n Cite as: CMAJ 2024 May 6;196:E596. doi: 10.1503/cmaj.231288
1 xercise effectively treats depression and may decrease suicide
E attempts A 2023 meta-analysis of randomized controlled trials (RCTs) found that References 1. Heissel A, Heinen D, Brokmeier LL, et al. Exercise as medi- cine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br J Sports Med supervised, group or non-group, moderate- or vigorous-intensity, aerobic 2023;57:1049-57. or resistance exercises (excluding mind–body activities such as yoga) 2. Fabiano N, Gupta A, Fiedorowicz JG, et al. The effect of exer- decreased depressive symptoms among participants with depression, cise on suicidal ideation and behaviors: a systematic review with a number needed to treat of 2 and an effectiveness comparable to and meta-analysis of randomized controlled trials. J Affect Disord 2023;330:355-66. first-line treatments such as psychotherapy and medication. 1 Another 3. Ross RE, VanDerwerker CJ, Saladin ME, et al. The role of exer- 2023 meta-analysis of RCTs found that exercise decreased suicide cise in the treatment of depression: biological underpinnings attempts among people with mental or physical illness.2 and clinical outcomes. Mol Psychiatry 2023;28:298-328. 4. Reed JL, Pipe AL. Practical approaches to prescribing phys
2 Psychological barriers to exercise should be addressed ical activity and monitoring exercise intensity. Can J Cardiol 2016;32:514-22. For people with depression, these include amotivation, low energy, and 5. Fortier M, McFadden T, Faulkner G. Evidence-based recom- perceived fatigue, among others.3 While meta-analyses have found posi- mendations to assist adults with depression to become tive effects of exercise interventions, these largely involved willing partici- lifelong movers. Health Promot Chronic Dis Prev Can pants with professional support.1,2 Addressing psychological barriers is 2020;40:299-308.
important for exercise implementation.
3 xercise prescriptions should be specific and exercise
E supervised Clinicians should specify the frequency, intensity, time, and type of exercise Competing interests: None declared. This article has been peer reviewed. Affiliation: Department of Psychiatry, University of for patients.4 Moderate- to vigorous-intensity aerobic or resistance exer- Ottawa, Ottawa, Ont. cise for 45–60 minutes 3–5 times per week has been shown to have anti- depressive effects,3 although any physical activity is better than none,5 Content licence: This is an Open Access article dis- tributed in accordance with the terms of the Creative and supervision by an exercise professional can maximize effects.1,3 Most Commons Attribution (CC BY-NC-ND 4.0) licence, importantly, patients should be involved in the choice of exercise to which permits use, distribution and reproduction in increase adherence.5 any medium, provided that the original publication is properly cited, the use is noncommercial (i.e.,
4 ehavioural change techniques, tailored to each stage of
B research or educational use), and no modifications or adaptations are made. See: https://creativecommons. change, can increase exercise initiation and adherence5 org/licenses/by-nc-nd/4.0/ Clinicians should begin with motivation-building techniques, then pro Correspondence to: Carl Zhou, gress to action-oriented strategies, and, finally, focus on maintenance. carl.zhou@medportal.ca They should regularly assess progress, adapt strategies as needed, and provide positive reinforcement. Fortier and colleagues5 have provided a practical guide for exercise among people with depression.5
5 CMAJ invites submissions to “Five things to know Exercise interventions are generally safe about …” Submit manuscripts online at http:// Exercise in this population is well tolerated, with minor adverse events mc.manuscriptcentral.com/cmaj. such as joint pain, headache, and fatigue.1,2 Patients should be screened for pre-existing comorbidities such as injuries, physical inability, and con- ditions such as severe cardiovascular disease that increase the risk of exercise.1 Among those without such comorbidities, clinical supervision is not necessary for safety.4
Your Examination for Stress & Trauma Questions You Should Ask Your 32nd Psychiatric Consultation William R. Yee M.D., J.D., Copyright Applied for May 31st, 2022
