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Depressed people not only feel better after working up a sweat, say Duke University researchers, but for some, exercise is better medicine than medicine itself.

"While there are tremendous advantages to drugs, they don't work for everyone," says psychologist James Blumenthal, a medical professor at Duke and lead author of the study on exercise and depression. "Now, at least, doctors have another option to offer."

The researchers worked with 156 older people who had major depression but were not suicidal or psychotic. They asked one group of participants to attend a group exercise programme for four months, another group to attend the exercise programme and also take the antidepressant Zoloft, and a third group to take the antidepressant only.

"We had two surprises with this," says Blumenthal. "That we got as many volunteers as we did, and that four out of five stayed with the programme."

Participants who exercised only - they took no antidepressant - showed greater improvement than those who just took antidepressants and those who took medication and exercised, the study says. Results appear in the October issue of the journal Psychosomatic Medicine. "Our findings show that a moderate exercise programme is an effective treatment for patients with major depression," Blumenthal says, "but our study did have some limitations. There was no control group, and we really don't know why exercise helps depression."

Richard Cotton, an exercise physiologist in San Diego County, has an educated guess. "Exercise helps depression for a number of reasons, both physical and psychological," says Cotton, who's also a spokesman for the American Council on Exercise. "When people begin to change their body and look better, they have a greater sense of control, and the helplessness that goes along with depression decreases. We create more body awareness when we exercise, and that sense of body compared to that numb state of depression can make you feel better. And just the fact that you are doing something for yourself makes you feel better about yourself.

Apparently, it's a feeling that can last, too.

Blumenthal followed the study participants for six months and found that those who continued to exercise were much less likely to see their depression return.

"The effectiveness of exercise seems to persist over time," he says.

But the study has one other limitation, Blumenthal says. Because the volunteers exercised in a group, it's unclear whether it was the exercise, the social interaction or a combination of the two that did the trick. He hopes to answer that question in the next study, which begins in early October.

"There was no therapy taking place in these groups, but the patients got a lot of encouragement and support," he says. "In the next study, we'll have patients exercising in a group and others on an independent programme at home."

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