A Different Kind of Prescription for Depression: Strength Training
Text by Angela Kuntz, MD, PMH-C, Psychiatrist – HopeWay’s Medical Director of Admissions & Women's Psychiatry
The Impact of Exercise on Mental Health
“How often are you able to exercise?” The psychiatrists typically ask this question during a HopeWay admission visit as a health metric requirement. We find that the answers vary. Some individuals have a regular exercise regimen, but most clients tell me they are not able to exercise at all. Maybe working out was something they were regularly doing in the past, but the severity of their depression has prevented them from getting out for their routine walk or going to the gym. They may have acute or chronic pain impacting their mobility, or they’ve never had an exercise routine before. Many share this with shame in their voice. Even though they perhaps know they should be exercising, it is often the furthest thing from someone’s mind when they are already struggling with just getting out of bed or brushing their teeth.
The Science Behind Exercise and Depression
When coming out of a depression, clients sometimes ask what they could do in addition to (or sometimes instead of) taking prescription medications to improve their symptoms and prevent relapse. Many people know that exercise can help with various physical health concerns - cardiovascular, bone health, and reducing the risk for diabetes.
Strength and Resistance Training
It also helps with depression, but some may not know the science behind why. Numerous studies have shown that various forms of exercise can improve depression symptoms (as well as anxiety symptoms), but strength or resistance training has shown some of the most substantial benefits. It has even shown similar effects to antidepressant medications3. Strength training can also enhance the results of antidepressant medications and other treatment approaches. For example, incorporating strength training 3 times per week can further support the benefits of antidepressant medications and talk therapy.
Clinical Trials on Resistance Training and Depression
A 2018 meta-analysis reviewing 33 clinical trials concluded that resistance training substantially reduced depressive symptoms in the adults studied. These improvements were evident regardless of age, gender, and health status. Even if there was no overall improvement in strength or fitness, the improvements in depression from resistance training were still apparent.2 On a molecular level, strength training and combined strength/aerobic training (as well as HIIT or High Intensity Interval Training)4 have shown increases in peripheral BDNF (Brain-Derived Neurotrophic Factor), which is essentially the equivalent of “Miracle-Gro” for the brain. Throughout adulthood, BDNF can continue to help support the survival and maintenance of neurons, and is found in high levels in the hippocampus, the part of the brain where memories are formed5. Antidepressant medications have shown similar increases in peripheral BDNF6.
Beginning With Progressive Strength Training
While the benefits of exercise, specifically strength training, are apparent, starting a new exercise regimen is not always easy. I often recommend starting with progressive strength training.
What is Progressive Strength Training
Progressive strength training is when one adds gradual weight increases each or every few sessions. For example, for large muscle groups, adding 5 pounds each training session is usually sufficient. For someone just starting out, Day 1, try five repetitions, for three sets with just body weight, Day 2, use 5lbs weights, Day 3, use 10lbs weights, and so on. Make sure to include rest in between sessions (typically 1 - 2 days).
Benefits of Progressive Strength Training
One of the other benefits of progressive strength training is how it can build confidence. Someone can visually see steady strength gains as the body is able to (with correct form) quickly adjust to increasing stress/weight loads. This can be very empowering and motivating.
For many individuals, exercise is just one tool to help address depression in addition to talk therapy and pharmacologic treatments or other regular healthy habits. It is important to speak to a physician about what type of exercise is most appropriate. Also, one should always speak with a provider before changing any aspect of their current treatment regimen. The body and brain, at all ages and fitness levels, are capable of remarkable progress. Strength training can lead to changes beyond the physical body, making our minds and mental health stronger.
Tips to Begin Your Strength Training Journey:
1. Start light: Use the lightest weights or just body weight initially to improve form and avoid injury.
2. Go slow: Aiming to lift just one to two times a week is best in the beginning, and always give your body time to rest between workouts.
3. Get help: Consider finding a personal trainer or downloading a workout app. There are often free exercise options available online.
4. 4 recommended exercises to start with:
- Deadlift Squat - Overhead press - Squat - Bench press
Repeat 3 sets, 5 repetitions per set. Add 2-5 lbs each time you go to the gym until this plateaus. It can take several months until you achieve your maximum weight.
Dr. Kuntz is a board-certified psychiatrist who joined HopeWay in 2019. With an additional certification in perinatal mental health, she specializes in women’s mental health and perinatal psychiatry including perinatal mood disorders. Dr. Kuntz also has an interest in working with college-aged clients dealing with anxiety, OCD, depression, bipolar disorder and psychotic disorders. She views psychiatric treatment as an opportunity to work together with her clients to help them achieve their goals and find meaning in their lives. Through her residency training at The University of North Carolina at Chapel Hill, where she served as Chief Resident, Dr. Kuntz learned the importance in many cases of incorporating evidence-based medication management and psychotherapy to achieve the best outcomes. She maintains this approach today and feels honored that her clients are willing to share their personal stories while engaging in the therapeutic process. One of the most fulfilling parts of Dr. Kuntz’s work is building relationships with her clients, being there for them during difficult times, and celebrating their achievements and progress. Dr. Kuntz works with adult clients in HopeWay’s residential and day programs while also providing medical expertise to the Admissions Team as the Medical Director of Admissions. At HopeWay Psychiatry & Associates, she treats clients on an outpatient basis either in-person or via telehealth. As a passionate and dedicated medical leader, Dr. Kuntz volunteered for the Physician Support Line during the pandemic which provided free, confidential support to doctors and medical students. Outside of work, Dr. Kuntz enjoys exercising, participating in a medical book club, spending time with family and friends and baking.
HopeWay is a nonprofit organization that offers life-changing mental health services for children, adolescents, and adults. As an accredited, physician-led program, HopeWay is committed to offering comprehensive care that focuses on the whole person. Their continuum of care includes residential, two levels of day treatment programs, mental health services specific for Veterans & First Responders, eating disorder treatment, and an outpatient clinic, HopeWay Psychiatry & Associates. Through HopeWay’s community education and outreach, they are working to normalize the conversation around mental wellness.