Why Aren’t More Doctors Prescribing Exercise as Medication?

This past weekend, I was on vacation when my friend dragged me to the gym. My definition of vacation is a weekend wherein I forget that cookies have calories and the only physical activity I participate in consists of walking from the couch to the pool. But it was raining, so I gave in.

My friend is a serious gym-nut. Proof: When we walked in, she dashed over to her favorite instructor and updated him on her life. Because they’re friends. Because she is at the gym Every. Single. Day. But here’s the thing: Her gym-devotion isn’t solely recreational, it’s medicinal. For years, starting in high school, she took a few anti-depressants with her morning OJ. But eventually she discovered the gym, ditched the meds and found that a daily BodyPump class evened her mood just as much as the pills she’d been popping.

A few weeks back, The New York Times published a touching personal essay of the same vein: a woman who used running as a form of therapy. The writer, who’d been through a crushing breakup, a death in the family, and a tragically impulsive house purchase, all in the course of six months when she took up running, says, “For me, the benefits went beyond brain chemistry. Running loosened my depression while giving my life structure.”

A few days after that essay was published, The Atlantic ran this piece: “For Depression, Prescribing Exercise Before Medication.” Do you see a trend?

The Atlantic’s piece discusses how, despite exercise’s abilities to combat depression by enhancing endorphins and promoting neuron growth in the brain, only a measly 40 percent of patients reported being advised to try exercise at their last physician visit. Meanwhile, the use of antidepressants has skyrocketed in the past few decades, increasing 400 percent between 1988 and 2008.

So the question is this: With boatloads of patients being treated for depression, why aren’t doctors even suggesting exercise? Lots of reasons. The first is the money question, according to The Atlantic, it’s pretty simple: Insurance companies pay doctors, exercise doesn’t. With insurance companies paying by the appointment, doctors are encouraged to see as many patients as possible, as quickly as possible. And in the end, it’s just faster to write a prescription for a patient than to come up with a detailed workout schedule for them. Besides, going on meds often requires follow-up visits, and … well, you get the point.

It’s not all on the doctors, either. Many people just want a quick fix. As physician Beth Salcedo told The Atlantic, “I think it’s difficult to convince people to spend half an hour a day on exercise when they have kids, a job and it can take months to see the benefit… What do you do? Do you let them walk around depressed? Or do you offer them a treatment that they’ll accept?”

And lastly, exercise is a difficult treatment to monitor. As Madhukar H. Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas and a supporter of exercise as medicine, told The Atlantic, not following your workout plan—or in treatment terms, dropping your dose—would be “like a diabetic person using insulin only occasionally.” In other words, making exercise work as a treatment option takes serious dedication.

So as you can see, there are arguments each and every way when it comes to exercise as treatment, and when it comes to a subject like depression, there is certainly no single cure-all for everyone affected. While exercise works wonders for many, it might be just a drop in the bucket for others. But my question is this: Shouldn’t patients at least be offered all of their options when it comes to treatment?

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