Sea swimming as a novel intervention for depression and anxiety - A feasibility study exploring engagement and acceptability- a single arm, unblinded feasibility study. of 61 participants recruited to an eight-session sea-swimming course… with reductions showing large effect in the severity scores of both depression and anxiety between the beginning and end of the course.

Is the Comparison Between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based? - “A review examining all RCTs and meta-analyses/systematic reviews published in 2009–2016 found exercise is an evidence-based medicine for depression – at least as an add-on to antidepressants, [and sometimes] equally effective in reducing symptoms of depression”

Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials- "The results suggest no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression. These findings support the adoption of exercise as an alternative or adjuvant treatment for non-severe depression in adults."

Exercise training increases size of hippocampus and improves memory- "Aerobic exercise training increases the size of the anterior hippocampus, leading to improvements in spatial memory"

Activity of serotonergic neurons in behaving animals- "...Serotonergic neurons are activated in association with increased muscle tone/tonic motor activity, especially if the motor activity is in the repetitive or central pattern generator mode."

Endorphins and Exercise -- "...studies have demonstrated that serum concentrations of endogenous opioids, in particular β-endorphin and β-lipotrophin, increase in response to both acute exercise and training programmes"

Cooper Institute Longitudinal Studies- “Longitudinal studies of 116,000 participants find people with greater levels of aerobic fitness had less risk of heart disease, chronic kidney disease, stroke, certain cancers, dementia, and more”

Non-Occupational Physical Activity and Risk of Cardiovascular Disease, Cancer and Mortality Outcomes: A Dose-Response Meta-Analysis of Large Prospective Studies - “75 min/week of moderate-intensity aerobic physical activity associated with…an appreciably lower risk of mortality, cardiovascular diseases and cancers”

Associations Between Commute Mode and Cardiovascular Disease, Cancer, and All-Cause Mortality, and Cancer Incidence, Using Linked Census Data over 25 Years in England and Wales: A Cohort Study - Twenty-five years of census data in England and Wales finds a strong inverse relationship between cycling and all-cause mortality, cancer morbidity, and cardiovascular risk factors.”

Various Leisure-Time Physical Activities Associated with Widely Divergent Life Expectancies: The Copenhagen City Heart Study -"Twenty five years of data from 8,000+ participants finds certain active sports can increase life expectancy… tennis (9.7 years); badminton (6.2 years), soccer (4.7 years), cycling (3.7 years), swimming (3.4 years), jogging (3.2 years), calisthenics (3.1 years), and health club activities (1.5 years)...the leisure-time sports that inherently involve more social interaction were associated with the best longevity”

Valuing the health benefits of nature-based recreational physical activity in England - "An analysis of population-representative data (n = 47,580; representing 44,386,756) found 22-million adults in England aged 16 years or older visited natural environments at least once a week, which was estimated to prevent 12,763 cases of non-communicable diseases and create annual healthcare savings of £108.7m."

Aquatic exercise and mental health: A scoping review -"Medication for depression may be discontinued in replacement for consistent doses of swimming.

Mental health can be influenced from exposure to water-based exercises.."

Mood and well-being of novice open water swimmers and controls during an introductory outdoor swimming programme: A feasibility study- "Swimmers reported acute increases in positive subscales (Esteem and Vigour, P < .001) and reductions in negative subscales (Tension, Anger, Depression, and Confusion and Total Mood Disturbance [TMD], P < .001, d = 1.1–1.7). TMD was also reduced between sessions (P < .001, d = 0.08). Well-being also increased during the course in swimmers (P < .001, d = 3.7) and controls (P = .019, d = 0.2). Greater reductions in TMD (P < .001, d = 0.8–2.5) and increases in well-being were observed in swimmers than controls (P = .034, r = .23)."

The impact of loneliness and social isolation on the benefits of an exercise program with hospitalised older adults - "Despite the high prevalence of loneliness and social isolation, individualised exercise programs provide significant benefits to hospitalised patients, especially in quality of life."

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials - "Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. "

The relationship between physical activity and anxiety in college students: exploring the mediating role of lifestyle habits and dietary nutrition - "By increasing the behavior and awareness of college students to participate in physical activity, supplemented by guiding them to develop regular lifestyle habits and correct dietary nutritional patterns, the anxiety level of college students can be effectively improved and reduced. "

Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review - "Nature prescription programmes showed evidence of cardiometabolic and mental health benefits and increases in walking"

Influence of aerobic exercise on depression in young people: a meta-analysis - "Both short (less than 40 min) and long (more than 40 min) periods of aerobic exercise were effective in improving depressive symptoms. However, the optimal duration of aerobic exercise may vary depending on the specific population and individual factors studied, such as age, health status, and exercise tolerance. Therefore, this study concluded that the most effective exercise regimen, 40 min of moderate-intensity aerobic exercise three times a week for 6 to 11 weeks, showed more significant improvement in depression indicators in individuals with depressive symptoms."

