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A Different Kind of Prescription for Depression: Strength Training

September 28, 2023

Angela Kuntz, MD, PMH-C, Psychiatrist - Medical Director of Admissions & Women's Psychiatry 

The Impact of Exercise on Mental Health

“How often are you able to exercise?” The psychiatrists typically ask this question during a HopeWay admission visit as a health metric requirement. We find that the answers vary. Some individuals have a regular exercise regimen, but most clients tell me they are not able to exercise at all. Maybe working out was something they were regularly doing in the past, but the severity of their depression has prevented them from getting out for their routine walk or going to the gym. They may have acute or chronic pain impacting their mobility, or they’ve never had an exercise routine before. Many share this with shame in their voice. Even though they perhaps know they should be exercising, it is often the furthest thing from someone’s mind when they are already struggling with just getting out of bed or brushing their teeth.

The Science Behind Exercise and Depression

When coming out of a depression, clients sometimes ask what they could do in addition to (or sometimes instead of) taking prescription medications to improve their symptoms and prevent relapse. Many people know that exercise can help with various physical health concerns - cardiovascular, bone health, and reducing the risk for diabetes.

Strength and Resistance Training

It also helps with depression, but some may not know the science behind why. Numerous studies have shown that various forms of exercise can improve depression symptoms (as well as anxiety symptoms), but strength or resistance training has shown some of the most substantial benefits. It has even shown similar effects to antidepressant medications3. Strength training can also enhance the results of antidepressant medications and other treatment approaches. For example, incorporating strength training 3 times per week can further support the benefits of antidepressant medications and talk therapy.

Clinical Trials on Resistance Training and Depression

A 2018 meta-analysis reviewing 33 clinical trials concluded that resistance training substantially reduced depressive symptoms in the adults studied. These improvements were evident regardless of age, gender, and health status. Even if there was no overall improvement in strength or fitness, the improvements in depression from resistance training were still apparent.On a molecular level, strength training and combined strength/aerobic training (as well as HIIT or High Intensity Interval Training)4 have shown increases in peripheral BDNF (Brain-Derived Neurotrophic Factor), which is essentially the equivalent of “Miracle-Gro” for the brain. Throughout adulthood, BDNF can continue to help support the survival and maintenance of neurons, and is found in high levels in the hippocampus, the part of the brain where memories are formed5. Antidepressant medications have shown similar increases in peripheral BDNF6.

Beginning With Progressive Strength Training 

While the benefits of exercise, specifically strength training, are apparent, starting a new exercise regimen is not always easy. I often recommend starting with progressive strength training.

What is Progressive Strength Training

Progressive strength training is when one adds gradual weight increases each or every few sessions. For example, for large muscle groups, adding 5 pounds each training session is usually sufficient. For someone just starting out, Day 1, try five repetitions, for three sets with just body weight, Day 2, use 5lbs weights, Day 3, use 10lbs weights, and so on. Make sure to include rest in between sessions (typically 1 - 2 days).

Benefits of Progressive Strength Training

One of the other benefits of progressive strength training is how it can build confidence. Someone can visually see steady strength gains as the body is able to (with correct form) quickly adjust to increasing stress/weight loads. This can be very empowering and motivating.

For many individuals, exercise is just one tool to help address depression in addition to talk therapy and pharmacologic treatments or other regular healthy habits. It is important to speak to a physician about what type of exercise is most appropriate. Also, one should always speak with a provider before changing any aspect of their current treatment regimen. The body and brain, at all ages and fitness levels, are capable of remarkable progress. Strength training can lead to changes beyond the physical body, making our minds and mental health stronger.

Tips to Begin Your Strength Training Journey:

1. Start light: Use the lightest weights or just body weight initially to improve form and avoid injury.
2. Go slow: Aiming to lift just one to two times a week is best in the beginning, and always give your body time to rest between workouts.
3. Get help: Consider finding a personal trainer or downloading a workout app. There are often free exercise options available online.
4. 4 recommended exercises to start with:
 - Deadlift Squat - Overhead press - Squat - Bench press
Repeat 3 sets, 5 repetitions per set. Add 2-5 lbs each time you go to the gym until this plateaus. It can take several months until you achieve your maximum weight.

Dr. Angela Kuntz is an Iowa native. She earned her Bachelor of Science with a major in Integrative Physiology and minor in Psychology at the University of Iowa. She also earned her Doctor of Medicine at the University of Iowa Carver College of Medicine. While in medical school she completed the Service Distinction Track, with a focus on providing mental health services to the underserved and completing a project on the Adverse Childhood Experiences Study (ACEs). She then moved to North Carolina for the excellent psychiatry training available at University of North Carolina at Chapel Hill. She served as chief resident while at UNC. She has specialized interest and training in Women’s Mental Health including Perinatal Mood Disorders.

Footnote/ citations: 1. Dr. David Puder- - obtained direct permission to utilize his podcast for inspiration and several articles referenced. 2. Gordon, B. R., McDowell, C. P., Hallgren, M., Meyer, J. D., Lyons, M., & Herring, M. P. (2018). Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA Psychiatry. 3. Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M., Watkins, L., Hoffman, B. M., Barbour, K. A., ... & Hinderliter, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic medicine, 69(7), 587. 4.) Jiménez-Maldonado, A., Rentería, I., García-Suárez, P. C., Moncada-Jiménez, J., & Freire-Royes, L. F. (2018). The Impact of High-Intensity Interval Training on Brain Derived Neurotrophic Factor in Brain: A Mini-Review. Frontiers in neuroscience, 12, 839. 5) Marinus, N., Hansen, D., Feys, P., Meesen, R., Timmermans, A., & Spildooren, J. (2019). The Impact of Different Types of Exercise Training on Peripheral Blood Brain-Derived Neurotrophic Factor Concentrations in Older Adults: A Meta-Analysis. Sports Medicine, 1-18. 6.) Zhou C, Zhong J, Zou B, Fang L, Chen J, Deng X, Zhang L, Zhao X, Qu Z, Lei Y, Lei T. Meta-analyses of comparative efficacy of antidepressant medications on peripheral BDNF concentration in patients with depression. PLoS One. 2017 Feb 27;12(2):e0172270. doi: 10.1371/journal.pone.0172270. PMID: 28241064; PMCID: PMC5328267.


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Editor’s note: This blog post is presented for informational purposes only and is not meant to diagnose or treat any illness. If you have any health concern, see a licensed healthcare professional in person.