Physical health Assessment & Training

 

 

 

Exercise is a structured and repetitive physical activity aimed at improving physical fitness. It can include aerobic exercise, high-intensity exercise, or resistance training. Mind–body interventions such as yoga, tai chi and Pilates are also popular forms of exercises.

Studies have shown health benefits of moderate-to-vigorous intensity exercise, if they are done for 1-2 hours per week for 6 months or more. We are well aware of the benefits of exercise on our physical health but wouldn’t it be nice if it also improves our mental fitness? Well, there is good news!

Exercise is extensively studied in a wide range of mental illnesses from Depression to dementia and overall, the results have been positive and the side effect estimates were low.

Exercise for prevention of mental illness

Physical exercise has been consistently shown to be associated with improved physical health, life satisfaction, cognitive functioning, and psychological well-being. Conversely low physical activity appears to be associated with the development of psychological disorders. Some studies even suggest a dose response relationship with exercise for instance, a review by A. Kandola et al found that low cardio-respiratory fitness is associated with an increased risk of developing common mental illnesses such as anxiety and depression, whereas improvements in fitness proportionately reduced the onset of mental illness. Moreover, these preventative effects are generalizable to all age groups.

Exercise as a treatment for mental illness

Depression (MDD/Clinical depression):

Exercise has a medium effect on depression in adults and a medium to large effect with adolescents when used alone compared to no intervention. However, when exercise was compared to established psychological treatments (CBT, IPT, and cognitive therapy) or antidepressant medication, the effect sizes were small. Nonetheless, studies did show its efficacy when used in combination with established treatments.  For optimal outcomes in MDD, it appears that supervised exercise interventions tailored to the individual are more effective and should be used for more than 6 months. Moreover, exercise seem to prevent relapses of depression. Hence it is vital that you formulate a physical training program with an expert to guarantee results.

Exercise for stress and anxiety disorders

In those with anxiety and stress disorders, there was evidence that exercise was effective versus non-active interventions in reducing anxiety symptoms. Most studies have focussed on aerobic exercise in people with clinical anxiety/stress disorders. However, there is encouraging evidence for the benefits of resistance training for people with elevated symptoms of anxiety. Exercise has a moderate effect on anxiety symptom reductions, which is of similar magnitude of the anxiolytic effects from common pharmacotherapy such as paroxetine, fluoxetine, quetiapine, fluvoxamine and venlafaxine in people with anxiety disorders. Although these results are promising, other studies could not replicate such findings. Once again, this shows the importance of choosing the right exercise for you to get the right results. For instance, those with panic disorder might require a tailored program to condition their heart rate variability and their autonomic nervous system. If done without supervision or expert guidance, this may cause more harm than good or may not give you results. A comprehensive fitness program may help you solve this problem.

Exercise for Post‑traumatic Stress Disorder (PTSD)

Exercises such as Yoga, aerobic exercise and resistance training can significantly reduce PTSD symptoms. Preliminary evidence also suggests that it is considerably more effective at decreasing depressive symptoms in people experiencing PTSD.

Exercise for eating disorders

Exercise reduced symptoms of anorexia nervosa such as less food preoccupation, following participation in an exercise program. This was also associated with a feeling of enhanced psychological wellbeing. More importantly, there is evidence that supervised exercise did not result in BMI or weight change thus indicating a degree of safety in Anorexia. Studies on Binge eating individuals found reduced binge eating episodes and associated dysphoria. Similar results were found in Bulimia nervosa as well.

Exercise in eating disorders require careful multi-disciplinary planning and monitoring, this may involve a personal trainer with qualifications in rehabilitation, a dietician, a physician/family doctor, a psychiatrist and or a psychologist. The central idea of such a program would be to defocus from weight as a goal to fitness as a goal in a non-judgemental, collaborative and positive setting. A comprehensive fitness program may help you reach such goals. Since such programs are hard to find, we have collaborated with Comprehensive health and fitness by Jiryes Abdel Nour to ensure quality and results.

