Exercise and Depression: I hate to cry and run, but...

I hate to cry and run, but…
Research Review

By Krista Scott-Dixon

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Winter’s on its way in the Northern Hemisphere. For some of us, less sunlight and colder temps means Seasonal Affective Disorder — we’re sad with SAD.

Normally in our research reviews we focus on quantitative studies — you know, number stuff. We’re sciencey like that.

This week we’re doing something a little different, and tackling a qualitative study.

After all, it’s hard to quantify certain things. Sure, shampoo commercials might try to tell you that people’s hair became 32% bouncier and 17% more fabulous after washing with their product.

But in the real world, it’s difficult to put numbers on a lot of important facts about life. Qualitative studies are useful for studying things like people’s ideas, opinions, and experiences.

This week we look at the relationship between exercise and depression.

Depression is a major health problem affecting the industrialized world. In fact, according to global statistics, it’s the #1 mental health problem. (Even for dogs.)

sad-dog

We also know that depression doesn’t seem to affect men and women equally. Women seem to get the blues more than men — approximately 20% of all women (1 in 5 women) will experience depressive symptoms at some point in their lives.

There are many possible reasons why: social factors (such as social inequality), economic stress, physical factors (such as brain chemistry or hormones), etc. We still aren’t completely sure why this gender difference exists.

In any case, there are definitely a lot of bummed-out people out there.

Research question

Exercise is an important part of treating or preventing depression. We know that exercise such as running makes people feel better mentally and physically, but we don’t fully know why. Like depression, exercise benefits are complex.

This week’s review looks at how women use distance running to make themselves feel better. Looking at women’s experiences of using exercise to treat depression might give us some insight about how exercise helps.

Leedy, Gail. “I can’t cry and run at the same time”: Women’s use of distance running. Affilia: Journal of Women and Social Work 24 no.1 (February 2009): 80-93.

Method

Qualitative studies are often seen as less rigorous than quantitative because they don’t make measurements.

However, again, it’s really hard to numerically measure people’s experiences. So in this case, the researcher simply collected women’s stories by interviewing them, and analyzed the stories together to look for common ideas.

Woman-on-the-street perspective

Along with enabling us to understand people’s experiences, qualitative interviews can validate the knowledge of “ordinary” people.

Participants don’t have to be particularly special, experts, or celebrities. Asking people about their stories can help us understand the experiences and worldviews of “average folks” (instead of “experts”).

You could almost think of this as the difference between “expert knowledge” and “common sense”.

If you were to interview your great-grandmother about nutrition, you’d probably get a much different explanation about how to eat than if you interviewed an “expert”. (And frankly, your great-grandmother would probably be more correct, since “experts” have told us that margarine was safe and zero-fat diets were a great idea.)

Researcher investment

Also, in certain kinds of qualitative studies, the authors state their “bias”, or their investment in the subject.

In quantitative work this is seen as a drawback (even though all researchers have a given perspective, and stating it up front would often be very helpful).

In qualitative work, stating one’s personal interest in the subject is seen as useful. It provides context, and it offers more insight. And it clearly identifies how the author is approaching the subject. For example, why would a researcher choose this topic?

In this case, the author explains that she herself struggled with depression, and used long-distance running to deal with it. This inspired to her to ask whether other women were doing the same thing.

Choosing participants

In this case, the researcher wanted depth rather than breadth. Typically, qualitative studies have smaller sample sizes than quantitative studies, although we’ve certainly profiled quantitative studies in this column that used only a handful of people. When it comes to qualitative research, size doesn’t always matter.

The researcher started with 131 runners who wanted to be interviewed. She then whittled down the pool until she found 13 women who met the exact criteria:

  • they had experienced a time of stress or crisis;
  • they had used running to help them during that time;
  • they lived within 100 miles of the original race site; and
  • they consented to participate in an interview.

Out of 13, she picked 5 to interview: Martha, Susan, Lori, Theresa, and Linda. (Note! Subjects are given names. Interesting how this automatically changes our relationship to them, isn’t it?)

Semi-structured interviews

The researcher used a semi-structured interview format. This means she had some general question areas she wanted to address, but the interview would be more like a conversation than a survey.

Her guiding questions were:

  • During ordinary times, what are the benefits and meaning of running for you?
  • What was the emotional stress or crisis you experienced? Please explain what this experience was like for you.
  • What was your running like during this period, and how did it help you through this crisis?
  • What role has your running taken since the resolution of this critical period?

Results

About the participants

Let’s get to know the 5 women briefly.

