The positive effects of exercise have been proven to help prevent and improve several health conditions such as high blood pressure, diabetes, and arthritis. Research has recently been conducted to help determine how exercise not only positively affects the body but also how it positively impacts mental health. The effects of exercise on mental health conditions, such as major depressive disorder, have been a source of contentious debate. Many research papers have been penned to help unpack the evidence, concluding that exercise may help reduce symptoms and improve comorbid conditions such as anxiety and insomnia. The lifespan of people with conditions such as Bipolar and Major Depressive Disorder (MDD) is reduced, on average, by 15-20 years compared to the average population. Depression is a prevalent condition worldwide and is known to be a major cause of disability, responsible for 40.5% of total disability-adjusted life years. Additionally, at least 61.4% of patients with MDD will have another comorbid psychiatric diagnosis.
With these statistics in mind, research has been conducted to show how physical activity and exercise can be an effective adjunct treatment intervention for those with mental health conditions. The effects of physical activity are powerful and offer immediate, long-lasting, and protective benefits not just for your body but also for your brain, and these effects can last for the rest of your life. Individuals with disorders such as MDD and Bipolar are at a higher risk of cardiovascular disease and premature death, partly as there have been reported increased rates of obesity, inactivity, and diabetes when compared to the general population. Exercise may reduce the increased risk of such health conditions and potentially improve the long-term outcomes of mood disorders. Doctors, neurologists, physiologists, and psychologists are working on uncovering the promising brain-changing effects of exercise. Mental health professionals are now at the precipice of understanding the importance of exercise and how to combine such interventions with traditional mental health treatments such as psychopharmacology and psychotherapy. As discussed by neuroscientist Wendy Suzuki, exercise can have potentially transformative effects on the brain for three main reasons.
The immediate effects of exercise on the brain. A single workout can immediately increase levels of neurotransmitters such as dopamine – which plays a role in pleasure, motivation, and learning; serotonin – which regulates anxiety, happiness, and mood; and noradrenaline – which plays an important role in the body’s fight-or-flight response. interventions
The long-lasting effects on the brain. Long-term exercise can have the potential to change the brain’s anatomy, physiology, and function. During physical activity and exercise, the hippocampus, which plays a major role in memory and learning, has the potential to help the brain make new neurons that can eventually rise to form new brain cells. Not only does it improve your attention span and focus, but the volume of the hippocampus also increases over time.
Long-lasting increases in positive mood neurotransmitters. Those immediate increases of neurotransmitters as mentioned in the first point will eventually stay elevated for longer periods when paired with a regular exercise regime.
Aerobic exercises such as jogging, swimming, cycling, walking, gardening, and dancing have been shown to reduce anxiety and depression which is believed to be caused by an exercise-induced increase in blood circulation to the brain which counters the physiologic reactivity to stress. Another conclusion drawn from research has shown that the beneficial effects of physical activity on mental health include self-efficacy, social interaction, and healthy distraction. Randomised clinical trials have reported that exercise improves outcomes in treatment-resistant depression, depressed patients with a chronic mental illness, as well as women with antenatal depression. Participants with MDD also took part in a randomized controlled trial where researchers compared people which participated in cognitive behavioural therapy plus a home-based walking program (Group 1) with other who participated in cognitive behavioural therapy plus educational sessions (Group 2). Results concluded that Group 1 had greater improvements in depression, anxiety, and stress compared to Group 2.
There have been fewer studies conducted for individuals with bipolar disorder however results from open trials of exercise as an adjunctive intervention show that it may have discerning effects on the physical and mental health of individuals with bipolar disorder. Whilst to date controlled randomised trials have not been conducted, open trials have found that more engagement in exercise was associated with improved quality of life, decreased depressive symptoms, and increased overall functioning. One study which investigated the effects of exercise interventions on symptoms of bipolar disorder was a retrospective cohort pilot study. This study was conducted in an inpatient setting and the aim was to identify the advantages of an adjunctive walking group for bipolar individuals within 24 months. Patients who participated in the group had lower levels of depression, anxiety, and stress after exercising. Additionally, an acute bout of exercise i.e. walking on a treadmill for 20 minutes at 70% of the individual’s maximum heart rate, also had significant improvements in mood. The long-term effects showed that those with bipolar disorder that participated in an exercise program of eight 30-minute walking sessions had a more astute understanding of stress reactivity, as well as reduced physiological reactions to stress. Studies have also explored the positive effects exercise has on highly comorbid conditions that come with mood disorders such as insomnia, anxiety, and pain. Sleep and exercise have a bidirectional relationship which means that implementing an exercise routine can potentially help an individual sleep better. Data shows that 97% of patients have trouble falling or staying asleep during a manic episode and one theory states that exercise helps entrain healthy daily routines such as regular sleep schedules and eating patterns.
There is strong evidence that suggests the use of adjunctive exercise interventions when treating individuals with comorbid anxiety and mood disorders. Anxiety is amongst the most prevalent comorbidities in individuals with MDD and bipolar disorder. Comorbid anxiety disorder can negatively impact treatment outcomes and is related to an increase in symptoms and increased impairment and has been linked to panic disorder which increases the risk of cardiovascular complications. With this data in mind, physical exercise can potentially have dual benefits for individuals with mood disorder and comorbid anxiety. Several studies conclude that exercise can be just as effective as psychotherapy when treating anxiety and nearly as effective as pharmacotherapy. Comparable results were found in a randomized controlled study when comparing exercise to clomipramine (serotonin reuptake inhibitor) or a placebo in outpatients with panic disorder.
It is against this background that suggestions for the ideal amount of physical activity per week are recommended. Available evidence suggests that undertaking moderate-to-vigorous intensity exercise may be the most beneficial in reducing symptoms of mental health conditions.
Moderate-intensity exercise may look like this:
Brisk walking
Dancing
Gardening
Yoga
Water aerobics
Doubles tennis
Vigorous-intensity exercise may look like this:
Running – (8 km/h >)
Swimming
Strength training
Fast cycling
Soccer
Jump rope
The current recommendation for adults is 150-300 minutes of moderate-intensity physical exercise per week. This number may seem like a lot, works but it should be seen as a guideline rather than as a must. The purpose of these guidelines is to have a target to work towards rather than something mandatory to obtain results. It is also essential to factor in chronic health and mental health conditions and work with what is attainable for each individual. At the end of the day, just getting started and progressively making small changes can still have a profound impact on your physical and mental health.
Ultimately, researchers and other professionals alike are still learning and trying to understand the link between the mind and the body. It is a lot more complex and multifactorial than first believed, and research is ongoing as many factors contribute to an outcome. Whilst there is no definitive solution, there is strong continual emerging evidence that suggests physical exercise can assist in the treatment of various mood disorders and comorbidities. And with the statistics mentioned previously, it certainly is beneficial to consider physical activity as an adjunct to other treatments.
Please find some further resources below that elaborate on the topics discussed. Research papers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423723/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961757/ Books Exercise-Based Interventions for Mental Illness – Physical Activity as Part of Clinical Treatment by Brendon Stubbs & Simon Rosenbaum Physical Exercise Interventions for Mental Health – Linda C. W. Lam & Michelle Riba Podcasts The Doctor’s Kitchen Podcast - #25 Exercise for Mental Health – with Dr Brendon Stubbs Psychiatry & Psychotherapy Podcast – Exercise as a Drug for Mental Health & Longevity – with Dr Stephen Seiler Videos https://www.youtube.com/watch?v=BHY0FxzoKZE https://www.youtube.com/watch?v=i8p693EprOE
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