Bringing exercise into depression care: Why it’s critical to equip practitioners with the right tools
By elevating physical activity from anecdotal advice to evidence-based intervention, the door is open to setting a new standard for how people treat, talk about, and move through depression
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This article was produced by the Healthing editorial team with the support of a grant from Canadian Society for Exercise Physiology. While the CSEP made the production of this article possible, they did not have any editorial influence or control over the content, including review prior to publication.
I’ve lived with depression for a long time, maybe 15 years, but I never asked my doctor for help or advice until recently. I’d fill out questionnaires about depression, ticking off the boxes for self-diagnosis. But what worked for me was running.
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I started about 10 years ago and just love the feeling of running outside, appreciating the sights and sounds of my neighbourhood and occasional forest trails. The energy and mood lift from this regular routine have been incredible for me and my depression. I even ran a half marathon in Ottawa with my sister! (She’s an inspiration.)
Exercise as a therapy for depression
A compelling paper on the effects and mechanisms of exercise on the treatment of depression in Frontiers in Psychiatry found that exercise has therapeutic effects on depression in all age groups (mostly 18 to 65 years old), as a single therapy, an adjuvant therapy, or a combination therapy.
Most important, the authors say, is that the benefits of exercise therapy are comparable to traditional treatments for depression. This is critical to note because commonly prescribed prescription medications carry the risk of potential side effects and there are barriers to accessing talk therapy, including cost and wait times.
The researchers also found that moderate-intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. “Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions,” the study says.
But what about people who live with depression who don’t gravitate toward physical activity or were never interested in sports as kids, and wouldn’t really know where to start even if they wanted to? Maybe they’ve read about the benefits of exercise for mental health, which are well-documented, or perhaps a doctor has suggested getting active to help relieve their symptoms of depression, but they don’t know where to turn.
Gyms can be overwhelming and intimidating for people, not to mention costly. And while there’s typically all kinds of community-based fitness classes to join, from water aerobics to salsa dancing, they might try something once and decide it’s not for them.
So, how do you solve this so more people living with depression can be motivated to get active on a regular basis?
This is a pressing matter when you look at the prevalence of depression and its sheer impact on society. The Global Burden of Disease project revealed that depression is the most serious disease burden of non-fatal neuropsychiatric diseases, projected to be in the top three of all disease burdens by 2030. The annual cost of days lost to depression and anxiety worldwide is estimated at $1.15 trillion and is expected to triple by 2030. The treatment and prevention of depression is widely studied.
“We can make the case that sweat is the best antidepressant I think,” says Dr. Guy Faulkner, professor in kinesiology at the University of British Columbia in Vancouver, B.C. “It’s not necessarily better or worse than medication or talking therapy. But the evidence demonstrates that the effects are comparable.”
“And there are added advantages of physical activity or exercise that we don’t see with medication or therapy. So, you know the physical health benefits are guaranteed that you’re not going to see with other types of treatments,” he continues.
Physical activity delivers on disease prevention, strength, balance, bone health, cognition and more, as well as relieving symptoms of depression.
Putting research into action for people with depression
Faulkner leads the university’s Population Physical Activity Lab that conducts research on physical activity and mental health, and leads initiatives to engage people in physical activity, also helping to identify and overcome factors that keep people inactive and sedentary.
He points out that Canada is one of the first countries in the world to recognize exercise as a frontline treatment for depression, based on the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines in 2016, which he helped to develop. They’ve been recently updated, providing evidence-based clinical guidelines for the diagnosis and treatment of adults with Major Depressive Disorder (MDD), designed for community-based psychiatrists and mental health professionals.
“It’s really trying to create additional treatment options for people so that they can consider the strengths and weaknesses of different approaches and try one that suits them,” Faulkner says. “Now clearly exercise is not going to be the answer for everyone. What we’re saying is that exercise is an option. Would you like to try it? Let’s see how it goes.”
Faulkner and his colleague, Dr. Madelaine Gierc, a postdoctoral fellow whose research focuses on the intersection between physical activity, health, and psychology, are leading the charge on a new training and credentialing specialization for fitness professionals and other healthcare providers, set to transform the model of care.
