Sport and depression: getting life moving again
“Physical activity is a powerful therapeutic tool. But it is not an alternative to other forms of treatment. It complements them.” For Dr Nicolas Juenet, Group Deputy Medical Director Psychiatry at emeis, the challenge is no longer to pit medication, psychotherapy and non-pharmacological approaches against one another, but to combine them in the best interests of each patient.
Complementary approaches: genuine therapeutic tools
Whilst medication remains essential in certain situations, complementary approaches are gradually gaining ground in scientific guidelines. Physical activity is now recognised as a genuine therapeutic tool. Available research shows benefits in terms of depressive symptoms, anxiety, sleep disorders and the prevention of relapses.
“It is impossible to study the effects of physical activity in exactly the same way as those of a drug. Participants inevitably know whether or not they are engaging in physical activity, which makes it impossible to establish a true placebo group,” explains Dr Nicolas Juenet. Despite this methodological difficulty, the results are consistent. But for the psychiatrist, the main benefit of physical activity may lie elsewhere: in everything it gradually sets in motion in patients’ lives.
Depression, an illness that paralyses
Depression is often characterised by a loss of drive, motivation and self-confidence: “Patients are sometimes convinced that they are no longer capable of doing anything,” observes Dr Juenet. The aim is therefore not to immediately turn patients into accomplished athletes. In some severe cases, a victory may simply consist of getting up, leaving one’s room or walking for a few minutes down a corridor: “Successfully completing an activity, however modest, already helps to restore a sense of personal efficacy,” explains the psychiatrist.
This gradual return to activity is in line with the principles of behavioural therapies: doing something, however small, restores confidence and encourages further action. Conversely, setting overly ambitious goals can be counterproductive: “Telling someone who has never run before that they must train for a half-marathon is probably the best way to reinforce their sense of failure,” he illustrates.
Much more than a question of sport
The benefits of physical activity are not limited to the exercise itself. Taking part in sport also means getting out of the house, getting back into a routine, being exposed to natural light and rebuilding social connections: “Activities carried out in a group and in the open air seem particularly beneficial, as social connection and natural light are themselves important therapeutic factors,” emphasises Dr Juenet.
Sometimes, the benefits come from very simple things: walking with other patients, passing a ball around during a gentle exercise session, or playing a game of pétanque together.
These moments encourage interaction and enjoyment, and gradually help patients to emerge from the isolation into which the illness often traps them.
Finding an activity that appeals to you
Whilst brisk walking, running, yoga and strength training are among the activities that have shown the best results in studies, the choice of activity must, above all, be driven by the patient: “The most effective physical activity will first and foremost be the one the person feels capable of doing and, above all, the one they want to do,” insists Dr Juenet.
This approach also means respecting each person’s own pace. Some patients, keen to return to their previous level quickly, may want to push themselves too hard, at the risk of injury. Those around the patient can play a supportive role if they wish, provided they do not resort to giving orders: “I have never seen a patient recover from severe depression simply because they were told to go for a run,” he emphasises. The key is to offer suggestions without pressuring them and to celebrate every bit of progress.
Whilst general guidelines recommend around 150 minutes of moderate physical activity per week, the psychiatrist points out that, in cases of depression, the key is to take things gradually: simply getting back into exercise is already a first therapeutic victory.
Finding an activity that reignites motivation through the emeis approach
At emeis clinics, adapted physical activity (APA) forms an integral part of the care pathway. Following an assessment carried out by the multidisciplinary team, various activities may be suggested depending on the patient’s abilities, preferences and clinical progress: walking, yoga, gentle gymnastics, strength training, cardio training, pétanque, horse riding, rowing or group outdoor activities. “Our aim is not to decide that a particular sport necessarily corresponds to a particular profile, but to offer a sufficiently wide range of activities to allow patients to choose what interests them,” emphasises Dr Nicolas Juenet.