Thursday, November 21, 2013

Fitness Fridays - Exercise and mental health (a research post)

Every now and then, I think I'd like to do more posts that draw on my research background. There are lots of research areas I'm interested in that don't quite fit in my work role, and I imagine that lots of you don't have time to trawl through research databases or determine what the latest recommendation on Topic X is.

Usually I have these kinds of thoughts and then don't find the time to follow them through, or I worry that no one else will want to know about Topic X anyway. Recently, though, the idea of research posts has been coming to me more and more often. I get frustrated by popular media stories that make claims without supporting evidence. I'd like to try and make science more accessible - and, I'd like an excuse to delve into all those  topics I'm curious about.

So, today, we have the first such post. In this case, it is an integration of research with my recently neglected Fitness Fridays initiative. The images (because all posts must have images!) come from our recent camping trip, which I've been wanting an excuse to share and which fit vaguely into the exercise focus.


Most of you who exercise will know that activity can be a huge mood booster. One of the reasons I love exercise in general, and running in particular, is that it keeps my anxious tendencies at bay, lifts my mood, and leaves me feeling far happier and calmer than I would otherwise be. However, until recently, it hasn't been clear if those "feel good" effects are enough to make exercise worthy as a 'prescription' for mental health difficulties.

Increasingly, exercise is starting to be seen as a serious treatment option for depression in particular and mental health problems generally. A recent review (available in full online [1]) was commissioned by Exercise and Sports Science Australia specifically to address this topic. The article reviewed research conducted up until to 2013 (including 25 randomised controlled trials) that tested the effects of exercise programmes on mental health. The main conclusions? Exercise is effective for treating depression and may also have benefits for general mental well-being and for people with long-term mental health problems, such as schizophrenia.

Consistent with these findings, The Royal Australian and New Zealand College of Psychiatrists has issued a recommendation that exercise may complement other mental health treatments [2]. It suggests it be used as a stress management strategy, to help manage medication side effects (such as weight gain with some medications), and to improve lifestyle and overall health.

Even more promising, the UK National Institute for Health and Clinical Excellence recommends that a structured group exercise programme be considered as a first step in the treatment of mild to moderate depression [3].


I think that last recommendation touches nicely on some of the issues in this area. First: individuals who are depressed or anxious may struggle to find the energy and motivation to exercise. This applies to many people without mental health problems, so we can hardly expect those who are struggling to suddenly embrace physical activity where many others can't. Second: effects may be limited to mild to moderate symptoms. It would be unfair to imply that all cases of depression can be "cured" with exercise.

I have been focusing on mental health difficulties like depression and anxiety, but exercise has also been studied in relation to neurological disorders such as Alzheimer's disease and Parkinson's disease [4]. There appear to be benefits there too. Exercise has been shown to boost cognitive functioning and brain plasticity, and improve quality of life, amongst elderly patients with these conditions. Whether exercise can actually influence disease progression is less clear, but evidence is promising. If nothing else, it certainly doesn't hurt.


Why and how do these benefits occur? There are grounds for hypothesising biological (brain changes) as well as psychosocial (a sense of purpose and reinforcement; social interaction; self-efficacy) reasons. At least some of the changes do seem to be attributable to biological effects, with a 2011 study finding that 30 minutes of exercise 3 times a week for 7 weeks resulted in reduced serotonin over the 7-week period [5]. Selective serotonin reuptake inhibitors (SSRI), the most commonly used anti-depressants today, also work to reduce serotonin circulating in the blood. Thus, these results speak to the possible benefits of exercise as an alternative and/or adjunct to conventional medication treatments.

The above study found that 30 minutes of exercise 3 days per week was enough to induce changes. There is some debate over 'optimal' levels of exercise to achieve benefits, but most agree that the general adult guidelines are appropriate as a starting point [1, 4]. This means 30 minutes of exercise on most days. Balance is also important, as always; exercising too much is just as problematic as not exercising at all.

Given that exercise programmes to boost mental health are not (yet) widely available, what do the above findings mean for those wanting to try the approach now? There is no specific set of guidelines for that. However, as with most things, a good starting place would be talking to your General Practitioner / primary care doctor. Even if a formal group programme isn't available, doctors can provide one-on-one support and facilitate appropriate goal setting around exercise frequency and intensity. They may also be able to make a referral to an exercise physiologist or physiotherapist who can provide specific activity guidelines.

Following on from the above, anyone who experiences symptoms of depression and anxiety should talk to their doctor. If you do not exercise regularly, seeing your doctor is also wise before starting an exercise programme.

