At least one in ten people have depression at some point in their lives, with some estimates closer to one in four. It’s one of the worst things for someone’s wellbeing – worse than debt, divorce or diabetes.

One in seven Australians take antidepressants. Psychologists are in high demand. Still, only half of people with depression in high-income countries get treatment.

Our new research shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it.

Walk, run, lift, or dance away depression

We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together.

We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as cognitive behaviour therapy – one of the gold-standard treatments for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.

Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.

But of these exercises, people were most likely to stick with strength training and yoga.

Antidepressants certainly help some people. And of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing.

Still, our evidence shows that if you have depression, you should get a psychologist and an exercise plan, whether or not you’re taking antidepressants.

Join a program and go hard (with support)

Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, such as “some physical activity is better than doing none.”

But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression.

We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.

Yes, it’s hard to keep motivated

We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results.

Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.

We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression.

Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result.

Other reviews found it’s important to have a clear action plan (for example, putting exercise in your calendar) and to track your progress (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult.

A 2021 mega-study of more than 60,000 gym-goers found experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted.

Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.

So, when starting out, it seems wise to avoid going it alone. Instead:

• join a fitness group or yoga studio

• get a trainer or an exercise physiologist

• ask a friend or family member to go for a walk with you.

Taking a few steps towards getting that support makes it more likely you’ll keep exercising.

Let’s make this official

Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only conditionally recommends exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”.

Based on our research, this recommendation is withholding a potent treatment from many people who need it.

In contrast, The Royal Australian and New Zealand College of Psychiatrists recommends vigorous aerobic activity at least two to three times a week for all people with depression.

Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.

I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Michael Noetel, Senior Lecturer in Psychology, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

After several highly publicised alleged murders of women in Australia, the Albanese government this week pledged more than A$925 million over five years to address men’s violence towards women. This includes up to $5,000 to support those escaping violent relationships.

However, to reduce and prevent gender-based and intimate partner violence we also need to address the root causes and contributors. These include alcohol and other drugs, trauma and mental health issues.

Why is this crucial?

The World Health Organization estimates 30% of women globally have experienced intimate partner violence, gender-based violence or both. In Australia, 27% of women have experienced intimate partner violence by a co-habiting partner; almost 40% of Australian children are exposed to domestic violence.

By gender-based violence we mean violence or intentionally harmful behaviour directed at someone due to their gender. But intimate partner violence specifically refers to violence and abuse occurring between current (or former) romantic partners. Domestic violence can extend beyond intimate partners, to include other family members.

These statistics highlight the urgent need to address not just the aftermath of such violence, but also its roots, including the experiences and behaviours of perpetrators.

What’s the link with mental health, trauma and drugs?

The relationships between mental illness, drug use, traumatic experiences and violence are complex.

When we look specifically at the link between mental illness and violence, most people with mental illness will not become violent. But there is evidence people with serious mental illness can be more likely to become violent.

The use of alcohol and other drugs also increases the risk of domestic violence, including intimate partner violence.

About one in three intimate partner violence incidents involve alcohol. These are more likely to result in physical injury and hospitalisation. The risk of perpetrating violence is even higher for people with mental ill health who are also using alcohol or other drugs.

It’s also important to consider traumatic experiences. Most people who experience trauma do not commit violent acts, but there are high rates of trauma among people who become violent.

For example, experiences of childhood trauma (such as witnessing physical abuse) can increase the risk of perpetrating domestic violence as an adult.

Early traumatic experiences can affect the brain and body’s stress response, leading to heightened fear and perception of threat, and difficulty regulating emotions. This can result in aggressive responses when faced with conflict or stress.

This response to stress increases the risk of alcohol and drug problems, developing PTSD (post-traumatic stress disorder), and increases the risk of perpetrating intimate partner violence.

How can we address these overlapping issues?

We can reduce intimate partner violence by addressing these overlapping issues and tackling the root causes and contributors.

The early intervention and treatment of mental illness, trauma (including PTSD), and alcohol and other drug use, could help reduce violence. So extra investment for these are needed. We also need more investment to prevent mental health issues, and preventing alcohol and drug use disorders from developing in the first place.

Preventing trauma from occuring and supporting those exposed is crucial to end what can often become a vicious cycle of intergenerational trauma and violence. Safe and supportive environments and relationships can protect children against mental health problems or further violence as they grow up and engage in their own intimate relationships.

We also need to acknowledge the widespread impact of trauma and its effects on mental health, drug use and violence. This needs to be integrated into policies and practices to reduce re-traumatising individuals.

How about programs for perpetrators?

Most existing standard intervention programs for perpetrators do not consider the links between trauma, mental health and perpetrating intimate partner violence. Such programs tend to have little or mixed effects on the behaviour of perpetrators.

But we could improve these programs with a coordinated approach including treating mental illness, drug use and trauma at the same time.

Such “multicomponent” programs show promise in meaningfully reducing violent behaviour. However, we need more rigorous and large-scale evaluations of how well they work.

What needs to happen next?

Supporting victim-survivors and improving interventions for perpetrators are both needed. However, intervening once violence has occurred is arguably too late.

We need to direct our efforts towards broader, holistic approaches to prevent and reduce intimate partner violence, including addressing the underlying contributors to violence we’ve outlined.

We also need to look more widely at preventing intimate partner violence and gendered violence.

We need developmentally appropriate education and skills-based programs for adolescents to prevent the emergence of unhealthy relationship patterns before they become established.

We also need to address the social determinants of health that contribute to violence. This includes improving access to affordable housing, employment opportunities and accessible health-care support and treatment options.

All these will be critical if we are to break the cycle of intimate partner violence and improve outcomes for victim-survivors.

The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.

Siobhan O’Dean, Postdoctoral Research Associate, The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney; Lucinda Grummitt, Postdoctoral Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, and Steph Kershaw, Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.