Exercise and Depression in Youth

CHILD & ADOLESCENT PSYCHIATRY

Following the holidays and the start of the New Year, adults often make renewed efforts to exercise. Physical and mental health can be affected positively by an increase in physical activity. Exercise has shown some benefits of improvement in depression for adults, but is there a relationship between exercise and depression in children and adolescents? Some recent studies shed light on this issue.

Physical activity and depression

The relationship between physical activity and major depression in middle childhood was assessed in a prospective study.¹ Six-year-old children (N = 795) in a community in Norway were followed up at age 8 and 10 years. Semistructured clinical interviews of parents and children were conducted to evaluate symptoms of major depression at each assessment. Physical activity was assessed using an accelerometer that was worn for 7 days during the assessment periods.

Higher levels of moderate to vigorous physical activity at age 6 predicted fewer major depressive symptoms 2 years later. Similarly, moderate to vigorous physical activity at age 8 predicted fewer major depressive symptoms 2 years later. There was no association between sedentary behavior and depression. On the basis of these findings, the investigators concluded that increasing moderate to vigorous physical activity in children may prevent future symptoms of depression.

The relationship between physical activity and depression was also recently studied in adolescents during the course of 11 years.² Adolescents (N = 1160) with a mean age of 13 years completed questionnaires at 4 points, up to age 21. Depression was assessed by self-report using the Children’s Depression Inventory. Physical activity was assessed by self-report using the Leisure Time Exercise Questionnaire in which adolescents assessed their activity over the past 7 days and recorded the number of episodes of mild, moderate, and strenuous activity.

It was found that physical activity decreased over time and symptoms of depression increased over time. Higher initial symptoms of depression were associated with greater decreases in physical activity over time. The authors suggest that treatment strategies target symptoms of depression at about age 13 to prevent a decrease in physical activity and an increase in depressive symptoms.

Role of exercise in the treatment of depression

Given the association between physical activity and depression in youth, would exercise add benefit to the treatment of depression in youth? In the largest controlled trial to date, Carter and colleagues³ evaluated preferred intensity exercise for depressed adolescents. Adolescents (N = 87) who were in treatment for depression were randomized to either 12 sessions of aerobic exercise at preferred intensity along with treatment as usual or treatment as usual only.

The exercise consisted of circuit training with 8 exercise stations. The duration of each session was 1 hour. Exercise was defined as preferred intensity because the participants chose the order of the different exercises, chose the intensity at which they exercised, chose when to rest, and were not obligated to exercise at higher levels or attend the sessions.

The primary outcome measure to assess depression was the Children’s Depression Inventory. No significant difference was found between the preferred intensity exercise plus treatment as usual group and the treatment as usual only group at 6 weeks after the intervention. However, at the 6-month follow-up, the group that received the preferred intensity exercise had a significantly greater improvement in depressive symptoms than the group that received only treatment as usual. The investigators conclude that preferred intensity exercise in addition to treatment as usual may have benefit for adolescents receiving treatment for depression.

From an adolescent’s perspective, what aspects of exercise are beneficial to improve depressive symptoms? Carter and colleagues⁴ interviewed 26 adolescents with depression who had participated in the preferred intensity exercise program. The valued aspects of the intervention were as follows:

⟶ The importance of choice: being able to select exercise intensity and choice of whether to attend

⟶ Shared experience: being with other adolescents who were experiencing similar problems and concerns

⟶ A sense of achievement: doing something and feeling better about themselves

⟶ Routine: having a consistent routine in their lives

⟶ Being distracted: being able to focus attention on exercise and distract themselves from other problems and concerns

⟶ Feeling healthier: as a result of participating in exercise

The perceived changes reported by the adolescents were improved sleep; increase in energy; improved motivation to engage with peers, family, and school activities; improved mood; improvement in self-efficacy; better social interactions; and a more positive attitude toward exercise.

In light of these findings, clinicians may want to add exercise to the treatment armamentarium for depressed youth.

Disclosures:

Dr. Wagner is Professor and Chair of the department of psychiatry and behavioral sciences at the University of Texas Medical Branch at Galveston. She is the Child and Adolescent Psychiatry columnist for Psychiatric Times.

References:

1. Zahl T, Steinsbekk S, Wichstrøm L. Physical activity, sedentary behavior, and symptoms of major depression in middle childhood. Pediatrics. 2017;139:e20161711.

2. Gunnell KE, Flament MF, Buchholz A, et al. Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence. Prevent Med. 2016;88:147-152.

3. Carter T, Morres I, Repper J, Callaghan P. Exercise for adolescents with depression: valued aspects and perceived change. J Psychiatr Mental Health Nurs. 2016;23:37-44.

4. Carter T, Guo B, Turner D, et al. Preferred intensity exercise for adolescents receiving treatment for depression: a pragmatic randomised controlled trial. BMC Psychiatry. 2015;15:247.