Comparing the Effectiveness of Mindfulness Exercises and Physical Exercises in
Treating Depression
Hung Doan, Amy Ramirez, Claysha Moss
Department of Exercise and Health Science, University of Massachusetts Boston
EHS 460: Research Method
Professor Julie A. Wright
November 14, 2021
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Depression is one of the leading causes of death (World Health Organization, 2021).
Mental health has always been underestimated for decades, and it leads to disability or even
death due to the vulnerability of patients with mental health problems. Anxiety disorder and
major depressive disorder are two of the most common types of mental problems, and it is
mostly treated by medications. However, since physical activity has been proved to bring
undeniable effects on mental health, people started changing from medication therapy to exercise
therapy. It is believed that mindfulness exercises (MEs) are more effective in improving major
depressive disorder compared to physical exercises (PEs). Nevertheless, this statement still has
not been scientifically proven, and there is no proof of how different types of exercises affect
depression in different ways.
College students might easily get mental problems, especially stress and depression due
to the overwhelm of studying and working at the same time. Therefore, Alsaraireh et al. (2017)
and Gallego et al. (2014) were conducted to compare the effectiveness of mindfulness exercises
and physical exercises on college students to find the ultimate ways to reduce their depression
and/or stress. Both studies showed the significant effects of mindfulness exercise in reducing the
symptoms of depression. In addition, Gallego et al. also found the significant effects of MEs on
stress and anxiety. However, only Alsaraireh et al. showed the significantly positive effects of
physical exercises on depression, while Gallego et al. found that there was no significant changes
of PEs on depression. Although Alsaraireh et al. showed the expected result, their sample was
only collected from one university, which can affect the generalizability of the result.
Additionally, the measurement was only taken on the completion of the program, so the result
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was not reliable in showing the effectiveness of the program at multiple points in time.
Furthermore, the study purpose of this study was being aware, so the result’s credibility could be
affected. Further research could focus more on the effectiveness over time, and blind study could
be a good way to eliminate factors that affect the result’s credibility as well as generalizability.
Although Gallego and his colleagues found that mindfulness-based training is more effective
than the physical one, there was no significant difference in reducing the symptoms of depression
and stress between these groups due to the common ingredients between two intervention
groups. Therefore, further research can focus on developing the specificity of each type of
exercise in order to eliminate the variables that affect the external validity of the results.
Through the result of these studies, mindfulness-based training could be suggested to help
college students learn how to manage and prevent their depression and stress.
Among those studies with the comparison between two types of exercises, there were two
studies, which are Gallego et al. (2014) and Goldstein (2020), that included the third group in
their method section. The presence of the third group, also called control group, showed the
cause and effect relationship of exercise training on people with mental problems. In other
words, it can be used to determine whether mindfulness exercise and physical exercise improve
the mental condition or not. Gallego and his colleague found that there were significant changes
in both types of exercise, and mindfulness exercise was better than physical exercise in treating
mental problems. With the presence of a control group, mindfulness exercise was shown to be
effective in treating depression, while the result for the physical exercise group was not different
from the control one. Therefore, the mindfulness exercise group was considered as being more
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effective than the physical one. Meanwhile, Goldstein et al. found that both programs were
equally effective in improving mental health. Goldstein et al. also included hypotheses to prove
the mechanism of both programs on mental health. However, their sample was mostly Caucasian
and well-educated, so their result was limited in generalizability. Furthermore, their data was
collected from self-report assessment measures instead of clinical interviews, which led to the
presence of biases, so the credibility of the result could be affected. In addition, the method
included 2½ hours weekly for group sessions and 45 minutes daily for self practice at home, the
result’s reliability could be affected by the different amount of time of home practice sessions.
As mentioned above, further research based on Gallego et al. should focus on developing the
method section to eliminate the external variables that could affect the result. For further research
based on Goldstein et al., researchers should collect data by clinical interviews, and increase the
diversity of the sample size to determine whether both programs have different effects on
different features, such as age range, sex, ethnicity, etc. With the presence of the control group,
the result is more reliable and credible in proving the effect of both exercise programs on treating
mental problems or depression.
