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The Effect of Physical Activity on Mental Health

By: Keely Boschee

Introduction

In any given year, 1 in 5 Canadians experience a mental illness or addiction problem (Canadian Mental Health Association, 2013). Since the prevalence of mental illness is so high people are constantly searching for a new way to positively deal with the side effects that are associated. One potential treatment plan for coping with mental illness is physical activity. I wish to explore the effect physical activity has on mental health - more specifically the benefits exercise has on improving depression, anxiety, addiction, and Post Traumatic Stress Disorder (PTSD)

Introduction

Rationale for choosing this topic

Rationale for choosing this topic

I chose to explore the effect of physical activity on mental illness for several different reasons. Personally, I live an active life-style and have been involved in a variety of exercise regimes throughout my entire life. While I am fortunate enough not to suffer with mental health problems, many people close to me have not been as lucky. I have seen first-hand the benefits exercise can have on mental health and have become heavily interested in exploring the correlation between the two; therefore, I have chosen to use this assignment as an opportunity to do this more in depth.

Inquiry Questions

Inquiry Questions

  • What are the relationships between physical activity and different mental illnesses?

  • Which types of physical activity provide the most benefits to mental illnesses?

  • How much physical activity is needed for mental illnesses to show improvement?

Categories and definitions

Categories and definitions

Depression

Depression

"Depression", defined by the American Psychiatric Association, is "a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home." (American Psychiatric Association, n.d).

Anxiety

Anxiety

The American Psychiatric Association explains "anxiety" as a "general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave and can cause physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can seriously affect day-to-day living." (American Psychiatric Association, n.d.)

Addiction

Addiction

"Addiction" is defined by the American Psychiatric Association as a "complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will causes problems." (American Psychiatric Association, n.d.)

Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder (PTSD)

The American Psychiatric Association describes "PTSD" as "a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault." (American Psychiatric Association, n.d.)

Relationships

Relationships

Physical Activity and Depression

Physical Activity and Depression

  • Globally, the prevalence and incidence of major depressive disorder is reported to be 4.7% and 3.0%, respectively (Stanton, Happell, & Reaburn, 2014)

  • Support for physical activity in the treatment of depression is continually increasing (Stanton et al., 2014)

Benefits of Exercise

Benefits of Exercise

Studies show that exercise can treat depression as effectively as antidepressant medication

No side-effects

Maintaining an exercise schedule can prevent relapsing

(Robinson et al., 2017)

Studies

Studies

Limitations

  • A randomized trial was done to look at the effect of Tai Chi on depression. The study consisted of 262 participants, with a mean age of 59.8 years, and a mean depression duration of 8.6 years. Following the trial, results showed participants had fewer depressive symptoms across the board and the greater self-efficacy patients had, the more their depression was relieved. (Stanton et al., 2014)
  • Small sample sizes in many studies
  • Use of volunteer subjects who may be particularly motivated to adhere to an exercise programme

Bias

  • A study was done analyzing the effects of aerobic exercise on depression, and resistance training exercise on depression (the two were not compared head-to-head). Results showed both types of exercise were associated with a substantial reduction in depression scores compared to no control/ no treatment. As well as, exercise was shown a favourable reduction in depression when compared with antidepressants. (Cooney et al., 2013)
  • Potential bias in favour of exercise
  • Possibility of publication bias.

How Does It Work?

How Does It Work?

Exercise is a powerful fighter against depression as it promotes all sorts of changes in the brain, such as neural growth, reduced inflammation, and new activity patterns that promote feelings of peace and comfort. Physical exercise releases the "happy chemical" endorphins, which are powerful substances in the brain that energize your spirits and generally make you feel good. Conclusively, exercise also has the ability to serve as a distraction, allowing you to find quiet time and essentially break out of the cycle of negative thoughts which feed depression.

(Robinson et al., 2017)

Physical Activity and Anxiety

  • Anxiety disorders affect 5% of the household population, causing mild to severe impairment (Mental Health Commission of Canada, 2013)

  • Psychologists studying how exercise relieves anxiety suggest that a 10-minute walk may be just as good as a 45-minute workout (Robinson et al., 2017)

Benefits of Exercise

Benefits of Exercise

Alleviate symptoms such as low self-esteem and social withdrawal

Increase your overall productivity

Decrease energy wasted from mental anxiety and stress

(Mental Health Commission of Canada, 2013)

Studies

Studies

  • A study used multiple logistic regression analyses to compare the prevalence of mental disorders among those who did and did not report regular physical activity using data from a nationally representative sample of adults ages 15–54 in the United States. Regular physical activity was associated with a significantly decreased prevalence of anxiety disorders and symptoms such as panic attacks and social phobia following the 6 week trial. (Marszalek, Price, Harvey, Driban, & Wang, 2017).

