Mental health disorders such as depression and anxiety are not easy to treat. Drugs help many, but they have a high failure rate and can have unpleasant side effects. Speech therapy takes time and money. And neither approach is adequate for preventing the development of the disorders in the first place. But many people overlook another option that, when it works, can be one of the most effective, least disruptive, and cost-effective ways to manage mental health disorders: exercise. It's nothing new that exercise is good for your physical health, and has long been praised for your mental health as well. But researchers are now making progress in understanding how, exactly, exercise can work with its mental magic. Exercise, they are learning, has profound effects on the brain structure itself, and especially on the regions most affected by depression and schizophrenia. It also provides other more subtle benefits, such as concentration, a sense of accomplishment, and sometimes social stimulation, all of which are therapeutic in their own right. And while more is generally better, even modest levels of physical activity, such as a daily walk, can have great mental health benefits. It is a very powerful intervention to be physically active," says Andres Howland, a clinical psychologist at the University of Bergen in Norway. But that knowledge is just starting to come into practice, says Joseph Firth, a mental health researcher at the University of Manchester in the UK. Just ask the hundred or so people receiving mental health care, how many receive exercise prescriptions as part of that care. "You won't find many," Firth says. Exercise: A Tool Against Depression Some of the strongest evidence of the mental benefits of exercise focuses on depression. In 2016, Howland and colleagues searched the published literature and identified 23 clinical studies that tested the effectiveness of exercise in treating depression. Exercise was clearly effective and, in few studies, on par with antidepressant medications, the researchers concluded. And exercise offers numerous benefits. For one thing, antidepressant medications typically take several weeks or months to show their full effect. Exercise can improve mood almost immediately, making it a valuable complement to front-line treatments like medication or therapy, says Brett Gordon, an exercise psychology researcher at Penn School of Medicine State. Plus, he says, exercise can counteract some bad side effects of antidepressants, such as weight gain. Additionally, exercise has few of the negative side effects so common with drug therapies for depression and other ailments. Many people with mental health problems are not thrilled to start a drug for the rest of their life and are interested in considering other options. Exercise could be one of those options, "says Jacob Meyer, an exercise psychologist at Iowa State University. Evidence is now emerging that exercise also appears to help treat or prevent anxiety disorders, including the disorder. From post-traumatic stress. (PTSD) and possibly other severe psychotic conditions as well. "The more we do these studies, the more we see that exercise can be valuable," Firth says. There is a downside to this coin that is particularly Relevant during the Covid-19 pandemic: If exercise stabilizes mental health, anything that prevents people from exercising risks destabilizing it. To test this, Meyer and colleagues surveyed more than 3,000 Americans about their activities before and during the pandemic. They found that those who became less active as a result of Covid reported more depression and worse mental health. (Ironically, those who were not and exercised regularly before Covid did not report many changes. "When you are already at zero, where are you going?" says Meyer.) But researchers are still trying to understand exactly how muscular effort in the brain works to improve mental health. For most biomedical questions like this one, animal experiments are the first stop, but they aren't as useful in studies of mental health problems. "Psychological health is so uniquely human that it can be difficult to make a good leap from animal models," says Meyer. Exercise and a healthy brain Scientists have come up with some ideas about how exercise improves mental health, says Patrick J. Smith, a psychologist and biostatistician at Duke University Medical Center in North Carolina, who wrote on the subject in Annual Review of Medicine 2021 with his Duke colleague. Rhonda M. Mervin. It doesn't seem to have much to do with cardiovascular fitness or muscle strength, the most obvious benefits of exercise, as the intensity at which a person can exercise is only weakly associated with their psychological health. There has to be something else going on that's more important than just physical fitness, says Smith. A likely possibility is that exercise strengthens both the brain and the body. Exercise triggers the release of a protein known as brain-derived neurotrophic factor (BDNF). BDNF is one of the key molecules that promote the growth of new brain cells, possibly including the hippocampus, a brain region important for memory and learning. Since the hippocampus tends to be smaller or distorted in people with depression, anxiety, and schizophrenia, increasing BDNF through exercise may be one way physical activity could help manage these conditions. In fact, studies show that people with depression have lower levels of BDNF, and one effect of antidepressant drugs in particular is to increase the production of that molecule. Researchers have not yet directly demonstrated that the increase in BDNF associated with exercise is what reduces depressive symptoms, The experiment has just ended and Mitral is still analyzing the results, which he describes as promising. However, he warns that exercise is not a cure-all. Schizophrenia is a different disease, and while physical activity is protective for some people at risk, not all are likely to respond in the same way. “It is very important to remember that these disorders are complicated. "I've worked with people who exercise a lot and still have schizophrenia, he says". If Mitral's work is successful, the exercise could allow mental health workers to help a group not easily treatable with medication. "Someone who is at risk for a psychotic disorder, you can't give them drugs, because that too has risks," Firth says. "It would be great to have something else in our arsenal." Exercise almost certainly has other effects on the brain as well, according to experts. For example, exercise stimulates the release of endocannabinoids, molecules that are important for changing the connections between brain cells, the mechanism that underlies learning. This can provide another way to improve learning that underlies the successful treatment of depression, post-traumatic stress disorder, and other mental disorders. Indeed, Combine study of exercise in a simplified model of therapy for post-traumatic stress disorder measured endocannabinoids and BDNF, and increases in both were associated with stronger learning responses. And physical activity also moderates the body's response to stress and reduces inflammation, which could help improve brain health in people with mental illness. "We just scratched the surface," says Howland. But it remains one of the most promising possibilities, says Howland.
