This series by BLOC Staff Coach Brooke Haubenstricker about coaching lifters with depression has been a welcome addition to Barbell Logic’s content on lifting and mental health. Part 1 laid a framework for thinking about depression as a coach. Often, we fill an important supporting role at the nexus of a person’s physical and mental health. Here, Part 2 analyzes the myriad of benefits lifters with depression get from training and looked at some comparisons between strength-based training and other types of physical activities. Part 3 gives us practical advice, including building or maintaining trust and having conversations about depression. And Part 4 helps shore up many coaches’ concerns about programming and how to provide value as a coach while supporting lifters through challenging times.

Coaching Lifters with Depression: Training Benefits

Part 2 of 4

(Read Part 1 Here)

We’ve known about the link between physical activity and mental health for a long time. Psychological distress, depression, self-harm, and suicidal behavior are more common in sedentary populations,[1] whereas physical activity has been shown to lessen symptoms of depression.[2] However, not all physical activities are equal in their effectiveness. Studies have begun to contrast the mental health outcomes of performing aerobic versus anaerobic activities. Taking a deeper look at these studies can shed light on the types of options available and the extent of their impact, which we can use to guide coaching and programing decisions for depressed lifters.

Anaerobic Training

Researchers are finally delving deeper into the effects of resistance training on mental health, and recent studies have shown that strength training is a particularly effective physical activity for people who are depressed. In one meta-analysis, 33 randomized controlled trials, involving 1,877 participants, found that resistance training was associated with a significant reduction in depressive symptoms, regardless of participants’ age and sex.[3] Resistance training has also been demonstrated to have a greater effect on depressed adults compared to endurance training. Another meta-analysis of 27 randomized controlled trials, involving 1,452 clinically depressed adults, showed a large, significant improvement in symptoms in favor of exercise intervention, with neuromuscular training having a greater effect than endurance training.[4] In addition, resistance training and moderate- to high-intensity aerobic activity resulted in increased concentrations of an important protein in the brain called brain-derived neurotrophic factor (BDNF) more than the typical low- to moderate-intensity aerobic training.[5] (BDNF may play a role in depression: the expression of BDNF is decreased in depressed patients, and antidepressants up-regulate the expression of BDNF.[6],[7]) All of these findings suggest intensity may play a key role in the effectiveness of a training program, which helps explain why resistance training has more favorable outcomes than aerobic exercise.[8]

While the training prescriptions used in these studies focus on resistance training, they’re a far cry from what we know as “strength training”: single-joint movements, higher-rep sets, and machine exercises are the norm. In contrast, the strength training methods defined by Barbell Logic focus on multi-joint movements with barbells, with programming that prioritizes intensity via lower-rep sets and PRs. However, the key takeaways are still the same, and if anything, this style of barbell training would be even more effective since it’s a more intense form of resistance training.

There have been some studies that looked into strength itself and mental health, but they remain controversial. One such study, conducted in South Korea, found that the risk of individuals having depressive symptoms was 2.5-3.4 higher for the lowest quartiles for handgrip strength compared to the highest quartile.[9] This was true for all age groups: young adults, middle-aged adults, and the elderly. Additional studies that have looked specifically at older populations – who are at risk for developing late-life depression (LLD) – have had similar results,[10],[11],[12] Interestingly, there has also been a study that looked at handgrip strength and cognitive functioning in individuals with mood disorders.[13] As expected, there was a correlation between handgrip strength and various markers for cognitive functioning for the healthy participants and the participants with Major Depression: visuospatial memory, reaction time, reasoning, prospective memory, and numeric memory. (These same correlations were also found for participants with Bipolar types I and II, although the numeric memory test fell short of significance, possibly due to the lesser number of participants.) While these studies demonstrated that people with greater handgrip strength are less at risk for developing depression and have better cognitive functioning, the exact contributions of strength are unclear. It may be that both strength and mental health benefits are purely the results of an active, healthy lifestyle, meaning that the physical activity is more important than the strength adaptations.

There are psychological benefits from strength training that should be noted as well. The process of voluntarily undertaking a difficult task—which requires overcoming fears, doubts, and insecurities—and then conquering that task builds up mental fortitude. This makes a person more capable of handling all types of stress, both inside and outside the gym. These regular training accomplishments can translate to increased confidence, increased assertiveness, and a shifted mindset from an external locus of control (the belief that one is helpless or not in control) to an internal locus of control (their effort will influence their outcomes).

