Exercise may be just as crucial to a depression patient’s good health as finding an effective antidepressant.

A new study of nearly 18,000 participants found that those with high fitness at middle age were significantly less likely to die from heart disease in later life, even if they were diagnosed with depression.

The research—a collaboration between UT Southwestern and The Cooper Institute—underscores the multiple ways in which depression may ultimately impact health and mortality. It also highlights the importance of overcoming a common dilemma among patients: How does one cope with hopelessness and still find motivation to exercise.

“Maintaining a healthy dose of exercise is difficult, but it can be done. It just requires more effort and addressing unique barriers to regular exercise,” says Dr. Madhukar Trivedi, coauthor of the study and director of the Center for Depression Research and Clinical Care, part of the Peter O’Donnell Jr Brain Institute at UT Southwestern.

The study, published in the JAMA: Psychiatry, utilized a Cooper Institute database of participants who had their cardiorespiratory fitness measured at an average age of 50 years. Researchers used Medicare administrative data to establish correlations between the participants’ fitness at midlife to rates of depression and heart disease in older age. Among the findings, participants with high fitness were 55% less likely to eventually die from heart disease following a depression diagnosis.

Dr. Trivedi says the findings are just as relevant to younger age groups, in particular college-age adults who are just entering the workforce.

“This is the age where we typically see physical activity drop off because they’re not involved in school activities and sports,” Dr. Trivedi says. “The earlier you maintain fitness, the better chance of preventing depression, which in the long run will help lower the risk of heart disease.”