The compilation reviewed and synthesized data from studies that analyzed three groups of people: healthy adults, people with mental disorders (such as depression, anxiety and psychological stress) and people with various chronic illnesses (which include people with cancer, cardiovascular disease, kidney disease and cerebrovascular accidents).
Many people with diagnosed depression and anxiety have comorbidities such as hypertension, diabetes, osteoarthritis and fatigue, among others – and suffer from the presence of two or more illnesses or medical conditions at the same time. Additionally, people with chronic medical conditions such as cancer, cardiovascular disease, kidney disease and stroke tend to have mental health issues such as depression, anxiety and psychological distress, among other conditions. However, in both cases, becoming physically active and changing your lifestyle is not the best recipe.
Despite the role of lifestyle management, including exercise, sleep and nutrition, in practice, pharmacotherapy (drugs administered by psychiatrists) and psychotherapy (psychological counseling or psychoanalysis) are considered the first line of treatment. This is despite national guidelines in several countries that recommend physical activity as a critical pillar of treatment. For example, in the United States, the American Psychological Association’s Clinical Practice Guidelines recommend psychotherapy or pharmacotherapy as an initial treatment approach, with lifestyle approaches considered a “complementary alternative treatment” if the former is “ineffective”. Beating exercise with acupuncture and calling it “alternative” is that your thinking is not supported by any evidence. In Australia, however, lifestyle management is recommended as a first-line treatment approach. Despite this, pharmacotherapy is usually provided first.
Ben Singh and his colleagues at the University of South Australia, authors of the study, acknowledged that several previous studies have shown the beneficial effects of exercise and physical activity in the treatment of depression, anxiety and psychological distress. Physical activity has also shown better effects and is advantageous in terms of cost, side effects and auxiliary health benefits. I admit to you, dear reader, that I have read many of these studies over the years. I thought I knew everything there was to know about the role of exercise in mental health, but I was also disillusioned with the chosen approaches and didn’t believe anything could change in the field. When I read this compilation that synthesized huge amounts of data (1,039 trials and 128,119 participants), I was astonished. And that’s why I wanted to share this crucial study with you.
Here’s why.
Despite the evidence surrounding the impact of physical activity, it has not been widely adopted therapeutically – leading to my frustration. It is often overlooked in managing these conditions and considered ineffective and unacceptable. Patients are also responsible for this situation, as they resist making exercise and activity an integral part of their treatment. Furthermore, clinicians and therapists are not enthusiastic about these modalities, despite the data that observes them.
This also occurs because there are no defined prescriptions and dosages, such as medications or frequency of counseling sessions, making it difficult to quantify their effects. It’s important to point out that exercise doesn’t work like a magic pill for these conditions. It takes time, patience and experience, which, unfortunately, our training in medical and psychological faculties does a poor job of. We are barely introduced to the role of exercise in any conditions. Our books have exercises and lifestyle changes mentioned at the top of management, but we just aren’t trained in the details and so we neglect them. And if we neglect them, they don’t get their importance. It’s a vicious wheel that keeps turning. Indeed, we don’t bother mentioning exercise in almost any medical condition, let alone mental health.
doctor Singh and his colleagues were keen to change that. Therefore, they searched twelve electronic databases for eligible studies published through January 1, 2022. The authors reviewed 97 review articles, which included 1039 research trials and had a total of 1,28,119 participants, ranging in age from 29 to 86 years.
What about exercise duration and intensity?
They found that doing 150 minutes a week of various types of physical activity – whether aerobic (walking or running), strength training, yoga or other – is 1.5 times more effective in reducing symptoms of depression, anxiety and psychological distress , compared to usual care, i.e. medication or cognitive-behavioral therapy. Also, people who exercised for six to twelve weeks saw the greatest benefits compared to those who exercised for a shorter period.
Most doctors and psychologists are apprehensive about recommending high-intensity exercise for any medical condition, but it has been linked to greater improvement for those with depression and anxiety. And contrary to popular belief in the exercise medicine fraternity, interventions of longer duration, i.e. longer than 60 minutes, had smaller effects compared to shorter bouts of exercise, which are more beneficial.
The Doctor. Singh added: “The greatest benefits (self-reported by participants) were seen in people with depression, pregnant and postpartum women, apparently healthy individuals, and individuals diagnosed with HIV or kidney disease.”