What are your thoughts on this area? Do you find exercise helps you stay focused / happy / calm?

Some references:

  1. Morgan et al. (2013). Exercise and mental health: An Exercise and Sports Science Australia commissioned review. Journal of Exercise Physiology, 16, 64 - 73. Available in full online (direct link to PDF).
  2. The Royal Australian and New Zealand College of Psychiatrists (2009). Coping with Depression: Australian Treatment Guide for Consumers and Carers. Melbourne, Australia: The Royal Australian and New Zealand College of Psychiatrists.
  3. National Institute for Health and Clinical Excellence (2010). The treatment and management of depression in adults (ipdated edition). National Clinical Practice Guideline 90. London, UK: The British Psychological Society and The Royal College of Psychiatrists.
  4. Deslandes A et al. (2009). Exercise and mental health: Many reasons to move. Neuropsychobiology, 59, 191 - 198. Available in full online (direct link to PDF).
  5. Wipfli B et al. (2011). An examination of serotonin and psychological variables in the relationship between exercise and mental health. Scandinavian Journal of Medicine and Science in Sports, 21, 474-481. Available in full online (direct link to PDF).
Linked in to The Fitness Fridays link up on Running Bloggers.

31 comments:

  1. Interesting post Kari - I agree that exercise is great for general wellbeing. I also am aware that exercise can be harder when life is harder. I had one experience of being very unhappy and being mentally unable to ride my bike very far even though I was quite fit and physically able to do it. It brought home to me just how important your mental state is to doing the exercise - did you come across any references to such experiences in your research?

    I was also interested to see that Dr Michael Mosley (who also presented the show on the 5:2 diet) has made a program about how doing exercise in short sharp bursts of energy can be as effective as long hours of exercise. I am interested in this as a way for people who don't have much time or inclination to exercise to get into the doing some. What is your take on this?

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    1. Hi Johanna, your first point is spot on - I think that is part of the problem with recommending exercise for mental health (or at all really) without sufficient support / structure around that. Low mood and heightened anxiety tend to reduce motivation in general and engagement in 'self care' behaviours in particular, so exercise does usually drop off when people aren't feeling good. I think structured and supported exercise groups would make a real difference in how many people could apply exercise as a treatment approach when they are struggling.

      I saw that documentary by Michael Mosley and found it very interesting! I may need to return to it in a future post :-) I don't believe that style of exercise has been studied in relation to mental health (my guess is that it would be less effective, but I could well be wrong), but it does seem to have growing support for cardiovascular and physical health benefits.

      Thanks for your thoughts!

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    2. Your point about supported exercise groups reminds me of a headline I saw recently about dancing being a good recovery exercise for cancer survivors - might also help people with mental health problems. Having said that, group activities might sometime be harder for people with mental health issues but maybe you would then be killing two birds with one stone if they could do such activities.

      re michael mosley's study I thought it might help to ease back into exercise to think you just had to do a small amount and it would be effective. But I think I understand why you think it would be less effective.

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    3. I think it would definitely help with easing back in - and who knows, perhaps it would be just as effective? I was amazed at the research on the physical effects and I can see that set of studies really helping to motivate people who are otherwise not very active.

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  2. Love love loved this post Kari!
    I'd love to read more research-ey posts if you've got the time to do them... but then I research for fun :)

    Great topic to start with too. I have a list on my fridge of the many many positives from a simple 30 minute walk a day... most days I'm sweet, some days I want to run and jump and swim but others I have to convince myself to get up to pee...

    Now I know those are the times I need to exercise more than ever but knowing it and doing it are two very different things... still, it's good to know the routine I need to keep me going. I've found the combination of sunlight, exercise and eating well to be more effective than drugs but there are still some days when getting up to open the blinds seems like a mammoth task.

    Loving the references, they're on my reading list :) Thank youuuu xxxxx

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    1. Thanks so much for your enthusiasm Claire! I'm so glad you like the idea, and this post topic too. It's great to hear you've found the things that work for you, even if some days it is harder to put them into action. I think we all have such days but at least it helps knowing what you need to do, even if doing it doesn't always happen.

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  3. Those are certainly interesting findings. I don't always feel on top of the world during exercise, but do feel as if I have achieved something once I am finished.

