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Published in final edited form as: Psychol Health Med. 2022 Oct 31;28(4):1068–1075. doi: 10.1080/13548506.2022.2141276

Effects of a Bout of Exercise on Mood in People with Depression with and without Physical Pain

Celeste M Caviness a,b,*, Ana M Abrantes a,b, Bailey J O’Keeffe b, Aubrey J Legasse b, Lisa A Uebelacker a,b
PMCID: PMC10006325  NIHMSID: NIHMS1857346  PMID: 36315041

Abstract

Physical and mental health symptoms can reduce participation in physical activity. The current study assessed the impact of a bout of exercise on mood state in depressed participants with and without current physical pain. We enrolled a community sample of 147 participants (Mage= 45.5; SD = 11.98; 87.1 % female) with elevated depressive symptoms. Individuals rated their mood state, completed a 1-mile walk test on a treadmill, and rated their mood state again. Pairwise comparisons between pre- and post-exercise mood ratings were statistically significant (p <.001) and showed improved mood state. People with at least moderate pain showed greater decreases in sadness and irritability from pre- to post- exercise bout. A single bout of exercise was associated with decreased sadness, anxiety, and irritability, and increased energy in a sample of adults with depression. The changes in sadness and irritability were greatest in those who reported at least moderate physical pain.

Keywords: depression, bodily pain, aerobic exercise intervention, mood changes

Introduction

Physical activity is associated with a host of physical (Warburton & Bredin, 2017) and mental health (Chan, et al., 2019; Morres, et al., 2019) benefits. Although physical activity is recommended for those with depression, factors such as chronic pain can interfere. A majority of those with depression report comorbid pain and a substantial minority of individuals with chronic pain also report depressive symptoms (Bair, et al., 2003). Chronic pain and depression appear to activate similar brain regions and exacerbate each other when present simultaneously (Sheng, et al., 2017), making recognition and treatment of each individually a challenge (Bair, et al., 2003).

Despite physical activity recommendations, pain and depression are often perceived as barriers to meeting weekly guidelines for physical activity and lead to low-active behavior (Koyanagi, et al., 2018; Larsson, et al., 2016; Rashiq & Dick, 2009; Rodriguez-Sanchez, et al., 2019; Shiraly, et al., 2017; Stubbs, et al., 2014). When combined, pain and depression can present significant hurdles for individuals engaging in physical activity, despite the potential benefits. There is evidence to suggest acute bouts of exercise can have a positive effect on mood state from pre- to post- exercise bout in depressed individuals (Meyer, Ellingson, et al., 2016; Meyer, Koltyn, et al., 2016) and those with chronic pain (Hoffman & Hoffman, 2007; Sullivan, et al., 2010). However, to our knowledge, physical pain has not been examined as a predictor of changes in mood state.

In this secondary data analysis, we aimed to examine changes in mood state pre- to post-exercise bout in individuals with elevated depressive symptoms and bodily pain during the past month. We hypothesized that a single bout of exercise would decrease negative mood states (e.g. sadness, anxiety, and irritability), and increase positive mood states (e.g. energy) in people with bodily pain. As an exploratory analysis, we planned to compare the degree of change in groups with different levels of pain.

Methods

Participants and Procedure

Study participants were recruited between November 2016 and March 2019 for a randomized controlled trial aimed at assessing interventions to increase and maintain physical activity among depressed individuals. More details on the study protocol can be found here (Uebelacker et al., 2020). The study protocol was approved by the Institutional Review Board where the study was conducted. A total of 147 individuals completed a baseline two assessment and walk test.

Measures

Demographics.

We asked participants to self-report on age, gender, race, and ethnicity.

Current Pain.

36-Item Short Form Health Survey (SF-36 (Ware & Sherbourne, 1992)). Bodily pain was measured with the question “How much bodily pain have you had during the past 4 weeks?” Scores range from 1 (none) to 6 (severe). Scores were dichotomized to indicate people with physical pain (score ≥ 4; Moderate or greater) and people with minimal physical pain (score ≤ 3; Mild or less).

Depressive Symptomology.

Depression symptoms were measured using the self-report 9-item Patient Health Questionnaire (PHQ-9 (Kroenke, et al., 2001)). Total score ranges from 0 (minimal) to 27 (severe).

Exercise testing.

Rockport 1.0 Treadmill Walk Test (Pober, et al., 2002) was utilized as a supervised submaximal exercise bout. Participants walked one mile at the fastest speed they could comfortably complete the test. The participant’s heart rate was measured every minute throughout the test while their blood pressure and rating of perceived exertion (RPE) (i.e., Borg Rating of Perceived Exertion Scale; (Borg, 1982)) were measured every 5 minutes.

Participant energy level and mood state before and after exercises were measured using a revised version of the National Institute of Mental Health (NIMH) self-rating scale. The measure was similar to single item measures of mood state used in experience sampling method/ecological momentary assessment studies (Band, et al., 2017). Participants were asked to rate 4 items (depression/sadness, anxiety, irritability, energy) on a 10-point Likert scale ranging from 0 (none) to 10 (extreme), immediately prior to and after the exercise test.

