Exercise Prescription

Exercise is structured physical activity with the goal of maintaining or improving physical fitness or health. Exercise is a highly effective, but often under-utilized treatment in the management of psychiatric disorders.

• Exercise is thought to improve depression symptoms via reduction in cortisol levels, increased turnover of neurotransmitters, release of endorphins, and neurotrophic factors like brain-derived neurotrophic factor.

• Exercise is not a disorder/disease specific treatment. Various studies have supported its use in:
  • Substance use disorders, posttraumatic stress disorder, and generalized anxiety disorder (leads to large, significant improvements in patient-rated sleep quality).^[1][2]
  • Eating disorders, schizophrenia, and dementia/mild cognitive impairment.^[3]
• Scheduled physical activity can induce improvements in physical, subjective and disorder-specific clinical outcomes.

• Antidepressants alone do not adequately treat many patients with depression.
  • Combining antidepressants with lifestyle changes, such as exercise is supported by well-designed studies.^[4][5][6][7]

• Animal studies indicates that exercise enhances brain development and overall behavioural functioning.
• Studies in children with attention-deficit/hyperactivity disorder suggest that both short-term (≥20 minutes) and long-term (≥5 weeks) of moderate-to-vigorous physical activity can improve ADHD symptoms and neuropsychological functioning.^[8]

• Exercise at least twice weekly of moderate intensity may provide benefits in cognition for individuals with mild cognitive impairment.^[9]

• In general, exercise is well tolerated, with adverse events rarely reported.
• Both cardiovascular (aerobic) and resistance (anaerobic) exercise reduce depressive symptoms, with no superiority of one over the other.
• Population studies show that participation in physical activity may prevent the onset of depression.^[10]

• Recommendations for total exercise time vary according to different studies.
• In the depression literature, at least 30 minutes of supervised, moderate-intensity exercise at least 3 times weekly for at least 9 weeks is recommended.
• As with any physical interventions, the participant's physical fitness needs to be taken into account as well.