Depression & Cardiovascular Disease, Chicken or the Egg
The world's reaction to COVID this past year has opened my eyes to a lot of our community's problems. Before COVID, exercise seemed to be something we just did if we wanted to. There was no big struggle to make it happen beyond perhaps bending over to tie our sneakers. We always had access to fitness centers, greenway trails, opportunities for community swimming, and lots of community and group events.
Then came the societal reaction to COVID. I say societal reaction because viruses have been around longer than we have. Viruses aren't making our choices, we are. Governments began shutting down access to outdoor opportunities, such as parks, playgrounds, and greenways. Governments told businesses they had to shut down their gyms. Running and biking clubs were shamed into not having group events. I was kicked out of my own fitness club for not being able to wear a mask while I exercised. I watched as many of my patients who were ordinarily very fit and active experience weight gains. In fact, I can count on less than both my hands my patients who lost weight during this past year.
I also watched depression and anxiety skyrocket. Many of you reading this will understand, because behind our exam room doors we have had painful conversations about the rejection and isolation many of you have felt. And in my typical integrative encouragement to exercise, I realized that might not be so fair to advocate to get out and move around when my depressed and anxious patients were stinging as much as I have from being shut out of our gyms and normal routines. How could I tell my patients to go exercise when they felt they had no place to exercise?
I just read an article that cardiorespiratory fitness could cut depression risk in half. We have known in healthcare for years that depression after a heart attack or stroke is real. We have known in healthcare for years that exercise can improve symptoms of depression and anxiety. What we don't know is which comes first, cardiovascular disease or depression/anxiety? I haven't seen any overwhelming evidence to support one stance over the other.
What I do know is we have a major obesity problem in our region. Far more people die from cardiovascular disease than have died from COVID, and in fact, a number of COVID deaths may be from having poor cardiovascular fitness. We know obesity, diabetes, and hypertension are huge risk factors for poor COVID outcomes, yet our society continues to largely ignore the correlation. Additionally, our society marginalizes depression and shames us for needing help. We don't have to look any further than the lack of mental health services. And why is mental health considered separate from the rest of healthcare? Doesn't our health start with our brains?
While our society continues to argue over the COVID response, our depression skyrockets. Be aware that the emotions so many of us are feeling may be increasing our cardiovascular risk of death from heart attacks, strokes, and blood clots. What have we accomplished if we die one way vs another? We are all still dead.
It's time to get back to living. Go get that cardiovascular fitness!