Dancing is best exercise to treat depression, study finds

Dancing might be one of the most effective ways of treating depression – even more effective than medication, a study has found.

The review of research, published in the BMJ, looked at 218 studies covering 14,000 individuals, and found that exercise led to moderate improvements in depression symptoms. The best results were seen in dancing, which was more effective at treating depression than other forms of exercise, including walking, jogging, tai chi, yoga and weight training.

The researchers note, however, that, although dance had a larger positive effect than other interventions, “the small number of studies, low number of participants, and biases in the study designs prohibits us from recommending dance more strongly.” Most research on dance as an intervention, it found, was carried out on young women, so may not be generalisable to other cohorts.

Older people benefit more from yoga and aerobics

While dancing had the best results overall, the effectiveness of other forms of exercise varied according to sex and age. In women, strength and cycling appeared to reduce more symptoms, while in men, better results were seen when they undertook yoga, tai chi, and aerobic exercise alongside psychotherapy. Older participants experienced symptom reductions when prescribed yoga and aerobic exercise alongside psychotherapy, while younger participants saw more benefits from strength training.

“The benefits from exercise tended to be proportional to the intensity prescribed, with vigorous activity being better,” the authors write. “Benefits were equally effective for different weekly doses, for people with different comorbidities, or for different baseline levels of depression.”

Almost all the types of exercise featured in the research saw better results than either serotonin reuptake inhibitors (SSRIs), the medication most commonly used to treat depression. In the list of most effective treatments, cognitive behavioural therapy (CBT)  came third, after dancing and walking or jogging.

Exercise could be included in clinical guidance

The authors say that the review did not uncover clear causal mechanisms, but that the trends in the data were useful for generating hypotheses. “It is unlikely that any single causal mechanism explains all the findings in the review,” they say. “Instead, we hypothesise that a combination of social interaction, mindfulness or experiential acceptance, increased self-efficacy, immersion in green spaces, neurobiological mechanisms, and acute positive affect combine to generate outcomes.”

They add that while meta-analyses have found each of these factors to be associated with decreases in depressive symptoms, no single treatment covers all mechanisms: “Some may more directly promote mindfulness (eg, yoga), be more social (eg, group exercise), be conducted in green spaces (eg, walking), provide a more positive affect (eg, “runner’s high”’), or be more conducive to acute adaptations that may increase self-efficacy (eg, strength). Exercise modalities such as running may satisfy many of the mechanisms, but they are unlikely to directly promote the mindful self-awareness provided by yoga and qigong.”

The authors say their findings support the inclusion of exercise as part of clinical practice guidelines for depression, particularly vigorous intensity exercise. “Doing so may help bridge the gap in treatment coverage by increasing the range of first line options for patients and health systems.,” they write. They also note that in many places there is still a stigma attached to seeking treatment for depression, and that exercise may appeal to patients because it carries less stigma than other treatment options.

Another benefit of prescribing group exercise as a treatment, they add, is that it “may provide relatively low cost alternatives for patients with depression and for health systems.” Practitioners who deliver psychotherapy may, they add, want to direct some time in tackling cognitive and behavioural barriers to exercise. Similarly, exercise professionals “might need to be trained in the management of depression.”