Mindfulness physical therapy, pain management, rehabilitation

Training Fast or Slow

In a study examining exercise training intensity in the treatment of depression, Helgadottir and colleagues, randomized 620 individuals with mild to moderate depression to four treatment arms: treatment as usual (TAU) (n =310), light exercise (yoga-based stretching or similar, n = 106), moderate aerobic exercise (n = 105) and vigorous aerobic exercise (n = 99).1 Thirty-two percent of participants participated in at least 12 sessions over 12 weeks and were considered intervention compliers. No significant differences were found regarding percentage of compliers between the groups. Depression was assessed on the Montgomery-Asberg Depression Scale.

At post-treatment, the exercise groups reduced depression scores significantly more than TAU. The mean reductions in depression scores from baseline to post-treatment were as follows: TAU – 5.34, light exercise – 9.40, moderate exercise – 7.43 and vigorous exercise  – 8.48.

Although there were no significant differences between the exercise groups at post-treatment, the difference between the light and moderate exercise groups approached statistical significance (p = 0.095).

These results suggest benefits of light exercise, such as gentle yoga, in the treatment of depression. Researchers propose that individuals with mild to moderate depression might find light exercise more enjoyable, easier to perform and thus promote self-esteem and feelings of mastery.

Many patients with chronic physical health problems also experience depression. I find my MBSR class participants appreciate gentle yoga. When I first began teaching, I included more challenging poses. With experience, I gravitated toward simple stretching poses and especially emphasized bringing mindful atitudes to movement. Participants taught me that they could benefit from learning to move with acceptance, kindness and curiosity. For this population, sometimes less is more. Once comfortable and confident with light exercise, then a more challenging exercise program can be introduced.

1Helgadottir B, Hallgren M, Ekblom O, Forselly. Training fast or slow? Exercise for depression: A randomized controlled trial. Prev Med. 2016;91:123-31.