Physical activity or exercise may not be a priority for patients who experience depression or anxiety disorders. However, research shows that doing regular exercise can reduce symptoms of depression. Physical activity and sports are not the same things, but if performed, they both have benefits for physical and mental health.

  • Physical activity: activities that involve muscles and require energy, including doing homework, gardening, or walking. 
  • Sports (exercise): physical activities that involve the movement of limbs that are planned, structured and carried out repeatedly to improve or maintain physical health (physical fitness)
Benefits of Exercise for Depressed Patient

Benefits of Regular Exercise in Relieving Depression Symptoms

  • After exercising, the number of endorphins will increase. Endorphins are closely related to changes in mood (mood) toward a better and comfortable feeling (overall wellbeing).
  • Physical activity and sports can divert attention from things that are not pleasant and reduce excessive anxiety and negative thoughts. 
  • Exercise can help increase self-confidence. Creating targets and achieving these targets (even if only on a small scale) can improve confidence.
  • Exercising regularly also helps improve physical appearance, thereby helping patients feel better about their appearance. 
  • Physical activity or exercise can increase social interaction. Jogging casually in the compound of the house while greeting other people found along the way can improve mood.
  • Regular Exercising can improve sleep quality.

Ways To Start and Maintain Patient's Motivation

  • Find activities that the patient likes. Start with the easiest and cheapest activity to do. Do not force exercise in the gym if it is not according to the patient's circumstances.
  • Set realistic targets. Start with goals that are as easily achieved as can be started with mild physical activity. If it is achieved, the target can be increased slowly.
  • Based on meta-analysis research, exercise for 20 minutes/day, 3 times a week with moderate intensity in helping to reduce symptoms of depression.
  • Patients can start with a short duration (10 minutes) with a frequency of 3 times a week. Start with the easiest activities to do, such as walking.
  • Determine the most comfortable time for the patient to do physical activities or sports. For some people, they feel most excited after waking up in the morning, then doing physical activity or sports.
  • Help the patient not to see physical activity or sports as a task to be done but rather as part of the therapy as important as psychotherapy or medication.
  • Find obstacles that prevent patients from physical activity or exercise. If the patient does not feel comfortable with his appearance, the patient can exercise at home.
  • If the patient needs motivation, the patient can exercise with friends who have the same interests. If the patient does not want to pay for sports or buy sports equipment, activities can be designed that do not require expensive costs such as jogging.
  • Advise patients to evaluate their physical activity targets or sports targets by making exercise logs.
  • Help the patient prepare to face obstacles. Give appreciation to patient's efforts in physical activities.  There will be a day when the patient feels unable to exercise. Motivate patients to keep trying.

Theories that support the association between exercise and the reduction in depressive symptoms

Thermogenic Hypothesis
Exercise increases body temperature, including brain temperature. Increasing temperature in specific parts of the brain, such as the brain stem, will produce a sense of relaxation and reduce muscle tension. The theory put forward by DeVries was further tested by several studies but found only the effects of exercise on anxiety, not depression.

The Endorphine Hypothesis
Endorphins are associated with good mood and comfort. After exercising, there is an increase in plasma endorphin levels. However, there is still debate about whether plasma endorphins reflect endorphin activity in the brain. Some studies say that plasma endorphins still have an association with mood changes (mood) for the better.  Even though plasma endorphins do not reflect endorphin activity in the brain.

Monoamine Hypothesis
This theory states that exercise can increase the number of neurotransmitters, such as serotonin, dopamine, and norepinephrine. These neurotransmitters are reduced in depressed people. After exercise, there is increasing neurotransmitters in urine and plasma.  However, increasing neurotransmitters in the brain are still unknown. 

In animal studies, exercise can increase the amount of serotonin and norepinephrine in various parts of the brain. Need further research on the human brain.

Distraction Hypothesis
Exercise can serve as a distraction for patients who are depressed. When exercising, the patient will focus on physical activities so that it can divert the patient's attention from negative thoughts or excessive anxiety.

In general, exercise shows a more significant positive impact on depressive symptoms and more helps patients to control their moods. 

Self Efficacy Hypothesis
Patients experiencing depression often feel unable to control their moods and do their daily activities usually. They often feel powerless to achieve their activity targets as they think their depressive episodes will hamper them.

Exercise can help patients experiencing depression by giving a feeling of being able to reach their targets.

Start Exercise with the simplest, which is frequency and intensity adjusted to the patient's condition. When patients can reach the target of exercise, patients will feel they have the ability to manage their activities and overcome their depressive episodes.

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