Help for Anxiety, Depression, and Even PTSD
A series of meta-studies shows that the benefits of exercise exceed plain old physical health and looking good naked. Check this out.
I’ve got a question for you: The time you spend in the gym… Do you think of it just as a workout, or do you regard it as a kind of psychotherapy? Or maybe you think it’s both?
I’d bet my original Legos Star Wars set (unopened) that most of you think it’s both a workout and your own version of an hour on the analyst’s couch. It sure as hell is for me.
I’m one of the millions of people who have “generalized anxiety disorder,” or GAD. For those of you lucky enough to not know what it is, it’s characterized by exaggerated and persistent worrying about often inconsequential stuff for no readily apparent reason; anticipating bad things that are unlikely to happen.
As my wife likes to say, even plain old air makes me anxious.
It’s like the poodle my mom had when I was a kid. Stanley would usually spend most of the day standing underneath the kitchen table, trembling, Lord knows what for. That’s GAD, or at least a doggy version of it.
Fortunately, I discovered quite by accident that lifting – exercise of any kind really – significantly diminishes my GAD. It’s like taking Xanax, Klonopin, Valium, Lorazepam, or a nice old-fashioned lude, or “disco biscuit,” only without the drowsiness, slurred speech, or strange desire to dance to “YMCA.”
If only I could exercise all day long and be relatively free of anxiousness. Sigh.
Nah, my situation isn’t quite that bad, but it probably is for a lot of people. Luckily, they too can benefit from exercise because science has shown that the exercise-as-therapy thing isn’t unique to just me. Several studies have found that exercise often works as well as chemical intervention in turning the anxiety dial down.
But what about other mood disorders? As awful as GAD is, it’s actually pretty low on the totem pole of the mental health conditions that affect millions of Americans. Higher up, of course, are mild or severe depression and PTSD, to name a few.
What about those conditions? Can exercise exorcise them too?
Exercise and PTSD
Most people might not know the clinical definition of post-traumatic stress disorder (PTSD), but they sure know it when they see it. After all, the combat veteran with PTSD is a common movie and television trope.
Generally speaking, it’s a psychiatric disorder that sometimes occurs in people who have experienced or maybe even witnessed a traumatic event. It’s characterized by emotional flashbacks, feelings of helplessness, persistent sadness, thoughts of suicide, and even “muscle armoring,” where the body is tense and braced for possible catastrophe.
While it’s easy to dismiss PTSD as something you only see in dramas, the American Psychiatric Association estimates that 1 in 11 Americans will be diagnosed with PTSD in their lifetime (and if you consider the number of people who’ll escape diagnosis because they never received care from a professional, the number of those who are or will be afflicted is probably a lot higher).
In 2019, Whitworth, et al. conducted a study of 30 people who’d screened positive for PTSD and anxiety and randomly assigned them to either a 3-week resistance exercise intervention (squat, bench press, pulldown, overhead press, and biceps curl) or a time-matched control condition (1).
The 80% of the participants who completed the study had large beneficial effects on symptoms of avoidance (the practice of avoiding particular people, situations, environments, or things because of anticipated negative consequences or painful feelings) and arousal (getting overly excited about a situation that ordinarily wouldn’t merit such excitement).
While the results of this study were exciting, it appears to be the first study to demonstrate the beneficial effects of resistance exercise on PTSS (post-traumatic stress symptoms), like hyperarousal and avoidance.
Exercise and Depression
There are various types of depression, ranging from major depression that’s characterized by having symptoms that interfere with normal functioning for at least two weeks, persistent depressive disorder that lasts for at least two years (think Anthony Bourdain), and perinatal depression to generic seasonal affective disorder (SAD).
It’s estimated that 4.4% of the world population is, at any one time, in the throes of one of these species of depression, and its prevalence has been reported to have increased by 27.6% during the COVID-19 pandemic (Allen, et al., 2022).
This is undoubtedly what compelled Andreas Heissel and his colleagues to attempt to figure out whether exercise (resistance training, aerobics, mixed exercise, or group exercise) was a viable treatment option (2).
The researchers compiled the results of 41 studies on exercise and depressive symptoms that included 2,264 participants. We don’t need to get into the psychological weeds of their meta-study. Suffice it to say that their major findings included the following:
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Exercise had moderate to large effects on exercise depressive symptoms, even when they limited the included studies to those that had a very low risk of bias.