Exercise for substance use disorders

Exercise effectively increased abstinence rates, particularly for nicotine, eased withdrawal symptoms, and reduced symptoms of anxiety and depression especially in females. Positive “addictions’ such as exercise is able to boost the same chemicals that get triggered by taking substances. But with one significant difference, whilst the recreational drugs and alcohol has a toxic effect on your brain leading to death of nerve cells, the “natural high” produced by exercise boosts nerve growth factors(BDNF) which actually restores and protects your nerve cells. Moreover, they also lift your hormonal system including growth hormones and sex hormones. Together they give you a revitalising feel which no recreational drugs could potentially match.

Exercise for Improving Women’s mental health

Exercise for premenstrual dysphoric symptoms

It is estimated that 1 in every 20 menstruating women have premenstrual dysphoria. Exercise is effective in improving physical symptoms such as pain, constipation, breast sensitivity, and psychological symptoms such as anxiety and anger.

Prenatal depression/ Depression during pregnancy

Aerobic exercise, resistance training and pelvic floor muscle training reduced the odds of developing depression in pregnancy by 67%. It is also moderately effective when used as an intervention for post-partum depression.

Exercise to enhance cognitive functions

ADHD: The effects of exercise is mainly studied in children with ADHD but preliminary results for adults with ADHD is also promising. In children, exercise improved core ADD symptom such as hyperactivity, impulsivity and inattention and enhanced their ability to set shift, inhibit responses and to plan ahead. This was more apparent when carefully designed programs which involved teamwork, anticipation and planning were involved as part of a group exercise. These positive effects were maintained long term in addition to enhancing their memory.

Elderly: Moderate intensity physical exercise can lead to significant changes in brain health and cognitive performance with potential effects on memory, attention, and executive function in elderly. Starting a moderate intensity physical exercise regimen at any time in later adulthood is beneficial, especially for very sedentary individuals.

Depression: Exercise did not improve speed of processing; attention/vigilance; working memory; verbal learning and memory and reasoning and problem solving. However, in a subgroup analysis that excluded mind–body interventions and included only exercise, it improved visual learning and memory.

Mechanism of action of exercise on the brain

Exercise is known to reduce oxidative stress and inflammation. Chronic anxiety and depression can potentially cause swelling and death of neurons. Some of the most susceptible nerve cells are in the memory storage space of the brain called hippocampus. Thus exercise helps to reduce stress and protects your memory. Through augmenting secretion of brain growth factors such as BDNF, it also helps with the regeneration of Hippocampal neurons. When you continue to do exercise long term, it can potentially make your brain grow in volume in crucial parts of the brain such as frontal and temporal cortices. In addition, Exercise seems to regulate the autonomic system (AS) functioning. Heart rate variability (HRV) and parasympathetic system activity thus breaking the feedback loop of anxiety in conditions such as panic disorder.  Moreover, exercise increases B-endorphins, serotonin, and other endogenous opioid neuropeptide transmitters which reduces anxiety and depressive symptoms.

Why does a comprehensive fitness program matter to you?

Although there is abundance of literature on the benefits of exercise on our mind and body, there is no “one size fits all” solution; individually formulated and carefully monitored exercise programs have shown to reduce anxiety and depression, compared to a App based general exercise regimen. When exercise is used as an intervention for mental illness, it must be clinically guided and carefully executed to assure safety and results. Hence Mindoc psychiatry has teamed up with Comprehensive health and fitness by Jiryes to give you the best chance to find the “next you”!

References:

  1. Exercise as a treatment for depression: A meta-analysis S. Kvam et al. / Journal of Affective Disorders (2016).
  2. Exercise for the treatment of depression and anxiety.Carek PJ et al. Int J Psychiatry Med. (2011).
  3. Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes. Ashdown-Franks Get al, Sports medicine Sports Med.(2020 ).
  4. Effect of exercise on premenstrual symptoms: A systematic review. Yesildere Saglam Het al Curr psychiatry Rep (2019).
  5. Innovations in the Treatment of Perinatal Depression: The Role of Yoga and Physical Activity Interventions During Pregnancy and Postpartum. Eustis EHet al. Eustis, E.H et al. Curr Psychiatry Rep (2019).
  6. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis.Stubbs B et al. Psychiatry Res. (2017).
  7. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. O’Keefe ELet al Mayo Clin Proc. 2019
  8. Sweat it out? The effects of physical exercise on cognition and behaviour in children and adults with ADHD: a systematic literature review.Anne E Den Heijer et al. Journal of Neural Transmission 2017