ArticlePDF AvailableLiterature Review

Abstract

Depression is a very prevalent mental disorder affecting 340 million people globally and is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by the year 2020. In this paper, we review the evidence published to date in order to determine whether exercise and physical activity can be used as therapeutic means for acute and chronic depression. Topics covered include the definition, classification criteria and treatment of depression, the link between β-endorphin and exercise, the efficacy of exercise and physical activity as treatments for depression, properties of exercise stimuli used in intervention programs, as well as the efficacy of exercise and physical activity for treating depression in diseased individuals. The presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments.
REVIEW ARTICLE
Effects of exercise and physical activity on depression
P. C. Dinas Y. Koutedakis A. D. Flouris
Received: 14 December 2009 / Accepted: 26 October 2010 / Published online: 14 November 2010
ÓRoyal Academy of Medicine in Ireland 2010
Abstract
Introduction Depression is a very prevalent mental disor-
der affecting 340 million people globally and is projected to
become the leading cause of disability and the second leading
contributor to the global burden of disease by the year 2020.
Aim In this paper, we review the evidence published to
date in order to determine whether exercise and physical
activity can be used as therapeutic means for acute and
chronic depression. Topics covered include the definition,
classification criteria and treatment of depression, the link
between b-endorphin and exercise, the efficacy of exercise
and physical activity as treatments for depression, proper-
ties of exercise stimuli used in intervention programs, as
well as the efficacy of exercise and physical activity for
treating depression in diseased individuals.
Conclusions The presented evidence suggests that exer-
cise and physical activity have beneficial effects on
depression symptoms that are comparable to those of
antidepressant treatments.
Keywords Exercise Depression Physical activity
Mood b-Endorphin
Introduction
Depression is a very prevalent mental disorder affecting
340 million people globally—independently of age, sex,
and ethnic background—and is projected to become the
leading cause of disability and the second leading con-
tributor to the global burden of disease by the year 2020
[1,2]. Current evidence also shows that 9% of children by
age 14 have already experienced at least one episode of
severe depression [3], while up to 10% of adolescents are
affected by a major depressive disorder [4]. These statistics
are a consequence of the multi-faceted effects of depres-
sion on health and well-being [1]. Indeed, individuals
suffering from depression show low levels of mood, lack of
interest or pleasure, disrupted appetite or sleep, low self-
worth, feelings of guilt, deprived concentration and lack of
energy. Very often these problems become chronic and
lead to disability or, even worse to suicide attempts [1].
Recent reports conclude that depression can be reliably
diagnosed in primary care and can be treated through
pharmacological agents and psychotherapy with a 60–80%
success [5]. However, only 10–25% of those affected by
depression receive treatment for their condition, either due
to lack of resources and/or trained providers or the social
stigma associated with this condition [1,5]. Therefore, it is
very important to discover alternative therapeutic methods
for depression. In this light, encouraging evidence has
shown that exercise and physical activity have beneficial
effects on depression symptoms that are often comparable
to those of antidepressant treatments [6,7]. Yet, to our
knowledge, these new evidence linking exercise and
physical activity with depression have not been critically
evaluated. Therefore, in this paper, we review the evidence
published to date in order to determine whether exercise
and physical activity can be used as therapeutic means for
P. C. Dinas (&)Y. Koutedakis
Department of Sport and Exercise Science,
University of Thessaly, TEFAA Karies,
Trikala 42100, Greece
e-mail: pentinas@pe.uth.gr
A. D. Flouris
FAME Laboratory, Institute of Human Performance
and Rehabilitation, Centre for Research and Technology,
Thessaly, Greece
A. D. Flouris
Department of Research and Technology Development,
Biomnic Ltd., Trikala, Greece
123
Ir J Med Sci (2011) 180:319–325
DOI 10.1007/s11845-010-0633-9
acute and chronic depression. It is hoped that the infor-
mation provided will be valuable not only to physicians,
exercise psychologists and physiologists, but also to those
interested in personal or public health, politics and
economics.
Approach
A comprehensive search in PubMed and Science Direct
was conducted using MeSH terms that are germane to
acute and chronic depression (e.g., depression symptoms,
mood, depressive disorder, psychotherapy) in conjunction
with exercise and psychophysical mechanisms (e.g.,
exercise, physical activity, b-endorphin, opioids, seroto-
nin, pituitary gland). The search also included the articles
cited in the identified papers. All articles resulting from
the above methods were considered in this review, and
only those deemed irrelevant (i.e., not directly studying
the effects of exercise and physical activity on depres-
sion) were omitted. The following pages cover informa-
tion regarding exercise and physical activity as
treatments for depression, the endorphin hypothesis and
the hormonal effects of b-endorphins on depression, the
effects and the required frequency and mode of exercise
and physical activity on depression, as well as the
influence of an individual’s age on the successfulness
of exercise and physical activity interventions for
depression.
