Walking as a treatment for depression is a good idea. Reports vary, but most suggest that there is a small, positive effect from encouraging people to exercise.[i]
I have seen patients who had a large and reliable response to walking therapy for depression. I ask people to simply scale their depression from zero to ten, where zero equals the worst they have ever felt, and ten is the best.
Most people will rate their depression at “3” on this scale, and that translates on the Center for Epidemiological Studies – Depression (CES-D) scale as “moderate depression,” scoring between 18 and 26. Beck Depression Inventory scores are essentially equal to the CES-D.
Now comes a study from Thailand comparing Buddhist Walking Meditation (BWM) with Traditional Walking Exercise (TWE) and with a control group. The whole study is available online at the Journal of Alternative and Complimentary Medicine site.[ii]
(Let us pause and offer thanks to the Journal of Alternative and Complimentary Medicine since most journals are greedy and selfish and want to charge us $30 or so for a download of an article. Kudos to JACM and shame on all the other publishers.)
The subjects were elderly female Thai scoring in the moderately depressed range on a geriatric depression measure. The actual exercise was as follows, from the article:
“Both TWE and BWM exercise programs were divided into two phases. In phase 1 (weeks 1–6), TWE and BWM training programs were conducted at mild intensity (20%–39% individually determined heart rate reserve) performed for 20 minutes, 3 times a week. In phase 2 (weeks 7–12), the training intensity was increased to moderate intensity (40%–50% heart rate reserve) performed for 30 minutes, 3 times a week. Both exercise programs were closely supervised by one of the investigators. Adherence to the prescribed exercise intensity was confirmed using heart rate monitors (Polar Team 2 Pro, USA). Both TWE and BWM programs also included 11 common stretching exercises performed during warm-up and cool-down stages. All of the exercise training involved walking on the 50-m oval-shaped indoor track.”
The walking meditation consisted of swinging both arms forward on the in-breath while thinking of the sound “Budd” and swinging the arms back on the out-breath, thinking of the sound “Dha.” Thus, the person meditated on the term “Buddha” as they walked.
While both of the active groups improved in fitness, only the BWM group improved in mental health. Talk a look at this chart:
This is a surprise to me because generally you would expect to see more improvement in the TWE as well as the meditation walking group. Why didn’t this exercise show that?
Yet, we have known for a long time that meditation has a positive effect on depression.[iii] So that part is not a surprise.
So thinking about the results, we have to wonder about the participants. Buddhism is respected and widely practiced in Thailand, so the acceptance factor should be very large with this group. How would you apply such a practice to Europeans or Americans?
Several ideas come to mind.
First, mindfulness is less explicitly aligned with Buddhism than the Budd-Dha prayer in this program. So one could do the same study by focusing on savoring as a skill (alignment to the current moment, dropping thoughts of the past or future). This promotes a mindful quality that isn’t so aligned with the religion.
Second, one could combine mindful walking meditation with a religiously appropriate prayer. If a person is Christian, some form of the Jesus prayer, or for a Jewish subject, the “Hear, oh Israel, G-d is one” prayer.
Third, any counselor can learn this, and if one does learn it, one can teach it. Try it and see. Use a reliable depression rating scale each session and see if you are having a positive impact. The CES-D is widely available and easy to use.
So I tried mindful walking meditation. As I practiced, I found my mind wandering shamelessly. I started thinking of how I could write this blog, I thought of how much time I needed to do this, I thought of all kinds of irrelevant ideas.
I practiced accepting and releasing. I would shift my awareness to “thinking, thinking . . .” and focus back on the feelings of walking and breathing.
When my mind wanders, I notice the wandering by observing that I am thinking, and I comment, “thinking, thinking, that’s just thinking . . .” The essence of savoring / mindful open meditation is to simply be aware of the sights, sounds, tastes, touch, and smell in my current experience.
I walk mindfully and then my mind wanders. I reorient it back to the moment, and enjoy the awareness of my feet and my breath and my arms swinging and the sights and sounds . . . and my mind wanders again. I practice it over and over. After about twenty minutes, my lunch hour was over and I went back to work.
It was a pleasant experience.
I might try it again some day.
[i] Rimer J, Dwan K, Lawlor DA, Greig CA, McMurdo M, Morley W, Mead GE. Exercise for depression. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub5.