Mental illnesses like sadness and anxiety are difficult to treat. Many people benefit from medications, but they have a high failure rate and can have unpleasant side effects. It takes a long time and costs a lot of money to go to talk therapy. And neither method is effective in preventing the illnesses from arising in the first place. However, many individuals neglect another alternative that, when used properly, may be one of the most effective, least inconvenient, and least expensive methods to manage mental health disorders: exercise.
Exercise is well-known for its physical benefits, and it has long been recommended for mental well-being. However, scientists are getting closer to figuring out just how exercise works its brain magic.
They are learning that exercise has a significant impact on brain structure, particularly in areas impacted by depression and schizophrenia. Other, more subtle effects include increased attention, a sense of achievement, and occasionally social stimulation, all of which are therapeutic in and of themselves. While more physical exercise is always preferable, even small amounts of physical activity, such as a daily stroll, can have a huge impact on mental health.
“Physical activity is a really powerful intervention,” says Anders Hovland, a clinical psychologist at the University of Bergen in Norway.
But, according to Joseph Firth, a mental health researcher at the University of Manchester in the United Kingdom, “that information has barely begun to trickle into practice.” Simply ask a hundred persons undergoing mental health treatment how many of them are prescribed exercise as part of their treatment. Firth says, “You wouldn’t find many.”
Exercise is a useful strategy in the fight against depression.
Some of the most compelling evidence for exercise’s mental health benefits comes from studies on depression. In 2016, Hovland and his colleagues conducted a review of the literature and discovered 23 clinical studies evaluating the effectiveness of exercise in the treatment of depression. The researchers determined that exercise was definitely helpful and, in a few cases, on par with antidepressant medicines.
Exercising also has a number of perks. For starters, antidepressant drugs typically take many weeks or months to fully take action. According to Brett Gordon, an exercise psychology researcher at Penn State College of Medicine, exercise may boost mood nearly instantly, making it a beneficial adjunct to frontline therapies like medicines or therapy. In addition, he claims that exercise can help with some of the worst side effects of antidepressants, such as weight gain.
Furthermore, unlike many pharmacological therapy for depression and other diseases, exercise has minimal bad side effects. “Many persons with mental health issues are hesitant to start taking a medicine for the rest of their life and want to explore alternative choices.” Jacob Meyer, an exercise psychologist at Iowa State University, argues that exercise might be one of those possibilities.
Exercise appears to help cure or prevent anxiety disorders, such as post-traumatic stress disorder (PTSD), and maybe other dangerous psychotic diseases, according to new studies. “The more we undertake these studies, the more we realize how beneficial exercise can be,” Firth adds.
The other side of this coin, which is especially pertinent during the Covid-19 epidemic, is: If exercise helps people maintain their mental health, everything that hinders them from doing so is likely to destabilize it. Meyer and his colleagues put this theory to the test by surveying over 3,000 Americans about their activities before and during the outbreak. They discovered that those who became less active as a result of Covid had more depression and had lower mental health. (Those who had not exercised consistently prior to Covid, ironically, did not report much difference.) “Where do you go when you’re already at zero?” Meyer asks.)
However, scientists are still trying to figure out how muscular effort affects the brain to boost mental wellness. Animal tests are the first stop for most biological concerns like these, but they aren’t as beneficial in investigations of mental health difficulties. “Psychological health is so distinctively human,” Meyer adds, “that it can be difficult to make a decent leap from animal models.”
Exercising and maintaining a healthy brain
According to Patrick J. Smith, a psychologist and biostatistician at Duke University Medical Center in North Carolina, who co-authored an article on the subject in the 2021 Annual Review of Medicine with his Duke colleague Rhonda M. Merwin, scientists have come up with a few theories about how exercise improves mental health. Since how hard a person can work out is very weakly connected with their psychological health, it doesn’t appear to have anything to do with cardiovascular fitness or physical strength – the most evident advantages of exercise. Something more significant than fitness must be going on, according to Smith.
One hypothesis is that exercise strengthens both the brain and the body. Exercise causes the release of a protein called brain-derived neurotrophic factor (BDNF) (BDNF). BDNF is a crucial protein that promotes the formation of new brain cells, perhaps in the hippocampus, a brain area involved in memory and learning. Because persons with depression, anxiety, and schizophrenia have smaller or malformed hippocampuses, increasing BDNF levels via exercise might be one method to help manage these diseases.