Definition, classification criteria and treatment
of depression
Depression represents a major illness with both health and
social consequences similar to chronic diseases such as
diabetes, congestive heart failure and hypertension [5].
According to the World Health Organization, depression is
an illness characterized by negative mood, decreased
interest for pleasure, feelings of guilt, uneasy sleep,
decreased appetite and energy, as well as poor brain con-
centration [1,2]. These feelings can be either acute or
chronic, resulting in a reduced interest for life which can
lead to extreme actions such as suicide [2]. The criteria
based on which classification of depression is accom-
plished are appointed by the International Classification of
Diseases (ICD-10) for worldwide use [8] and the Diag-
nostic and Statistical Manual of Mental Disorders (DSM-
IV) developed in the United States [9]. Generally, these
standardized criteria are used to separate ‘‘normal’
depressed mood caused, for instance, by disappointment,
from depressive disorders also known as ‘‘affective disor-
ders’’ and ‘‘mood disorders’’ [8,9].
Depression is normally treated with various pharma-
ceutical agents or psychotherapeutic interventions or a
combination of these. Current evidence shows that patients
seeing a primary care provider are more likely to have a
failed treatment than patients seeing a psychiatrist [10].
This, however, does not suggest that pharmacological
agents are unsuccessful in the treatment of depression.
Indeed, a large number of studies show that different
pharmacological treatments are successful in treating acute
depressive episodes [5]. In this light, a successful cooper-
ation between primary and specialty mental health sectors
is crucial, since most patients with depression first seek
help in primary care [1113]. Therefore, consultative roles
for mental health specialists have been recommended in
some countries to support primary care physicians in the
treatment of depression [14,15]. Relatively, recent evi-
dence suggests that an exercise science specialist may also
need to complement the primary care physicians and
mental health specialists in order to successfully tackle
depression symptoms and episodes [5]. For instance, it is
widely accepted that mood states are highly depended on
endorphin secretion [16]. Moreover, according to the
endorphins hypothesis, exercise augments endorphin
secretion which, in turn, reduces anxiety and depression
levels [17]. These notions are further discussed in the fol-
lowing section.
b-Endorphin and exercise
Endorphins are endogenous opioid polypeptide compounds
produced by the pituitary gland and the hypothalamus in
vertebrates during strenuous exercise, excitement, pain,
and they resemble the opiates in their abilities to produce
analgesia and a sense of well-being [16]. The opioid system
plays a key role in mediating analgesia and social attach-
ment and may also affect depression given the link between
b-endorphins and depression symptoms [1820]. To date,
b-endorphin secretion has been used for the diagnosis of
depression and it could be used as an agent in a therapeutic
strategy [21]. Moreover, available data have shown that the
l-opioidergic system is considerably involved in the eti-
ology of mental disorders, thus providing a rationale for the
use of l-opioid ligands such as b-endorphin in behavioral
therapies [16]. A recent meta-analysis concluded that the
mechanisms by which exercise may improve depression
remain uncertain mainly due to methodological limitations
of existing research [22]. Yet, based on recent biological
evidence linking the opioid system with mood and
depression [16,19,23], it seems reasonable to explore a
relevant hypothesis that has received considerable atten-
tion. According to the ‘endorphins hypothesis’, exercise
augments the secretion of endogenous opioid peptides in
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the brain reducing pain and causing general euphoria
(Fig. 1)[17,24,25]. In turn, the latter reduces anxiety and
depression levels [17,24]. These notions were confirmed
by a recent study showing an exercise-induced beneficial
effect of endorphins in mood, which suggests that further
research is warranted on the endorphins hypothesis [25].
