Krista Glowacki first realized the transcendent power of exercise when a close family member was diagnosed with a serious mental illness.
"I saw them through the ups and downs of being hospitalized and then getting better and going back into the community and daily life," she said. "The healthiest — mentally and physically — I ever saw them is when they lived in B.C. and were hiking or running or walking every single day."
The experience continues to resonate in Glowacki's work — first as an occupational therapist, and now as a University of British Columbia PhD candidate in Vancouver researching the connection between depression and exercise.
The result is a new and free online resource called the Exercise and Depression Toolkit which aims to inform doctors and patients alike on the who, what, why and how of using exercise as medicine.
"As far as we know this is the first tool of its kind that really addresses collaborative decision making between the health care provider and the individual," said Glowacki.
Front line treatment
In 2016, the Canadian Network for Mood and Anxiety Treatment elevated exercise to a front-line, standalone treatment for mild to moderate depression, on par with anti-depressants and psychotherapy.
Exercise promotes the release of serotonin and dopamine in the body — both "feel good" chemicals — although how it helps with depression still isn't fully understood.
According to the evidence, a 30-minute "dose" of moderately intense activity, two to three times a week, can be enough to provide relief.
But prescribing exercise as medicine can be tricky for doctors. And for someone in the throes of depression, starting and maintaining an exercise regime — even a simple one — can be challenging.
That's where the toolkit comes in.
Dr. Renee Jacques says the concept makes a lot of sense. She's been piloting the toolkit in her Sudbury family practice.
"I have found it very valuable," said Jacques.
"I'm someone who really likes handouts and drawings, anything to help facilitate a discussion with a patient and enhance what I'm saying because sometimes I only have 15 minutes.
"When we talk about exercise, if it's not something that's already a part of someone's life, how to [introduce] it can be the most challenging."
Glowacki say the toolkit is also designed to work in the reverse, with patients introducing it to their doctor.
Advocating for exercise
"So somebody with depression could use it to advocate for themselves and bring it to a health care provider to learn more and discuss exercise and what it might look like for them," she said.
Glowacki believes the next logical step in the evolution of depression treatment is for patients to be enrolled directly into exercise programs.
"There are referral schemes in Australia and the U.K. where somebody who gets diagnosed with depression at a GP's office is referred to a leisure activity program with subsidised funding," she said.
Facts about depression and exercise:
- The Canadian Network for Mood and Anxiety Treatment recommends exercise as a standalone treatment for adults aged 18-65 with mild to moderate major depressive disorder.
- Exercise can also be used in combination with other treatments such as pharmaceuticals and psychotherapy.
- Evidence shows exercise to be effective in a dose of 30 minutes at moderate intensity, two to three times a week, for a minimum of nine weeks.
- Physical inactivity can lead to depression and depression can lead to physical inactivity.
- Increased physical activity can induce feelings of higher energy, less fatigue and improve sleep.