Studies have shown that patients with depression have lower amounts of BDNF, and that one of the effects of antidepressant medicines is to enhance BDNF production. Although researchers have yet to prove that an increase in BDNF caused by exercise improves depression symptoms, Hovland believes it is one of the most intriguing options.
Exercise produces brain changes and encourages people to engage in beneficial habits. These factors, taken together, may be able to assist exercisers in better coping with mental health issues. 2021 by Knowable Magazine, adapted from P.J. Smith and R.M. Merwin
Anxiety problems may also benefit from exercise. BDNF-induced brain alterations appear to improve learning, which is a key component of various anti-anxiety treatments. This shows that exercise might be a good strategy to improve the efficacy of these treatments. For example, one of the conventional therapies for PTSD involves exposing patients to the fear-inducing stimuli in a secure setting so that they may learn to retrain their responses to trauma-related signals — and the better they learn, the more persistent this response may be.
Kevin Crombie, an exercise neuroscientist at the University of Texas at Austin, and his colleagues put this theory to the test with 35 women suffering from PTSD in the lab. The subjects were initially trained to link a certain geometric shape with a small electric shock by the researchers. The volunteers were shown the identical form without the shock the next day in order to learn that the stimulus was now safe. Half of the volunteers underwent 30 minutes of moderate activity – running or uphill treadmill walking — while the other half conducted only mild movement, not enough to make them breathe deeply.
Crombie discovered that individuals who had exercised the day before were less likely to expect a shock when they saw the “trigger” form the next day, indicating that they had learnt to link the trigger with danger. Furthermore, the individuals who had the highest exercise-induced elevations in BDNF also performed the best in this relearning.
Although the data isn’t conclusive, a few studies have showed that regular exercise may improve results in schizophrenia patients as well. Working out could help prevent people from having the illness in the first place, according to Vijay Mittal, a psychologist at Northwestern University.
Mittal works with teenagers who are at high risk of developing psychotic illnesses like schizophrenia but have not yet developed the full-fledged illness. Researchers have grown much better at detecting such people just as they start to show the first indications of disease, such as seeing shadows out of the corner of their eye or hearing indistinct voices when no one is home, over the last two decades.
For between 10% to 33% of these teenagers, these early warning symptoms develop into something more serious. “A shadow may become a person,” Mittal argues. “It’s possible that a whisper will develop into words. A hunch that they are being followed may develop into a notion that they are being pursued by the government.”
Mittal had previously discovered that the hippocampus of at-risk youth who eventually slipped down this slippery slope differs from that of individuals who did not. He wondered if exercising may help strengthen the hippocampus and prevent the decline. So his team put this theory to the test in a group of 30 high-risk teenagers, half of whom did aerobic exercise twice a week for three months. (The other half, the control group, was informed they were on the exercise waiting list.) Before and after the training, the researchers conducted brain scans to examine the individuals’ hippocampus.
Mittal is currently studying the findings of the trial, which he describes as encouraging. He does warn, though, that exercise is not a cure-all. Schizophrenia is a complex condition, and while physical exercise may be beneficial for certain people at risk, not everyone will respond in the same way. “It’s critical to keep in mind that these problems are complex.” He says, “I’ve worked with folks who do a lot of exercise and yet have schizophrenia.”
If Mittal’s research is successful, it may allow mental health professionals to aid a population that is difficult to treat with medications. “You can’t just give someone who’s at risk of a psychotic condition medicine,” Firth adds, “because that has hazards as well.” “Having anything extra in our arsenal would be amazing.”
Experts believe that exercise has a variety of additional affects on the brain. Exercising, for example, causes the production of endocannabinoids, which are chemicals that play a role in changing the connections between brain cells, which is the process that underpins learning. This might be another another method to improve the learning that underpins effective therapy for depression, PTSD, and other mental illnesses. Crombie’s research of exercise in a simplified model of PTSD therapy examined both endocannabinoids and BDNF, and found that higher levels of both were linked to better learning responses.
Physical activity also decreases inflammation and moderates the body’s response to stress, both of which might potentially assist persons with mental illness improve their brain health. “We’ve only scratched the surface,” Hovland adds.
Engaging the thoughts while moving the body
However, modifying the structure of the brain isn’t the only way that physical activity may help people with mental illnesses. According to Smith, the practice of exercising can be beneficial in and of itself by modifying people’s mental habits.
