Saturday, 25 October 2014

ClinicSpeak: exercise and depression

How effective is exercise as an anti-depressant in MS? #MSBlog #MSResearch #ClinicSpeak

"The meta-analysis below does not show a clear link between exercise and a reduction in depression in MSers. Too few studies that are underpowered and/or poorly designed. Despite this I recommend that all MSers should try and exercise. There is good evidence from outside the field of MS that it works and it is an important component of any programme that targets brain health. Regular aerobic exercise delays the onset of Alzheimer's disease and may slow down the progression of MS. Exercise has numerous positive effects in the brain; increasing so called endorphins (one of the brain's antidepressants) and growth factors that promote neuronal survival (insulin-like growth factor-1 or IGF-1). I know many of you very disabled and are not capable of ordinary exercise; if this is the case you should ask to be referred to a neuro-physiotherapist who can help devise an exercise programme for you. You will be surprised what a difference exercise can make."

"If haven't read my previous post on brain health, I would urge you to read it now."

BACKGROUND AND PURPOSE:The purpose of this study was to perform a systematic review of the literature on the effects of exercise on depressive symptoms in MSers, as well as to apply meta-analytical procedures to the results.

METHODS: A systematic search covering eight databases was conducted. The included studies were randomized controlled trials applied to people with definite MS who completed a structured exercise intervention which were compared to any comparator, including other forms of exercise. The outcomes included a primary measure of depression/depressive symptoms or an instrument with a clearly defined depression subscale.

RESULTS: Fifteen randomized controlled trial studies were identified including a total of 331 exercising subjects and 260 controls. The average Physiotherapy Evidence Database (PEDro) score was 5.6 ± 1.3 points. Only one study applied depressive symptoms as the primary outcome. Four studies showed positive effects of exercise on depressive symptoms. An in-depth analysis of the studies revealed that the baseline level of depressive symptoms, patient disability level, choice of depression instrument and exercise intensity may influence the results. The meta-analysis included 12 studies reflecting a total of 476 subjects. The standardized mean difference across studies was g = -0.37, 95% confidence interval (-0.56; -0.17), and the null hypothesis of homogeneity within the sample could not be rejected (Q = 12.05, df = 11, P = 0.36).

DISCUSSION: Exercise may be a potential treatment to prevent or reduce depressive symptoms in individuals with MS, but existing studies do not allow solid conclusions. Future well-designed studies evaluating the effects of exercise on depressive symptoms and major depression disorder in MS are highly warranted.


  1. I was prescribed anti-depressants years ago when a relative died. They made me into a person I didn't recognise. Never took anything again. However, short term counselling helped. Even better exercise has an incredible effect and it is the best treatment for me. After a good session, it is almost as if I've been given a happy pill. It's important to find out which type of exercise is suitable for an individual. I have SPMS and I swim .

  2. The longer I have MS the more I'm convinced that my main effort has to be to keep in overall good health. I know this was said to me at the outset, but it's a message that is easily swamped by the MS-specifics. Seems to me that optimal health is the key to keeping symptoms at bay and I've been seriously scared reading your posts on the dangers of developing co-morbidities... but it's tough. When you're achey and tired, the natural reaction is to flop and eat chocolate. I get a lot of things wrong but I have managed to find/keep to an exercise regime and now swim four or five times a week for at least half an hour continuously. This plus weekly Pilates keeps me pretty well. I also take antidepressants.

  3. There is some evidence to show that Mindfulness may help with depression.

  4. Exercise and mindfulness both. I've always been a glass is half-full person, but to make sure I don't get gloomy (especially in cold dark winter months), it doesn't matter what the weather is like, I walk 5-miles in the morning and then around 3-miles in the afternoon. I also practice qi gong every day along with Zen meditation. It helps that I work from home and internationally with Asia, so usually I've done 2-3 hours work by 8am, so then take off for a couple of hours walking before getting back to work. I have masses of energy, which is partly because I've always had loads (even a relapse, though it slows me a bit, doesn't stop me walking etc) and partly because walking in wonderful nature always makes me feel happy, revived and energetic.

  5. “I know many of you very disabled and are not capable of ordinary exercise; if this is the case you should ask to be referred to a neuro-physiotherapist who can help devise an exercise programme for you.”
    I am not what is considered “very disabled”, but due to fatigue and weakness (especially leg weakness) had no hope of sticking to any sort of exercise program. I did consult a physio with a special interest in MS, and asked for a collection of appropriate exercises I could do in 5 minute “bursts”, as I knew I needed to try and build up some muscle strength – the old not been using it so I was losing it scenario. An ever increasing part of the problem was the vicious cycle of depression related inertia leading to inactivity leading to less strength leading to less capacity and so on round in circles – for me making even attempting the exercises a mountain that was too high to climb.

    Having had a couple of bouts of endogenous depression many years ago, and had them treated through use of antidepressants I knew about their side effects and the problems with weaning off some of those meds. For well over ten years I have successfully kept depression out of my life (despite dealing with more nasty major life events than many people), largely through using practical coping skills learnt through cognitive behavioural therapy.

    Having MS ain’t much fun, and being depressed is equally horrible (although usually fixable to a greater or lesser extent), but the two together - well – enough said.

    And I know there are various posts on here about depression as a side effect of Interferons, and warnings from manufacturers to watch out for this. When my GP wanted me to start on antidepressants I knew things could not keep going as they were. Some action was in order. After very careful consideration, I’ve stopped my interferon for the time being, and lo and behold, within two weeks the depression had significantly lifted, my fatigue is a bit more manageable, I’ve even been out and managed to do some gardening. Now, a bit over a month after stopping the meds, I actually have some motivation to do things, and the feasibility of doing the exercises that the physio recommended seems in reach now.

    So – what’s my message in all of this? I believe that inertia caused by being depressed can be as big a barrier to exercising as a lack of physical capacity, despite any objective knowledge you may have that exercise can help with depression. I’m hoping that my previously downwards spiral of decline now has a chance of becoming an upwards spiral of improvement – and so far it’s looking promising.

    (Note – this is not a recommendation to stop any meds, but my observations on the inter-relatedness of it all, and the need for a holistic approach to find what may work for each individual).


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