AlMomen 2018, AJMS 1(1): 1-6. DOI:10.5455/ajms.

Arabian Journal of Medical Sciences

http://www.ajms.tk

Physical activity reduces the burden and prevalence of depression

Hajer Mohammed AlMomen

Psychatric Hafouf Hospital, AlAhsa, Saudi Arabia

Abstract
Keywords:
Physical activity, Lifestyle modifications and physical activity have shown major evidence in reduc-
Exercise, ing the burden and prevalence of depression. There is still a debate about the effect
Prevention,
Management, of physical activity on depression prevention. This study aimed at reviewing the
Depression. effect of physical activity on prevention of depression. This review included 40

Received Jul 14,
Revised Aug 1,
Published Aug 2, 2018
*Corresponding author:
hajar.almomen@hotmail.com
studies out of 2300 published studies available on initial search during the last
10 years. These studies showed that exercise is a better strategy for management
of depression and its benefits are not limited to decreasing the depressive symp-
toms but also to improve the quality of life, managing and preventing depression

1. Introduction
Depression and anxiety are worldwide disorders
that could result in high economic burden on health
authorities and individuals as well (Collaborators,
2017). The effective treatment of depression is cost
effective and need various strategies which would
impact the quality of life of individuals (Chisholm
et al., 2016). There are no distinct etiological fac-
tors for depression but different factors may con-
tribute to progression of depression including
economic status, relationships, work load, family
stress and academic achievement (Lee et al., 2013).
Lifestyle and physical activity have shown ma-
jor evidence in reducing the burden and prevalence
of depression (Cleare et al., 2015). Many prospec-
tive studies also showed that there is a significant
association between depression and physical inac-
tivity and this could be postulated to that the exer-
cise could result in a number of biological changes
that affect the mental health of individuals (Carek
et al., 2011; Freitas et al., 2014; Rebar et al., 2015).
Physical activity could alter the activity of the
nervous system and increase the parasympathetic
1
vagal tone which lead to physiological changes in-
cluding the resting bradycardia. The stimulation of
autonomic nervous system was used for treatment of
depression (Hill et al., 2006; Krokstad et al., 2013).
There is still a debate about the effect of phys-
ical activity on depression prevention, however
the evidenced studies and the trend of many agen-
cies were toward benefiting from exercise and
physical activity decrease the depression rates.
This review study aimed at examining the effect
of physical activity on prevention of depression.
2. Information sources and search strat-
egy
The eligibility criteria and data collection were done
according to a literature search in the systemic re-
view conducted in 2013 (Mammen and Faulkner,
2013). The search items were ‘effect of physical
activities on prevention of depression.’ This review
included 40 studies out of 2300 published studies
available on initial search during the last 10 years.
 AlMomen 2018, AJMS 1(1): 1-6. DOI:10.5455/ajms.2
3. Results and discussion
3.1. Definition of physical activity
The definition of physical activity is the movement of
the body that could produce energy coming from the
contraction of skeletal muscles. Physical activities
are done for many purposes and could be related to
having leisure time or work related activities (Brooks
and Magnusson, 2007). Exercise and physical ac-
tivity were also defined as repetitive and structured
as well as planned exercise that could improve the
physical fitness and prevent obesity (Spencer et al.,
2015). Physical activity was associated with leisure
time in many studies and reduction of the depressive
symptoms among women as well as among older
subjects (Joshi et al., 2016; Teychenne et al., 2017).
3.2. Physical activity and depression
Depression and physical activity have a bidirection-
al relationship as each one impacts the other. Many
prospective cross sectional studies showed that
healthy subjects with lower activity levels are more
susceptible to depression than others who regularly
practice exercise. This relationship was evidenced
in many studies around the world. Brazilians who
don’t regularly practice exercise or have low lev-
els of physical activity have increased symptoms
of depression (De Mello et al., 2013). Also, in Ko-
rea, depressive symptoms are doubled among inac-
tive subjects than active population (Kremer et al.,
2014). Among children with high levels of physical
activity, the depressive symptoms were decreased
by 38% than physically inactive subjects (Kremer et
al., 2014). In addition, the levels of developing de-
pression among older subjects were increased (83%)
among population with lower activity levels in com-
parison with active equivalents (Paulo et al., 2016).
Many studies summarized that physical activity is
inversely correlated with the prevalence, prevention
and treatment of depression (Korczak et al., 2017;