Martha

  • 43 years old
  • Running for 8 years
  • Dealing with a divorce; drinking problem; suicidal thoughts

Is running an addiction?
Yes, “but it’s a good one… It makes me feel good.”

Why does running work for you?
“It’s probably better than getting violent, throwing the coffee cups around. It’s an outlet that’s constructive and not destructive.”

Susan

  • 42 years old
  • Running for 3 years
  • Dealing with aging and difficulties with adopted child

What do you like about running?
“Glorious! You’re just out there, and nobody knows you. I can be someone else. It’s so neat.”

Running brings her closer to her husband, also a runner.

“When I had huge problems with my daughter, I could think of my successes as a runner!”

Lori

  • 37 years old
  • Running since college
  • Dealing with several deaths in her family, including father’s suicide

After finding out about her father’s suicide…
“I went out and ran five miles. And that was one of those days I got blisters on my feet. I went out and pounded out my anger.”

Theresa

  • 41 years old
  • Running since early adulthood
  • Dealing with several deaths in her family, marital problems, severe depression

What did running mean to you during these time?

“Even when the floor was shifting and the carpet was being taken out from underneath me, in terms of my professional identity with no family grounding, running was something I had that was mine.”

“I think [there was] something about the repetitive movements, the relaxing rhythm of feet — breathing. I looked around and breathed the air and looked up at the sky and at the changes on the trail.”

Linda

  • 40 years old
  • Running since late 20s
  • Dealing with divorce; guilt over children
  • Found two female running partners for companionship, listening, mentorship, and “running therapy”

What do you like about running?
After running, “I have energy. It’s the type of energy where your body is sort of tired, but your soul and your head [are energized]. It’s like you accomplished something that day.”

Common themes

After collecting the women’s stories, the researcher analyzed them together, and came up with some common themes.

  • Running in general promoted health and empowered the women.
  • In times of crisis, running acted as therapy, providing women with a coping mechanism.
  • For some women, the social aspect of running was important — running with loved ones, friends, or a group/team.
  • For other women, the solitary aspect of running was important — being able to be alone with one’s thoughts and feelings.
  • Running improved women’s sense of self-efficacy and self-worth: it made them fit, gave them goals, provided a sense of accomplishment, and offered them an identity (i.e. “I’m a runner”).
  • A regular running routine provided structure — the women felt badly if they didn’t run (but they didn’t feel guilty or shameful; they felt badly because they knew they’d missed something that would make them feel good).

The benefits of physical activity, especially running, thus occur in several areas:

  • Physical/biochemical, e.g. endorphins released during exercise, having more energy
  • Cognitive, e.g. focus on something other than problems (or being able to focus on and work through problems)
  • Emotional, e.g. experiencing happiness while running
  • Psychic/existential, e.g. a sense of identity in a time of crisis; sense of accomplishment and self-worth
  • Social, e.g. having running companions and social interaction
  • Preventive/habitual, e.g. one cannot do negative things while running (Martha couldn’t drink, for instance); running as a habit can displace other addictions

However, the researcher also noted that despite important similarities, each woman had an experience that was unique. Thus, it’s important to understand that certain things are the same (or related), but also that people are diverse.

Conclusions

Anti-depressant/anti-anxiety medications are one of the most prescribed (and over-prescribed) classes of drugs in North America. These drugs have many undesirable side effects (including negative effects on body composition). And people spend billions on them.

In comparison, exercise is a low-cost, low-tech, entirely beneficial way to manage depression and mental health issues.

In this study, running helped five women work through serious crises in their lives, and emerge stronger and happier. It would be interesting to know whether other types of exercise have the same effect, or whether there’s something special about running.

For example, one might argue that an endurance sport that’s usually done outside might have different effects than, say, a short interval-type sport (e.g. sprinting), or a team-based sport, or a sport where there isn’t as much sustained exertion (e.g. baseball or golf), or a sport done inside (e.g. does light exposure or natural surroundings change one’s experience?)

I’d guess that each sport has its advantages, and the most important factor is finding a sport that fits one’s “exercise personality”.

Another question is whether this type of study would show similar effects in men. I’d guess that it would; men’s experiences might be much like women’s. Or there may be a few key differences, such as the degree to which men are likely to internalize feelings like anxiety, guilt, and sadness.

Bottom line

It might not fix every downer, but regular exercise is certainly cheaper and safer than pharmaceutical alternatives.

And people who do it end up in better shape — something that antidepressants certainly can’t claim!

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