Unfortunately, in India we don’t even have a public health policy on physical activity during pregnancy, which I intend to change with the help of experts in the field. The same is the case with many other medical conditions.
So why does exercise work on conditions related to mental health?
It is common knowledge today that exercise leads to the release of endorphins and dopamine in the brain. But there is also irisin, an “exercise hormone” that is manufactured in our muscles when we are physically active at an optimal level. It is released into the bloodstream and starts to stimulate the brain’s reward system, making it reach a state of tranquility. Together they improve our mood and reduce our stress levels. When the same happens for a longer period, there is a change in the brain that helps make mood swings more permanent, reduce inflammation and boost immunity. Exercising regularly gradually raises the pain threshold, which further improves confidence. And then when we sleep, we get to sleep much better and wake up refreshed the next morning to face the world – a challenge for those suffering from depression, they just don’t wake up refreshed. And the vicious circle continues.
The Doctor. Singh concluded: “It is likely that the beneficial effects of physical activity on depression and anxiety are due to a combination of several psychological, neurophysiological and social mechanisms. Different modes of physical activity stimulate different physiological and psychosocial effects, and this was borne out by our findings, for example, resistance exercise had the greatest effects on depression, while yoga and other mind-body exercises were most effective in reducing anxiety. Physical activity improves depression through several neuromolecular mechanisms, including increased expression of neurotrophic factors, increased availability of serotonin and norepinephrine, regulation of hypothalamic-pituitary-adrenal axis activity, and reduction of systemic inflammation. Therefore, low-intensity PA (physical activity) may be insufficient to stimulate the neurological and hormonal changes that are associated with greater improvements in depression and anxiety.”
Unfortunately, despite the abundance of evidence in favor of exercise being better than other treatment modalities for depression, anxiety, and so on, it is not given due weight.
There is a caveat here that Dr. Singh and his colleagues acknowledge. In cases of severe depression, anxiety and psychological distress, Dr. Singh concedes the limitation of the review is that it focuses on mild to moderate depression rather than severe depression.
For that, I turned to Dr. Anurag Mishra, psychiatrist, psychoanalyst and founder of the Livonics Institute of Integrated Learning and Research.
He said, “The challenge with physical activity of any kind is that one is confronted with one’s deepest childhood fears, such as imploding, exploding, drowning, suffocating, falling, and so on. These are the fears that interrogators exploit with torture techniques – such as simulated drowning, where water is poured over a cloth covering the face, causing the subject to experience the sensation of drowning. In the case of fasting, it exposes us to the fear of dying of hunger and thirst. However, once we start to master them, our tolerance for anxiety increases. The biggest problem in all our lives is us, nobody else. Once people get over these fears and feel comfortable with themselves, facing them head-on and mastering them, they can put it all into action. In this case, physical activity and exercise. People with mild to moderate mental health symptoms tend to do well, but when it comes to severe depression and advanced mental conditions, these fears are even more of a challenge and we need the help of medication, counseling, training and so on to help. them to deal with. with their fears to get them started.”
Whether mental or physical health, the debate is not, or rather should not be, about one treatment modality versus another. It should be about what works best for the patient. To do that, my medical colleagues need to understand the human being on the other side of their desk. We need to put ourselves in their shoes and make a decision with them and not for them.
As for the person suffering from mental health issues alone, or along with physical medical conditions, it’s about taking control while learning to let go, which sounds like an oxymoron, but it’s not. All you can do is try your hardest while acting proactively.
Doctors, councilors, trainers and therapists are all on your team, but you need to be in charge. Be it the degree of intensity, duration or frequency of exercise and physical activity, everything is relative. Gradually build it up. You just need to do a little more than you did yesterday. Don’t consider it a rat race because the only person you are competing with is who you were yesterday. There will be good days and bad days. Don’t let them excite or irritate you. Just be on the journey to be a better you.
And like Dr. Singh so rightly says, “Exercise should not be seen as a ‘nice to have’ option. It’s a powerful, affordable tool for managing mental health conditions — and the best part is, it’s free and comes with lots of additional health benefits.”
At the end of the day, the idea is to move, one step at a time.
Keep miling and smiling.
Rajat Chauhan (drrajatchauhan.com) is the author of The Pain Handbook: A non-surgical way to managing back, neck and knee pain; MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days
He writes a weekly column, exclusively for HT Premium readers, that details the science of movement and exercise.
Opinions expressed are personal.