While it can sometimes be hard to admit, many people will struggle with their mental health at some point in life. The pressures of work, study, family, finances, and life in general can become overwhelming, and taking care of ourselves can be forgotten under an ever-growing pile of responsibilities.
The World Health Organisation defines mental health as a state of well-being whereby individuals recognise their abilities, can cope with the everyday stresses of life, work productively, and make a contribution to their communities.
The WHO also revealed in a study of global disease burden that mental health disorders account for five of the ten leading causes of disability in the world. The most common mental health conditions, including depression, anxiety and other stress-related issues have also replaced musculoskeletal problems as the leading cause of work absence and incapacity in the majority of developed countries.
The costs of these mental health disorders are vast. The annual economic impact in Europe has been estimated in recent years to be around €187 billion; in the U.S., depression alone costs over $40 billion yearly, and has been deemed the leading cause of disability in the country in years past.
Many factors can influence our mental health, whether you’re a professional with high job demands, low control, or work stress; a young adult feeling the pressures of social, educational, and vocational change; or an older citizen dealing with a diminishing sense of self-efficacy and social inclusion.
Mental health disorders are often non-specific, and treatment can easily be overlooked or lack a basis in therapeutic evidence. It may be due partly to the fact that many people do not seek professional help for their issues, and when they do, they often receive pharmacological therapy alone.
This predominant method of treatment for mental health conditions stems from mental health practitioners’ significant lack of importance placed on lifestyle factors such as exercise in their capacity for treatment of multiple psychopathologies, as well as their ability to foster social well-being and optimise cognitive function.
This article will explore the full circle relationship between your physical activity and mental health. We will explain the direct psychological benefits of exercise, discuss methods to motivate yourself to overcome barriers to exercise, and prescribe the optimal modes of training to help you improve your body and mind.
How your Mental Health Changes Your Body
Mental health issues can affect your mood, diminish your interest in activities, disturb sleep, cause fatigue, and impair concentration. People with depression can have their physical work capacity declined by up to 20%, and tend to be less physically active than mentally healthy individuals.
This sedentary behaviour leads sufferers of poor mental health to also develop poor physical health, which predisposes them to an increased risk of chronic diseases, such as obesity, diabetes, and cardiovascular disease. The rates of these comorbid conditions are as high as 60% in the population of those suffering from more severe forms of these mental health conditions.
The combination of a sub-optimal stress regulation system, along with an unhealthy lifestyle, can mean that poor mental health is predictive of developing obesity over time. In addition to being less active, those with poor mental health are more likely to use certain foods as ‘drugs’ when exposed to stress, leading to weight gain.
It can be further exacerbated by the fact, as mentioned above, that mental health conditions are often treated solely by pharmacological means. Many of the medications prescribed in this field can cause a high risk for obesity-related morbidity, also jeopardising compliance with taking medication.
Research shows this to be a particular challenge for women, with a strong and consistent link between depression and obesity in this cohort.
Concerning Type 2 Diabetes Mellitus, depression in particular is linked with a 60% greater risk of developing this chronic disease. It presents a major clinical challenge as the outcomes of both depression and diabetes are worsened by each other.
People with depressive symptoms also have a graded relationship with risk of mortality or cardiovascular events, being more likely to develop these conditions and having worse outcomes than the general population.
Other comorbid illnesses also present at a rate of up to 60% in those with poor mental health include hypertension, respiratory disease, and cardiovascular disease. The combination of these psychological and physical health conditions leads to individuals with mental illness dying approximately 10 to 15 years earlier than their healthy age-matched peers.
Let’s see how we can use exercise to improve the health outcomes for these comorbid conditions, before diving into how exercise can improve your mental health more directly.
Helping the Body is Helping the Mind
While it’s clear that mental health has an impact on our physical health, the opposite is also true.
For example, depression has twice the prevalence (15 to 30%) in diabetes patients compared to the general population. Depression also presents in one out of five cardiovascular disease patients, and obesity - through somatic means and opposing effects on self-image - increases the risk of clinically diagnosed depression among Americans.
Physical activity plays a critical role in combating mental health issues indirectly through improving our physical health. In a randomised controlled trial of people with a history of congestive heart failure, the risks of heart attacks, hospitalisations, and death was reduced by 60% in those patients who participated in an exercise intervention.
These improvements don’t necessarily rely on weight loss, either. The research shows that active obese individuals are healthier than those who are obese and sedentary.
So we know that physical ailments create poor mental health outcomes, and that exercise by improving our physical health can help improve mental health. But for those individuals who are physically okay and still suffer from mental health challenges, exercise can have a direct impact, too.
How is Exercise Related to Mental Health?
Physical activity and exercise have strong evidence of alleviating specific symptoms associated with mental health disorders. It applies to both clinical and non-clinical populations.
Exercise improves self-image, social skills, and cognitive functioning. It can also reduce the symptoms of depression, anxiety, and the physiological response to stressors.
One study showed that an exercise intervention was more effective than a social support group in alleviating somatic symptoms of depression.
Additionally, in a study that compared running with psychotherapy in the treatment of depression, the results indicated that running was just as effective in alleviating symptoms as the traditional approach.
Both aerobic exercise and strength training also improve symptoms of depression, anxiety and panic disorders equally compared to meditation or relaxation.
Exercise also works to improve your mental health in the long term. Research shows that while medication can work more quickly to reduce symptoms of depression, there is no significant difference between taking medication and exercising after 16 weeks of treatment.
Exercise having a similar impact to anti-depressant medication has also been shown in coronary heart disease patients, with the physically active group receiving the additional benefit of having a higher VO2 peak (aerobic work capacity).
As mentioned, while the ability of exercise to improve depression symptoms is supported by substantial evidence, the positive effects of physical activity have also been noted in people with generalised anxiety disorder, phobias, panic attacks, and stress disorders.
