Live in rooms full of light.
Avoid heavy food.
Be moderate in the drinking of wine.
Take massage, baths, exercise, and gymnastics.
Fight insomnia with gentle rocking or the sound of running water. Change surroundings and take long journeys.
Strictly avoid frightening ideas.
Indulge in cheerful conversation and amusements.
Listen to music.
—Aulus Cornelius Celsus, c.25 BCE–c.50 CE
We are what we repeatedly do. Excellence, then, is not an act, but a habit. —Aristotle
I get my exercise being a pallbearer for those of my friends who believed in regular running and calisthenics. —Winston Churchill
Notwithstanding Churchill’s acerbic observation, an accumulating flood of data continues to reveal the importance of exercise for physical and mental health. Here are some of the widely endorsed benefits of exercise:
- Helps prevent heart attack and stroke
- Helps reduce blood pressure
- Helps prevent and control adult onset diabetes
- Helps prevent obesity (along with diet), thereby reducing many
obesity-associated conditions, including several types of cancer
- Prevents bone loss and osteoporosis
- Helps prevent age-related muscle loss
- Helps improve self-esteem
- Helps various neurological conditions, including Parkinson’s dis-
ease and Alzheimer’s disease
These last two benefits of exercise are particularly interesting and surprising to me since they involve brain conditions that have thus far been shown to resist improvement with multiple interventions. Although there are medications that reduce some of the symptoms of Parkinson’s disease, for example, none of them has thus far been shown to modify the course of the disease. The only thing that has been shown to slow down the progression is exercise! In fact, box- ing turns out to be particularly popular (and perhaps effective) with people suffering from Parkinson’s disease, and other forms of exercise can help as well.
A similar situation exists with Alzheimer’s disease. All drugs approved so far for its treatment have been of marginal benefit at best and have yielded no evidence of slowing down the progression of the disease. In a recent British study published in JAMA Neurology, however, researchers found a relationship between walking—the number of daily steps taken over a seven-year period—and reduced development of Alzheimer’s disease.1 Researchers found a maximal reduction in dementia risk at approximately 9,800 steps per day, but that even lesser amounts of exercise, specifically 3,800 steps per day, were associated with a significant risk reduction. Further analysis found that greater intensity of walking was also associated with better outcomes.
As always, we must acknowledge that these are just correlations, which, as the well-known saying goes, do not equal causation. To establish the latter would require controlled studies. Nonetheless, a significant correlation does not exclude causation! Meanwhile, we can take comfort in the possibility that this is one thing we can do that may fend off this dreaded disease. Since it is worth exercising for so many other reasons as well, this possible bonus could serve as an additional incentive.
Exercise and Depression:
In a review of four meta-analyses on the potential benefits of exercise on major depression, researchers J. Knapen and colleagues from the University of Leuven in Belgium found that for mild to moderate depression, the effects of exercise are comparable to those of antidepressant medicines and psychotherapy. For severe depression, exercise seems to be a valuable complementary therapy to traditional treatments. Although there are as yet no published studies investigating the benefits of exercise for SAD, clinical experience has demonstrated its value time and again.
Exercise combined with light therapy and other treatments is a powerful remedy for SAD. Research in Switzerland by Anna Wirz- Justice and colleagues found that walking briskly outdoors for as little as thirty minutes a day has antidepressant effects.
Some suggestions for walking and SAD:
- When walking outdoors, be sure not to block out the sky completely with your hat, scarf, or other garments. Don’t forget that the sky is where the light comes from. Gazing periodically at the sky can give you a surprising amount of light even on a cloudy day.
- If it is not possible to walk outside on a winter day, try exercising indoors in front of one or two light boxes. If you want to set up a system of indoor exercise in front of bright light, check out the models in chapter 7 to determine which devices might work best for your indoor space.
- Intermittent high-intensity exercise is considered particularly beneficial. My favorite way to accomplish this is to walk briskly up and down hills, though there are many other ways. Some people run or walk fast for, say, two minutes, then slow down for a while, and repeat.
You may recall my patient with SAD who visited me once a sum- mer to see what new technique I might have acquired in the interim. He told me that my suggestion that he exercise aerobically outdoors, glancing intermittently at the sky, was “the winning technique of the year,” which had kept him going strong through the intervening winter.
Of course, other forms of exercise can be as good as walking, especially if you can combine them with natural light (as with cycling and skiing). Pick a form of exercise that you enjoy, since you will be more likely to practice it regularly. More ideas for exercising outdoors in winter can be found in chapter 16.
There is overwhelming evidence that exercise (including resistance training) helps depression.
Excerpted from Defeating Sad: A Guide to Health and Happiness Through All Season, by Norman E. Rosenthal, M.D. published by G&D Media, August 2023