A recent study investigated the endorphins hypothesis in
competitive long distance athletes (i.e., training [4 h per
week in the last 2 years) [26]. The participants underwent
positron emission tomography ‘‘ligand activation’’ [27],
toxicological examinations, and completed the visual ana-
log mood scales [28] at rest and after 2 h of endurance
running. Based on a large effect size, the results confirmed
the endorphins hypothesis demonstrating that exercise
leads to an increased secretion of endorphins which, in
turn, improved mood states [26].
b-Endorphin, an endogenous l-opioid receptor-selective
ligand [29], has received much attention in the literature
linking endorphins and depression or mood states.
b-Endorphin is primarily synthesized in the anterior pitui-
tary gland and cleaved from pro-opiomelanocortin, its
larger precursor molecule [30]. It reaches the circulation
either through secretion from the pituitary gland or via
projection into specific brain regions through nerve fibers
[30]. To date, clinical studies have shown an increased
level of b-endorphin and l-opioid receptors in plasma and
brain of patients suffering from depression and schizo-
phrenia [3135]. Moreover, clinical trials on patients with
different types of psychiatric disorders (i.e., depression,
schizophrenia and neuroses) demonstrated an antidepres-
sant effect of b-endorphin [36]. These results support,
in part, the endorphins hypothesis given that exercise of
sufficient intensity and duration can increase circulating
b-endorphin levels [30,37]. Indeed, b-endorphin levels of
women with cardiologic problems (syndrome of prolapsed
of maternal valve) show an increase following an exercise
session to a degree that constitutes treatment [38]. More-
over, a recent study demonstrated that exercise and phys-
ical activity increased b-endorphin levels in plasma with
positive effects on mood [39]. Interestingly, the researchers
reported that, independently of sex and age, dynamic and
anaerobic exercises increased b-endorphin, while resis-
tance and aerobic exercises seem to have only small effects
on b-endorphins [39]. In general, the evidence thus far
suggests that exercise-induced b-endorphin adaptations are
depended on the type of exercise and population tested, and
may differ in individuals with health problems. Further-
more, some of the proposed mechanisms inducing the
exercise-induced b-endorphin changes include analgesia,
lactate or base excess, and metabolic factors [30,37].
Nevertheless, the social element of exercise and its effects
on b-endorphin levels has not been examined. While
individualized and group-based interventions appear to be
equally beneficial for treating depression [40], we remain
naı
¨ve as to the effects of these protocols on b-endorphin
levels.
Exercise, physical activity and depression
It is known for some time that physical activity and exer-
cise are inversely associated with depression levels. A
relevant classic study was conducted by Paffenbarger and
colleagues [41] who examined questionnaires of 31,000
Harvard College graduates in 1962, 1966, 1977, and 1988.
Results showed that physically active individuals reported
lower depression levels than their physically inactive peers.
These results are supported by a more recent study that
examined 5,877 individuals aged 15–54 years showing that
physically active individuals report lower levels of
depression than non-active individuals [42]. Moreover,
there was an inverse linear relationship between physical
activity participation and depression with individuals
reporting as frequently active showing lower levels of
depression, individuals reporting as occasionally active
showing higher levels of depression and, finally, individ-
uals reporting as inactive showing the highest levels of
depression [42].
The beneficial effects of physical activity and exercise
on depression symptoms and general mood have been
confirmed in individuals of all ages. In children and ado-
lescents, a small beneficial effect of exercise in reducing
depression and anxiety scores has been recorded, yet the
small number of studies included and the clinical diversity
of participants, interventions and methods of measurement
limit the ability to draw conclusions [43]. In younger
adults, a previous investigation examined whether daily
activity and the tendency to participate in exercise are
Fig. 1 The endorphins
hypothesis mechanism
321
123
associated with mood states in a student cohort [44]. The
results showed that mood tends to be higher in a day an
individual exercises as well as that daily activity and
exercise overall are strongly linked with mood states. In
line with these findings, a recent study showed that exercise
significantly improves mood states in non-exercisers, rec-
reational exercisers, as well as marathon runners [45].
More importantly, the effects of exercise on mood were
twofold in recreational exercisers and marathon runners
[45].
In older adults, exercise interventions have shown very
promising results for alleviating symptoms of major
depression [46]. These findings are supported by a more
recent study examining the effects of physical activity in a
sample of depressed elderly patients showing that physical
activity is associated with reduced concurrent depression
[47]. Based on these findings, it was suggested that phys-
ical activity may be especially helpful in the context of
medical problems and major life stressors, while encour-
aging depressed elderly patients to engage in physical
activity is likely to have potential benefits on clinical
depression symptoms [47]. Finally, elderly who remain
physically active across time demonstrate lower levels of
depression symptoms compared to those who adopt inac-
tive lifestyles when they get older [48].
Exercise and physical activity as treatments
for depression
A recent meta-analysis reported a large clinical effect of
physical activity and exercise interventions on the
symptoms of depression for adults of both sexes [22].