Mental health problems in general and depression in particular is one of the most
vulnerable diseases, and since it has been underestimated for a long time and has become silent
killer, many people started to be concerned and aware of it. Thus, many researchers started
conducting research on this topic. Exercise become an outstanding target for this topic due to its
remarkable benefits from other aspects. Beside of improving physical function and appearance,
exercise is also believed to play an important role in mental health. Therefore, the purpose of this
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study is not only investigating whether exercise has positive effects on mental health or not and
how it affects the mental health but also determining which is the best type of exercise in treating
mental illness, mindfulness exercise or physical exercise. Additionally, by researching the
effectiveness of physical activity or exercise in improving depression conditions, the rate of
depression-related trauma or death could be significantly reduced. It is expected that the outcome
of this study could find the best methods to avoid or reduce the symptoms and effects of
depression.
The use of exercises will help patients with depression improving their condition,
especially those with extreme symptoms that could lead to suicide. Since college students might
easily suffer through depression because of being overwhelmed by studying and working,
Alsaraireh et al. and Gallego et al. conducted research on them and found that both exercise
programs had positive effects, and mindfulness exercise was more effective than the physical one
in improving their depression conditions. In addition, Gallego et al. and Goldstein et al. included
the control group in their method in order to test the effectiveness of both programs and
determine whether they brought the improvement to people with mental problems in general and
depression in specific. However, Goldstein was one of the few researchers who found that both
programs share the same effects on improving mental health problems. Therefore, future
research should focus on adjusting the method, and also explaining the mechanism of both
programs to determine the effectiveness of these programs. Furthermore, there were limited
sample sizes of Alsaraireh et al. and Goldstein et al., so further research should increase the
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diversity of the sample size in order to determine whether different effects are applied on
different features of participants.
Exercise was found to be effective in improving mental health, and mindfulness exercise
has been proved to be more effective in improving depressive conditions than physical exercise.
Moreover, this study will play an important role in helping people with depressive conditions,
and it can help them to choose the best program for them. However, further research on this topic
should be conducted since the current research is not sufficient to prove the actual mechanism of
both programs on depression.
Method section:
To summarize a clear overview of the aim of the study, it is to research and examine
which type of exercises will improve mental health conditions such as anxiety, depression, and
other mood disorders. Exercises that will determine this will be split to two categories: mindful
exercises such as yoga/meditation and moderate to vigorous cardio exercises. By comparing both
methods of exercise will determine the best outcome for alleviating mental health issues. The
type of study design executed in this research will be a cohort study comparing three groups of
participants sharing the similar demographic and characteristics. There will be one control group
without treatment, another assigned with performing yoga and lst group is assigned to do
vigorous exercises.
The primary outcome for the dependent variable will determine which will have a better
effect on one’s mental health and which method reigns superior (or not) over the other. The main
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age groups focused in this study are from the ages of 18-30 (college age) who are affected with
depression and anxiety. Reasoning for selecting participants within this age range is because this
age group have shown the most signs of mental health issues than any other age group also due
to demographic disparities. College undergraduates and graduate populations are dealt with
many academic responsibilities as well as financial burdens. The sample of participants will be
recruited from Umass Boston, students attending as Freshmans to students attending as Graduate
students. The ideal amount of students to be recruited would be 100 or more students of ages
18-30. The reason for over 100 students is because it is difficult to monitor who is consistent in
following up with their exercises or not, so the reliability is low because depression and anxiety
can be unmotivating for some.