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“Non-inferiority trials” (where they test whether a new treatment isn’t worse than a current treatment) indicated that exercise is non-inferior to current first-line treatments (e.g., drugs, therapy).
While that last finding (exercise works as well as drugs) might raise some eyebrows, another meta-study (Recchia, et al.) set out to compare the effects of exercise to antidepressants on treating non-severe depression (3).
Their analysis of 21 studies suggested that there was “no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression.”
Granted, exercise as therapy had higher drop-out rates (because it involves effort, of course) than pharmaceutical intervention, but exercise had no adverse side effects, other than an occasional sore muscle or the like.
Resistance Exercise and Plain Old Anxiety
If you suffer from anxiety, you’re not alone. It seems at least 15% of the population reports frequent bouts (at least 15 times a month). While anxiety may seem relatively benign to the uninitiated, it can lead to poor health in general, poor sleep, poor performance, mental stress, and even pain.
You might, just on intuition alone, assume that lifting might have a beneficial effect on anxiety. After all, anything that provides a distraction from the perceived dangers of the world, real or not, is often helpful.
Well, your intuition would be right. There’s a relatively large amount of research on the subject, thus enabling another group of researchers (Gordon, et al., 2017) to conduct yet another fruitful meta-study (4). This group found 16 articles comprising 922 participants (486 who performed resistance training and 436 of whom served as controls).
Be aware that there was little homogeneity among training protocols. Regardless, the results universally showed that resistance training improves anxiety symptoms among both healthy participants and participants with a physical or mental illness. None of the results were moderated by sex or even any specific feature of the training protocols.
How Does Exercise Benefit Mood Disorders?
The mechanisms by which exercise affects mood disorders aren’t well understood. It could simply be a matter of increased levels of the “feel good” chemical, dopamine, that are normally elicited by exercise. Psychologists, however, suggest it might be partly due to the supposedly soothing effects of social interaction (for those exercising with a group or even in a gym), or merely the expectation of psychological benefit, i.e., you think it’s going to help, ergo it does.
Another theory, this one targeted more at PTSD patients, is called the “cross-stressor adaptation hypothesis.” It suggests that the repeated exposure to a specific stressor (like exercise) that’s intense enough and long enough can cause modifications to the stress response system that eventually leads to a reduction in the stress response of other stressors.
In other words, once one gets used (become “habituated”) to the stress of exercise, a patient is less likely to get triggered by the other stressors that might have normally set them off.
What Should I Do with This Information?
Some of you probably know that without weightlifting, you’d be a case study in several chapters of the DSM (the “bible” of mental disorders). That, or your picture would be on the wall in several U.S. Marshalls’ offices, causing you considerable chagrin because the poor resolution of the photo doesn’t show off your definition.
Really, I can’t imagine the number of depressed people, anxious people, or plain old psychotic people we’d have wandering the streets, forests, and prairies if they didn’t have the gym or some weights in the garage as an outlet.
However, as I mentioned earlier, it’s not feasible to work out all day, and the music of clanging plates only soothes the savage breast for so long. Anxiety or depression is a patient hunter and will attack when defenses are down.
One strategy to try as an alternative to popping a pill is to do a “fitness snack” whenever anxiety psychologically pantses you, i.e., pick up a pair of dumbbells and do some floor presses. Take a resistance band out of the closet and do some cable squats. Slip a stretch band around your lower thighs and do duck walks around the apartment. Anything physical. Anything to thwart the anxiety or depression demons and send them screaming back to hell.
References
References
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James Whitworth, et al., Feasibility of Resistance Exercise for Post-traumatic Stress and Anxiety Symptoms: A Randomized Controlled Pilot Study, Journal of Traumatic Stress, 2019, 00, 1-08.
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Andreas Heissel, et al., Exercise as medicine for depressive symptoms? A systematic review and network meta-analysis of randomized controlled trials, Br J Sports Med 2023,;0:1-10.
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Francesco Recchia, et al., Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression; a systematic review and network meta-analysis of randomized controlled trials, Br J Sports Med 2022;56:1375-1380.
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Brett R. Gordon, et al., The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials, Sports Med, 17 August 2017.
