Latest / Hardiness with Dr Paul Taylor / Exercise First, Drugs Second

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Exercise First, Drugs Second · Hardiness with Dr Paul Taylor

• 0:04
  Speaker 1: Hey everybody, welcome to another edition of Wisdom Wednesdays. So
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  Speaker 1: today I want to talk about a new study that
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  Speaker 1: is a pretty astounding effect on depression and anxiety as well.
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  Speaker 2: And this intervention also.
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  Speaker 1: Improves sleep, it improves self-esteem, it improves bone density, it
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  Speaker 1: improves blood sugar. There are no withdrawal symptoms, there are
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  Speaker 1: no side effects, there's no weight gain. And it costs
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  Speaker 1: the price of a gym membership or nothing at all
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  Speaker 1: if you use your own body weight. And its main
• 0:37
  Speaker 1: side effect is that you get stronger and a bit
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  Speaker 1: more buff. And I think given the results, you'd want
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  Speaker 1: it on every GP's prescription pad in the country. And
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  Speaker 1: it basically is lifting heavy shit. And for about 40 years,
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  Speaker 1: we've mostly ignored it as an intervention for mental health. Now,
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  Speaker 1: when researchers have talked about exercise and mood, which they
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  Speaker 1: have done for quite a few decades, they were talking
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  Speaker 1: about aerobic or endurance training. running, cycling, runners high, and
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  Speaker 1: weights were for bodybuilders. But the evidence really is now
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  Speaker 1: starting to turn. Resistance training trials for depression were run
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  Speaker 1: mostly in middle age and older adults. And as recently
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  Speaker 1: in 2023, a review of exercise for depression in young
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  Speaker 1: people could only find two.
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  Speaker 2: Trials that use resistance training on its own.
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  Speaker 1: Now that is pretty odd because Aerobic or endurance training
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  Speaker 1: has got some well-recognized limitations in the literature, particularly for
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  Speaker 1: people who have anxiety or depression. Somewhere between 20% and 75%
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  Speaker 1: of people don't respond to it. It needs sustained effort
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  Speaker 1: at about 65% to 85% of your max heart rate,
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  Speaker 1: which is hard to keep up when you're depressed or anxious.
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  Speaker 1: And if you have panic disorder, a pounding heart and
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  Speaker 1: heavy breathing feels exactly like the thing that you're afraid of.
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  Speaker 1: And a lot of people drop out for exercise interventions
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  Speaker 1: for exactly that reason. Now, strength training is different. It
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  Speaker 1: is short bursts of activity. It's rest between sets. You're
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  Speaker 1: in control of the load. The heart rate goes up,
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  Speaker 1: but it comes back down. And for an anxious or
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  Speaker 1: depressed brain, that is a very different conversation. So I
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  Speaker 1: want to talk about this new study. It was done
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  Speaker 1: in 2024 and a team from Victoria University here in Melbourne.
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  Speaker 1: It's led by Ryan Marinelli and Mary Wooshner. And they
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  Speaker 1: set out to answer one question. Does resistance training treat
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  Speaker 1: depression and anxiety? in young people aged 26 and under. Now,
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  Speaker 1: as I said before, there's plenty of evidence in older
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  Speaker 1: adults now. So what they did is they started a
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  Speaker 1: randomized control trial from 1980 to 2023. There were nearly
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  Speaker 1: 2,000 articles came back, but only 10 trials made the cut.
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  Speaker 1: All of them were randomized. They ran for at least
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  Speaker 1: four weeks. They recruited young people with clinically elevated symptoms
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  Speaker 1: of either anxiety or depression. And together in those studies,
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  Speaker 1: there was 376 participants. Average age was 19, some as
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  Speaker 1: young as 11. And they were treated in schools, clinics,
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  Speaker 1: hospital wards and community settings for their anxiety or their depression.
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  Speaker 1: And one of the trials in 1982 was run with
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  Speaker 1: young offenders.
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  Speaker 2: Now, here's what they found.
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  Speaker 1: For depression, the effect size... was minus 1.06. For anxiety,
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  Speaker 1: minus 1.02. This is what's called Hodges. And anything above 0.8,
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  Speaker 1: or in this case, minus 0.8 because there was a reduction.
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  Speaker 2: Is a large effect.
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  Speaker 1: Now, to put this in context, antidepressants against placebo in
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  Speaker 1: adults usually lands at an effect size of about 0.3.
