I appreciate this paper but the hard problem with exercise and depression is that depression affects ability to comply with the intervention. So if you observe a difference in depression with exercise assignment, is it because of a causal effect of exercise, or because of attrition?
Studies Ive seen have suggested exercise does decrease depression, and there's neuroscientific explanations, but some of those studies suggest effect sizes are smaller once you account for attrition effects.
On the other hand, pharmacological studies have their own issues too so who knows.
I don't need a scientific paper to tell me that exercise helps depression. I wouldn't be here if it wasn't for exercise. That's not to say it'll work equally well for everyone, but there's enough empirical evidence to suggest that it's one of the best tools available. That said, every doctor I've ever visited (except one), recommended exercise as part of their treatment.
> Maybe, there is a reluctance to accept that changes in lifestyle as opposed to pharmacological treatment can alter biological mechanisms.
My doctor told me that he doesn't recommend lifestyle changes for, e.g. diabetes, because patients ignore it. It seemed to annoy him when I chose low carb over metformin and glyburide and succeeded. I think that with him his policy was more because he was an agreeable type who did not want to be put in a position to have to hector his patients. But as a result he wasn't informing us well either. It was conflict avoidance rather than doubt as to biological mechanisms.
If a doctor tells you they don't make proper recommendations because patients ignore it, you should get a different doctor. They're an honest doctor, but they're honestly telling you they don't care about their patients. I am currently dealing with that with my current doctor (I moved across the country so can't go to my former physician). But my previous primary care doctor actually thanked me for losing weight rather than just taking medication and calling it good. Apparently I was the only one to listen to his advice (I was also tired of getting winded on the stairs at the office).
> My doctor told me that he doesn't recommend lifestyle changes for, e.g. diabetes, because patients ignore it.
That's refreshing, at least if provided with the explanation.
> I think that with him his policy was more because he was an agreeable type who did not want to be put in a position to have to hector his patients. But as a result he wasn't informing us well either. It was conflict avoidance rather than doubt as to biological mechanisms.
He probably should inform, but I can understand why he was reluctant to go beyond that - those interventions basically won't work unless the patient has external supervision. It's common knowledge you should exercise and eat healthy - those who could manage it on their own already do it.
Personally, I consider "diet and exercise" to be "fuck off advice", precisely because most people will try, fail after seeing no effect, and either ignore it from now on, or blame themselves for not being able to stick to regimen - but importantly, will not bother the advice giver for however many weeks or months it takes to admit to failure.
I worked in a setting where very similar arguments were raised (about a different medical issue) and I always wondered about conflicts of interest. In that case, recommending lifestyle changes instead would have meant undermining the financial rationale for the clinic.
Virta Health has built a business around hectoring type-2 diabetes patients. And it works. Many of them have put the disease into remission and are no longer dependent on exogenous insulin.
Studies Ive seen have suggested exercise does decrease depression, and there's neuroscientific explanations, but some of those studies suggest effect sizes are smaller once you account for attrition effects.
On the other hand, pharmacological studies have their own issues too so who knows.