Limitations

  • In another study, researchers found that those who got regular vigorous exercise were 25% less likely to develop an anxiety disorder over the next five years.( Cooney, Dwan, & Mead, 2014).
  • "Regular" physical activity is not defined so the amount which individuals engage may vary
  • Specific activities are not stated so it is unclear which type of exercises are best for improving mental illness
  • An epidemiological study found that patients engaging in regular physical activity were more likely to recover from their anxiety disorders at a three-year follow-up. (Zschucke, Gaudlitz, & Ströhle, 2013).

Mechanisms of Action

Mechanisms of Action

A number of acute changes occur during and following bouts of exercise. Potential psychological mechanisms of action include changes in body scheme and health attitudes/behaviors, social reinforcement, shift of external to more internal locus of control, improved coping strategies, and simple distraction (Robinson et al., 2017).

Physical Activity and Addiction

Physical Activity and Addiction

  • Figures from the World Health Organization (WHO, 2016) show that 2.5 million people die from alcohol abuse each year, and at least 15.3 million people have substance use disorders (SUD)

  • Research on the effect physical activity has on addiction is not as far along as depression and anxiety, but studies that have been done show positive effects of physical exercise on SUD (Wang et al., 2014)

Background

Background

Currently, one commonly used treatment for substance addiction is drug replacement therapy, using substances such as methadone or buprenorphine. Both methadone and buprenorphine are long-acting opioid agonists that are used to treat addiction, by reducing substances craving behavior and suppressing abstinence symptoms. However, both methadone and buprenorphine have risk of addiction themselves which is where the interest for alternative treatments such as physical activity comes in. (Wang et al., 2014).

How Can Exercise Help?

How Can Exercise Help?

Exercise triggers a dopamine release so people get the "reward chemical" without the risk of becoming addicted to harmful substances (Robinson et al., 2017)

Abuse of drugs and alcohol cause an imbalance of chemicals in the brain that interfere with a person’s ability to feel pleasure, happiness, and satisfaction. Dedicated physical activity during treatment and recovery will help you reintroduce natural levels of endorphins in your system (Li, Zhuang, Zhang, Guo, & Wang, 2013)

Physical activity is affordable, accessible, and natural; making it a great potential treatment for addiction and SUD (Wang et al., 2014)

Studies

Studies

  • A study used randomized controlled trials (RCT) in regards to the effects of physical exercise on SUD between the years 1990 and 2013. Subjects of the study were adults over 18 years old who were assessed as alcohol, nicotine, and illicit drug abusers through the DSM-IV. Exercise had two categories: moderate and high-intensity aerobic exercises (designed according to the Guidelines of American College of Sports Medicine) and mind-body exercises. The results indicated that physical exercise can effectively increase the abstinence rate and ease withdrawal symptoms. Overall, it was found that physical activity is an effective treatment for those with SUD (Wang et al., 2014)

Limitations

Bias

  • Only published RCT studies from 1990 to 2013 were included
  • Addictive drugs involved in the studies often include participants with polydrug use disorders. So, the specific treatment of exercise on a single drug abuse was difficult to analyze
  • Delphi List Criteria, (assesses the quality of RCT) was used so that the bias of the study was relatively low
  • Authors of the study have a sports medicine or kinesiology background/ PhD

Physical Activity and PTSD

  • By concentrating on the way your body feels during exercise, you can help your nervous system become "unstuck" and start to move out of the immobilization and stress response that is characterized with PTSD (Robinson et al., 2017)

Background

Background

PTSD is commonly associated with combat veterans, but also often affects survivors of violent personal assaults, childhood abuse, natural disasters, and life-threatening illnesses

(PTSD Association, 2017)

According to the National Centre for PTSD about 8 out of every 100 people will experience PTSD at some point in their lives ("PTSD: Beyond Trauma", 2017)

Sexual assault is one of the most likely events to cause PTSD and women on average experience sexual assault more than men. Therefore, twice as many women as men suffer from PTSD ("PTSD: Beyond Trauma", 2017)

How Can Exercise Help?

How Can Exercise Help?

Low-to-moderate intensity exercise can elevate mood, reduce anxiety, and act as an overall stress-buffer (Muller, 2015)

Exercise increases respiratory sinus arrhythmia. This naturally occurring variation in heart rate is linked to higher levels of emotion-focused coping; which is disrupted in people with PTSD (Muller, 2015)

Treatment adherence is often a problem for PTSD sufferers, however, physical exercise has shown to have low drop out rates since it tends to re-establish a sense of achievement -specifically in veterans (Muller, 2015)

Studies

Studies

  • A recent quantitative meta-analysis, which included four randomized-controlled trails (RCT), reported a moderate effect size of exercise on reducing PTSD symptoms in people with PTSD. Suggesting aerobic, resistance training, and yoga-based exercises are effective treatments for PTSD. (Rosenbaum et al., 2015).