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  Speaker 1: That is a small effect. Here, we're talking 1.02 and 1.06,
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  Speaker 1: which is just massive. It's three times the effectiveness. Now,
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  Speaker 1: the quality of the evidence for depression was rated as high,
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  Speaker 1: and for anxiety, it was rated as moderate. And they
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  Speaker 1: tend to be quite critical when they're looking at the
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  Speaker 1: quality of the studies. And what's called the funnel plots,
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  Speaker 1: they showed no sign that only the good news got
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  Speaker 1: published and the bad studies weren't published. And so if
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  Speaker 1: we dig into the detail in one trial, young women
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  Speaker 1: with generalized anxiety disorder trained with their lower body only
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  Speaker 1: twice a week for six weeks, 60% went into remission, 60%
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  Speaker 1: on the wait list, 30% did, right? In another study,
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  Speaker 1: young adults trained for just 25 minutes twice a week
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  Speaker 1: for eight weeks and their anxiety dropped significantly. Now, when
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  Speaker 1: the researchers looked at the trials with the biggest effects,
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  Speaker 1: there was a clear recipe. It was two to three
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  Speaker 1: sessions a week, one to three sets of eight to
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  Speaker 1: 12 reps at about 60 to 70% of your.
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  Speaker 2: One rep max.
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  Speaker 1: So that's heavy enough that the last few reps are
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  Speaker 1: a genuine effort. And then the rest was anywhere between
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  Speaker 1: 30 seconds and two minutes. And some of them were
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  Speaker 1: supervised with home programs on top. And the programs that
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  Speaker 1: ran for longer than 12 weeks were did better than
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  Speaker 1: the shorter.
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  Speaker 2: Ones, right?
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  Speaker 1: Now you might be thinking teenagers won't stick to it.
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  Speaker 1: They don't like exercise. Adherence in these studies was above 70%
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  Speaker 1: in every trial that reported it and three trials reported 99%
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  Speaker 1: or better. There is nothing in the world of pharmaceuticals
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  Speaker 1: that comes anywhere near close to this. So let's dig
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  Speaker 1: into the mechanisms. Now, they weren't fully mapped, but there
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  Speaker 1: are strong hints. Resistance training helps to regulate our stress
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  Speaker 1: hormone system, which runs too hot or too cold in
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  Speaker 1: anxiety and depression, respectively. It also raises IGF-1, the growth
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  Speaker 1: factor that supports brain health. And BDNF, which you've heard
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  Speaker 1: me talk about, which is an important growth factor that
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  Speaker 1: supports brain health. And when antidepressants do work, they seem
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  Speaker 1: to raise BDNF. And then there's the psychology. Strength training
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  Speaker 1: gives you fast, objective feedback. Last week, you lifted 40 kilos.
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  Speaker 1: This week, it was 42 and a half. The bar
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  Speaker 1: doesn't lie. But that progression is really useful, particularly for
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  Speaker 1: a young person whose inner voice says they can't do anything.
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  Speaker 1: This gives them evidence to the contrary, and it's delivered
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  Speaker 1: twice a week. So there's another study that I've talked
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  Speaker 1: about before, but I think it's important to add to this. 2024,
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  Speaker 1: British Medical Journal, the largest analysis of its kind. They
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  Speaker 1: looked at 218 randomized controlled trials in over 14,000 people
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  Speaker 1: with depression.
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  Speaker 2: This is just depression. These were mostly adults.
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  Speaker 1: And they used something called a network meta-analysis, which allows
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  Speaker 1: you to compare treatments head to head, even when no
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  Speaker 1: single trial did. So it put exercise, therapy, and drugs
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  Speaker 1: on the same scoreboard. And compared with active control conditions,
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  Speaker 1: walking or jogging came in at an effect size of
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  Speaker 1: minus 0.62. Yoga, minus 0.55. Strength training in this was
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  Speaker 1: minus 0.49. So they're all sort of small to actually
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  Speaker 1: moderate effect sizes. Cognitive behavior therapy, minus 0.55. And SSRIs,
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  Speaker 1: the most commonly prescribed antidepressants, minus 0.26. So again, a
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  Speaker 1: small effect size. All the exercise interventions and the CBT
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  Speaker 1: beat the antidepressants, right? So the intensity actually counts what
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  Speaker 1: they found in this study. The harder people worked, the
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  Speaker 1: bigger the benefit. Light activity helped, but vigorous activity helped more.
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  Speaker 1: And in this study, again, the strength training worked better
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  Speaker 1: in younger people and in women.
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  Speaker 2: Right.
