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The Mental Elf

‘Exercise doesn’t help with depression’ – have the headline writers got it wrong again?

Andre Tomlin

Back from my 5-mile run around the woodland yesterday morning I sat down to catch up on the latest elf stories.

Many of the national newspapers reported on a new randomised controlled trial published in the BMJ, which studied ‘facilitated physical activity’ for people with depression.

The headlines seemed to be in agreement:

Anyhow, this all came as a bit of a surprise to me.  I’ve always thought that exercise was a good thing and certainly something that people with poor mental health should be encouraged to take up.  I always feel invigorated and ready for the day after my early morning Chariots of Fire shenanigans.

What’s more, there has been a lot of evidence published (even in the last few months) supporting the links between physical exercise and good mental health, so what’s going on?

Looking at the paper in the BMJ I see that the research was conducted in general practices in Bristol and Exeter.  361 adults with depression were randomised to one of two treatments:

  1. Usual care
  2. Usual care plus three face-to-face sessions and 10 telephone calls with a trained physical activity facilitator over eight months (the aim being to offer tailored support and encourage people to take part in more physical activity)

It’s a well conducted trial with a good sample size and excellent randomised design.

The outcomes of interest were:

  • Depression symptoms
  • Use of antidepressants
  • Physical activity

Here’s what they found:

  • At 4 months and at 12 months, the patients who had been encouraged to exercise did not have better mood than the patients who had received usual care
  • Patients who had been encouraged to exercise did not reduce their antidepressant use
  • However, at 4, 9 and 12 months, the patients in the physical activity group did report significantly more physical activity than the usual care patients

The authors concluded:

The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone.

Now is it just me or is this a long and winding road away from ‘exercise doesn’t help with depression’?

  • The study did not assess whether exercise helps to prevent depression
  • It looked at one intervention, but there are many other exercise programmes that have been shown to work well
  • And of course we know that exercise helps prevent obesity, reduce the risk of diabetes and help with cardiovascular fitness; all potential health issues for every man, woman and child who ever got depressed.

Us elves have a lot of sympathy for health writers. Most of the articles I read yesterday were actually very balanced and well informed.  As usual it was the headline writers who got it wrong; trying to grab your attention and sell some newspapers!

Link

Chalder, M. Lewis, G. et al Facilitated physical activity as a treatment for depressed adults: randomised controlled trial. BMJ 2012; 344 doi: 10.1136/bmj.e2758 (Published 6 June 2012)

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Written by

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

Add a comment
  • Chris

    Chris

    14 years ago
    Bravo to you for pointing out the utter rubbish being spouted by the press on this... although I wish more doctors would, whilst pushing exercise on people as a remedy for depression, remember that it does not in fact help everyone with depression. It's great for people it helps, but when you're one of the people who simply becomes even more exhausted and collapses into bed for the rest of the day, it gets pretty fricking annoying when every healthcare professional you meet goes on at you about the powers of exercise (and then if you tell them you've found it just exhausts you, they assume you've just never kept it up for long enough). Sorry for the rant. Obviously this cannot apply to every healthcare professional out there. Just every one I've ever dealt with.
  • Sarah Graham

    Sarah Graham

    14 years ago
    Well, I personally swear by exercise for counter-acting depression. For me it helps if I do something I really enjoy like tap-dancing or walking/cycling in the countryside. It really sets me up for the day if I do a half hour walk, say, increasing my energy levels, my sense of being able to cope, and greatly enhances my sense of well-being. I have been on many different kinds of anti-depressant in the past, and I feel that pleasurable exercise (whatever kind floats your boat) is far more effective in improving mood than any prescribed medication. Guess the fresh air, and being in nature also help. Hope my thoughts are helpful to someone out there?! Poppy!
  • wendy

    wendy

    14 years ago
    They basically showed that in people with depression, encouraging them to exercise doesnt actualy increase the amount of exercise. And therefore by not actually exercising more, depsite encourgaement, you dont get any less depressed. Groundbreaking it isn't wx
  • The Mental Elf

    The Mental Elf

    14 years ago
    It’s been a very interesting day on Twitter. I’ve had a lot of feedback on this blog and thought I’d summarise it here for readers. Overall, the response was extremely positive. My followers felt that I had highlighted an important issue about poor headline writing in the media. ‪ @AlisdairC summed it up nicely, well flatteringly: “Getting irked at the false 'debate', arising from misreporting of the story. @Mental_Elf nails it” Cheers Alisdair! And one of my own favourite bloggers (Julia Belluz from Science-ish) concurred: @juliaoftoronto "Excellent analysis by you, an over-selling/mis-rep of science in headlines to get eyeballs". I was interested to see that the BBC changed their headline during the afternoon. It read: “Exercise ‘no help for depression’, research suggests” in the morning, but by mid-afternoon this had changed to “Depression: Exercise advice questioned when added to standard treatments”. I also had some great feedback from Branwen Jeffreys, the BBC Health Correspondent who wrote the excellent article, including the comment that she had no involvement in writing the original headline. ‪@branwenjeffreys “I didn't write original one - added by subs overnight!” This is something I’ve heard from a few health journalists over recent weeks. I attended a great workshop last week, put on by the team from Sense About Science, where BBC Science Correspondent Tom Feilden, former Daily Mail Science Editor Mike Hanlon and former Sun Health Editor Jane Symons all commented on the lack of control they have over headlines. Sub-Editors have a lot to answer for when it comes to writing potentially misleading, or sometimes just plainly inaccurate headlines, but I guess there’s always going to be a tension between providing accurate information and selling the story! This was very much the case with the media stories on this research, which were on the whole well researched, clearly written and well-balanced articles. It was the attention grabbing headlines that did the damage. In this Twitter-friendly sound bite age, we often just read the headline and that can communicate misinformation that has a big impact. I also received ‘party-line’, but nonetheless very helpful responses from the Royal College of Psychiatrists, the British Psychological Society, Mind and Sane. All highlighting the importance of exercise for people with depression and sticking to their guns by saying they will continue to promote physical activity. This message was echoed by a number of GPs, including @andyhersh: “Excellent article. I shall continue to push exercise in those with depression. Beneficial on numerous levels”. All in all, a satisfying day in the Twittersphere for this little Elf. Now, I’m off for a game of 5-a-side with the Lifestyle, Dental, Diabetes and Learning Disabilities Elves. We’re playing the Pixies from the next woodland along and they normally stuff us with their long balls and strong headers in the final third. We’ll lose 17-2 again no doubt, but I’ll feel better after a bit of a run around. Tally ho! The Mental Elf
  • Ka Hang Leoungk

    Ka Hang Leoungk

    14 years ago
    Haha, great how you included The Sun's headline... On a more serious note, it just shows how important it is for health (and science) writers to get their point across to the public. Many people only ever read headlines and as you say, a lot of them are misleading to get your attention. A while back there was fuss over the health and science writers not really looking at the studies and research and just paraphrasing the press releases, so at least it's good to know that most are pulling their weight again.