The Duke SMILE Studies: Can Exercising Replace Antidepressants?

Blumenthal and colleagues conducted several randomized controlled trials in 2000 comparing the effects of aerobic exercise to antidepressant medication. These were called the SMILE (Standard Medical Intervention & Long-term Exercise) studies.

For the record, depression is a common disorder that is associated with compromised quality of life, increased health care costs, and greater risk for a variety of medical conditions, particularly coronary heart disease.

Blumenthal and colleagues chose a sample of 156 people aged 50 to 77 years who were suffering from clinical depression – they had been diagnosed with major depressive disorder (MDD) – and randomly divided them into three groups:

The exercise group spent 30 minutes either riding a stationary bike or walking or jogging 3 times a week. The anti-depressant used by the medication group was sertraline, a SSRI class drug commonly used to treat depression.

The results after 4 months showed improvement in all the 3 groups – all felt happier, better and less depressed. No surprise here. Unexpected results, however, were seen after 10 months:

Summary and Bottom Line

These and other studies suggest that exercise is an effective treatment for depression, improving depressive symptoms to a comparable extent as pharmacotherapy and psychotherapy. Observational studies suggest that active people are less likely to be depressed, and interventional studies suggest that exercise is beneficial in reducing depression. It appears that even modest levels of exercise are associated with improvements in depression, and while most studies to date have focused on aerobic exercise, several studies also have found evidence that resistance training also may be effective. While the optimal “dose” of exercise is unknown, clearly any exercise is better than no exercise. Getting patients to initiate exercise —and sustain it – is critical.

Harvard lecturer Tal Ben-Shahar puts it differently in his 2010 book Even Happier. He writes, “Is exercising, then, like taking an antidepressant? Not exactly. In essence, not exercising is like taking a depressant.”

The Link With Laughter: Working Out Can Be Fun, Not Tedious

Physical fitness stemming from laughter is a benefit known to few. The diaphragm is the only muscle in the body attached to other muscles. This is why laughter jogs all your internal organs. The mere act of laughing exercises the diaphragm, as well as the abdominal, respiratory, facial, leg, and back muscles.

Laughter is particularly important for seniors as well as bedridden or wheelchair-bound people. It is a unique way to enhance one’s daily wellbeing.

Professor A. Berk of Johns Hopkins University writes, “Laughing creates a total body response that is clinically beneficial. It exercises the facial, chest, abdominal, and skeletal muscles and improves their tone (Paskind, 1932), which can be particularly important for bedridden or wheelchair-bound older people.”

Here is what Michael Miller, M.D. (Director of Preventive Cardiology at the University of Maryland Medical Center) said after a study on the health impact of laughter:

The magnitude of change we saw in the endothelium is similar to the benefit we might see with aerobic activity, but without the aches, pains and muscle tension associated with exercise.

Dr. Michael Miller, director of the Center for Preventive Cardiology at the University of Maryland Medical Center

Should we stop exercising and laugh instead?

The purpose of this article is not to claim that laugh-letics is a sport that can replace a workout and one should laugh instead of exercise. It is low-impact after all and you are unlikely to build muscle mass laughing. But sweating profusely and building strong muscles or running for hours is not what exercise is all about, or is it?

While many forms of exercise may leave you tired, laughter interventions with methods such as Laughter Wellness leave you bursting with energy and ready for anything. Laughter makes working out fun, not tedious. Best of all is that it requires no special equipment, environment or clothing.

Here is our recommended next step: Don’t replace, complement! Add laughter to your current exercise program. Here is a simple tip: Try smiling when engaged in challenging exercises (engage your eyes as much as your mouth muscles!), and laughing on the exhale. You will get lots more ideas and tons of exercises presented to you in a clear and structured, easy to use format in our online training Laughter For Self-Help.

In joy!