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Pearls


Depressed patients won’t exercise? 7 ways to get them started

Vol. 2, No. 11 / November 2003

Exercise has been shown to significantly reduce depressive symptoms and decrease the chances of relapse. 1

If you’re having trouble getting a depressed patient for whom exercise is not contraindicated to take that first step on the road to fitness, the following motivational tips can help:

  • Explain how exercise can decrease mild to moderate depressive symptoms and improve overall health.2
  • Ask patients to document the time they spend watching television, sitting in traffic, or lying on the couch, and to compare this with time spent doing physical activity. By keeping this record, patients often discover they are not exercising nearly enough.
  • Emphasize that yoga, t’ai chi, aerobics, and walking are all effective types of exercise. Patients often associate “exercise” with weightlifting or long-distance running and do not consider less-strenuous options.
  • Tell unmotivated patients that getting started is the hardest part. The more a patient exercises, the more motivated he or she will feel.

Keys to safe exercise

Once the patient decides to begin exercising, tell him or her to:

  • Start with a light-intensity workout and gradually increase the regimen’s intensity. Encourage the patient to start with at least a once-weekly routine and advise him or her that overexertion can lead to injury.

Have a physical therapist or exercise trainer devise the program. For older or medically ill patients, clearance from an internist or family physician may be necessary.

  • Exercise where the patient feels most comfortable. For example, patients who are obese or are self-conscious in public settings may prefer to work out at home.
  • Keep exercising regularly and in moderation to guard against exercise addiction, “burnout,” or overtraining. Warn patients that stopping regular exercise can lead to rebound depression, anxiety, and insomnia. 3 These pitfalls—which could occur as early as 2 weeks after stopping—can derail a fitness regimen and obstruct future attempts at exercise.

References

1. Martinsen EW, Hoffart A, Solberg O. Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. Compr Psychiatry 1989;30:324-31.

2. Penninx BW, Rejeski WJ, Pandya J, et al. Exercise and depressive symptoms. A comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B Psychol Sci Soc Sci 2002;57:124-32.

3. Morris M, Steinberg H, Sykes EA. Effects of temporary withdrawal from regular running. J Psychosom Res 1990;34:493-500.

Dr. Pillay is assistant neuroscientist at McLean Hospital, Belmont, MA, and an instructor of psychiatry at Harvard Medical School, Boston.

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