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study - "An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness."

Effect of Integrated Yoga as an add-on therapy in adults with clinical depression - A randomized controlled trial - "Adults aged 18 to 64 with clinical depression were randomized to either an Integrated YOga Module (IYM) or an active control group using a computer-generated mixed block randomization sequence.The IYM group showed statistically significant improvements in BDI-II scores β = -6.7 (95% CI [-10.8, -2.5]; p = .001), resilience β = 0.4 (95% CI [0.02, 0.80]; p = .037), physical health domain of WHOQOL - BREF β = 10.1 (95% CI [0.7, 19.5]; p = .035) and negative emotions (SPANE-N) β = 2.8 (95% CI [0.1, 5.4]; p = .037). IYM as an adjunct is superior to conventional medical management in reducing symptoms and improving positive psychological resources in clinical depression."

Effects of Forest Environment (Shinrin-yoku/Forest Bathing) on Health Promotion and Disease Prevention: The Establishment of `Forest Medicine- “[Forest bathing] increases human natural killer (NK) activity,reduces blood pressure and heart rate, reduces stress hormones, increases the activity of parasympathetic nerves and reduces the activity of sympathetic nerves to stabilize the balance of autonomic nervous system, improves sleep, reduces the scores for anxiety, depression, anger, fatigue, and confusion”

Nature Experience Reduces Rumination and Subgenual Prefrontal Cortex Activation - “Participants who went on a 90-min walk through a natural environment reported lower levels of rumination and showed reduced neural activity in an area of the brain linked to risk for mental illness compared with those who walked through an urban environment”

Children With Attention Deficits Concentrate Better After Walk in the Park - Seventeen children 7 to 12 years old professionally diagnosed with ADHD were assigned to take a 20 minute walk in a park or an urban setting. Children with ADHD concentrated better after the walk in the park than after the downtown walk … Effect sizes were substantial and comparable to those reported for recent formulations of methylphenidate (Ritalin).”

Valuing the health benefits of nature-based recreational physical activity in England - "An analysis of population-representative data (n = 47,580; representing 44,386,756) found 22-million adults in England aged 16 years or older visited natural environments at least once a week, which was estimated to prevent 12,763 cases of non-communicable diseases and create annual healthcare savings of £108.7m."

Contact with nature may be a remedy for loneliness: A nationally representative longitudinal cohort study - "At each time point, the prevalence of loneliness was lower among participants with more time in nature. Just 1-2 hours per week in nature (versus <1) was associated with relief from social loneliness at 4 months (Odds Ratio [OR] 1.69, 95%CI 1.10, 2.65) and at 16 months (OR 2.10, 95%CI 1.34, 3.30). Higher odds of relief from emotional loneliness were observed at 3-4 hours spent in nature at 4 months (OR 1.84, 95%CI 1.11, 3.06) and at 16 months (OR 1.82, 95%CI 1.09, 3.07). Incidence of loneliness was not associated with nature contact."

Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review - Compared with control conditions, nature prescription programmes resulted in a greater reduction in systolic blood pressure (mean difference –4·82 mm Hg [–8·92 to –0·72]) and diastolic blood pressure (mean difference –3·82 mm Hg [–6·47 to –1·16). Nature prescriptions also had a moderate to large effect on depression scores (post-intervention standardised mean difference –0·50 [–0·84 to –0·16]; change from baseline standardised mean difference –0·42 [–0·82 to –0·03]) and anxiety scores (post-intervention standardised mean difference –0·57 [–1·12 to –0·03]; change from baseline standardised mean difference –1·27 [–2·20 to –0·33]).

Effect of gardening physical activity on neuroplasticity and cognitive function - This systematic review of 23 studies on the effects of gardening on brain health suggests gardeners experience gains in the nerve levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF)--both associated with improving cognitive function. 

Lifestyle factors and risk of dementia: Dubbo Study of the elderly - This  longitudinal study that followed Australian men and women throughout their sixties (n = 2805) found that those who gardened on a daily basis had a 36% lower risk of developing dementia than those who didn’t.  