There are also important lessons that every lifter learns through strength training, and they can be especially influential for someone who’s depressed. They play a big role in reshaping distorted thoughts and behaviors that can perpetuate depression. Some of these lessons are:

• You are more capable than you think you are.
• There are many aspects of your life that are within your control.
• You don’t need to be perfect to be successful.
• Your body is more than its aesthetics; it’s powerful and functional.
• You can be proud of your accomplishments, no matter how small they seem.
• It’s ok to mess up, have bad days, and get off track. It happens to everyone.

Lifters can learn these lessons on their own over time, but working with a coach can expedite the process. Coaches are already familiar with these lessons and can steer their lifters toward whichever ones they may benefit from learning on the sooner side. For example, a lifter who is constantly comparing their performance to that of someone who’s stronger may need to hear that they’re making unfair comparisons, and their accomplishments are still worth celebrating. Or a lifter who’s struggling with unrealistic aesthetic standards may benefit from a conversation about their standards and being told that their value as a person extends far beyond what they look like. Offering praise when lifters learn and fully accept these lessons will encourage them to continue making these positive changes to their mental state.

Aerobic Training

For coaches at Barbell Logic, strength training is the preferred physical activity for addressing a plethora of issues because it’s simple, effective, customizable, and an excellent way to improve various aspects of our health. But it’s not the only option when it comes to depression. In fact, there may be times when strength training isn’t feasible. During episodes of depression, lifters often face training obstacles inside or outside the gym that can grow to heights of insurmountability. (Obstacles to training will be discussed in detail in part 3.) In these situations, it’s better for a lifter to continue doing some sort of physical activity than none at all.

Even though there is emerging evidence on the greater effectiveness of anaerobic exercise over aerobic exercise, the latter is still an effective tool for combating depressive symptoms. Just 10 minutes of endurance training can have a significant antidepressant effect,[4] and improvement can be seen in a variety of applications:[14] indoors or outdoors, with or without equipment, independently or in groups. Combining aerobic and anaerobic activity can also be an incredibly effective way to reduce depressive symptoms,[8] albeit higher frequencies of muscle-strengthening activity have the most favorable depression outcomes.[15]

Not a Cure

All of these studies universally agree that physical activity has positive outcomes on depressive symptoms, but it also has its limitations. Physical activity is not a cure for depression, and it should not be used as a substitute for other forms of treatment. To protect yourself from liability, never make claims or promises that any physical activity will reduce or eliminate depressive symptoms, episodes, or disorders. Citing studies is fine; guarantees put you on shaky ground. Lifters who are receiving other forms of treatment for their depression should only make adjustments to those plans under the guidance of a mental health professional. Depending on their diagnosis, they may always need these other treatments, even if they are not experiencing depressive symptoms and have not had an episode in a long time.

Physical activity is a powerful additive to a lifter’s treatment plan, but it’s not a magical cure. Accepting its limitations and focusing on the whole treatment picture will instill realistic expectations and make it easier to find the best balance of treatment and physical activity for that lifter.

A Change in Priorities

As mentioned in part 1, it can be helpful from a coaching perspective to view depression as a sort of mental injury. It’s completely normal in these situations for recovery from that “injury” to take precedence over previous training drivers like performance goals and strength progress. In other words, if depression is severely interfering with a lifter’s strength training, then strength is no longer the goal; the goal is to improve mental health so the lifter can return to strength training.

Given the importance of strength and the benefits of anaerobic training referenced in this article, it can be tempting to continue pushing a lifter down the same strength training path they were on before their episode. Unfortunately, it’s not that simple. Due to the complex nature of depression, both coaching and programming tend to need adjustments, especially in moderate to severe cases of depression. (These topics will be covered in parts 3 and 4, respectively.) If this isn’t done, the lifter may have worse communication, compliance, and long-term training outcomes.

Strength coaches are in a fantastic position for helping people who have depression because there are so many powerful elements in this type of training. Specific programming variables and coaching tactics can be adjusted to most effectively help lifters with whatever they are struggling with. Draw from your strength coaching foundations, but embrace your creative side too. Remember that it’s more important that they continue to stay active during depressive episodes than make steady strength progress.