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  Speaker 1: And third, people stuck with it. The odds of dropping
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  Speaker 1: out of strength training were about 45 percent lower than
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  Speaker 1: in the control conditions.
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  Speaker 2: And yoga was pretty similar there.
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  Speaker 1: And the effects in this study also held up for
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  Speaker 1: six months after the programs ended, right? Now, you can't
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  Speaker 1: blind somebody to the fact that they're doing deadlifts, right?
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  Speaker 1: So the certainty ratings were modest, but the authors calculated
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  Speaker 1: that positive studies would have to be published 58 times
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  Speaker 1: more often than negative ones to drag these effects down.
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  Speaker 1: below clinical significance so that's pretty robust when it comes
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  Speaker 1: to research so we clearly have a treatment here that
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  Speaker 1: works very very well young people especially respond to it
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  Speaker 1: and young women in particular and they suffer much more
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  Speaker 1: particularly with anxiety now how do they actually do when
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  Speaker 1: it comes to exercise in australia the australian bureau of
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  Speaker 1: statistics found in 2023 just 18% of 5 to 17-year-olds
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  Speaker 1: met the guidelines of 60 minutes of activity a day.
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  Speaker 1: For girls, it was under 15%. Only about 7% met
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  Speaker 1: all the movement guidelines, which included screen time and sleep.
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  Speaker 1: In England, Sport England reports 49% now meet the guideline.
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  Speaker 1: This is the best figure since the survey began, but
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  Speaker 1: that's measured as an average across the week.
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  Speaker 2: Which is a little bit easier to do.
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  Speaker 1: And more than one in four are active for less
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  Speaker 1: than 30 minutes a day. In the United States, just
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  Speaker 1: for comparison, the CDC's 2025 survey found about one in
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  Speaker 1: four high school students met the aerobic guideline, about half
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  Speaker 1: did enough muscle strengthening, and only 16% did both. So
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  Speaker 1: to kind of sum those and put them in sort
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  Speaker 1: of round numbers, in Australia, And four in five kids,
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  Speaker 1: three and four of American teenagers and half of English
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  Speaker 1: children are missing the basic dose.
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  Speaker 2: And one of the treatments with no prescription.
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  Speaker 1: No wait list, no side effects, and the most effective
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  Speaker 1: of all, and they're just not doing it. Now, here's
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  Speaker 1: my view on this, which you probably have heard before.
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  Speaker 1: When a young person presents with depression or anxiety, what
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  Speaker 1: tends to happen is it's the prescription pad first And
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  Speaker 1: it may be some psychotherapy if they can get in
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  Speaker 1: to see a psychologist, but very few GPs or psychologists
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  Speaker 1: would actually prescribe exercise. I think we have it completely backwards.
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  Speaker 1: The effect sizes for exercise piss all over the effect
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  Speaker 1: size of antidepressants.
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  Speaker 2: Exercise improves the body as well as the mind.
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  Speaker 1: There's no warnings on the box about suicidal thinking and
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  Speaker 1: under 25s as there are in antidepressants.
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  Speaker 2: There's no withdrawal symptoms. There's less stigma.
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  Speaker 1: And it's cheap enough to deliver through every school in
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  Speaker 1: the country. So I really strongly believe exercise should be
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  Speaker 1: prescribed like a medication with a dose of frequency and
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  Speaker 1: an intensity, with a follow-up, and ideally supervised and done
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  Speaker 1: in groups with lots of strength and a bit of cardio. Now,
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  Speaker 1: medication clearly still has a place, particularly in severe illnesses.
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  Speaker 1: And if your child or young person is already on it,
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  Speaker 1: you certainly shouldn't think about just whisking them off it
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  Speaker 1: and saying, hey, go to the gym instead. But I
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  Speaker 1: think as a starting point for young people, there are
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  Speaker 1: three real takeaways here. Strength training is a very beneficial
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  Speaker 1: mental health treatment. It's not just about vanity or it's
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  Speaker 1: not about vanity. Two to three sessions a week, eight
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  Speaker 1: to 12 hard reps per set for at least 12 weeks.
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  Speaker 1: And structure actually is really useful for them, giving them
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  Speaker 1: clear prescriptions, real intensity, ideally supervised as well. And for me,
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  Speaker 1: the order should be exercise first, psychotherapy second, drugs third.
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  Speaker 1: And that should really be the order of operations based
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  Speaker 1: on the available evidence.
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  Speaker 2: That's it for this week, folks. Catch you next time.