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What lifts depression, jump-starts creativity, soothes jitters, muscles up immune systems, reignites sex lives, and zings your body with tiny arrows of pleasure? Would you believe: small—really small—amounts of regular exercise. Honestly, it's a miracle.
Jennifer Travis* was a 28-year-old student pursuing a second master's degree at the University of Wisconsin. She lived alone, rarely went out except to her classes, and constantly complained that she would never meet the man of her life. Her existence seemed empty, and she had lost hope that it would change. Her only consolation was her beloved three packs of cigarettes a day. She spent her time watching smoke waft upward in wreaths instead of concentrating on her course notes.

Jennifer wasn't surprised when the doctor at the school clinic reported that her score on a scale for depression placed her among the most affected 10 percent of the patients there. By then her depression had been going on for two years, but neither of the suggested treatments was acceptable to her. She did not want to talk to a psychologist about her mother and father or the problems of her childhood. And she refused medication because, as she said, "I may be depressed, but I'm not sick." She agreed nevertheless to take part in a research project the doctor was conducting, perhaps because it seemed like a challenge.

Jennifer was supposed to jog three times a week for 20 to 30 minutes. She could run alone or in a group—how she did it was completely up to her. At her first meeting with the jogging instructor, the reality of what she had signed up for hit her in the face. How could he possibly expect a person 20 pounds overweight who had not exercised since the age of 14 and smoked three packs a day to start running? The last time she'd gone biking, she had made it only ten minutes and thought she was going to die. "Never again," she'd sworn. And the idea that she needed an instructor to learn how to run seemed even more ridiculous.

Still, Jennifer listened to the instructor's advice, guidance that turned out to be absolutely essential to her future success.

First, he directed her to take very small steps, trotting rather than running, leaning forward very slightly, without raising her knees too much. Above all, she was told to go slowly enough to hold a conversation ("You have to be able to talk but not sing," the instructor insisted). If she got out of breath, she was ordered to slow down—if need be, to go at no more than a brisk walking pace. She must never experience pain or fatigue.

The goal at the outset was simply to cover a mile, taking as long as she liked, trying to jog as much as possible. The fact that she managed to reach this objective on the very first day was a source of satisfaction for her. After three weeks, at a rate of three weekly sessions, she was able to keep up her jogging pace for a mile and a half, then two miles without any real hardship. She had to admit that she found herself feeling a bit better—overall, she was sleeping more soundly, had more energy, and was spending less time dwelling on her problems. Then, at the end of one of her runs, she twisted her ankle—not badly enough to completely immobilize her but enough to keep her from exercising for three weeks. She was surprised at how disappointed she was not to be able to go jogging. After a week, dark thoughts came crowding in and she noticed her symptoms of depression returning.

When Jennifer's ankle healed and she was finally able to exercise again, the depression waned within a few weeks. She had never felt so well. Even her period—which was usually very painful—seemed less uncomfortable. Long after the research project ended, Jennifer was still regularly spotted running around the lake with a smile on her face.

*Indicates name has been changed.
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Depression is always associated with gloomy, pessimistic, recurrent thoughts that undercut the self and others: "I'll never succeed. I'm ugly. I'm not bright enough. I have bad luck. I'm sick...." These ideas may be as excessive as they are hurtful (such as "I always disappoint everybody," which simply cannot be true). But by the time they manifest in depression, they've usually become so automatic that it is no longer obvious how abnormal they are. One of the characteristics of sustained physical effort is precisely that it puts a halt, at least temporarily, to the torrent of depressive thoughts. Most people who jog or run say that after 15 or 20 minutes, they reach a state in which they feel spontaneously positive and even creative. If negative messages pop up, which is rare, just diverting your attention to your breathing, or to the sensation of your feet pressing down on the ground, is usually enough to see them off.

