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Depression is considered a mental health problem characterized by a lack of physical interactions, continuous low mood, and many other emotional and behavioral symptoms. Anxiety and depression are on a rise as major mental health problems across the world. Even though many available and effective treatments exist, they are very expensive, while only less than half of the patients would show positive results. Additionally, there has been some evidence provided that lifestyle factors, such as lack of physical activity or diet may become the potential target for new methods to prevent depression and anxiety. In fact, the quality of diet has stolen the attention in mental health research most recently. Chronic stress, alcohol, and drug use, and even exposure to sunlight/vitamin D are also very significant factors in the maintenance of depression and anxiety. 1, 2 This is the reason why many agencies have started to focus more on the prevention of both depression and anxiety.
Physical exercise has been always associated with multiple health benefits. Reduced overall mortality, stress regulation, and reduced risks of cardiovascular diseases or obesity are only a few to mention. Any kind of physical exercise alternates the activity of the autonomic nervous system as well as cognitive functioning, angiogenesis, neurogenesis, and plasticity.1, 3 Hippocampal volume, white matter integrity, and higher levels of neurotrophic factors in healthy older adults and patients with schizophrenia have increased due to physical exercise.4 In fact, some of the studies evidence that regular physical exercise can treat mild or moderate depression. Furthermore, the same studies also state that physical activity can also improve self-esteem, coping with stress, social contact, and independence, which are important factors of depression. On the other hand, different controlled studies assert that there is not enough evidence of positive association provided by observational studies.2, 3 The evidence base for positive effects of physical activity on depression is more established overall, although the exact conditions of an exercise should be more controlled and specified to convey a beneficial effect. A small number of studies contend that exercise, the use of antidepressants, and psychological therapies have the same effectiveness. Surprisingly, response rates touched 10% in the anti-depressant groups compared to 60% in the combined treatment group.1, 2 Chekroud et al. found that physical activity in a group (eg. Participating in a popular team sports) evidences the greatest positive correlation with mental well-being because it induces motivation, communication, and social activity. Moreover, mindful exercises such as yoga, or tai chi have been also coupled with lower mental health burdens.3
Physical activity implies more occupational tasks compared to physical exercise, which is considered a regular, structured, and leisure-time pursuit (10-12 weeks). Both have proven benefits for the cardiovascular system however, psychological effects have been evidenced only for physically organized exercise.5 Developing an exercise program for a patient with depression varies from the plan for healthy individuals and requires skilled physical therapists to be mindful of all possible interfering problems. Before individual treatment, physical therapists have to identify somatic diseases and patient medical history, nevertheless, the risks are usually minimal when starting with low-intensity activities.2 Additionally, the discussion about patients' barriers is necessary before starting the organized program as well as setting achievable goals.2 Prolonged activity of muscle groups induced by jogging, or any other aerobic activity, which is crucial to cardiovascular conditioning, has stolen all the attention in psychological research from anaerobic activity, such as weight lifting. The usual measure of aerobic fitness includes measuring oxygen uptake at maximal exertion (VO2max) however, this type of measurement has limitations on the technical and ethical sides. The most convincing fact that physical exercise has some effect on psychological processes was shown when mood had been measured immediately before and after exercise, which the person was already familiar with. Once the exercise becomes competitive, the effects on the mood depend on the result.5 Contrarily, when the exercise was performed in more intense exertion than a person's average level, the mood worsen and decreased all positive thoughts. Extreme volumes of more than 23 times per month, or sessions longer than 90 minutes were proved to worsen mental health.3 For diagnosed depressed and anxious patients, submaximal levels are the most recommended. The high state of anxiety patients can terror that maximal aerobic activity leads to borderline physiological reactions such as tachycardia, dizziness, or hyperventilation, which provokes panic attacks. These are only some of the reasons why the six-minute walk tests and the Franz ergo cycle test are the most frequently used.2, 5
The evidence from human and animal studies reveals that cellular processes through which physical exercise stimulates neurogenesis and cognitive performance are closely connected with an increase in brain-derived neurotrophic factors (BDNF), which is the most abundant growth factor in the human brain.4
Little differences in each study will never give a definitive conclusion.
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