Analytic Methods

We present descriptive statistics to summarize the sample characteristics. Pre- and post- walk test mood state ratings were evaluated using independent sample t-tests. Finally, regression analyses examined predictors of post-test ratings of sad mood, anxiety, irritability, and energy, with covariates including pre-test rating of the same variable, PHQ-9 score, and age.

Results

Participants averaged 45.50 (SD = 11.98) years of age, 87.1% were female, 91.84% were white, and 8.16% identified as a racial minority. The mean PHQ-9 score was 13.37 (SD = 4.96). Thirty one percent of participants reported moderate or greater (MoG) bodily pain in the past four weeks. The group with MoG bodily pain did not differ significantly from the group with mild or less (MoL) pain on any of the background variables examined (Table 1). The 1-mile Rockport treadmill walk test lasted an average of 22.43 minutes (SD=4.8). Overall, participants engaged at a moderate-intensity level of physical activity during the walk test (Table 1).

Table 1.

Descriptive summary of sample characteristics (N=147)

Variable Mild or Less Physical Pain (n = 102)
n(%) or M(SD)		 Moderate or Greater Physical Pain (n = 45)
n(%) or M(SD)		 t or x 2 df p
Age 44.3 (12.5) 48.3 (10.2) −1.90 145 0.059
Gender
Female 85 (83%) 43 (96%) 4.26 2 0.12
Male 15 (15%) 2 (4%)
Other 2 (2%) 0 (0%)
Race
American Indian 0 (0%) 1 (2%) 4.36 6 0.63
Asian 3 (3%) 1 (2%)
Black 1 (1%) 1 (2%)
White 94 (92%) 41 (91%)
Other/multiracial 4 (4%) 1 (2%)
Ethnicity 1.69 2 0.43
Latino/a 3 (3%) 0 (0%)
Not Latino/a 98 (96%) 44 (98%)
Chose not to say 1 (1%) 1(2%)
PHQ-9 13.0 (4.9) 14.3 (5.0) −1.47 145 0.145
Rockport Treadmill Walk Test
Duration (in mins) 22.2 (4.2) 23.0 (6.0) −1.00 146 0.32
Highest RPE 12.8 (1.6) 12.7 (1.6) 0.41 145 0.68
% of age-predicted max HR at peak HR 68.2% (0.1) 70.0% (0.1) −0.89 146 0.38
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Note: Chi-squared t-tests revealed no significant demographic, depressive symptom, or walk test differences between those with and without pain.

We ran pairwise comparisons between pre- and post-exercise ratings of mood state in the full sample as well as by MoG pain vs MoL pain. Reductions in mean sadness, anxiety, and irritability, and increase in energy were statistically significant in the full sample as well as those with MoG pain and with MoL pain (Table 2). In those reporting at least MoG pain, the absolute change in means was greater than those with MoL pain in all four mood state rating categories.

Table 2.

Mood effects of exercise for total sample and by presence of physical pain (N = 147)

Acute Symptoms Self-Rating Scale Pre-exercise M(SD) Post-exercise M(SD) Cohen’s d t df p
Sadness –All participants 3.8 (2.2) 2.2 (2.0) 0.74 11.58 146 < 0.001
MoL physical pain 3.8 (2.2) 2.5 (2.1) 0.66 8.40 101 < 0.001
MoG physical pain 3.8 (2.3) 1.7 (1.8) 0.91 8.72 44 < 0.001
Anxiety–All participants 3.7 (2.4) 1.7 (1.8) 0.84 12.98 146 < 0.001
MoL physical pain 3.6 (2.4) 1.6 (1.7) 0.84 11.88 101 < 0.001
MoG physical pain 4.0 (2.5) 1.9 (2.2) 0.85 6.12 44 < 0.001
Irritability–All participants 2.1 (2.2) 1.0 (1.5) 0.50 7.88 146 < 0.001
MoL physical pain 2.2 (2.3) 1.2 (1.6) 0.44 1.37 101 < 0.001
MoG physical pain 1.9 (1.9) 0.6 (0.9) 0.68 6.38 44 < 0.001
Energy–All participants 3.8 (1.5) 5.3 (1.6) −0.95 −9.76 146 < 0.001
MoL physical pain 4.0 (1.5) 5.3 (1.6) −0.91 −8.47 101 < 0.001
MoG physical pain 3.3 (1.6) 5.1 (1.7) −1.08 −5.24 44 < 0.001
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Note: Cohen’s d = 0.2 is considered a ‘small’ effect size, 0.5 a ‘medium’ effect size, and 0.8 a ‘large’ effect size.