More specifically, aerobic exercise indicated a moderate
clinical effect, while mixed and resistance exercise indi-
cated large effect sizes. Moreover, when compared
against other established treatments (i.e., cognitive
behavior therapy and antidepressants), exercise appears to
produce the same results [22]. Indeed, published evidence
shows that exercise and physical activity interventions are
generally successful in reducing depression symptoms.
For instance, a recent study found that patients with major
depression receiving aerobic exercise training performed
either at home or in a supervised group setting achieved
reductions in depression comparable to standard antide-
pressant medication (sertraline) and greater reductions in
depression compared to placebo controls [7]. Interest-
ingly, a different study reported that individuals with
major depressive disorder undergoing an aerobic exercise
program were as likely to be in remission as those taking
standard antidepressant medication (sertraline) or medi-
cation and exercise combined [49]. These results are
further supported by a study showing that a 4-month
aerobic exercise program was more successful in reducing
depression symptoms than a placebo and a pharmaco-
logical treatment [50]. In line with these findings, a recent
study demonstrated that an 8-month exercise program was
successful in improving depression symptoms in 40–60
year-old depressed women, unlike a pharmacological
treatment [51].
Properties of exercise stimulus
Methodological limitations in existing research preclude a
clear identification of the optimum exercise properties for
treating depression [22]. However, it is important to
acknowledge that the majority of relevant published evi-
dence suggests an inverted dose–response relationship
between exercise frequency and depression symptoms.
More specifically, a recent study examined the efficacy of
low-frequency (one aerobic session/week) and high-
frequency (3–5 aerobic exercise sessions/week) exercise
interventions for 8 weeks showing that high-frequency
exercise interventions are more efficacious in reducing
depression symptoms [40]. These findings are supported by
a Finnish study of 3,403 adults which demonstrated that
exercise frequency is inversely associated with depression
symptoms and overall well-being [52].
Based on evidence published to date, the duration of
exercise intervention is not clearly related to outcome [22].
On the other hand, some—but not all [43]—evidence
supports that more intense exercise regimes lead to larger
improvements in mood [5355], while aerobic ?resistance
training appears to generate stronger effects than aero-
bic ?flexibility training [53]. These results mirror the
finding that dynamic and anaerobic exercises have a more
potent effect on b-endorphin than resistance and aerobic
exercises [39]. Individualized and group-based interven-
tions appear to be equally beneficial for treating depression
[40]. Moreover, several sources of data—but not all
[22,40]—show that supervised physical activity programs
may produce more potent effects on depression than non-
supervised programs [7,56,57]. These findings may be
explained by the fact that depressed patients in unsuper-
vised programs fail to sustain a high-enough interest in
order to complete the prescribed intervention, as shown in a
previous study [58].
Exercise and physical activity for treating depression
in diseased individuals
Two previous studies examining the efficacy of exer-
cise interventions as a treatment for depression in seden-
tary individuals with hypertension reported significant
322
123
reduction of depression symptoms [57,59]. Previous work
in cardiovascular disease patients has shown that adding
high-intensity resistance training to an outpatient cardiac
rehabilitation aerobic exercise program is more efficacious
in improving mood and depression levels compared to
adding flexibility training [53]. Moreover, aerobic exercise
appears to be beneficial in improving depression symptoms
and quality of life in patients recovering from a heart attack
[60]. Therefore, there is some support to the notion that the
beneficial effects of exercise and physical activity on
anxiety and depression can reduce the risk for death from
cardiovascular illnesses, obesity and osteoporosis in car-
diovascular disease patients [61]. However, given that
classic depression treatments (i.e., not based on exercise/
physical activity) do not reduce the associated morbidity/
mortality in cardiac patients [62,63], the beneficial effects
of exercise and physical activity on cardiovascular mor-
bidity/mortality may be independent of their effects on
depression.
Discussion
Based on the presented evidence, it becomes clear that
exercise and physical activity have beneficial effects on
depression symptoms that are comparable to those of
antidepressant treatments. Research thus far is showing that
exercise and physical activity can be used as therapeutic
means for acute and chronic depression in the general
population as well as in hypertensive and cardiovascular
disease patients. In this light, the presented evidence sup-
ports that an exercise science specialist may need to
complement the primary care physicians and mental health
specialists in order to successfully tackle depression
symptoms and episodes.
