Happy without pills? Sports therapies against mental illness

The figures from the World Health Organization (WHO) are worrying: According to its report on mental health published in June 2022, almost one billion people worldwide are living with a mental illness - almost one in eight people in the world.

In Germany, according to the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), even more than one in four adults meet the criteria of a mental illness in the course of a year. Among the most common are anxiety disorders, depression or disorders caused by alcohol or medication use.

This is a huge burden, first and foremost for sufferers, but also for society and the healthcare system.

It is no secret that regular exercise and sports not only help prevent lifestyle diseases such as cardiovascular disorders, diabetes, severe corona processes or even mental illnesses. Less common, however, is how successfully sport can also be used in therapy.

Running in the woods and jogging against depression - aren't we moving into dangerous homeopathic waters? On the contrary: more and more practices and therapists are now offering running therapies. Numerous studies show that endurance sports such as jogging, walking or cycling are particularly suitable for treating mild depression. They increase the level of the reward hormone serotonin, reduce the release of stress hormones and thus provide a greater sense of well-being.

"When running, patients understand that they can accomplish things under their own power. During the eight weeks in the forest, they often show more symptom improvement than after many sessions in the doctor's office," says Diana Stöckel, a psychological psychotherapist and trained running therapist: "These people take every step under their own steam. So they can't be as bad as they think."

Especially in a group, running therapy is a suitable support in the treatment of depression and anxiety, emphasizes a spokeswoman of the German Foundation for Depression Aid: "The regular appointment gives structure and works against listlessness. In addition, the community has a strengthening effect."

All-clear for jogging muffle: other sports such as swimming, dancing or yoga can also help with the right training plan in coping with mild or moderate depression. A Norwegian study even came to the conclusion that East Asian martial arts had a better effect than working out on the home trainer. The following applies here: the more satisfying the sport is subjectively perceived to be, the better.

Studies show: It works. According to the Swiss Society for Sports Psychiatry and Psychotherapy, endurance training of 40 to 60 minutes each 3 times a week for at least 10 weeks has even been shown to be as effective as pharmacotherapy or psychotherapy for mild to moderate depression.

An Australian research team recommends at least three training sessions per week of 30 minutes each at moderate to high intensity for at least eight weeks.

Even in the inpatient treatment of depression, endurance training several times a week is useful as an add-on therapy and shows a "significant positive effect on depressive symptoms."

Even in the treatment of schizophrenia, which often originates at a young age, exercise can work wonders: In a metastudy, the European Psychiatric Association (EPO) demonstrated a reduction in psychopathological schizophrenia symptoms with regular moderate- to high-intensity exercise for at least 90 minutes per week. At least 150 minutes of moderate- to high-identity aerobic exercise per week is effective for therapeutic treatment of schizophrenia patients, according to the EPA.

The advantages of sports and exercise therapy are obvious: Not only is it usually cheaper than medication, which is expensive in research and production. In addition, medically coordinated training can counteract the side effects of drug therapy - for example, compensating for the weight gain caused by antidepressants. In addition, psychologists suspect a positive effect of the feeling of self-control and power after overcoming the inner pig.

And, exercising as an activity provides much needed distraction from symptoms and self-destructive thought patterns. If depressives are made painfully aware of their illness every time they swallow a pill, sport can be therapy and fulfillment at the same time.

So would it be better in the future to have a prescription for running shoes instead of medication? It's not quite that simple. "It is dangerous to think that sport can replace drug treatment or therapy," warns Ulrich Hegerl, Chairman of the Board of the German Depression Aid Foundation. Rather, he says, exercise should complement treatment.

Because sport as a therapy does not work equally well for everyone. And: Depending on the physical condition, even sports therapy is not free of side effects. "If I have severe high blood pressure or an eating disorder, sport can also have negative consequences," says Professor Andreas Ströhle, head of psychiatry at the Charité hospital in Berlin.

It is therefore all the more important that patients do not arbitrarily stop taking medication and seek their salvation in running in the woods alone. Instead, it is important to discuss the possibilities of sports therapy with the attending physician or therapist, and thus create a medically supervised sports program.

What is an opportunity for sufferers is a new challenge for healthcare professionals. "It's not enough to just tell patients, 'You should exercise to treat your disease,'" explains U.S. sports medicine physician Anne K. Swisher of West Virginia University, "That would be like telling a patient to 'just pop some pills' - no serious doctor would do that."

In practice, this means a difficult balancing act for physicians and therapists, who are suddenly also called upon to create exercises and training sessions or exercise management. And this despite the already fatal bottleneck in the care of mental illnesses.

In Bavaria, doctors interested in running have taken matters into their own hands and launched local running initiatives for patients.

Throughout Germany, a consortium of health insurance companies and research institutions is investigating ways to close the psychological care gap in Germany through sports therapists. In training courses, sports scientists and physiotherapists are made fit to be more than just fitness trainers for depression patients.

"This prepares the therapists optimally for caring for the patients. For example, talking to them about what they want to get out of therapy - and how to achieve that goal," explains Dr. Andreas Heißel from the University of Potsdam, who helped develop the training. The therapy staff would also benefit from the sensitization: "It's important that they recognize and reflect on their own handling patterns. This not only makes them better, but also more satisfied. We are surprised how much the therapists accept the offer, open up and get involved."

For mentally ill people, initiatives like this are one thing above all: good news! Those suffering from mild or moderate depression have another perspective on recovery in the sports therapy offerings. Running alone is not a panacea, but it can provide valuable services in both prevention and therapy. Severely depressed patients are still dependent on conventional treatment, but they benefit there from the capacities freed up by sports.

One thing is certain: whether sports therapy, drug treatment, psychotherapy or a combination of all of these - those who have decided to undergo treatment have already taken the most important step.