A first of its kind, Faulkner and Gierc and the lab team have worked with the Canadian Society for Exercise Physiology (CSEP) to create a program that deep-dives into the clinical aspects of depression and teaches strategies for incorporating physical activity into a structured treatment plan for people living with depression.
CESP is the leading national body for physical activity, health and fitness research and personal training in Canada.
Now available, the new CSEP Exercise and Depression Specialization will equip CSEP-certified professionals, including clinical exercise physiologists and high-performance specialists, with the education, protocols and empathy required to support people with depression through structured and supported movement.
The program is an online course that brings together theory, clinical research, practical application, and scenario-based learning—with the overarching theme that everyone is different and a structured program will be customized for the individual and tweaked along the way.
“Now they have specialized training to work with individuals with depression that is building the pipeline so that mental health professionals feel confident that they can refer to exercise professionals who have received the training,” Faulkner explains of establishing a referral system between mental health and movement professionals.
“And exercise professionals can feel confident and potentially develop their practice to reach out to mental healthcare teams or mental health professionals to provide exercise programming. Now there is this certification.”
Setting a new standard for treating depression
By elevating physical activity from anecdotal advice to evidence-based intervention, the door is open to setting a new standard for how people treat, talk about, and move through depression.
People living with depression are not just left with the recommendation to get some regular exercise in their life. They can be connected with a fitness professional who has the knowledge and training to set them up for success—someone who understands how depression affects mood, energy, decision-making, and physical behaviour.
It’s complicated, but it’s a big step toward applying the science of exercise and mental health to real-world practice. So, when you connect with a professional who has specialization, you won’t be thrown into high intensity interval training or a program that is all about traditional athletic goals of higher, stronger, and faster.
“One of the theories we use to guide exercise programming is behavioural activation. This is an intervention that focuses on positive reinforcement—doing things that are enjoyable and rewarding,” says Gierc.
“Some people like intense exercise, where you’re sweating and shaking and drenched in sweat. But, for many people, this isn’t fun. We don’t want exercise to be a negative experience where you’re in physical pain and sore the next day.”
The focus is on creating a positive environment that comes from positive relationships with clients. Gierc says the training discusses how to create a warm, supportive, and person-centred environment. “It’s not about doing 10 pull-ups or running a marathon. It’s about joyful movement and having fun when you’re active.”
When you think about it, that’s part of why anyone who joins a gym or class is gung-ho at the start but then falls off. They’re likely not having fun or interested in the activity. Factor in the low energy and disengagement of people living with depression, and lack of fun and interest become even bigger hurdles.
Faulkner explains that the CESP specialization is trying to increase knowledge about depression “about its prevalence, about how it’s treated, the evidence for exercise and where exercise fits into treatment.”
“The main focus is also on the practical skills of how to work with someone with depression,” he says of how the course skills and strategies have broad appeal.
“This is really just good practice for working with anyone whether they have a clinical diagnosis of depression or not. We all suffer from feelings of lack of motivation and fatigue and feeling down, so really this is reinforcing some of the good practices that that we know in general that work.”
The aim is to reinforce supporting autonomy, giving people choices about what they want to do, along with feelings of self-efficacy and confidence, Faulkner notes. Building opportunities for social connection and exploring with a client what their interests are to collaborate on a program can also help with the enjoyment and commitment to movement.
“So, are people feeling engaged? Do they feel that they are being challenged but at a realistic level? Are they interacting with others, making new friends? Are they learning new skills?” Faulkner asks.
“It’s really important for the exercise professional to think more about the experience for participants than the structure of ‘let’s try to do these three sessions a week of 30 minutes,’ but let’s package it in a way where people are having fun and feeling good about themselves. All of these messages would be good for anyone, irrespective of whether they have depression or not.”
If movement can be the medicine that’s effective for people living with depression as a first line treatment or in combination with other therapy boosting efficacy, then it’s worth giving health professionals the tools to make it part of their care.