The tools and instruments that will be used and administered in this study in order to
evaluate the state of mind after sessions of exercises will be determined through surveys, stress
tests that will determine the health of our participants blood pressure (important especially
because Anxiety can raise blood pressure), and possibly Koru Mindfulness program. Koru
Mindfulness is a program developed by college professors and psychiatrists that introduces
mindful meditation and exercises for college students as a 75-minute class. This program is
helpful for the mindful meditation/yoga group. These surveys, tests and programs will take place
in the UMASS Boston Beacon gymnasium. How we will divide the participants up into three
groups is by randomization. By randomizing all ages into three groups, this will ensure the most
accurate outcome without any bias. One group will be the control group where no treatment or
exercise will be applied to them. The second group is designated to perform mindfulness
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exercises such as yoga and or meditation. The third group will focus on moderate to vigorous
physical activity such as cardio exercises.
While implementing this study, there will be a follow up period to ensure our participants
are still in the program and to keep an update on any mood changes that occur. The program
study will be implemented for 2-3 months with a follow-up every end of the month. During these
two-three months, participants of the mindfulness group are expected to do 30 minutes of
meditation/yoga and participants of the physical activity are also expected to perform 30 minutes
of moderate to vigorous cardio exercises. Both treated groups will be doing this 3 days a week
for the duration of the study. To go more in depth about the participants, they will be of ages
18-30 of both genders who are enrolled in college. All of the participants in this study will share
similar characteristics having or experiencing mental health conditions relating to anxiety and
depression. The 100+ participants will be randomized into three groups. The first group which is
the control group is the independent variable where they will be left untreated for their mental
health conditions. The next two groups assigned with exercise treatment are the dependent
variables of this study.
The demographic of these participants included in the study are from 18 years of age to
being 30 years of age. 18 years olds who have just graduated high school and are enrolled in
college, 20-25 year olds who are studying as an undergraduate and then 26-30 who are in
between being an undergraduate to enrolling in graduate school. The demographic focuses on
this population who have shown prevalence of mental health issues compared to any other age
group. The demographic of the participants are also classified by their incomes which is also
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taken into consideration for this research that contributes to one’s extent of mental health issues.
Students will also range in ethnic, education and economic status. Lastly, the inclusion and
exclusion criteria used in this study is limited to specific characteristics and demographics
required to participate in this research. Inclusion criteria includes ages 18-30, enrolled in college,
both sex and all ethnicities, and thos of low-middle class income. Exclusion criteria include no
one younger than the age of 18 or older than 30. This is because younger teens are cognitively
developing and older adults may not feel the pressure of society or have grown out of mental
health issues, students who aren’t diagnosed with mental health conditions, those with physical
health issues.
Intervention
In the intervention, the mindfulness group would be performing meditation/yoga
exercises for 45 minutes, while the physical activity group would be performing moderate to
vigorous cardio exercise for 60 minutes at the UMASS Boston Beacon gymnasium. The control
group would not perform any exercise training. In the mindfulness group, they would have a
yoga instructor showing them how to perform and monitor their performance while they
complete their training. First, they would be performing yoga for 30 minutes as a warm-up then
do meditation for 15 minutes as a closing for the assessment. A yoga mat is essential for this
assessment as their yoga and mediation training equipment.
The participants would perform two yoga exercises called “Downward Dog Pose” and
“Child Pose,” a full-body stretch exercise that would help improve their posture, strengthen their
upper body, stretch their lower body, blood circulation, and reduce anxiety and fatigue. For a
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downward dog pose, they would start on the floor by placing their hands shoulder-width apart,
with their shoulders above their wrist by aligning their inner shoulders with their index fingers
on the mat. The second is lifting the knees by tucking in the toes against the mat, extending the
legs, and lifting both knees into the air, which body posture should be an upside-down V shape.
Third, extend and lengthen the spine by pulling the pelvis up toward the ceiling and using the
triceps to stabilize form. Lastly, hold the body in that position for 60 seconds, then breathe
slowly by releasing the knees to the mat and then transitioning to the next pose. The child poses,
sits on the knees, and then rests the belly between the thighs and forehead on the mat. They need
to relax their shoulders by stretching the arms in front of them with their palms facing upward on
the mat while staying in that position for 60 seconds, inhaling and exhaling. Between the two
yoga poses, they would perform it as two sets each for 60 seconds holding the poses.