Lucas et al., 2011; Mikkelsen et al., 2010; Schuch et
al., 2017a). From which it could be concluded that
regular physical activity is preventive against de-
pression among non-depressive subjects. However,
some other studies showed that the protective effect
of physical exercise is restricted to women (Carroll et
2
al., 2010; Mikkelsen et al., 2010; Wang et al., 2011).
Increasing the rate of physical activity could reduce
the future risks of depression and the more physi-
cal activity level, the more preventive outcomes
and better response to cognitive behavior therapy
(Gudmundsson et al., 2015; Hallgren et al., 2015).
Physical activity during major depressive disorder
could be difficult as those patients are usually inactive
when compared with other suffering from moderate
depression (Helgadottir et al., 2015; Wielopolski et
al., 2015). Variations are found between different
populations from different cultures, ages and genders
thus about 2 and half hours of physical exercise per
week could be effective for prevention of depression
(Correia and Ravasco, 2014; Schuch et al., 2015).
3.3. Potential neurobiological mechanisms as-
sociated with exercise
Many hypotheses were postulated to explain the
effect of exercise on depression. These hypotheses
include increasing the hormonal levels of serotonin,
epinephrine and dopamine which could increase
the levels of neurogenesis markers, reduce the oxi-
dative and pro-inflammatory markers with increas-
ing the antioxidants thus change the activity of the
cerebral cortex (Schuch et al., 2016). The chemical
imbalance between the brain and neurotransmitters
could result in depression thus exercise could pro-
mote the response on the levels of neurotransmit-
ters (Schuch et al., 2016; Szuhany et al., 2015). It
also increases the level of antioxidants as well as
decreases the inflammatory markers which impair
the activity of the brain, thereby preventing and
managing depression (Miller and Raison, 2016).
3.4. Factors influencing physical activity
among depressive subjects
Many factors could influence the physical activity
among depressive patients including low energy, no
motivation and laziness as well as low self-esteem,
efficacy, body mass index and presence of diseases
(Vancampfort et al., 2015). Physiological, emotion-
al and negative experience factors as well as lack
of knowledge about the importance of exercise are
major domains for inactivity among depressive pa-
tients (Bruins et al., 2014; Tordeurs et al., 2011).
 AlMomen 2018, AJMS 1(1): 1-6. DOI:10.5455/ajms.2
3.5. Physical activity for management of de-
pression
There is still a debate surrounding the benefits of
physical activity to depressive patients (Schuch et
al., 2017b). Including exercise for management of
depression is a recent focus of many researchers
(Augestad et al., 2008; Cleare et al., 2015; Hickey et
al., 2012; Yuan et al., 2015). Exercise could result in
treatment of depression among adolescents as well
as among adults but among older population it could
decrease the symptoms of depression (Blumenthal
et al., 2012; Dopp et al., 2012; Hughes et al., 2013;
Mikkelsen et al., 2017; Nasstasia et al., 2017).
3.6. Effect of physical exercise compared
with other treatments
The benefits of physical activity is comparable to
other treatments for depression including com-
mon psychotherapies. Regular exercise showed
similar effects to psychotherapies among many
clinical studies (Hallgren et al., 2015; Strid et
al., 2016). The best results from regular physi-
cal activity could be obtained after one year of
treatment by exercise (Hallgren et al., 2016). The
benefits of physical activity can also be com-
pared to those obtained by electroconvulsive
therapy (ECT), light and wake therapy among
depressive resistant patients (Salehi et al., 2014).
3.7. Recommendations of exercise for treat-
ment of depression
The long term effects of physical activity could re-
sult in management of depression, satisfaction and
enjoying better physical health. But different rec-
ommendations were presented for the optimal du-
ration, frequency and intensity of physical activity
for treatment of depression. A recent study showed
that a session of 1 hour for 3-5 times per week with
an intensity not exceeding 85% heart rate for at
least 10 weeks could be supportive for treatment
of depression (Rethorst and Trivedi, 2013). Also,
another study suggested that a session length of
40 minutes repeated for 4 sessions per week with
moderate intensity would result in management of
depressive disorder (Stanton and Happell, 2013).
Moreover, moderate to vigorous exercise could
3
significantly affect the depressive symptoms among
depressive patients (Meyer et al., 2016). The ses-
sions of exercise must be supervised by health and
exercise professionals for gaining great effects
and management of depression (Sui et al., 2009).
Conclusion
These studies showed that exercise is a bet-
ter strategy for management of depression and
its benefits are not limited to decreasing the de-
pressive symptoms but also to improve the quali-
ty of life, managing and preventing depression.
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