Notwithstanding the attention on the effects of exercise
and physical activity on depression and the excitement for
the new discoveries in this area, our knowledge on the
biophysical mechanisms (e.g., b-endorphins) involved in
the exercise-induced decrease of depression symptoms is
incomplete. Moreover, methodological limitations in
existing research preclude a clear identification of the
optimum exercise properties for treating depression, while
the risks and cost effectiveness associated with relevant
interventions remain unknown. These topics should be
addressed by future research in order to improve and/or
standardize the exercise prescription for individuals with
depression symptoms.
Acknowledgments This work was supported in part by funding
from the European Union 7th Framework Program (FP7-PEOPLE-
IRG-2008 grant no. 239521).
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... In summary, increased levels of pro-inflammatory cytokines change neuroendocrine function, neurotransmitter metabolism and neuroplasticity to cause detrimental effects on psychological states (Elenkov et al., 2005;Maes et al., 2009;Miller et al., 2009;Rethorst et al., 2013). Individuals with clinical depression and anxiety disorders experience changes in mood, energy loss, and reduced exercise levels (Dinas et al., 2011). ...
... In addition to increasing opioid peptides, exercise also modulates the binding affinity of endogenous opioids to mu (μ), kappa (κ) and delta (δ) receptors (Boecker et al., 2008). Exercise modulation of the sensitivity and number of opiate receptors (especially μ receptors) in the brain is associated with positive alterations in mood, depression, anxiety, analgesia, euphoria, and stress (Boecker et al., 2008;Dinas et al., 2011;Tantimonaco et al., 2014;Arida et al., 2015). ...
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Multiple sclerosis (MS) is a demyelinating disease characterized by plaque formation and neuroinflammation. The plaques can present in various locations, causing a variety of clinical symptoms in patients with MS. Coronavirus disease-2019 (COVID-19) is also associated with systemic inflammation and a cytokine storm which can cause plaque formation in several areas of the brain. These concurring events could exacerbate the disease burden of MS. We review the neuro-invasive properties of SARS-CoV-2 and the possible pathways for the entry of the virus into the central nervous system (CNS). Complications due to this viral infection are similar to those occurring in patients with MS. Conditions related to MS which make patients more susceptible to viral infection include inflammatory status, blood-brain barrier (BBB) permeability, function of CNS cells, and plaque formation. There are also psychoneurological and mood disorders associated with both MS and COVID-19 infections. Finally, we discuss the effects of exercise on peripheral and central inflammation, BBB integrity, glia and neural cells, and remyelination. We conclude that moderate exercise training prior or after infection with SARS-CoV-2 can produce health benefits in patients with MS patients, including reduced mortality and improved physical and mental health of patients with MS.
... PA is defined as a type of bodily movement that consumes energy from skeletal muscles and (US Department of Health & Human Services, 1996) has beneficial psychological effects (Miles, 2007). Specifically, the positive links of PA with stress, anxiety, and depression have been well documented across different age groups and individuals with or without chronic illnesses (Dinas et al., 2011;Kandola et al., 2019;Rethorst et al., 2009;ter Riet et al., 2012). Such psychological benefits from regular engagement in PA can be attributed to changes occurring at different levels of analysis: (i) molecular level; (ii) brain structure and function; and, (iii) psycho-social factors (Stillman et al., 2020). ...
... Firstly, our findings reveal a significant and negative association between PA level and emotional states. This finding is consistent with previous studies and supported the positive effect of a relatively high PA level on emotional states (Anderson & Shivakumar, 2013;Dinas et al., 2011;Kruk et al., 2019;Teixeira et al., 2013). More importantly, the promising results of the present study helped to explain how PA results in reductions of negative emotional states (stress, anxiety, and depression), mainly due to the serial mediation effects of exercise tolerance and resilience. ...
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Background/objective Negative emotional states, such as depression, anxiety, and stress challenge health care due to their long-term consequences for mental disorders. Accumulating evidence indicates that regular physical activity (PA) can positively influence negative emotional states. Among possible candidates, resilience and exercise tolerance in particular have the potential to partly explain the positive effects of PA on negative emotional states. Thus, the aim of this study was to investigate the association between PA and negative emotional states, and further determine the mediating effects of exercise tolerance and resilience in such a relationship. Method In total, 1117 Chinese college students (50.4% female, Mage=18.90, SD=1.25) completed a psychosocial battery, including the 21-item Depression Anxiety Stress Scale (DASS-21), the Connor-Davidson Resilience Scale (CD-RISC), the Preference for and Tolerance of the Intensity of Exercise Questionnaire (PRETIE-Q), and the International Physical Activity Questionnaire short form (IPAQ-SF). Regression analysis was used to identify the serial multiple mediation, controlling for gender, age and BMI. Results PA, exercise intensity-tolerance, and resilience were significantly negatively correlated with negative emotional states (Ps<.05). Further, exercise tolerance and resilience partially mediated the relationship between PA and negative emotional states. Conclusions Resilience and exercise intensity-tolerance can be achieved through regularly engaging in PA, and these newly observed variables play critical roles in prevention of mental illnesses, especially college students who face various challenges. Recommended amount of PA should be incorporated into curriculum or sport clubs within a campus environment.
