Mental Health & Exercise: They're More Connected Than You Think

This might be one of the most important topics that will ever be part of this blog site. We are going to learn about a major, and I mean MAJOR, medical health concern that is rampant among many individuals in healthcare: mental illness.

Depression. Anxiety. Bipolar disorder. Psychotic mania disorders. Schizophrenia.

These are all just a few of the many mental conditions that are prevalent among all types of individuals these days.

According to the National Institute of Mental Health (NIH), nearly 1 in 5 individuals in the United States suffers from some type of mental illness.

For perspective, that is 20% of all Americans…roughly 46 million individuals every year.

If you didn’t think mental health was a serious problem, hopefully now you do, or will at least think so by the end of this post.

When it comes to typical healthcare management of mental health conditions (medications, psychiatric therapy, community support, etc.), there is one treatment modality that many people don’t initially think about…

That modality is EXERCISE.

As someone who is ingrained in the physical therapy community, I live my professional life by the motto that “Exercise is Medicine”.

This phrase is not some meaningless tag-line or anthem that physical therapists use as a hashtag on social media or use to make cool t-shirts out of.

It is something that I, personally, live by and swear by wholeheartedly.

I love exercise (but don’t me wrong, I’m as lazy as a pig). Hopefully you all love exercise as well.

Today, we are going to look at mental health and the impact of physical activity and exercise on various components, such as stress, depression, physiological changes, and more.

Let me preface the content below by clarifying that I have been fortunate enough to never have experienced times of severe depression, anxiety, or any other mental health compromise. I cannot begin to understand all the factors that lead to mental health issues.

With this in mind, what I write below is meant to be a representation of what the research says about exercise and its benefits on mental health. It is not my goal to generalize any characteristics of mental health and mental illness.

If you are someone that suffers from mental illness or compromised mental health, I hope you get a lot out of this post, and leave with feelings of optimism and hopefulness on improving your feelings of depression or anxiety.

With that said, let’s dig into it.

HOW OFTEN IS EXERCISE USED TO TREAT MENTAL ILLNESS

Before we get into all the effects that exercise can have on mental illness, it is first important to quickly understand when this idea of exercise as treatment came about.

One study of over 2,000 physicians found that roughly 85% of doctors used exercise prescription in the management plan of care for individuals with depression and anxiety (1).

The kicker here: this study was performed over 30 years ago.

This shows that the idea that exercise is beneficial is not some new, unfounded concept. It has been around for decades.

Though exercise prescription for mental illness has been around for a long time, unfortunately we are just now getting high quality evidence to prove the effects of exercise.

A majority of the articles I will refer to in this post are relatively older, with only a couple of them written in the last 5-10 years.

6 MAJOR EFFECTS OF EXERCISE ON MENTAL HEALTH

1. Exercise has been shown to decrease depressive mood states (2, 3, 4, 5, 6).

There were roughly 6 or 7 good studies I read in which positive correlations were present between physical activity and the reduction of depressive mood states.

The reduction in a depressive mood state was shown to last for several hours after exercise (3). This emphasizes the importance of routine, daily exercise to maximize the beneficial effects.

There is one article specifically that you just HAVE to hear more about. It was by far my favorite one.

For this study, they observed each participant running on a treadmill for 30 minutes. The unique thing here is that some participants were facing a blank wall, while others were facing a slide show full of pleasant urban and rural scenery pictures.

They found that the participants who were facing the pleasant scenery pictures actually demonstrated greater reductions in depressive mood states and blood pressure (2) than those that were exercising while looking at a blank wall.

This is a highly interesting article that might suggest exercise in an outdoor environment could improve exercise’s depression reducing effects greater than normal. The article specifically called it “green exercise”.

Another study found that exercise actually produces reductions in anxiety and depressive mood states comparably to that of medications and psychological therapy (6). The good news about this article was that it was written in 2019 (I told you the research is coming around).

This article especially is a strong case for using exercise to reduce depressive mood states.

2. Exercise has been shown to markedly improve quality of life (5).

So, what does “quality of life” even mean? This is a question that most people ask, with good reason.

Quality of life is essentially the general well being of an individual, with roots in the strength of one’s relationships, fulfillment of pleasurable experiences, religious beliefs, family support, and emotional health.

I know this post is dedicated to mental health, but I would be remiss if I didn’t mention how exercise effects the body in so many more ways. Common themes between each article I read were general physical improvements such as reduced blood pressure, reduced weight gain, reduced appetite, etc.

Each of these factors leads to improved physical health. Why is this important for this post? It’s because emotional and mental health are both highly correlated with physical health.

If you love math, I have a formula for you…

Emotional Health + Mental Health + Physical Health = Quality of Life

3. Exercise has been shown to improve self-esteem and cognitive function (4, 7, 8).

I don’t ever like to assume anything, but I think I would be accurate in stating that self-esteem is an issue that runs deep (way deep) in all of us, whether we struggle with mental health issues or not.

I know there are countless days where I feel self-conscious about things I say, things I do, or the way I look.