Joggers and runners also gradually become less conscious of themselves as they go—easing the depressive inward dwelling that interferes with the ability to enjoy the simple events of life. They describe letting the rhythm of their effort lead them on—an experience some refer to as the runner's high, a kind of flow. Only those who persevere for several weeks experience it. This state, subtle as it is, often becomes addictive. After a certain amount of consistent exercise, many joggers can no longer go without their 20 minutes of running, even for a single day.

The big mistake that beginners make is to want to go too fast for too long. Truthfully, there is no magic speed or distance. What leads to a feeling of flow is persisting in an effort that you sustain at the limit of your capacities. At the limit, but no further. Research on states of flow has demonstrated this. For a first-timer, the distance will inevitably be short and the steps small. Later the jogger may have to go faster and longer in order to maintain flow, but probably only after he or she has already become addicted.
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The project Jennifer Travis participated in was one of the early studies to show the mood-lifting power of exercise. The evidence has grown steadily more convincing ever since. In 1999 researchers at Duke University published the results of a study in which they divided depressed patients ages 50 to 77 into three groups. The first did 30 minutes of jogging or brisk walking three times a week; the second took the antidepressant Zoloft; the third did both. After four months, patients in all three groups were doing equally well, the medication offering no particular advantage over the regular practice of working out, except in relieving the symptoms a little faster. When the researchers followed up six months later, however, they found a major difference between the types of treatment. About a third of the patients who initially improved on Zoloft (alone and with exercise) had relapsed, whereas 92 percent of those benefiting from just the aerobic exercise program were still doing well. Most of the joggers and walkers had decided on their own initiative to keep exercising even after the study had ended.

I have experienced both the preventive and therapeutic value of exercise in my own life. When, at 22, I arrived in America from France, I hardly knew anybody. Besides going to medical school, I was looking for an apartment, moving in, getting the lay of the land. Starting all over again, without parents around to tell me what to do, was fun at the beginning, but after a few months, my life seemed empty, devoid of pleasure. Without my family, my friends, my culture, my favorite hangouts, I felt as if I were slowly withering away. I remember one evening in particular, nothing seemed to matter or make sense except classical music. I listened to Schubert endlessly instead of studying. After several weeks in this stark mood, I realized that if I didn't do something, I was going to fail my exams.

I didn't know where to begin, but I knew I had to shake myself out of my stupor. I thought about squash, which I had taken up shortly before leaving Paris. Luckily, I had brought my racket with me—and it saved me.

During the first two weeks of playing at a local health club, nothing changed except that I finally had something to look forward to. But also, thanks to squash, I met a few people who were nice enough to invite me over for dinner. For a long time, I didn't know whether it was the exercise or my new friends that helped me most, but whatever the explanation, it didn't matter. I felt far better, and I was back in the saddle.
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How can exercise change the we feel? Deep inside our skull, we have a "brain within the brain" that is responsible for emotions. This so-called limbic region also balances heart rate, blood pressure, digestion, and all the hormones of the body. Because of such neural multitasking, when our body changes, our emotions change, too. During exercise, for example, our body releases endorphins—tiny molecules that resemble opium and its derivatives (like morphine and heroin). The emotional brain contains many receptors for endorphins, and that's why it is so sensitive to opiates. (The drugs hijack the pleasure-registering receptors, immediately radiating a sensation of well-being and satisfaction.) When opiates are used often, however, they can become habit forming. The flooded brain reacts by reducing the number of receptors in order to avoid overstimulation. So the dose must be systematically increased in order to produce the same response. Moreover, because the receptors become less and less sensitive, regular pleasures lose their potency—including sex, which for drug addicts often offers little or no enjoyment.

The secretion of endorphins brought on by physical exercise does exactly the opposite. The more the natural mechanism of pleasure is gently stimulated by exercise, the more sensitive it becomes. In addition to relishing sex and life's other big rewards, people who exercise regularly actually get more pleasure out of the little things: their friendships, cats, meals, hobbies, even the smiles of passersby in the street. Essentially, it becomes easier for them to be satisfied. Such heightened enjoyment is the antithesis of depression.