Mindfulness meditation would be used as a closing exercise just by sitting criss-cross with palms
sitting on the lap with closed eyes and then taking steady deep breaths for 15 minutes.
Participants in the physical activity group would have a fitness specialist who would
monitor and take their blood pressure measurements by performing moderate-intensity cardio
exercise on the treadmill for 30 minutes and vigorous-intensity cardio exercise on the bike for 30
minutes. On the treadmill, the participants would do a warm-up of light walking for 5-10 minutes
at two mph, then increase the speed by either fast walking or a light jog at a moderate intensity
speed of 3.5 or 4 mph 20 minutes. On the cardio bike, the participants would be completing a
5-10 minute warm-up at a leisurely pace, then start increasing speed on cycling at 14 mph on
level 6 or 7 for 20 minutes or until they reach fatigue.
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Instrument and Apparatus
The instruments used are the blood pressure machine, survey, and stress test. The blood
pressure machine and the stress test would be used for the physical activity group to measure the
force in the arteries while the heart pumps and monitors how their heart works during the
exercises. The blood pressure machine is called Classic III Stethoscope & Prestige
Sphygmomanometer Kit, known as mercury sphygmomanometer. Mercury sphygmomanometers
are made up of manually inflatable cuffs attached to measuring units with mercury-infused tubes
(Conduct Science). For example, using a mercury sphygmomanometer is valid during exercise
because if you wanted to measure the participants on the bike again for their second
measurement to see if there is a probability they would get the same results, it would be false.
Therefore, the mercury sphygmomanometer is a reliable instrument for accuracy for this study.
Shinohara et al. (2017) explain that the difference in bilateral SBP was less than 15 mmHg of BP
that could be measured accurately, only sitting posture at rest showed a high accuracy
measurement rate (95%).
A stress test usually involves walking on a treadmill or riding a stationary bike while
your heart rhythm, blood pressure, and breathing are monitored (Mayo Clinic). The stress test
equipment is known as stress echocardiography, and it is a small device called a “Transducer”
that you hold against your chest with a special gel used to help the ultrasound waves get to your
heart (Medline Plus). The stress test is valid because "An exercise stress test is not 100%
accurate—no medical test is," Dr. Bhatt says. "But it helps decide what the next step should be."
(Harvard Health Publishing). The participants in the all three groups including the control group
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would be doing surveys. The survey they would be using is National Health Interview Survey is
to monitor the health of the United States population through collection and analysis of data on a
broad range of health topics (CDC). Morrison (2021) stated that surveys are valid because it’s in
the view of the respondents, the questions measure what they are intended to measure.
Reliability, on the other hand, is concerned with consistency or the degree to which the questions
used in a survey elicit the same kind of information each time they’re asked (Talent Map).
Data Analysis Plan
To test the hypothesis that mindfulness exercise and physical activity shared the best
outcomes to reduce mental health issues an dependent t-test was conducted in this study. For
example, if we were to conduct the data for the study there would be 33 randomized participants
who did mindfulness exercise and 33 randomized participants who did physical activity and the
rest of the participants are in the control group which gives a total of 34 participants who didn’t
participate in exercises. Even Though, the control group is not asked to participate in any form of
exercises, they would get tested and surveyed during the study. Since, there's no constrict data
analysis within the study but there's made up data as an example that could be used for future
preference to help create data for your study. The statistical package that was used is called the
GrapePad and it's a software company calculator that simplifies data analysis, statistics and
graphing. It helped calculate and made up data which gives all of the information on the p-value,
mean, standard deviation, t-score, degrees of freedom and also creates a chart. By putting
randomized numbers to get the p value was .0455 which tells you that the hypothesis is true than
the other.
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