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 ) 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 . 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 .
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 . 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 . 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?
- 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).
- 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.
- 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.
- 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).
- 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).