not an exercise substitute

(Blogging on mental health from WIAMH shall now begin ... it's about time, I think.)

A recently published study from Texas, USA [1] indicates that individually targeted exercise is as beneficial, in around half of cases, as secondary medication as a means of alleviating depression.  This isn't the first study to have shown a generally positive effect; it's almost received wisdom; but this study gets very interesting in its exploration of the difference between the effect on people in different circumstances, including the difference between people with family history of mental illness and those without.

WIAMH along with other local agencies has for several years been attempting to get people into different kinds of exercise programmes, outdoor activities, and the like.  There is an argument that paid work which involves physical labour would be as effective if not better (along the lines of if exercise is good for you, being paid to exercise is better).  The problem here is that paid work is not the same as an individually targeted exercise programme – where there is an element of physical labour it can be beneficial on various levels, but if it’s repetitive labour, unsupervised (in terms of its actual short or longer term impacts), it may do more harm than good.

But what if we combined the two?  Hypothetically, for anyone who is able to work at a paid job in the longer term, there would be an optimal exercise programme that could help people adjust to the requirements of a job involving physical labour – whilst alleviating depression and keeping people off additional medications in the interim.  Depending on the medication, the job and the exercise programme delivery, it might even be cheaper than medication.  (As with everything else, the major difficulty might just be project design.)

The University of Texas study is quite specific about the need for individually targeted exercise:

“This is an important result in that we found that the type of exercise that is needed depends on specific characteristics of the patient, illustrating that treatments may need to be tailored to the individual ... It also points to a new direction in trying to determine factors that tell us which treatment may be the most effective.”

But this also flags up one potential problem – not a new one – that in the longer term, if the physical labour of the job itself does not fulfil the individual therapeutic requirements, we may expect the person to require either additional therapeutic inputs, or to deteriorate again.  And here there is a specific problem – if the input required is additional targeted exercise (or other activity-based therapy, because exercise is not the only therapeutic activity), it would have to be fitted around the requirements of the job.  Or – back to medication.  Which implies the prospect of paying, perhaps, more NHS money to keep people medicated and in work (to the extent these are compatible, which they sometimes are), rather than flexibly organising work and therapeutic provision to fit round each other.  (Speaking as a volunteer at a project which can’t foreseeably operate outside the 11am to 4pm range, you understand...)

We’re now clearly in an era where people will be “encouraged into work” rather than encouraged into benefit dependency, whether or not support programmes are funded – whether or not the actual effect will be to subject people to continuous harrassment and impaired mental health in the absence of available jobs; and whether or not it would be cheaper to revive the job creation approach we knew and coped with in the cash-strapped 1970s and 80s, than to buy more drugs.  Would it be?  Even as a preventative measure to avoid creating (expensive) new cases of depression?  I don’t have the figures to give an unequivocal answer – but I strongly suspect it would be worthwhile even if it weren’t a cost saver in financial terms.

Even so, I think we can state an understanding: exercise isn’t a substitute for health; medication and work aren’t always a substitute for exercise; generic solutions aren’t a substitute for individually-targeted solutions, and indvidual targeting is impossible without good science, flexible project design and provision, and flexible working for those that need it most.  Are we going to get these?  Well, I think we have some of the science...  What’s next?

1. http://www8.utsouthwestern.edu/utsw/cda/dept353744/files/651304.html