Redefining “exercise” in depression

Exercise is as important for the health of the brain as it is for the body; this is well established science. However, the term “exercise” often conjures up images of joining a gym, pumping iron, walking or jogging on a treadmill, and doing calisthenics. For someone who is deeply depressed, breathing may feel like too much work, let alone taking a walk around the block. And telling someone how much better they would feel if they just went for a walk or a jog or played tennis or rode their bike is likely to do more harm than good when the person can barely drag their body out of bed.

Physical movement is natural, and it should and usually does feel good. But when it doesn’t — or when it is hard to even imagine it feeling good — see if there is a place to start the tiniest bit of “action.” Doing, rather than not doing. Finding joy and pleasure in movement can be a key part of recovering from depression, bipolar depression, and other forms of mental illness, but slow and steady is often the most effective approach. Here are a few suggestions to consider:

• If you or a loved one rejects or resists or simply cannot bear the thought of exercise, realize that these responses may be deeply rooted in the depressive brain circuits. A person feels the way she feels. Accept the fact.
• Acknowledge the paradox; a person can feel that movement is impossible and be well aware of the likely benefits of movement at the same time.
• Try to find language that the person living with depression finds more appealing or at least neutral. For example, instead of “exercise,” talk in terms of “movement” or “activity.” The words you choose can play a big role in problem solving.
• Bring the starting point into reach. Set goals that are small (sometimes extremely small) steps from where the depression has taken you or your loved one.
• Keep in mind that even small periods of movement — even one minute of intense movement — can have health benefits. Even standing up and walking around the room gives some benefits over lying or sitting still for extended periods.
• Look for types of movements that feel bearable or even wonderful, but at the very least not terrible. One person may find yoga insufferable while another finds doing a single sun salutation pose a vast improvement over depressed stillness. Being outdoors may be essential for some but may be far too much sunlight or activity for another. Sometimes kids with depression have avoided movement since an early age, so finding something that feels good can be a real challenge.

Whatever you do, don’t blame or shame or say anything that might make a person feel that if she would just try harder, she could will or work herself back to feeling better. Such an approach adds insult to an already deeply injured sense of self and can trigger more feelings of helplessness. It can also spark anger and resentment, particularly in an adolescent, when they feel they are being told to do something they are one hundred percent clear they do not want to do.

If you have had success in helping yourself overcome the inertia of depression by taking the tiniest of steps, please share your story. While unsolicited advice may do more harm than good, a success story can often be inspirational.