Continue Reading with Part 3: Coaching Considerations—>

<—Read Part 1: An Introduction

References

1. Grasdalsmoen, M., Eriksen, H. R., Lønning, K. J., & Sivertsen, B. (2020). Physical exercise, mental health problems, and suicide attempts in university students. BMC Psychiatry, 20(1), 175. doi:10.1186/s12888-020–02583-3
2. Schuch, F. B., Vancampfort, D., Richards, J., Rosenbaum, S., Ward, P. B., & Stubbs, B. (2016). Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research, 77, 42–51. doi:10.1016/j.jpsychires.2016.02.023
3. Gordon, B.R., McDowell, C.P., Hallgren, M., Meyer, J.D., Lyons, M., & Herring, M.P. (2018). Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA Psychiatry, 75(6), 566–576. doi:10.1001/jamapsychiatry.2018.0572
4. Nebiker, L., Lichtenstein, E., Minghetti, A., Zahner, L., Gerber, M., Faude, O. and Donath, L. (2018). Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review. Front Psychiatry, 9(305). doi: 10.3389/fpsyt.2018.00305
5. Marinus, N., Hansen, D., Feys, P., Meesen, R., Timmermans, A., & Spildooren, J. (2019). The Impact of Different Types of Exercise Training on Peripheral Blood Brain-Derived Neurotrophic Factor Concentrations in Older Adults: A Meta-Analysis. Sports Med., 49(10), 1529-1546. doi:10.1007/s40279–019–01148-z
6. Dwivedi, Y. (2009). Brain-derived neurotrophic factor: role in depression and suicide. Neuropsychiatric disease and treatment, 5, 433–449. doi:10.2147/ndt.s5700
7. Phillips, C. (2017). Brain-Derived Neurotrophic Factor, Depression, and Physical Activity: Making the Neuroplastic Connection. Neural Plasticity, 2017, 7260130. doi:10.1155/2017/7260130
8. O’Connor, P. J., Herring, M. P., & Caravalho, A. (2010). Mental Health Benefits of Strength Training in Adults. American Journal of Lifestyle Medicine, 4(5), 377–396. doi:10.1177/1559827610368771
9. Lee, M.R., Jung, S.M., Bang, H., Kim, H.S., & Kim, Y.B. (2014). The association between muscular strength and depression in Korean adults: a cross-sectional analysis of the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI) 2014. BMC Public Health, 18(1), 1123. doi:10.1186/s12889–018-6030-4
10. Ashdown-Franks, G., Stubbs, B., Koyanagi, A., Schuch, F., Firth, J., Veronese, N., & Vancampfort, D. (2018). Handgrip strength and depression among 34,129 adults aged 50 years and older in six low – and middle-income countries. Journal of Affective Disorders, 15(243), 448-454. doi: 10.1016/j.jad.2018.09.036
11. Brooks, J.M., Titus, A.J., Bruce, M.L., Orzechowski, N.M., Mackenzie, T.A., Bartels, S.J., Batsis, J.A. (2018). Depression and Handgrip Strength Among U.S. Adults Aged 60 Years and Older from NHANES 2011-2014. The Journal of Nutrition, Health, & Aging, 22(8), 938-943. doi: 10.1007/s12603-018-1041-5. PMID: 30272097; PMCID: PMC6168750.
12. Volaklis, K., Mamadjanov, T., Meisinger, C., & Linseisen, J. (2019). Association between muscular strength and depressive symptoms. Wiener Klinische Wochenschrift. doi:10.1007/s00508-019-1491-8
13. Firth, J., Firth, J.A., Stubbs, B., et al. (2018). Association Between Muscular Strength and Cognition in People With Major Depression or Bipolar Disorder and Healthy Controls. JAMA Psychiatry, 75(7), 740–746. doi:10.1001/jamapsychiatry.2018.0503
14. Morres, I. D., Hatzigeorgiadis, A., Stathi, A., Comoutos, N., Arpin-Cribbie, C., Krommidas, C., & Theodorakis, Y. (2018). Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety, 36, 39–53. doi:10.1002/da.22842
15. Bennie, J.A., De Cocker, K., Biddle, S.J.H., & Teychenne, M.J. (2019). Joint and dose‐dependent associations between aerobic and muscle‐strengthening activity with depression: A cross‐sectional study of 1.48 million adults between 2011 and 2017. Depression and Anxiety, 1-13. doi:10.1002/da.22986