... PA is defined as a type of bodily movement that consumes energy from skeletal muscles and (US Department of Health and Human Services, 1996) has beneficial psychological effects (Miles, 2007). Specifically, the positive links of PA with stress, anxiety, and depression have been well documented across different age groups and individuals with or without chronic illnesses (Dinas et al., 2011;Kandola et al., 2019;ter Riet et al., 2012). Such psychological benefits from regular engagement in PA can be attributed to changes occurring at different levels of analysis: i) molecular level; ii) brain structure and function; and, iii) psycho-social factors . ...
... Firstly, our findings reveal a significant and negative association between PA level and emotional states. This finding is consistent with previous studies and supported the positive effect of a relatively high PA level on emotional states Dinas et al., 2011;Kruk et al., 2019;. More importantly, the promising results of the present study helped to explain how PA results in reductions of negative emotional states (stress, anxiety, and depression), mainly due to the serial mediation effects of exercise tolerance and resilience. ...
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Background/Objective: Negative emotional states, such as depression, anxiety, and stress challenge health care due to their long-term consequences for mental disorders. Accumulating evidence indicates that regular physical activity (PA) can positively influence negative emotional states. Among possible candidates, resilience and exercise tolerance in particular have the potential to partly explain the positive effects of PA on negative emotional states. Thus, the aim of this study was to investigate the association between PA and negative emotional states, and further determine the mediating effects of exercise tolerance and resilience in such a relationship. Method: In total, 1117 Chinese college students (50.4% female, Mage=18.90, SD=1.25) completed a psychosocial battery, including the 21-item Depression Anxiety Stress Scale (DASS-21), the Connor-Davidson Resilience Scale (CD-RISC), the Preference for and Tolerance of the Intensity of Exercise Questionnaire (PRETIE-Q), and the International Physical Activity Questionnaire short form (IPAQ-SF). Regression analysis was used to identify the serial multiple mediation, controlling for gender, age and BMI. Results: PA, exercise intensity-tolerance, and resilience were significantly negatively correlated with negative emotional states (Ps<.05). Further, exercise tolerance and resilience partially mediated the relationship between PA and negative emotional states. Conclusions: Resilience and exercise intensity-tolerance can be achieved through regularly engaging in PA, and these newly observed variables play critical roles in prevention of mental illnesses, especially college students who face various challenges. Recommended amount of PA should be incorporated into curriculum or sport clubs within a campus environment.
... This result is also similar to the previous study 31 , explained by estrogen's proinflammatory effect while androgen has immunosuppressive when exposed PM 32 . Exercise and physical activity have beneficial effects as antidepressant 33 , lowers suicidal ideation 34 , which explains why people who do not exercise was sensitive to PM exposure on our study. Finally, the risk of suicide is highest within 90 days of diagnosis of depression depression (aOR 7.33, 95% CI 4.76-11.3) ...
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... In addition to improvements in addiction-related outcomes, several studies documented improvements to mental health (e.g., depressive symptoms), providing evidence that exercise supports the change process involved in recovery from addiction, which is characterized by improvements in overall health and well-being (Ashford et al., 2019;Panel, 2007). The extant literature largely supports a relationship between exercise and improved mental health (Dinas et al., 2011), and incorporating exercise into the treatment of addiction should help with improved mental health and longer term recovery. Specifically, exercise is frequently used as a stress ...