Simply doing something — anything — can be beneficial in and of itself for persons with mental health concerns since it focuses their attention and stops them from obsessing on their situation. Indeed, one review of the data revealed that placebo exercise — that is, moderate stretching that is too light to have any physiological effect — had almost half the positive impact on mental health as vigorous exercise.
Regular exercises not only occupy the mind, but they also provide exercisers with a definite sense of progress as their strength and conditioning increase. According to Gordon, this sense of success — which may be especially noticeable in weight training, where people make rapid, easily observable increases — might help alleviate some of the stress of anxiety and melancholy.
If that’s the case, learning to play a musical instrument, learning a language, and a variety of other hobbies might help people cope with mental health issues in a similar way. But exercise has additional benefits, making it one of the finest ways to manage mental health. “Anything can provide advantages,” Firth adds, “but exercise may provide larger benefits.”
For one reason, moderate exercise trains people to tolerate short-term discomfort in exchange for long-term benefits. People with anxiety disorders, such as post-traumatic stress disorder (PTSD) or panic attacks, have a diminished ability to bear mental discomfort, thus events that most people would manage with result in uncontrollable distress. According to Smith, there’s now evidence that regular exercise increases tolerance for internal discomfort, which might explain why it’s so effective at controlling these disorders.
However, there are certain drawbacks to using exercise as a mental health treatment. “People who suffer from mental illness are also more likely to struggle with poor motivation,” Firth adds. It can be difficult to plan and keep to an exercise regimen because of this, and many people require additional assistance.
This is often challenging due to the fact that psychologists, psychiatrists, and other mental health professionals are frequently overworked. Furthermore, prescribing and monitoring exercise has generally been outside the scope of these professionals. “We’re telling people, ‘Hey, exercise is good for you,’ but we’re telling it to people who can’t actually implement it because they don’t have any instruction,” Firth adds. Exercise referral systems have been utilized in the UK and elsewhere to encourage people with physical illnesses like obesity and diabetes to exercise by connecting them with fitness professionals and organized programs at community leisure facilities. According to Firth, a similar strategy might be beneficial for mental health disorders.
Therapists can also aid patients’ long-term success by adapting exercise prescriptions to each person’s capabilities. “I usually tell my patients that doing anything is better than doing nothing,” Smith adds, “and the greatest exercise for you is the one you’ll really perform.”
The key, he claims, is to ensure that individuals stop exercising before they’ve done so much that they’re fatigued. “If you feel bad after exercising, you’re not going to want to do it,” he explains, because the action is labeled as unpleasant by the brain. It’s considerably preferable to have the patient stop while they’re still feeling good about the workout. “Their brain tries to label that action as something more joyful without them even understanding it.” They aren’t afraid of it.”
Even mild movement, such as moving around every now and then during the day rather than sitting for long periods of time, may be beneficial. Aaron Kandola, a psychiatric epidemiologist at University College London, and his colleagues discovered that teenagers who engaged in more light exercise during the day had a reduced incidence of depressive symptoms than those who spent more time sitting in a study of almost 4,000 adolescents in the UK.
“What we really need are large workout studies where varied quantities are compared to one other,” Kandola explains. “Instead, we have a variety of studies that employed varying levels of exercise.” Because each study differs in terms of patient groups and techniques, as well as the amount of time it follows outcomes, accurate recommendations are difficult to provide. Researchers should be able to fine-tune their exercise prescriptions as they understand more about the pathways tying exercise to mental health, allowing patients to better manage their conditions.
And, in addition to its impact on the disorders themselves, exercise provides significant advantages for those with mental illnesses. According to Firth, many people deal with associated difficulties such as social isolation and a diminished ability for enjoyment. Standard drugs can help with some symptoms, but they don’t address the underlying issues. Exercise, especially in a social setting, can assist them improve their mood and enhance their life.
Persons with substantial mental disorders, such as severe depression and schizophrenia, are also more likely to have significant physical health difficulties, such as obesity, heart disease, and other chronic diseases, resulting in a life expectancy of 10 to 25 years less than people who are not afflicted.
“Reducing those health hazards is particularly important right now,” Kandola adds. “We already know that exercise can enhance physical health, so that’s the huge draw of it.” If it also has mental health advantages, it might be a very useful complement to treatment.”