessen the adverse affects of exercise therapy. Not exercising can have negative effects on health and well-being. In doing this research, I have learned that everyone can benefit from the positive effects of regular physical activity.

Work Cited

Broman-Fulks, J. J., & Storey, K. M. (2008). Evaluation of a brief exercise intervention for high anxiety sensitivity. Anxiety, Stress, and Coping, 21, 117-128.

Daley, Amanda (2008). Exercise and depression: a review of reviews. Journal of Clinical Psychology in Medical Settings, 15, 140-147.

Martinsen, E.W. (2008). Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry, 47, 25-29.

Rot, M., Collins, K. A. & Fitterling, H. L. (2009). Physical exercise and depression. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 76, 204-214.

Smits, J. A., Berry, A. C., Rosenfield, D., Powers, M. B., Behar, E. & Otto, M. W. (2008). Reducing anxiety sensitivity with exercise. Depression and Anxiety, 25, 689-699.

Strohle, A. (2008). Physical activity, exercise, depression and anxiety disorders. J Neural Transm, 116, 777-784.