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Background: Exercise has been recognized as a promising and emerging treatment for individuals recovering from addiction. The purpose of this article was to systematically review scientific studies using exercise as a means to improve, sustain, or treat addictions, and to provide suggestions for the future use of exercise as a treatment method for addiction. Methods: Using PRISMA guidelines, a database search was conducted for articles that tested the impact of exercise interventions on addiction-related outcomes. To be included, peer-reviewed experimental design studies had to use human subjects to investigate the relationship between exercise and the treatment of or recovery from addiction. Garrard's Matrix Method was used to extract data from reviewed articles (n = 53). Results: Nearly three quarters of the studies reviewed documented a significant change in addiction-related outcomes (e.g., more days abstinent, reduced cravings) in response to exercise exposure, particularly while someone was receiving treatment at an in or outpatient clinic. Many studies investigated the effect of acute bouts of exercise on nicotine dependence, and many studies had small sample sizes, leaving room for future research on how exercise might benefit people recovering from substance and process addictions. Conclusion: Results affirm that exercise can be a helpful aspect of addiction treatment. Future researchers should investigate different exercise settings (e.g., group-based exercise vs individual) and explore exercise maintenance and the long-term outcomes following discharge from treatment facilities.
... Weight bias and stigma are also critical reasons enhancing the evidence that individuals with obesity are likely to demonstrate depressive disorders compared to those with healthy weight [10]. Physical activity and exercise appear to reduce depression symptoms comparable to those of antidepressants in individuals with acute or chronic depression [91]. Interestingly, both depressed and nondepressed patients with obesity demonstrate similar physical activity levels, highlighting the crucial role of obesity in mental health and particularly in depressive disorders [92]. ...
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Regular exercise has been reported as a fundamental piece of the management and treatment puzzle of obesity, playing a vital role in numerous psychological indicators. However, it is unclear whether high-intensity interval training (HIIT) can improve critical psychological health markers such as adherence, exercise enjoyment, affective responses, health-related quality of life, anxiety, and depression in overweight and obese adults. The purpose of this topical review was to catalogue studies investigating the psychological responses to HIIT in order to identify what psychological outcomes have been assessed, the research methods used, and the results. The inclusion/exclusion criteria were met by 25 published articles investigating either a traditional, single-component (84%) or a hybrid-type, multi-component (16%) HIIT protocol and involving 930 participants with overweight/obesity. The present topical review on HIIT-induced psychological adaptations shows that this popular exercise mode, but also demanding for the masses, can meaningfully increase the vast majority of the selected mental health-related indices. These improvements seem to be equal if not greater than those observed for moderate-intensity continuous training in overweight and obese adults. However, further research is needed in this area, focusing on the potential mechanisms behind positive alterations in various psychological health parameters through larger samples and high-quality randomized controlled trials.
... week is associated with a lower risk of severe acute respiratory syndrome coronavirus 2 infection [61]. PA can also improve an individual's depression and mood by the augmented release of endorphins [62]. Thereby, health authorities should implement new strategies to promote active lifestyle (especially MVPA) during and after lockdowns. ...
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Objective To conduct a systematic review and meta-analysis to summarize evidence regarding differential changes in PA involvements and exercise habits in people with/without chronic diseases during the COVID-19 outbreak. Data Sources MEDLINE, Embase, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, PEDro were searched from November 2019 to May 2021. Study selection Two reviewers independently screened cross-sectional and longitudinal studies that investigated changes in PA-related outcomes in people with/without chronic diseases during the pandemic. Data Extraction PA-related outcomes and sedentary time were extracted from the included studies. Relevant risk of bias were assessed. Meta-analyses were conducted for each PA-related outcome, if applicable. Quality of evidence of each PA-related outcome was evaluated by GRADE. Data Synthesis Of 1,226 identified citations, 36 articles (28 with and 8 without chronic diseases) with 800,256 participants were included. Moderate evidence from wearable sensors supported a significant reduction in pooled estimates of step count (standardized mean differences (SMD)=-2.79, p<0.01). Very limited-to-limited evidence substantiated significant decreases in self-reported PA-related outcomes and significant increases in sedentary behaviours among people with/without chronic diseases. Specifically, pooled estimates of metabolic equivalent-minute per week (SMD=-0.16, p=0.02), and PA duration (SMD=-0.07, p<0.01) were significantly decreased, while sedentary time (SMD=0.09, p=0.04) showed significant increases in the general population (small- to large-effects). Very limited evidence suggested no significant PA changes among people in a country without lockdown. Conclusion During the pandemic, objective and self-reported assessments showed significant reductions in PA in people with/ without chronic diseases globally. This mainly occurred in countries with lockdowns. Although many countries have adopted the “live with the coronavirus” policy, authorities should implement population-based strategies to revert the potential lockdown-related long-term deleterious impacts on people's health.
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This is the protocol for a review and there is no abstract. The objectives are as follows: 1.To determine whether exercise interventions reduce and/or prevent anxiety and/or depression among children and young people compared to other treatments or no treatment. 2.If so, what are the characteristics of the most effective interventions?