  • Caddick and Smith (2014) highlighted in a systematic review of quantitative and qualitative studies on various outcomes of physical activity on the well-being of combat veterans with PTSD. Exercise was found to actively help with coping and doing things again, improved quality of life, increased determination and inner strength, a sense of achievement, social well-being, and a source of motivation for living.

  • Van der Kolk et al. (2014), from a 10-week RCT with 64 women suffering from chronic, treatment-resistant PTSD, concluded that “yoga significantly reduced PTSD with effect sizes comparable to well-researched psychotherapeutic and psychopharmacologic approaches” (p. e559).

Limitations & Bias

  • Inability of the participant, therapist, and observers to capture, recall, and narrate complete happenings and experiences
  • Potential biases of the researchers

Types of Physical Activity

Types of Physical Activity

Aerobic Exercise

Aerobic Exercise

Aerobic exercise is also known as "cardio" and is anything that gets you breathing harder and your heart beating faster (Physical Activity Guidelines for Americans, 2008)

Examples

  • Selected studies have focused on walking as the principle physical activity associated with a protective benefit from future depressive illness in both adult and elderly populations (Stanton et al., 2014).
  • Walking
  • Running
  • Swimming
  • Aquarobics
  • Cycling
  • Rowing
  • Boxing

Mind-body Exercise

Mind-body Exercise

Mind-body exercise is a form of physical activity that combines body movement, mental focus, and controlled breathing to improve strength, balance, and flexibility (National Cancer Institute, n.d.)

Examples

  • Studies have shown that the intensity of Tai Chi is about 52–63% HR maximum, which is similar to low-to-moderate intensity of aerobic exercises. Tai Chi has shown to decrease both symptoms of depression and addiction (Wang et al., 2014).
  • Yoga
  • Pilates
  • Martial arts
  • Tai Chi
  • Another physical exercise regarded as low-to-moderate intensity is yoga. Yoga-based exercises have been shown to be an effective treatment for PTSD - specifically for women. (Rosenbaum et al., 2015)

Amount of Physical Activity

Amount of Physical Activity

Intensity

Intensity

In a study of more than 4,323 men and women, those individuals undertaking either moderate or vigorous physical activity were significantly less likely to develop depressive or anxiety symptoms, compared to those undertaking light physical activity or sedentary behaviour (Stanton et al., 2014).

RCT studies presented that long-term treadmill exercise at moderate-intensity (55–69% HR max) can effectively increase abstinence rate of drugs in SUD (Wang et al., 2014).

Duration

Duration

Studies show that as little as 10 minutes of physical activity per day may be beneficial (Robinson et al., 2017). For example, in a 10 year prospective study of almost 50,000 men and women, it was found the relative risk of depression and anxiety associated with 10–29 minutes of physical activity per day, compared to <10 minutes per day was statistically significant in favour of 10+ minutes per day. Increasing amounts of physical activity up to more than 90 minutes per day were associated with further significant reductions in the risk of depression and anxiety (Zschucke, Gaudlitz, & Ströhle, 2013).

Caddick and Smith (2014) found participating in regular exercise classes (3-5 times per week) helped veterans increase their energy levels and allowed them to manage their daily activities much better.Their exercise was also found to help counter the dampening and depressive tendencies associated with PTSD.

Summary

Summary

What I Learned

What I Learned

Throughout my research I have learned the effect of physical activity on different mental illnesses. Due to limited time I chose to keep my research simple and only explore four types of mental illnesses which I was interested in. By narrowing my research to a small number I was able to get a better, more in depth understanding of the benefits exercise has shown to have on depression, anxiety, addiction, and PTSD - both differently and similarly.

While I knew going into this topic that exercise was important, I did not realize the extent even just 10 minutes of exercise can have on a person's mental health. It's truly fascinating to explore the way in which exercise - a natural treatment - promotes all sorts of changes in the brain, such as neural growth, reduced inflammation, and the release of endorphins and dopamine.

Something I found similarly in all the studies I looked at was that aerobic exercise and mind-body exercise are the two most beneficial types of physical activity in regards to improving symptoms of depression, anxiety, addiction, and PTSD. However, physical activity such as resistance training requires more studies and research at this point in time.

Another thing I found similarly in a number of studies which I researched was that while any amount of exercise was beneficial, moderate and vigorous intensity exercises were the categories that showed the greatest benefits to improving mental illnesses.

In conclusion, while I find myself advocating for physical activity following my research, I am aware of the fact that no single treatment works successfully for every person and that exercise is just one of many different treatments that those suffering from mental health problems may turn to.

References

References

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Smith, P.J., Potter, G.G., McLaren, M.M., & Blumenthal, J.A. (2013). Impact of aerobic exercise

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