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    1. Sometimes, half way through a run that is proving difficult, it's knowing how accomplished I'll feel if I finish that keeps my going ;)

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  4. Really interested in this sort of thing...I often wonder if one of the reasons we are seeing an increase in stress and depression is because we are so inactive these days...there was also an interesting article about some research that demonstrated exercise keeps people younger, I didn't look up the original research because I was too lazy (oh, the irony!) but you may find it interesting! http://mobile.news.com.au/national/victoria/new-research-shows-ultra-marathons-could-add-16-years-to-your-life/story-fnii5sms-1226763742845

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    1. I do indeed find it interesting! Thanks so much :) And I agree with your point about increased depression likely being linked to decreased activity - we really didn't evolve to sit at a desk all day and yet so many of us (me included) do!

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  5. There is SO much evidence that exercise is beneficial for all kinds of neuronal health! Love that it's being used for psychiatric disorder.

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    1. Me too! It is one of those things that seems kind of obvious, and yet the research has really lagged - and so health recommendations have lagged too.

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  6. Definitely agree! As someone who's suffered with serious anxiety issues (and still occasionally struggles) I find exercise so valuable. Even if it's just a 15 minute brisk walk it makes a huge difference to my mental wellbeing. Equally, motivation is a sticky issue since in "low" periods it's difficult to motivate to do anything, let alone exercise.

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    1. That's the catch, isn't it? When you need exercise the most, it is the hardest to get out and do!

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  7. What a great post!!
    It never occurred to me that although it is widely known that exercise gives you those happy endorphins that it should be recognised medically and prescribed by doctors. I do agree though, exercising when you are in the fits of depression is hard. I would hope there could be a group exercise program as a first step to treating people suffering depression.
    Personally, I need to exercise for anxiety issues. I have been doing this for two years now and it helps a lot!

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    1. Thanks so much for sharing your perspective Gourmet Getaways...like you say, in some ways it is obvious that exercise should be considered for mental health, and yet it hasn't been formally recommended and comes with its challenges for implementation!

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  8. I have a few friends who suffer from mild depression and the one common thread is that none of them do any exercise. It is so well known that exercise lifts your mood and makes you feel a lot more positive. I've suggested to one of my friends that she gets outside and just goes for a short walk every day. She lives near the beach so there are some beautiful coastal walks she could do. But I haven't been able to convince her! Very interesting post, Kari xx

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    1. Thanks Charlie - your friends sound like just the sort of people who might benefit from some sort of formal support / structure in exercise!

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  9. So interesting! I know when I run consistently I feel healthier, happier and more focused. I know I feelthe effects right way after a run in terms of focus!

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    1. Me too! I feel so grateful to have discovered it.

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  10. I am so glad that you decided to post this! Since I changed my diet and began exercising two years ago I have been able to completely stop taking medications for depression. I fully contribute this to exercising. I know that if I go a few days without at least a 30 minute run, I become miserable and feel depressed and irritable.

    I did not know about the benefits for Parkinson's. I don't have it, but my father does. I do have pernicious anemia and lack intrinsic factor which I've read can sometimes lead to Parkinson's since it is an autoimmune disorder.

    Thanks so much for this article Kari!

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    1. Thanks for sharing your perspective Anna! I love that exercise has made such a big difference for you. I wonder how many people could have similar experiences if only they knew (and had the support) to give activity a try?

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  11. One of the reasons I created a separate blog for running is to be able to write about my struggle with mental health (manic-depression, panic and anxiety attacks), and how greatly sports have helped me not only cope but overcome.

    I feel empowered whenever I get positive feedbacks from readers, on how I have encouraged them to be physically active.

    It is great to read that medical research supports the positive benefits of sports for the mental health.

    I dream one day the pharmaceutical industry will work hand in hand with health insurance, and doctors to get people to be physically active than resort immediately to anti-depressants*.

    (*It is too long for me to write my stand point about anti-depressants. Of course it is self-explanatory, that this is not applicable for the chronically depressed.)

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    1. I dream of that too Joanna - with your same point, of course, about anti-depressants being necessary for some. Just not for all!

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    2. :) I am very happy to have discovered your blog, Kari! Another one of the positive or running and blogging, reading one is not alone in the struggle and the effort to contribute to a change.

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    3. Thank you so much Joanna :)

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  12. I absolutely believe exercise (and for me, running in particular) helps me stay happy/calm ESPECIALLY in the winter months when the days are short. I struggle with anxiety and this is one of my coping techniques

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    1. Me too Lisa :-) Winter isn't really a factor here in Australia (I find summer harder to cope with because I hate extreme heat!) but I can imagine in the northern hemisphere exercise would be extra hard but extra important during that time of year.

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  14. As someone who has issues with anxiety, I know running helps me calm down and be way more centered and focused. I 100% agree with the findings in this study!

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    1. Thanks for sharing your perspective Stephanie. Running definitely calms me down too - better than just about anything in fact!

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