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Recent and exciting research in animals has described endogenous polypeptides, endorphins, which in many biological respects resemble opiate agonists.1-3 While behavioral effects in animals are under intense investigation, the effects of the pure endorphins in man require specific testing. The effect of opiate antagonists in schizophrenic patients4 are in some dispute, but a recent doubleblind study revealed no effects.5 Thus, direct measures of injected endorphins are relevant to understanding their effects in man. Accordingly, when the opportunity presented itself, it seemed logical to evaluate synthetic β-endorphin in schizophrenic and depressed patients, and this preliminary report describes our initial observations. Thirty milligrams of synthetic material was prepared by one of us (C. H. L.) and made available for this purpose; subsequently, a second batch was used.6SUBJECTS AND METHODS Laboratory Procedures Preliminary experiments were carried out to determine whether or not morphine-like substances in blood could
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Objective: Exercise appears to be generally comparable to antidepressant medication in reducing depressive symptoms. The current study examines the effects of aerobic exercise, compared to antidepressant medication and placebo pill, on sexual function among depressed adults. Methods: Two hundred clinically depressed adults, aged 40 years and over, who were sedentary and generally overweight, were randomized to 4 months of Aerobic Exercise, Sertraline (Zoloft), or Placebo pill, for the treatment of depression. Exercise condition participants engaged in walking, running, or biking, 30 min/day, 3 days/week, to 70-85% of their heart rate reserve, in either a supervised group setting or independently at home. Before and following treatment, participants completed the Arizona Sexual Experiences Questionnaire (ASEX) and the Hamilton Rating Scale for Depression (HAM-D). An ANCOVA was performed to test the effects of treatment on post-treatment sexual function, controlling for age, sex, body mass index, diabetes, hypertension, pretreatment HAM-D scores, and pretreatment ASEX scores. Results: The treatment group main effect was significant (p = .02); exercisers had better post-treatment ASEX scores (adjusted ASEX M = 16.6) compared to the placebo group (adjusted ASEX M = 18.3; p = .01). Exercisers had post-treatment ASEX scores that were marginally better compared to the sertraline group, but this difference did not reach statistical significance (adjusted ASEX M = 17.9; p = .05). Conclusion: Aerobic exercise, which has been associated with reduced symptoms of depression comparable to antidepressant medication, appears to result in greater improvement in sexual function compared to placebo pill. A nonsignificant trend towards better sexual function among exercisers compared to antidepressant medication may be attributable to medication-related sexual side effects.
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This paper focuses on application of neuroscience techniques to exercise psychology for the purpose of obtaining better answers to questions about the effects of acute exercise on mood and other affective experiences. We do this through the lens of the popular idea that exercise can cause an endorphin-based high. Endogenous opioids and their interaction with other neurotransmitter systems are discussed, followed by a succinct historical account of the effects of acute exercise on endorphins and mood. Limitations of the approaches that have been taken are identified. A key message is that optimal progress toward truly understanding the psychological consequences of exercise will require that neuroscience techniques be combined with the strongest possible research designs.
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A considerable body of knowledge now exists in the area of depressive disorders in primary care. Primary care clinicians appear to identify less than half of patients with major depressive disorder and adequately treat only a portion of those they identify. However, recent research suggests that identification and treatment of depressive disorders in primary care is a far more complex process than previously assumed. The presence of significant differences in patient expectations, the process of care, and the clinical epidemiology of depression between psychiatric and primary care settings makes it difficult to interpret existing studies of primary care clinician performance. This paper describes an alternative conceptual model for the identification and management of depression in primary care which incorporates the concept of “competing demands” derived from the preventive services literature. The central premise of this model is that primary care encounters present competing demands for the attention of the clinician and that there is not enough time to address each demand. The identification and treatment of depression represents an active choice from multiple clinician and patient priorities such as treatment of acute illness, provision of preventive services, and response to patient requests. Choice is influenced by three sets of interrelated “domains,” representing the clinician, the patient, and the practice ecosystem. Each domain is indirectly influenced by the general policy environment. Detection and treatment of depression in this model occurs over time as clinicians work through these competing demands. Although the competing demands model contains many unproven elements, it is likely to have a great deal of “face validity” for practicing primary care clinicians, and its validity can be empirically tested. Using the model as a framework to guide inquiry into the identification and management of depression and other mood disorders in primary care may lead to the discovery of more creative and effective solutions to the problem of underdiagnosis and undertreatment.