MoL = Mild or Less; MoG = Moderate or Greater

To determine whether the presence of pain was a significant predictor of post-exercise mood state when controlling for pre-exercise mood state, we conducted a regression. Baseline age and PHQ-9 score were used as additional covariates. Pre-exercise mood state ratings were significant predictors of corresponding post-exercise mood state ratings for sadness, anxiety, irritability, and energy (Table 3). Those reporting MoG pain had significantly greater decreases in sadness (B = −.60, t = −2.28, p = 0.024) and irritability (B = −.40, t = −2.00, p = .047). Bodily pain was not a significant predictor of post-exercise ratings of anxiety or energy when controlling for pre-exercise ratings (Table 3).

Table 3.

Regressions predicting post-exercise mood state including baseline age and baseline depression as predictor (N=147)

B SE t p
Predicting post-exercise sad mood
Pain −0.60 0.26 −2.28 0.024
Pre-exercise sad mood 0.59 0.06 10.54 <0.001
PHQ-9 total 0.13 0.03 0.51 0.608
Age −0.02 0.01 −1.55 0.124
Predicting post-exercise anxiety
Pain 0.25 0.26 0.97 0.335
Pre-exercise anxiety 0.44 0.05 8.69 <0.001
PHQ-9 total 0.01 0.02 0.36 0.720
Age −0.03 0.01 −2.58 0.011
Predicting post-exercise irritability
Pain −0.40 0.20 −2.00 0.047
Pre-exercise irritability 0.39 0.04 9.25 <0.001
PHQ-9 total 0.01 0.02 0.65 0.514
Age −0.02 0.01 −2.94 0.004
Predicting post-exercise energy
Pain −0.04 0.29 −0.15 0.879
Pre-exercise energy 0.33 0.09 3.91 <0.001
PHQ-9 total −0.04 0.03 −1.37 0.173
Age 0.02 0.01 1.43 0.155
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Discussion

In the current study, a single bout of exercise was associated with changes in mood state in a sample of adults with elevated depressive symptoms. Although changes in mood and affect following acute exercise have been documented previously, to our knowledge, pain has not been examined as a predictor of post-exercise mood state. In this study, having experienced MoG bodily pain prior to baseline predicted larger decreases in sadness and irritability from pre- to post exercise. Notably, those with MoG pain had similar baseline levels of sadness and irritability to those with MoL pain which rules out the explanation that those with MoG pain were more depressed or irritable immediately prior to exercise and therefore saw greater decreases. We considered other possible. First, fear avoidant beliefs and pain catastrophizing are barriers to physical activity in those with pain (Nelson & Churilla, 2015) and may contribute to negative mood state prior to exercise. However, post-exercise, feelings of accomplishment, pride, and self-efficacy for physical activity may be enhanced as they accomplished something they had previously avoided. Second, it is possible exercise relieved pain for individuals used to experiencing pain. In healthy adults pain perception and sensitivity to experimentally induced pain conditions was lowered following acute bouts of exercise (Naugle, et al., 2012). It is likely the experience of pain and mood state following a bout of exercise are entwined given that pain and depression can have synergistic effects (Sheng, et al., 2017).

Although changes in mood state were considered modest, the effect sizes were large based on Cohen’s d criteria in this group of low active individuals with depressive symptoms. Participants were not asked to subjectively compare their mood post-exercise to pre-exercise, which may be informative in future studies. Pain was also measured on a single item making it difficult to distinguish the source and type of pain. However, even small, positive changes can be used to encourage subsequent physical activity.

When evaluating the findings from this study, limitations should be considered. First, the sample was quite homogenous and the results may not generalize outside this population. Second, there was no control condition, which would be valuable in future studies. Third, although all participants completed the Rockport walk test, the duration (in minutes) of the exercise bout was variable (per protocol). However, previous work has shown duration and intensity does not impact ratings of mood state post-exercise (Crush, et al., 2018). Fourth evaluating fluctuations in mood state throughout an exercise bout could be informative. Fifth, we did not evaluate pain level immediately prior to the exercise bout. Finally, post-exercise mood state rating was taken five minutes post-exercise. Although the mood enhancing effects of acute exercise have generally been found to be stable up to thirty minutes post-exercise (Crush, et al., 2018; Meyer, Koltyn, et al., 2016), it would be enlightening to examine the decay trajectory.

This study had important strengths, which include the use of a standardized exercise activity and evaluating the effect of pain on post-exercise mood state. Future studies on changes in pre- and post-exercise pain levels in addition to mood state would further our understanding of these mechanisms. It would also be beneficial to replicate these findings while participants engage in other forms of exercise.

Although exercise has been recommended for pain conditions and depression, this study shows that there may be added benefit for those experiencing both, especially for short term changes in mood state. When recommending increased physical activity, health care providers should highlight the potential for short term mood state enhancement as well as the long term mental and physical health benefits.

Acknowledgments

Funding:

This work was funded by R01HL127695. ClinicalTrials.gov Identifier: NCT02691845.

Footnotes

Declaration of Interest: Dr. Uebelacker’s spouse is employed by Abbvie Pharmaceuticals.

Ethics Approval: Study approval was obtained from the Butler Hospital Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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