Friday, July 10, 2009

Depression and anxiety: Exercise eases symptoms

Exercise can improve symptoms of depression and anxiety. Even a little exercise helps. Use these realistic tips and goals to get started and stick with it.

By Mayo Clinic staff

If you have depression or anxiety, you might find your doctor or mental health provider prescribing a regular dose of exercise in addition to medication or psychotherapy. Exercise isn't a cure for depression or anxiety. But its psychological and physical benefits can improve your symptoms.

"It's not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety," says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn.

When you have depression or anxiety, exercising may be the last thing you think you can do. But you can overcome the inertia. See how exercise can ease depression symptoms and anxiety symptoms. Plus, get realistic tips to get started and stick with exercising.

How exercise helps depression and anxiety

Exercise has long been touted as a way to maintain physical fitness and help prevent high blood pressure, diabetes and other diseases. A growing volume of research shows that exercise can also help improve symptoms of certain mental health conditions, including depression and anxiety. Exercise may also help prevent a relapse after treatment for depression or anxiety.

Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve depression symptoms. But smaller amounts of activity — as little as 10 to 15 minutes at a time — can improve mood in the short term. "Small bouts of exercise may be a great way to get started if it's initially too hard to do more," Dr. Vickers-Douglas says.

Just how exercise reduces symptoms of depression and anxiety isn't fully understood. Some evidence suggests that exercise raises the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release muscle tension, help you sleep better, and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, seek professional help. Exercise isn't meant to replace medical treatment of depression or anxiety.

The benefits of exercise for depression and anxiety

Exercise has many psychological and emotional benefits when you have depression or anxiety. These include:

  • Confidence. Being physically active gives you a sense of accomplishment. Meeting goals or challenges, no matter how small, can boost self-confidence at times when you need it most. Exercise can also make you feel better about your appearance and your self-worth.
  • Distraction. When you have depression or anxiety, it's easy to dwell on how badly you feel. But dwelling interferes with your ability to problem solve and cope in a healthy way. Dwelling can also make depression more severe and longer lasting. Exercise can shift the focus away from unpleasant thoughts to something more pleasant, such as your surroundings or the music you enjoy listening to while you exercise.
  • Interactions. Depression and anxiety can lead to isolation. That, in turn, can worsen your condition. Exercise may give you the chance to meet or socialize with others, even if it's just exchanging a friendly smile or greeting as you walk around your neighborhood.
  • Healthy coping. Doing something positive to manage depression or anxiety is a healthy coping strategy. Trying to feel better by drinking alcohol excessively, dwelling on how badly you feel, or hoping depression and anxiety will go away on their own aren't helpful coping strategies.

Tips to start exercising when you have depression or anxiety

Of course, knowing that something's good for you doesn't make it easier to actually do it. With depression or anxiety, you may have a hard enough time just doing the dishes, showering or going to work. How can you possibly consider getting in some exercise?

Here are some steps that can help you exercise when you have depression or anxiety. As always, check with your health care provider before starting a new exercise program to make sure it's safe for you.

  • Get your mental health provider's support. Some, but not all, mental health providers encourage exercise as a part of their treatment plan. Talk to your doctor or therapist for guidance and support. Discuss concerns about an exercise program and how it fits into your overall treatment plan.
  • Identify what you enjoy doing. Figure out what type of exercise or activities you're most likely to do. And think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening or go for a jog in the pre-dawn hours? Go for a walk in the woods or play basketball with your children after school? Do what you enjoy to help you stick with it.
  • Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think about what you may be able to do in reality. Twenty minutes? Ten minutes? Start there and build up. Tailor your plan to your own needs and abilities rather than trying to meet idealistic guidelines that could just add to your pressure.
  • Don't think of exercise as a burden. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise schedule the same way you look at your therapy sessions or antidepressant medication — as one of the tools to help you get better.
  • Address your barriers. Figure out what's stopping you from exercising. If you feel intimidated by others or are self-conscious, for instance, you may want to exercise in the privacy of your own home. If you stick to goals better with a partner, find a friend to work out with. If you don't have extra money to spend on exercise gear, do something that's virtually cost-free — walk. If you think about what's stopping you from exercising, you can probably find an alternative solution.
  • Prepare for setbacks and obstacles. Exercise isn't always easy or fun. And it's tempting to blame yourself for that. People with depression are especially likely to feel shame over perceived failures. Don't fall into that trap. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you're a failure and may as well quit entirely. Just try again the next day.

Sticking with exercise when you have depression or anxiety

Launching an exercise program is hard. Sticking with it can be even harder. One key is problem solving your way through when it seems like you can't or don't want to exercise.

"What would happen if you went out to your car and it wouldn't start?" Dr. Vickers-Douglas asks. "You'd probably be able to very quickly list several strategies for dealing with that barrier, such as calling an auto service, taking the bus, or calling your partner or friend for help. You instantly start problem solving."

But most people don't approach exercise that way. What happens if you want to go for a walk but it's raining? Most people decide against the walk and don't even try to explore alternatives. "With exercise, we often hit a barrier and say, 'That's it. I can't do it, forget it,' " Dr. Vickers-Douglas says.

Instead, problem solve your way through the exercise barrier, just as you would other obstacles in your life. Figure out your options — walking in the rain, going to a gym, exercising indoors, for instance.

"Some people think they need to wait until they somehow generate enough willpower to exercise," Dr. Vickers-Douglas says. "But waiting for willpower or motivation to exercise is a passive approach, and when someone has depression and is unmotivated, waiting passively for change is unlikely to help at all. Focusing on a lack of motivation and willpower can make you feel like a failure. Instead, identify your strengths and skills and apply those to taking some first steps toward exercise."