Stimulating the emotional brain through exercise also promotes the proliferation of the immune system's natural killer cells, making them more aggressive against infections and cancer. In addition, people who exercise show a greater balance in heart rate control than people who do not. All the symptoms of anxiety start with an overactive sympathetic nervous system, which releases adrenaline and causes an increase in heartbeat, blood pressure, sweating, and trembling. With regular exercise, the parasympathetic nervous system—the physiological "brake" that slows all these reactions (and works in opposition to the sympathetic system)—becomes healthier and stronger. Eventually, it simply blocks the symptoms of anxiety.

Even soft forms of exercise such as yoga and tai chi have been found to help elevate mood. The 5,000-year-old yoga tradition recommends specific postures (asanas) to fight off depression. In one study at the University of California, Los Angeles, just two hours a week of yoga practice enhanced mood and reduced anxiety in less than a month. In a study of tai chi at the Oregon Research Institute, a nonprofit primarily funded by the National Institutes of Health, people ages 65 and older who attended two one-hour classes a week were in a much brighter mood compared with a control group after six months. And typically those who do the least amount of physical activity are precisely the people whose moods are the most improved through exercise. This is one of the curious things about exercise: The less fit we are (the richer our meals, the more time we spend in front of TV or behind the wheel of a car), the more noticeable its benefits, even in small doses. What's essential is to find a form of activity that feels right to us and that we soon start looking forward to.
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So what are the keys to success? Despite the most convincing argument that regular exercise matters, often it seems nothing can be harder to integrate into our daily lives—particularly when we're depressed or under stress. A few simple secrets, however, make it easier to undertake a more active physical life.

To begin with, you do not have to get a lot of exercise; what's important is regularity. Various studies show that the minimum quantity needed to affect the emotional brain is 20 minutes of exercise three times a week. The duration seems to matter but not the distance covered nor the intensity. If you sustain the effort to the point where you can still talk but can't sing, you're fine.

As with certain medications, however, the benefits may be in proportion to the dose: The more severe the symptoms of depression or anxiety, the more regular and intense the exercise required. An hour of spinning is probably superior to 20 minutes of steady walking. Still, the worst scenario would be to try spinning, get overly tired, and then give up altogether. In this case, 20 minutes of regular walking would be vastly more effective.

Also, don't push too hard. Begin gently and let your body be your guide. The objective is to reach the state of flow. To do so, you must always be at the limit of your capacity and no further. (Think of the talk-but-not-sing principle.) When your capacity expands as a result of training, you will have the option—and likely the desire—to go farther and faster.

Most studies suggest that joining a group can make a big difference in terms of staying on track—answering the need for regularity that is so crucial to success.

One of the most important secrets is to choose a form of exercise that seems like fun. The more it resembles a game or a passion, the easier it will be to stick to. Many communities have informal walking clubs or basketball teams that meet a few times a week. A dance class (African, tango, salsa, tap), volleyball team, or tennis club can serve the same purpose, provided that the practice is regular. Even trapeze school or surfing lessons. But if you hate running, don't make yourself do it. You will probably not keep it up.

Finally, you can get more out of your stationary bike, stair stepper, or treadmill by watching action movies. Good examples are Speed, Ocean's Eleven, or any James Bond film (sorry, love stories and comedies don't work as well). Keep the film playing for as long as you exercise, then turn it off the minute you stop. This method has several advantages. First, action films, like dance music, stimulate the body physiologically and thus make you want to move. Second, a good plot helps you forget the passage of time. And, third, since watching the film after you stop is not allowed, suspense motivates you to begin again the next day, if only to find out what happens.

There is nothing new in the idea that we all feel better when our body is in better shape. Two thousand years ago, the Roman philosopher Juvenal emphasized the importance of having "a healthy mind in a healthy body." We've had to wait 20 centuries for science to catch up with philosophy and demonstrate that as little as 20 minutes of exercise three times a week can be as effective as a modern pill. Now it's up to each of us to put this to work in our own lives.

NEXT: Are there faster, more effective ways to treat depression?
As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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