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Resistance Exercise and Cardiovascular Fitness Combine to Reduce Depression and Stave Off Heart Disease Death

A short time ago I wrote about a book by Dr. Tim Bono, a professor of positive psychology, telling us how exercise—any kind—makes us happy and combats depression: https://www.cbass.com/exercise_happiness.html. We now have two new studies—one from Ireland and the other from Texas—which uncover more of the details. One supports resistance exercise as a standalone or additional therapy for depression and the other shows the connection between midlife fitness, depression, and CVD death in later life. Cardiovascular disease is a leading cause of death for people with clinical depression.

The two forms of exercise are proving to be frontline therapy for depression.

Resistance Exercise Training

Brett R. Gordon, MSc, and colleagues from Ireland, Sweden, and Iowa State University analyzed 33 randomized trials involving 1877 participants, mean age 52, 67% women. The resistance exercise programs ranged from 2 to 7 days a week and lasted an average of 16 weeks.

The results were published online May 9, 2018, in JAMA Psychiatry.

Their goal was to determine the relationship between resistance training and depressive symptoms.

The trials measured depressive symptoms at baseline, mid-intervention and/or after resistance training. Four possible moderating factors were also considered: Total volume of resistance training, whether participants were physically or mentally ill, and whether strength was significantly improved.

They concluded: “Resistance exercise training significantly reduced depressive symptoms among adults regardless of health status, total prescribed volume of RET, or significant improvements in strength.”

Resistance exercise reduced depressive symptoms under all conditions. Sounds familiar doesn’t it? Professor Bono told us that feelings of taking care of oneself are an important part of psychological health. “Psychologists refer to it as self-efficacy, a sense that we are the masters of our own domain, capable of carrying out our work with confidence and competence,” he explained. “For my student, small daily exercises may not have looked like much from the outside, but they served as stepping stones to lead him out of depression and up to a path of accomplishment.” Unlike taking a drug, recovery was due to something they did on their own.

Importantly, the Irish authors and their colleagues added that RET may be particularly helpful for reducing depressive symptoms in people with greater depressive symptoms.” It worked best for those who need it most.

“The available empirical evidence supports [the finding] that RET may be an effective alternative or adjuvant therapy for depressive symptoms,” lead author Brett Gordon told Medscape Medical News.

The authors call exercise interventions “promising treatments for depressive symptoms, [because they are] free from adverse effects and high costs associated with anti-depressive medications and psychotherapy.”

Most studies up to this time have looked at the connection between cardiovascular fitness and depression. The second study adds the risk of late life cardiovascular disease, a leading cause of death for people with clinical depression.

Cardiovascular Fitness

This study, a collaboration between the Cooper Institute and the University of Texas Southwest Medical Center, included nearly 18,000 participants who had their cardiorespiratory (heart, lungs, and muscles) fitness measured at the Cooper Clinic at midlife (around age 50). Participants were 80% men and had Medicare coverage beginning January 1, 1999. Using Medicare administrative data, the researchers examined the correlation between fitness, depression, and cardiovascular disease death. (My fitness was measured on a treadmill at the Cooper Clinic in Dallas during that time frame, at age 50.)

The results were reported online June 27, 2018, in JAMA Psychiatry.

Compared to low fitness, the findings revealed that participants who demonstrated a high level of fitness in midlife had a 16% lower risk of depression and a 61% lower risk of death from cardiovascular disease. After a diagnosis of depression, higher levels of fitness were associated with a 56% lower risk of CVD death.

In recognition that most of the study subjects were men, the researcher adjusted for sex differences and found that fitness was just as beneficial in women as men.  

“These new insights illustrate the importance of fitness to maintain both physical and psychological health as we age,” said lead author Benjamin L. Willis, MD, MPH, Director of Epidemiology at The Cooper Institute. “Now we know that the long-term benefits and the connection between mind-body wellness are more significant than we thought. We hope our study will highlight the role of fitness in early prevention efforts by physicians in promoting healthy aging.” (Cooper Institute, July 2, 2018)

“What’s surprising about this study is the time interval between the measurement of fitness and the outcomes of depression and CVD mortality,” Dr. Willis told Medscape Medical News. “Something that you’re doing right now can actually provide some benefits many years later, even when you might have a problem, say, of depression that occurs because of some other life event. It’s never too late to get off the couch, bur sooner is better,” he added.

Fitness levels were not retested after the midlife examination. This prompted Dr. Willis to call for more study: “A good research question is the effect of change in fitness over time.”

Commenting on the study for Medscape Medical News, Robert Roca, MD, a professor on geriatric psychiatry, took up that line of inquiry.

Observing that people who are very fit at midlife also tend to be very fit late in life, he observed that “it may be what they’re doing currently is what matters.”

“If you were fit at midlife and then were a sloth after that, would that still be protective? That’s not clear to me.”

That said, Dr. Roca called fitness one of his “favorite interventions” to recommend to people who are depressed. “It’s often difficult to mobilize people who are depressed to be active, but it can be very helpful if they are.”

My Take

Dr. Roca is on the right track. The best approach is to get fit and stay fit.

I have no difficulty choosing between the two forms of exercise. I’ve been doing both since I turned 30—and read Dr. Ken Cooper’s landmark book “Aerobics.” I was a little more open minded than Dr. Cooper in his book; it took him quite a while to acknowledge the value of weight training. I like to think that I played a small part in convincing him of the value of resistance training—by coming to the Cooper Clinic to be tested as a person who had been lifting weights since my teen years. To the delight of Dr. Arnie Jensen, who brought me to the Cooper Clinic, my treadmill time was 90 seconds above the 99th percentile for my age group.  Dr. Cooper now recommends strength training, especially for those over 40--and lifts regularly in the Cooper Fitness Center.
 

This photo was taken by my father at the Teenage National Championship where I placed second.
An athlete himself, he encouraged me always.

No question in my mind that exercise—resistance and aerobic—relieves depression. My current doctor at the Cooper Clinic assures me that feeling “down” from time to time is not real depression.

When I wake up feeling a little “down,” I get up, get dressed, do my “morning motion” routine, and then go for a walk. It’s almost magic. My “mini-depression” disappears once I get moving. I’m fine as long as I stay busy and keep my blood sugar on an even keel by eating regularly.

If I feel “down” at bedtime, I nip it in the bud by reading something that lifts my spirits. (I keep a stack of paperbacks by my bed.) If I wake up, I read some more to put me in the mood to go back to sleep.

It really works. Fitbit shows my sleep pattern to be the best in memory.

I combat my “down” periods with regular exercise and staying busy doing things that I enjoy and do well.

Nothing keeps me “happy” more than exercise and productive living.

The researchers from Ireland and Dallas—along with Dr. Roca—are confirming what I'm living.


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