Exercise more effective than medicines to manage mental health, says study | Hacker News Reader

Exercise more effective than medicines to manage mental health, says study

medicalxpress.com

83 pointsPaulHoule24 comments

As someone who deals with serious mental health issues, I think the headline sends an erroneous message.

Without exercise, I feel laconic and less motivated.

Without medicine, I hallucinate and generally lose my groundedness in reality.

One is clearly more important/effective when managing my mental health.

yeah, the title is wrong. the study says exercise is more efficacious for depression than medicine. as if depression is the only mental illness.

In the Freudian era they made a distinction between neurosis (which Freud thought emerged from the Oedipus Complex) and psychosis which was believed to be organic in origin.

In the pharmaceutical age one would distinguish between common anxiety and depression which are treated primarily with SSRIs and related drugs, and ‘serious mental illness’ (bipolar + schizophrenia) which are treated with antipsychotic drugs of various sorts. Both are serious but the second particularly so.

I’d advocate that anyone who is suffering from mental health problems use a combination of exercise, drugs, talk therapy plus an attempt to find meaning in spirituality, friends, creative activities, etc. Mental illness kills (I’ve lost many friends to it) and it is worth attacking with all the tools available.

I’m a great deal more active physically since my mental health has been better managed with meds. It’s not an either/or proposition.

Good thing that’s not what the paper said either then, huh

It’s a good thing I’m able to even do exercise at all because my baseline mental health is managed with meds. I’m not sure what your point is, mine was a “yes and”.

I wonder if there is a selection bias at play. One of the major symptoms of depression is lack of motivation. Exercise requires some level of motivation. If people are exercising, that could mean that their depression is not as severe.

I have the same thought. Since you mentioned it first, you've been tasked as of now with reading the selection methodology and reporting back.

somebody with low motivation breaking the vicious cycle they are in are taking the first step to getting better

Psychomotor retardation is a symptom of severe depression but if it's an RCT with minimal drop outs that shouldn't be an issue. If it's an epidemiological study then yeah I wouldn't trust the results.

> Exercise requires some level of motivation

Only when you don't enjoy that particular from of exercise. If it is fun, that's the only motivation you need.

I used to struggle with anxiety and depression, until I found that 60-90 minute walks would clear my mind and help me feel much better. The effects wouldn't last very long, though, so I walked around five days per week, or around 30Km per week.

Then I bought a bike and found it much more fun, which means I look forward to my bike rides. Because of that it doesn't feel like a chore. It also turned out to be more time efficient, and the mental benefits of a single ride last for a few days, so if I catch a cold and can't ride ride for a few days I am not crawling up the walls like I did back when I only walked.

and when you don't find 'going out' or 'moving around' fun ?

Whilst I am really happy that you found your solution, it's akin to most people telling a depressed person to 'find something that you enjoy'. When you don't enjoy anything - or the things that do bring you comfort are bad and/or isolating - you are stuck.

You haven't tried everything, so you can't say you don't enjoy anything.

I experienced depression for many years. Perhaps the worst part of depression, and what makes it so hard to treat, is this defeatist attitude of "nothing is going to work, so I may as well not try".

Start by accepting that other people in your exact same circumstances, with your exact same abilities, go through life with a smile on their faces. Ask yourself, what is different about them? That is how I started to crawl out of the hole.

This isn't even news really, but it's not adopted because getting sick people to exercise is more difficult and more expensive in practice than getting them to swallow a drug. So we stick with subpar treatments. Diet is also more effective than most drugs but giving everybody a good diet is arguably even more difficult than getting them all to exercise, given we only have so much supply of healthy foods available.

I still hear an attitude that telling unhealthy people to exercise is condescending and neglectful because you aren't giving them "real medicine" meaning a drug, which I generally see as either grounded in sheer ignorance or one persons anecdotal experience. The amount of confidence I see in drugs that are effective in maybe 20% of the population, which is a lot of those used for mental health, is utterly bizarre.

What's the minimum effective dose here? What should I be optimizing for? Somthing like "get your heart rate to above 130 for 20 minutes, 3 times a week" would be a helpful guidance

I used to think like that: exercise literally as a prescription.

Then I bought a bike. Do you remember how fun it was to ride when you were a kid? It is just as fun when you are an adult. As a result, you don't carefully perform your prescribed dose of weekly exercise, you just go out for a ride when you feel like it.

It doesn't need to be a bike. The point is to try a few things until you find something that you enjoy doing. Then exercising won't feel like a chore. Instead, it will be that thing that you do for fun, which just happens to also make you healthier.

Depression is really good at sucking the joy from normally joyful activities. If you need to remind yourself to eat, to sleep, to shower, to change clothes, then “exercise when you feel like it” translates to not exercising at all. Having a minimum suggested routine or target is helpful for the people who are struggling the most.

I have always wondered why doing physical work never seems to provide the same feelings of wellbeing as an equivalent amount of cardio type exercise. Maybe its the constant rhythm, or enforced mental blankness, but even a 30 min walk is much more relaxing for me than yardwork.

I feel like yard work induces a similar amount of calmness in me. I love a good walk but I get the same feeling of centeredness and grounded mental state from mowing the lawn that I do from an equivalent length walk

Yeah true, mowing is a great mental break and basically just a walk. I probably ruin the relaxation with all the trimming, raking, planting, weeding etc afterwards.

Maybe you dislike getting dirty?

Exercise is like a manual labor charade performed in a sterile environment, at most you get sweaty.

Correlation does not equal causation.

No, but a scientific study of over 100,000 participants, over 1,000 trials with almost 100 reviews isn't a simple correlation.

It's science.

This article doesn't provide enough info for me to see exactly what they did, but to me it seems more like a correlation that the people most likely to be able to perform exercise in a trial are also the people most likely to be able to improve their mental state over time.

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