Moving for Mental Health! The role of exercise in mental health treatment. | A Healthy State of Mind

Posted by Mary R. Fry, N.D. on Tuesday, May 27, 2014

May is National Physical Fitness and Sports month {http://www.fitness.gov/}, and with the warmer days and more sun, it hopefully is easier for people to get motivated to move! Doctors have a tendency to overlook or understate the value of exercise in being busy to find the best treatment(s) for a patient’s ills (I include myself in this), but the effects of exercise really ought to be appreciated! For anxiety and depression, it can sometimes be the best, or only, treatment. Studies have shown that exercise can be as effective as antidepressants and cognitive behavioral therapy and may have longer-lasting effects (in treating cases of mild to moderate depression).  In some cases, it may be more effective than medication and in other cases it can augment the effect of antidepressants (i.e. help the medication to work better).

Exercise in Anxiety & Depression

Depression is an independent risk factor for increased cardiovascular mortality. Couple this with a more sedentary lifestyle, another independent risk factor for increased cardiovascular mortality, and the risk of cardiovascular mortality then exceeds the sum of either of these two risk factors alone.  Exercise can also improve sleep, and both anxiety and depression are major contributors to insomnia.

Those suffering from anxiety have been shown to have a significant reduction in worry rates following a 6 week exercise trial conducted in a study by Herring et al. Anxiety and stress also increase the risk of heart disease, whereas  exercise can reduce the risk of heart disease.

Exercise in Severe Mental Illness

People suffering from severe mental illness have higher risks of obesity, diabetes and cardiovascular disease. These risk factors can be reduced with regular physical exercise (which also has some of the added benefits mentioned below). “Physical activity has the potential to improve the quality of life of people with serious mental illness through two routes—by improving physical health and by alleviating psychiatric and social disability.” (Richardson et al., 2005)

How Exercise works on Mental Health

Exercise may exert some of its effects on mental health through a protein called ‘Brain Derived Neurotrophic Factor’ or ‘BDNF’. BDNF protects neurons and supports their growth and maintenance. Levels of BDNF have been shown to be depressed in those with anxiety, depression and panic disorder. As little as 30 minutes of exercise can increase BDNF levels.

Exercise can also reduce negative mood, improve self- esteem, improve body image, distract one from worry, alter circulation of neurotransmitters, improve cognition and decrease social withdrawal. Exercise can increase libido (which is decreased due to depression and other mental health issues or from treatment (it is a side-effect of some pharmaceutical medications used to treat mental illnesses)), decreases cholesterol  preferentially (Exercise can increase the ‘good’ cholesterol, HDL (which is often lower in those with depression). And those on  atypical antipsychotic medications often have elevated levels of cholesterol and triglycerides as result of the medications- exercise can reduce these levels) Finally,exercise reduces weight (a problem for many taking antidepressants or antipsychotic medications is weight gain), is cardioprotective and helps to improve sleep.

How Much to Exercise is Recommended?

US Center for Disease Control & Prevention recommendations:

  • Adolescents should exercise 60 minutes a day.
  • Adults 18-64: 150 minutes of moderate intensity aerobic activity per week and muscle strengthening activities 2 or more days per week. (Even short (10 minute) stints of exercise can be helpful and count toward the weekly 150 minute total.)
  • Adults >65 years of age: the same recommendations as adults as long as the individual is fit.

For more information on this, see the CDC website: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html

Getting Motivated!

Exercising with a friend or family member is a great way to stay motivated and to get some social contact (which many suffering from mental illness need more of). Classes are also a good way to stay motivated, to meet others and to learn new skills. Setting goals/tracking outcomes is important. Personal trainers can help with this, as can a calendar, poster or paper and pencil to sketch out a list of goals &/a workout schedule. For some such a tangible visual reminder is necessary. Others may prefer using their smartphone or tablet with apps. Here is a slideshow of a variety of fitness-based apps that are available: http://www.pcmag.com/slideshow/story/292474/the-25-best-fitness-apps

I hope that this blog post helps you to improve your activity level and ultimately your health! Be sure to ease into exercise slowly if you haven’t done it for a while. Including a variety of activities can help minimize overuse of joints and prevent boredom. And don’t forget that exercising outdoors in the spring/summer gives you some vitamin D and fresh air – which most of us can’t get too much of!

A note on future blog posts: Outside of the office over the next few months I am working on developing a Master’s Level Nutrition class in Advanced Biochemistry, Pathophysiology & Assessment. Immersing in this material helps me to help my patients and to teach other practitioners how best to help their patients. As the work is rather time-consuming, it is likely that my writing schedule for the blog and newsletter will change…I may not post again until September. If that is the case, I wish you a healthy, happy and safe summer!

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References & Resources

Herring, M.P., Jacob,  M.L., Suver, C., Dishman, R.K., O’Connor,  P.J. (2011). Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial.  Psychother Psychosom., 81(1),21-28.

McClafferty, H., Lam, N., Weil, A., McGee, L., & Smith, R.C. (2013) Introduction to Integrative Mental Health. University of Arizona. Arizona Center for Integrative Medicine. Retrieved from: http://integrativemedicine.arizona.edu/online_courses/intro_to_mental_health.html

Article with podcast recommendations to follow:

Mental Health Foundation (n.d.).Exercise and Mental Health Retrieved from: http://www.mentalhealth.org.uk/help-information/mental-health-a-z/E/exercise-mental-health/

Richardson, C.R., Faulkner, G., McDevitt, J. , Skrinar, G.S., Hutchison, D.S., & Piett, J. D. (2005). Integrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness.  Psychiatric Services 56(3),324-331.

Categories: Anxiety Disorders, Depression, Exercise, Psychiatric Medications, Schizophrenia & Psychosis, Sleep Tags: exercise, insomnia