Mental health issues have increased in recent years. Add to the current lifestyle the uncertainty generated by the COVID-19 pandemic or war, and you have a perfect storm. According to a study published in The Lancet, the COVID-19 pandemic has increased the prevalence of major depression by 27.6%, adding 53.2 million to the previous number of cases (1). The same tendency has been observed in cancer patients.(2) This has very important consequences for health. For example, depression is the leading cause of disability in the world (3). Moreover, depression, anxiety disorders and psychological distress predict poorer survival in cancer patients.(4)

Although it is very difficult to comprehensively address all the factors that trigger the depression, we can modify some of them. One of the main modifiable risk factors associated with depression is a sedentary lifestyle. Thus, to increase physical activity levels may help to prevent depression. The largest study of its kind to date – involving more than 1 million individuals – showed that exercise was associated with reduced self-reported mental health burden (5). The authors found that among individuals with a previous diagnosis of depression, those who exercised had 34.5% lower days of mental health burden each month. In other words, physical exercise reduced the number of "bad" days per month by almost 4. In addition, people with higher levels of physical activity have a 17% lower risk of depression compared to people who hardly move in their daily lives (6). Furthermore, physical activity had a protective effect against the emergence of depression in youths, in adults, and in elderly persons (10%, 22% and 21% lower risk, respectively) (6). Moreover, exercise has beneficial effects on depression among cancer survivors.(7)

To answer this question, a meta-analysis published in JAMA Psychiatry involving more than 2 million individuals calculated the dose-response of the association between physical activity and depression (8). An inverse curvilinear dose-response association between physical activity and depression was observed, such that the greatest benefits were seen when sedentary people began to engage in physical activity, even if only a little. In addition, relative to adults not reporting any activity, people who met the international recommendations (at least 150 minutes of moderate physical activity) had 25% lower risk of depression.

Assuming the multifactorial nature of mental disorders, a sedentary lifestyle, which is also a growing problem today, is a factor that increases the risk of depression. Therefore, being active, even if it is only 30 minutes a day, would have a protective effect in general population and cancer survivor. Exercise can be a useful strategy to manage mental health in people undergoing and recovering from cancer and side effects of treatment.(7)


Author: Javier S. Morales, UCA

(1)   Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398(10312):1700–12.

(2)   Wang Y, Duan Z, Ma Z, Mao Y, Li X, Wilson A, Qin H, Ou J, Peng K, Zhou F, Li C, Liu Z, Chen R. Epidemiology of mental health problems among patients with cancer during COVID-19 pandemic. Transl Psychiatry. 2020 Jul 31;10(1):263. doi: 10.1038/s41398-020-00950-y. PMID: 32737292; PMCID: PMC7393344.

(3)   Friedrich MJ. Depression Is the Leading Cause of Disability Around the World. JAMA. 2017;317(15):1517.

(4)   Wang YH, Li JQ, Shi JF, Que JY, Liu JJ, Lappin JM, Leung J, Ravindran AV, Chen WQ, Qiao YL, Shi J, Lu L, Bao YP. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry. 2020 Jul;25(7):1487-1499. doi: 10.1038/s41380-019-0595-x. Epub 2019 Nov 19. PMID: 31745237.

(5)   Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal JH, et al. Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. The Lancet Psychiatry. 2018;5(9):739–46.

(6)   Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Ward PB, Silva ES, et al. Physical activity and incident depression: A meta-analysis of prospective cohort studies. Am J Psychiatry. 2018;175(7):631–48.

(7)   Fuller JT, Hartland MC, Maloney LT, Davison K. Therapeutic effects of aerobic and resistance exercises for cancer survivors: a systematic review of meta-analyses of clinical trials. Br J Sports Med. 2018 Oct;52(20):1311. doi: 10.1136/bjsports-2017-098285. Epub 2018 Mar 16. PMID: 29549149.

(8)   Pearce M, Garcia L, Abbas A, Strain T, Schuch FB, Golubic R, et al. Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022;79(6):550–9.