“If exercise could be purchased in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” -- Robert H. Butler
The date is July 18, 2014. I’m competing at the U.S.A. Powerlifting National Competition in Denver. I made my first squat attempt of 451 pounds and my second attempt of 484 pounds. I’m now about to attempt my third and final squat of the day at 501 pounds. This is two and a half times my body weight. As I approach the weight, the voices in my head try to talk me out of it:
Why are we doing this? Why couldn’t we take a Zumba class?
“Squat!” says the head judge. I descend and then fight the weight to the top. This is the longest seven seconds of my life. The crowd is cheering me on and their enthusiasm energizes me. I stand up with the weight. “Rack!” says the head judge. I put the weight back on the rack and look to the three judges’ scoring lights for confirmation: two of three white lights, a good squat!
The boost in my mood from that experience was amazing. I was cheerful for about three weeks after accomplishing that goal. One could come to the conclusion that a person who puts two and half times his bodyweight on his back for a trophy may have significant judgment problems. But this extreme example of a mood-improving physical activity should not distract us from the benefits of all types of exercise on psychological health.
General physical activity has been shown to have salubrious effects on psychological health in numerous studies. In one study, researchers confirmed that physical exercise provides moderate benefits as a treatment for depression. This same study also affirmed that physical exercise is an efficient alternative treatment to reduce symptoms of depression and noted a 49 percent increase in the probability of response to treatment with exercise training. A second study favorably cited research which concluded that physical activity interventions have a moderate inhibitory effect on depressive symptoms in adults with and without clinical depression. A review summarizing evidence from 22 studies on strength training and depression noted that although the trials produced mixed results, there was sufficient evidence to support resistance training as an effective intervention for reducing depression symptoms in adults with depression.
Given these promising results, how can clinicians help their patients improve their psychological well-being with weight training or other physical activities? One suggestion is that clinicians follow the recommendation of the 2016 VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder. The authors reviewed the evidence for exercise as a treatment for depression and made the following recommendation: “For patients with [Major Depressive Disorder], we suggest offering patient education on the benefits of exercise as an adjunct to other evidence-based treatments for depression or as monotherapy when patients are unwilling or unable to engage in first-line evidence-based psychotherapy or pharmacotherapy.”
If you think your patient would benefit from a more active intervention, another suggestion is to create a SMART goal plan centered on exercise. A SMART goal is Specific, Measurable, Achievable, Relevant, and Time-bound. For example, you could create a daily walking plan for a patient who wants to become more active. The plan could be to walk on a treadmill or outside for 45 minutes, three times a week for three months. This is specific (walking), measurable (45 minutes three times a week), achievable (walking outside or inside maximizes opportunities to complete the weekly goal), relevant (patient wants a simple way to become more active), and time-bound (patient commits to three months initially).
Perhaps a patient would like to enter a powerlifting competition, train for a bike race, begin an exercise program or simply pass their next PT test. You could help the patient create a SMART plan and help him or her to monitor, achieve and re-evaluate goals. The plan could include consulting a coach or a trainer if physical training is outside your field of expertise. Physical activities of all kinds can provide benefits and supplement evidence-based treatment for your patients with depression.
Mr. Christian Evans is a public health analyst at the Deployment Health Clinical Center. He has a master’s degree in economics and a master of divinity.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.