A study of U.S. active-duty military service members with major depressive disorder at the Naval Medical Center San Diego showed that surfing and hiking reduced symptoms of depression. Participants who underwent the surfing program were somewhat more likely to be able to return to normal levels of social functioning three months after the study than those who were hiking. The study was published in BMC Psychiatry.
Depression, or major depressive disorder, is one of the most common mental disorders. Approximately 5% of people worldwide suffer from it. This percentage is even higher among military personnel (around 8%). Symptoms of depression include continuous low mood or sadness, low self-esteem, feeling tearful, hopeless, helpless, guilt-ridden, and others. Depression is often associated with substance abuse and having suicidal thoughts.
Depression is treated using antidepressant drugs such as citalopram, escitalopram, fluoxetine, and many others. However, after one stops using them, there are no sustained effects that would prevent another depressive episode from occurring. Cognitive-behavioral therapy is also used and found to be effective. However, a large percentage of patients either do not respond to it or it does not lead to the complete withdrawal of depression symptoms.
Another promising approach to treating depression involves physical activity. Studies have shown that exercise is a viable adjunctive intervention to standard treatments. Additionally, findings indicate that physical activity happening in natural environments has larger effects on depressive symptoms than physical activity indoors.
Such activities include hiking i.e., going for long walks across country, and surfing i.e., the activity of riding waves, usually at sea, towards the shore using a surfboard. Previous studies have indicated that both of these activities confer additional benefits on top of physical activity alone, but such studies were few.
Study author Kristen H. Walter and her colleagues, wanted to explore the effects of surf therapy and hiking therapy on the level of depressive symptoms. They devised an experiment. Participants were 96 active-duty military service members referred to the Wounded, Ill, and Injured (WII) Wellness Program at the Naval Medical Center San Diego (NMCSD).
All participants suffered from major depressive disorder, as assessed by the Mini International Neuropsychiatric Interview 7.0 (MINI-7). They were enrolled in the surf or hike therapy programs for the first time in the scope of this study.
Participants were randomly assigned to either hike or surf therapy – 48 participants to each. Both of these programs consisted of 6 consecutive weekly sessions, each lasting 3 or 4 hours. The surf therapy program was conducted at a public beach in San Diego and the hike therapy program took place at various locations throughout San Diego County. Additionally, participants undergoing surf therapy were also offered yoga sessions before each surf session.
Participants were assessed before the program start, after the program ended, 3 months after the end of the program, and within each session. Before the start of the program, participants also provided their demographic information, service characteristics, information on the therapy they were using at that moment.
The researchers also assessed participants’ satisfaction with each program using the Client Satisfaction Questionnaire (CSQ-8). Roughly 77% of participants completed the assigned intervention i.e., did not miss more than two sessions and 78.1% of participants completed the assessments three months after the study.
Results showed that depression symptoms decreased substantially through the sessions. Participants who attended more therapy sessions, either hike or surf therapy, had less pronounced symptoms after the study, on average. These effects were not dependent on medications taken during the treatment or psychotherapy programs.
There was no difference between hike and surf therapy in how much they reduced depression symptoms. However, participants who underwent surf therapy were more likely to go into remission i.e., be able to return to normal social functioning three months after the study compared to those who underwent hiking therapy. The reduction in symptoms was found to remain three months after the treatment in both groups.
“The current study provided support for surf and hike therapies as effective adjunctive interventions for service members with major depressive disorder, and participants were highly satisfied with both programs,” the study authors concluded. “Results indicated that there were significant decreases in clinician-rated and self-reported depressive symptoms across groups.
“The reductions in clinician-rated depressive symptoms were large, clinically significant, and greater among service members who attended more sessions. The programs were also associated with statistically and clinically significant improvements in self-reported depressive symptoms, and effects were stronger among those enrolled in pharmacotherapy.”
The study makes a valuable contribution to understanding the effects of physical activity on depressive symptoms. However, it should be taken into account that the study was conducted on active-duty military personnel. Results on other groups or the general population might not be the same.
The paper, “A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder”, was authored by Kristen H. Walter, Nicholas P. Otis, Travis N. Ray, Lisa H. Glassman, Jessica L. Beltran, Kim T. Kobayashi Elliott, and Betty Michalewicz‑Kragh.