One article I read stated that “physical activity and exercise might provide a beneficial adjunct for alcoholism and substance abuse programs; improving self-image, social skills, and cognitive functioning; reduce the symptoms of anxiety; and alter aspects of Type A behavior and stressors.” (7)

As you can see, the beneficial effects of exercise can impact all personality types and all individuals, no matter the mental state.

Not only does exercise improve self-esteem by improving general physical aesthetics, making you feel like you “look fit” or “look good”, it also improves self-esteem by the release of specific neurotransmitters in the brain.

We will cover the physiologic mechanisms of how exercise works to fight mental health in just a second.

4. Exercise is much more (and I mean MUCH more) cost effective than medication prescriptions or psychotherapy.

We all know how it goes with medications. If you don’t have great insurance, meds can get pretty pricey.

Not only are meds pricey, but you couple that on top of the co-pays for psychiatric therapy and you may find yourself paying quite a price for treatment of your anxiety or depression.

There were many articles I read that found exercise to be just as cost effective, and at times even more effective, than the use of medications and psychotherapy in reducing feelings of anxiety and depression (5, 9)

The evidence that is out there further supports the fact that exercise prescription is a MUST HAVE adjunctive therapy to combine with medications and psychotherapy (5).

5. Exercise has been shown to prevent feelings of depression and anxiety.

From one study I read, there was a major conclusion that exercise may perform better preventatively than it does as a treatment once mental illness is diagnosed (1).

Another exercise found that exercise, when performed at moderate intensities, was effective in reducing the impact of common life stressors (8).

This, I feel, is one of the most important findings I read throughout this whole process.

When it comes to mental health, we always talk about how we need to reduce the stress in our lives and try to get rid of tense jobs or people.

However, how possible is it to really get rid of all the stressful things we experience day to day?

I am in physical therapy school (at the time of this post) and there is no possible way for me to reduce or remove the stressors of exams and practicals in my life…short of dropping out of school, which is not an option due to the copious amount of student loan debt I have already taken in, HA.

Ahhh, look at that, student loan debt: yet another stressor in my life.

If we can use exercise to soften the blow of these stressors, then we can substantially cut down the instances of declining mental health.

WHAT’S THE PHYSIOLOGY BEHIND THESE EFFECTS?

I read a couple of articles that purposed themselves with explaining the biological and physiological mechanisms by which exercise improves self-esteem and fights against mental health issues.

Let me preface this content by saying this: neurology, emotion, and the psychosocial aspects that go into mental health go very deep.

So deep, in fact, that it would take hours of explanation, most likely from someone much more educated than I, to completely understand all the ways that the brain is affected by neurotransmitters, hormones, and blood flow.

But never fear, I believe I have done sufficient enough research to give you a surface explanation that will hopeful give you a look at how the brain reacts to exercise. So, let’s get into it.

According to a couple of articles I read, there seems to be agreement on multiple ways that exercise reduces mental health issues.

One explanation is that physical activity and exercise work by way of distraction techniques (10).

This means that exercise can be effective in distracting the brain from its typical thoughts of depression and feelings of anxiety. When someone is experiencing feelings of depression or feeling anxious about an upcoming job interview, exercise is an effect way to turn away from those feelings.

Exercise provides us with a way to sort of “escape” the stressors and realities of the real world.

Another explanation is due to improved blood flow to the brain during exercise (8, 10). Now, when you exercise, more blood is typically going to be redirected away from the brain and to the body’s muscles.

However, the brain is an exception. When blood flow is improved to the brain, it stimulates the increased release of neurotransmitters that improve self-efficacy and reduces depression, such as serotonin, dopamine, and epinephrine/norepinephrine (11).

The final mechanism (which goes hand in hand with improved blood flow) I will talk about, and by far the most complicated, is that of the HPA axis.

The HPA stands for the hypothalamic-pituitary-adrenal axis.

The HPA, in short, is responsible for controlling the way that certain hormones interact with different areas of the brain (12).

For example, there is the limbic system, the area of the brain controlling motivation and mood swings. Then there is the amygdala, which is responsible for the fear response (known as “fight or flight”) in response to stress and worry. Finally, there is the hippocampus, which plays a huge role in memory formation mainly, but additionally has an impact on mood and motivation.

The HPA axis is where you will find that most anti-psychotic drugs take their effects.

Hopefully this brief information gives you a better idea of how exercise works with hormones and the brain physiologically.

WRAPPING IT ALL UP

So as you can see, exercise is an absolutely crucial part (or at least should be) of the treatment plan of individuals with mental health issues.

In addition to all the effects I mentioned about, multiple articles partially mentioned other health benefits that contribute to mental health and satisfaction.

These include better sleep, improved libido (sex drive), better endurance, increased energy levels, and weight reduction (12).

These are all highly impactful components of life that can change one’s level of satisfaction mentally and emotionally.

Before I conclude this post, it is important to note that the best type of exercise, regarding intensity and volume, has not quite been established by the research (13).

This being said, the best parameters we have to go with are those in according with the general exercise recommendations from the American College of Sports Medicine: 150 mins per week of moderate intensity aerobic activity.

That equals roughly 30 minutes per day, for 5 days of the week.

As mentioned before, I hope this post has opened your eyes to the importance of exercise in the treatment of mental illness. Thanks for reading!