28 Feb Mental Health and Exercise – The vital link
In Australia, we are experiencing higher than ever before numbers of people living with clinically diagnosed mental health disorders.
Previously, mental health issues were rarely discussed due to the sense of weakness or shame in admitting that one may have a problem. Thankfully now, society and its perception of mental health issues is becoming better informed and developing a better educated understanding of the incredibly significant impact that mental health disorders has on an individual, family, healthcare system and the country as a whole.
Mental and behavioural disorders, such as depression, anxiety and drug use, are important drivers of disability and morbidity.
This impact has been shown by the Australian Burden of Disease Study 2011 which examined the health loss due to disease and injury that is not improved by current treatment, rehabilitative and preventative efforts of the health system and society (AIHW 2016). For Australia, Mental & Substance Use Disorders were estimated to be responsible for 12.1% of the total burden of disease in 2011, placing it 3rd as a broad disease group after Cancer (18.5%) and Cardiovascular diseases (14.6%) (AIHW 2016).
In terms of the non-fatal burden of disease, which is a measure of the number of years of ’healthy’ life lost due to living with a disability, Mental and Behavioural Disorders were the largest contributor (23.6%) of the non-fatal burden of disease in Australia followed by Musculoskeletal disorders (22.7%) and Respiratory disorders (11.9%) (AIHW 2016).
As further research comes to light, it is becoming more apparent that when dealing with mental health disorders medication based treatment alone is not as effective as when combined with physical activity and healthy lifestyle modification. Many individuals with serious mental health disorders such as, but not limited to, depression, anxiety, schizophrenia and substance abuse also experience at or at a much higher rate the risk of chronic disease associated with sedentary behavior including diabetes, hyperlipidemia, and cardiovascular disease as well as medication side effects.
According to the 2010 Survey of People Living with Psychotic Illness, people with psychotic illness also frequently experience poor physical health outcomes and comorbidities (Morgan et al. 2011). For example, over one-quarter (27%) of survey participants had heart or circulatory conditions and over one-fifth (21%) had diabetes (compared with 16% and 6% respectively in the general population). The prevalence of Diabetes found in the National Survey of People Living with Psychotic Illness is more than 3 times the rate seen in the general population, along with the increased occurrence of other health issues such as severe headaches/migraines (25% compared with 9% in the general population).
So now that we have acknowledged the data detailing the effects of mental health, how do we as health professionals help our clients?
The importance of exercise is not adequately understood or appreciated by patients and mental health professionals alike. Evidence has suggested that exercise may be an often-neglected intervention in mental health care (Callaghan, 2004).
Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression. These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, thus, on the physiologic reactivity to stress (Guszkowska , 2004). This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation.
Other hypotheses that have been proposed to explain the beneficial effects of physical activity on mental health include distraction, self-efficacy, and social interaction (Peluso, 2005). While structured group programs can be effective for individuals with serious mental illness, lifestyle changes that focus on the accumulation and increase of moderate-intensity activity throughout the day may be the most appropriate for most patients (Richardson, et. Al. 2005). Interestingly, adherence to physical activity interventions in psychiatric patients appears to be comparable to that in the general population.
Simply put, exercise improves mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function (Callaghan, 2004). Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal.
Thirty minutes of exercise of moderate intensity, such as brisk walking for 3 days a week, is sufficient for these health benefits. Moreover, these 30 minutes need not to be continuous; three 10-minute walks are believed to be as equally useful as one 30-minute walk.
Health benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients include the following:
- Improved sleep
- Increased interest in sex
- Better endurance
- Stress relief
- Improvement in mood
- Increased energy and stamina
- Reduced tiredness that can increase mental alertness
- Weight reduction
- Reduced cholesterol and improved cardiovascular fitness
My top tips for health professionals to help patients with mental health increase their level of physical activity:
- Help the person to set realistic goals, set a plan that gives them direction
- Start small and complete achievable amounts of exercise to start with, this will help them to feel that they are improving and achieving
- Empower your clients through education, a lot of people want to help themselves but simply do not know how to start
- Establish a strong network of health professionals in the local area working in mental health- a strong multi-disciplinary team is the best asset a client can have
Mental health service providers can provide effective, evidence-based physical activity interventions for individuals suffering from serious mental illness. More than that, we can provide a supportive, caring and empowering environment in a professional setting to help clients dealing with their mental health issues to receive the treatment they require and help them to achieve long lasting changes towards a healthier lifestyle.
Where to get help
If you are new to exercise, pregnant, a smoker, overweight, have heart disease or major health problems, it is recommended that you seek medical advice before commencing a vigorous exercise program. Accredited Exercise Physiologists are the health professionals trained specifically to assist in this process.
Accredited Exercise Physiologists are university qualified allied health professionals who specialise in the delivery of exercise, lifestyle and behavioural programs for the prevention and management of chronic conditions (including depression) and injuries.
People who have ongoing health conditions (e.g. depression) are able to receive Medicare rebates for up to five sessions with an Exercise Physiologist.
For more information on Exercise Physiologists (and to find an exercise physiologist in your area), visit www.essa.com.au/find-aep or visit www.medicareaustralia.gov.au to find out more about the available Medicare rebates.
REFERENCES:
- Australian Institute of Health and Welfare (AIHW) 2016. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW.
- Callaghan P.. Exercise: a neglected intervention in mental health care? J Psychiatr Ment Health Nurs. 2004;11:476–483. [PubMed]
- Guszkowska M.. Effects of exercise on anxiety, depression and mood [in Polish] Psychiatr Pol. 2004;38:611–620. [PubMed]
- Morgan VA, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, et al. 2011. People living with psychotic illness 2010. Canberra: Australian Government Department of Health and Ageing.
- Peluso MA, Andrade LH.. Physical activity and mental health: the association between exercise and mood. Clinics. 2005;60:61–70. [PubMed]
- Richardson CR, Faulkner G, and McDevitt J. et al. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005 56:324–331. [PubMed]