What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly?- a large-scale review of horticultural therapy in older populations found support suggesting gardening improves attention, lessens stress, modulates agitation, reduces falls, and lowers reliance on medications and antipsychotics.

Reduction of Cortisol Levels and Participants' Responses Following Art Making -Results [from a 45 minute visual art making session] indicate that art making resulted in statistically significant lowering of cortisol levels. Participants' written responses indicated that they found the art-making session to be relaxing, enjoyable, helpful for learning about new aspects of self, freeing from constraints, an evolving process of initial struggle to later resolution, and about flow/losing themselves in the work.

Effectiveness of Creative Arts-Based Interventions for Treating Children and Adolescents Exposed to Traumatic Events: A Systematic Review of the Quantitative Evidence and Meta-Analysis - “Pooled effect estimates indicated that arts-based interventions significantly reduced PTSD symptom scores compared to pre-intervention (15 studies, g = -.67, p &lt; .001) and a control group (7 studies, g = -.50, p &lt; .001). Significant reductions were also found for measures of negative mood”

Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials“bibliotherapy — [a method using books to guide and encourage the reader to challenge unhelpful thoughts and behaviors] was significantly more effective than the control conditions in reducing the symptoms of depression or anxiety

Treating nighttime fears in young children with bibliotherapy: evaluating anxiety symptoms and monitoring behavior change-Pre-post group analyses revealed that children demonstrated clinically significant change in anxiety severity. In addition, decreases in child-reported nighttime fears were observed, as were parent-reported decreases in separation anxiety and increases in the number of nights children slept in their own bed.

Arts, mental distress, mental health functioning & life satisfaction: fixed-effects analyses of a nationally-representative panel study - "A nationally representative and longitudinal cohort study of adults in Britain (n = 23,660) found participating in arts and cultural activities was associated with lower levels of mental distress, higher levels of life satisfaction, and better mental health functioning.

Participatory and receptve arts engagement in older adults: Associations with cognition over a seven-year period- "For older adults, doing 1-3 hours of arts activities per week helps to prevent cognitive decline, with similar benefits to exercising for 1 hour per week”

Cross-sectional and longitudinal associations between arts engagement, loneliness, and social support in adolescence- "A longitudinal study of adolescents (n=11,780) found doing school-based arts activities were associated with higher odds of social support.

Arts and Cultural Engagement, Reportedly Antisocial or Criminalized Behaviors, and Potential Mediators in Two Longitudinal Cohorts of Adolescents - "Two sets of longitudinal data following adolescents (n= 10,610, n = 15,214) associated arts and cultural engagement with fewer reportedly antisocial or criminalized behaviors, and better self-control scores.

The impact of arts on prescription on individual health and wellbeing: a systematic review with meta-analysis - "The meta-analysis showed a statistically significant improvement in wellbeing, and the narrative review identified promising outcomes that require further evidential support (e.g., reductions in anxiety and depression)."

Classical Music Works as an Antidepressant: Here's How - "Using these implants for deep-brain stimulation, the researchers discovered that music creates its antidepressant effects by synchronizing the neural oscillations between the auditory cortex, a part of the brain responsible for processing sensory information, and the rewards circuit, a part responsible for processing emotional information."

Systematic Review of Arts-Based Interventions to Address Suicide Prevention and Survivorship in Australia, Canada, the United Kingdom, and the United States of America - "The nine programs studied used the arts -- film and television (n = 3), mixed-arts (n = 3), theatre (n = 2), and quilting (n = 1) -- to elicit emotional involvement, while seven also used the arts to encourage engagement with themes of health. Study outcomes included increased self-efficacy, awareness of mental health issues, and likelihood for taking action to prevent suicide, as well as decreases in suicidal risk and self-harming behaviors. "

*For more studies on the power of arts as medicine, check EpiArts Lab- exploring the impact of arts and cultural engagement on population health outcomes in the US through epidemiological analyses of US cohort studies

The effects of choice and enhanced personal responsibility for the aged: a field experiment in an institutional setting - “An experimental group was given the freedom to make choices and the responsibility of caring for a plant rather than having decisions made and the plant taken care of for them by the staff…questionnaire ratings and behavioral measures showed a significant improvement for the experimental group over the comparison group on alertness, active participation, and a general sense of well-being.”

Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years - “…study's results indicated that stronger purpose in life was associated with decreased mortality. (Learn more inWhy Good Things Happen to Good People by Dr. Stephen Post)

Feeling stressed and depressed? A three-wave follow-up study of the beneficial effects of voluntary work - ""For the first comparison, we found statistically significant differences between volunteers and non-volunteers at T1 for (1) age (volunteers were significantly older than non-volunteers; t = 8.94, p < .001, mean difference = 3.04), (2) general health (volunteers had a significantly higher general health than non-volunteers; t = 9.90, p < .001, mean difference = .23), (3) symptoms of stress (volunteers had a significantly lower experience of symptoms of stress than non-volunteers; t = 7.73, p < .001, mean difference = .10), and (4) the experience of depressive symptoms (volunteers had a significantly lower experience of depressive symptoms than non-volunteers; t = 8.67, p < .001, mean difference = .20)."

The Mediating and Moderating Effect of Volunteering on Pain and Depression, Life Purpose, Well-Being, and Physical Activity - " People who volunteered less had more pain, lower perceived life purpose, more depressive symptoms, and decreased physical activity. Volunteer activities did have a significant mediating effect on the relationship between pain and depression; approximately 9% of the relationship between pain and depression can be accounted for by volunteering. "

Key findings from Time Well Spent 2023 Report from the National Council for Voluntary Organizations - surveys of 10,000+ members of the public find volunteering improves gives respondents enjoyment (89%), a feeling of making a difference (89%), a sense of achievement (88%), Increased social connection (87%), and improved mental health and wellbeing (75%)

Effect of gardening physical activity on neuroplasticity and cognitive function - This systematic review of 23 studies on the effects of gardening on brain health suggests gardeners experience gains in the nerve levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF)--both associated with improving cognitive function. 

Lifestyle factors and risk of dementia: Dubbo Study of the elderly - This  longitudinal study that followed Australian men and women throughout their sixties (n = 2805) found that those who gardened on a daily basis had a 36% lower risk of developing dementia than those who didn’t.  

What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly? - a large-scale review of horticultural therapy in older populations found support suggesting gardening improves attention, lessens stress, modulates agitation, reduces falls, and lowers reliance on medications and antipsychotics.

Social Relationships and Mortality Risk: A Meta-analytic Review - A meta-analytic review of 148 studies (n = 309,849) assessing the relationships between social relationships and mortality risk found people with strong social relationships were 50% more likely to survive

Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries - A review spanning sixteen countries and five longitudinal studies of older adults (N = 93,263) found that having a hobby is associated with fewer depressive symptoms and higher levels of self-reported health, independent of confounders

The effect of housing and gender on morphine self-administration in rats - “To determine the effect of housing conditions on morphine self-administration, rats isolated in standard laboratory cages and rats living socially in a large open box (8.8 m2) were given morphine in solution (0.5 mg/ml) ….the isolated rats increased their consumption, but the socially housed animals decreased theirs.”

“Harvard study, almost 80 years old, has proved that embracing community helps us live longer, and be happier” — “Close relationships, more than money or fame, are what keep people happy throughout their lives….Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes.” (Learn more in The Good Lifeby Dr. Robert Waldinger and Marc Schulz)

Synergy of pandemics-social isolation is associated with worsened Parkinson severity and quality of life- “Individuals who reported being lonely experienced a 55% greater symptom severity than those who were not lonely (P < 0.01). Individuals who documented having a lot of friends had 21% fewer symptoms than those with few or no friends (P < 0.01). Social isolation was associated with greater patient-reported PD severity and lower quality of life”

Effect of group online-based peer support intervention on psychological distress of adolescent and young adult cancer patients: a randomized controlled trial - "Eight-week peer support intervention was effective in improving psychological distress, anxiety, and depressive symptoms in the experimental group with statistically significant differences (P < 0.05). Time affected psychological distress, anxiety, and depressive symptoms in AYA cancer patients (P < 0.05), and there was an interaction with intervention factors (P < 0.05). The intervention has a positive effect on relieving the psychological status of AYA cancer patients."

Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study - "Clusters of happy and unhappy people are visible in the network, and the relationship between people’s happiness extends up to three degrees of separation (for example, to the friends of one’s friends’ friends). People who are surrounded by many happy people and those who are central in the network are more likely to become happy in the future. Longitudinal statistical models suggest that clusters of happiness result from the spread of happiness and not just a tendency for people to associate with similar individuals. A friend who lives within a mile (about 1.6 km) and who becomes happy increases the probability that a person is happy by 25% (95% confidence interval 1% to 57%). Similar effects are seen in coresident spouses (8%, 0.2% to 16%), siblings who live within a mile (14%, 1% to 28%), and next door neighbours (34%, 7% to 70%).

(Learn more in Together by Dr. Vivek Murthy)