Often people can suffer from more than one mental health issue, and studies of different age groups have revealed that physical activity appears beneficial to those who suffer from both depression and anxiety simultaneously.
Individuals report improvements in their quality of life and feelings of well-being as a result of exercise, even in the absence of objective diagnostic improvement. It may be in part due to the role of physical activity in reducing feelings of social isolation that often comes with decrements to mental health.
Next, we’ll take a look at the physiological mechanisms behind the ability of exercise to improve mental health.
The Physiological Effects of Exercise on Mental Health
Mental health struggles are the result of many underlying biological and behavioural mechanisms. These include inflammation, sleep disturbance, inactivity, poor dietary habits, and environmental or cultural risk factors.
These functions, as well as pain sensitivity, blood pressure regulation, and mood control, are modulated by neurotransmitters such as serotonin. These monoamines, as well as other chemicals like endorphins, most frequently explain the improvements in anxiety, depression and mood states.
Acutely, exercise promotes changes in atrial natriuretic peptide, brain natriuretic peptide, copeptin and growth hormone in people with depression, with long-term adaptations in several of these as well.
By acting through these mechanisms, the ability of exercise to improve these factors is independent of changes in cardiovascular reactivity. This means that even a single bout of exercise has the potential to benefit both clinical and non-clinical cases of mental health symptoms.
Exercise increases body temperature and blood circulation to the brain, and it has an impact on one’s physiological reactivity to stress. Exercise also improves mental health through psychological mechanisms, including improving self-efficacy, and even cognitive dissonance or distraction from life stressors.
Given the many direct and indirect benefits of exercise on mental health outcomes, one of the critical remaining factors is how to get motivated to participate in more physical activities, while overcoming the additional barriers that can result from these conditions.
Mental health and Motivation to Move
While some research shows adherence to physical activity interventions appears to be comparable between people with mental health challenges and the general population, other studies suggest people with more severe symptoms are less likely to engage in exercise.
Some barriers to entry for those with poor mental health include medication side effects, specific mental health symptoms, and physical comorbidities. Other social factors that can hinder exercise adherence include lack of support.
Some of the reasons that motivate people with poor mental health to exercise include improving health, losing weight, improving mood, and reducing stress. One of the challenges in this field is that these motivators are often inversely related to the barriers that prevent people from participating.
One of the main factors to ensure when trying to get motivated to exercise is seeking a supportive environment that allows autonomy, or a sense of control and accomplishment over your intentions and actions in being physically active.
Make sure to seek the assistance of a health professional if you are struggling to find motivation or overcome barriers that may be hindering you from enjoying the benefits of physical activity.
Finally, we’ll discuss some of the unique challenges of 2020 on our mental health, and just what kind of exercise can help us improve mood, energy, and decrease stress.
COVID Countermeasures - The Best Exercise Prescription for Mental Health
With the current worldwide pandemic situation we are currently facing in 2020, mental health issues stemming from fear, vulnerability, and the use of isolation and quarantine in disease management may evolve into long-lasting health problems.
Other causes of mental health exacerbations resulting from COVID-19 include unemployment and exposure to negative media. All of the above factors have led to increased mental distress and higher rates of anxiety, depression, post-traumatic stress disorder, and psychological distress globally.
The American College of Sports Medicine makes recommendations on the appropriate amounts of exercise that is needed to attain minimal levels of physical fitness, maintain cardiovascular health, and reduce body fat. According to this position statement, exercise should consist of at least two to three 20-30 minute exercise sessions per week. It should be individualised to accommodate conditions like mental health illnesses by a training professional.
Supervised, structured exercise programs and home-based, lifestyle physical activity interventions can both be useful for people with poor mental health. Structured programs are safe, monitored, and help verify adherence, whereas home-based programs save travel time, are more cost-effective, and flexible.
Most studies examining the mental benefits of physical activity have employed walking, jogging or stationary cycling programs of varying lengths. From four 30-minute sessions a week on a cycle ergometer, to 30 minutes of treadmill walking daily, to three 20-minute group running sessions a week. All of these methods showed significant positive benefits on mental health, with these improvements still present at follow-ups from 4 to 12 months.
For those interested in improving their lean mass and muscular strength, resistance training has provided similar reductions in depressive symptoms after four sessions per week for eight weeks compared to aerobic exercise.
Exercise should be done at low to moderate intensities, which improve mood, vigour, and feelings of exhilaration; whereas high-intensity training can lead to increased tension, anxiety and fatigue.
If possible, exercising outside in nature has additional mental health benefits, including lower levels of stress, and reduced symptoms of depression/anxiety.
This ‘green exercise’ has been shown to improve self-esteem and mood while interacting with nature, which promotes psychological restoration and improved attention. Escaping into nature improves mental health by promoting the experience of ‘being away’, exchanging the stressful demands of daily life for a perception of vastness and connectedness with the environment.
Additionally, being outside also allows you to receive the benefits of healthy sunlight exposure, which plays a vital role in mental well-being by regulating our circadian rhythms, energy levels, and sleep quality. We also receive more than 90% of our vitamin D from sunlight, which is essential for maintaining calcium levels and bone health.
Don’t forget your loved ones! Exercise is an excellent opportunity to spend time with friends and family, fostering our much needed social connections and social health in a time of growing feelings of isolation from others.
Take the First Step
We hope this article has helped explain the many benefits that being more physically active can have, not only for your physical health, but for your mental health as well. In 2020, it’s more important than ever to ensure we take the best possible care of our bodies and minds.
Don’t hesitate to contact a health professional if you feel you need help or guidance in beginning an exercise program that is individualised for you and your specific health needs.
Let us know your favourite way to exercise to reduce stress and improve your mood in the comments below!