Exercise can also help with anxiety disorders. The brain changes caused by BDNF appear to improve learning, which is an important part of some antianxiety therapies. This suggests that exercise may be a useful way to improve the effectiveness of such therapies. One of the standard therapies for post-traumatic stress disorder, for example, is to expose patients to the fear-causing stimulus in a safe environment so that patients learn to recalibrate their reactions to trauma-related signals and how much the better they learn, the longer it will last. The answer could be. Kevin Crombbie, an exercise neuroscientist now at the University of Texas at Austin, and his colleagues tested this idea in the lab on 35 women with PTSD. The researchers first taught the volunteers to associate a particular geometric shape with a mild electric shock. The next day, the volunteers repeatedly saw the same shape without the shock, to know that the stimulus was now safe. A few minutes later, half of the volunteers did 30 minutes of moderate exercise (jogging or walking uphill on a treadmill), while the other half did only light movements, not enough to breathe out of breath. The experiment has just ended and Mitral is still analyzing the results, which he describes as promising. However, he warns that exercise is not a cure-all. Schizophrenia is a different disease, and while physical activity is protective for some people at risk, not all are likely to respond in the same way. " It is very important to remember that these disorders are complicated". "I've worked with people who exercise a lot and still have schizophrenia", he says. If Mitral's work is successful, the exercise could allow mental health workers to help a group not easily treatable with medication. "Someone who is at risk for a psychotic disorder, you can't give them drugs, because that too has risks," Firth says. "It would be great to have something else in our arsenal." Exercise almost certainly has other effects on the brain as well, according to experts. For example, exercise stimulates the release of endocannabinoids, molecules that are important for changing the connections between brain cells, the mechanism that underlies learning. This can provide another way to improve learning that underlies the successful treatment of depression, post-traumatic stress disorder, and other mental disorders. Indeed, combine study of exercise in a simplified model of therapy for post-traumatic stress disorder measured endocannabinoids and BDNF, and increases in both were associated with stronger learning responses. And physical activity also moderates the body's response to stress and reduces inflammation, which could help improve brain health in people with mental illness. "We just scratched the surface," says Howland.
Move the body, involve the mind, But changing the structure of the brain is not the only way that physical activity can be beneficial for those with mental health problems. The exercise habit itself can be beneficial, altering people's thinking patterns, says Smith. For people with mental health problems, the simple act of doing something, anything, can be beneficial in itself because it occupies their attention and prevents them from reflecting on their condition. In fact, a survey of published literature found that placebo exercise - that is, a slight stretch too gentle to cause any physiological effect - had nearly half the mental health beneficial effect of strenuous exercise. In addition to occupying the mind, regular workouts also give users a clear sense of progress as their strength and fitness improve. This sense of accomplishment, which can be especially evident at weight training, where people make quick, easy-to-measure gains, can help offset some weight of anxiety and depression, says Gordon. If so, playing a musical instrument, studying a language, and many other activities could also help people cope with mental health conditions in similar ways. But exercise does more, making it one of the best options for mental health management. "You can see the benefits of doing anything, but exercise can confer greater benefits," Firth says. For one thing, relatively strenuous exercise teaches people to endure short-term discomfort for long-term gains. People suffering from anxiety disorders such as post-traumatic stress disorder or panic attacks often exhibit a reduced ability to tolerate mental distress, so the experiences most people would have to deal with result in uncontrolled anxiety instead. There is now emerging evidence that regular exercise increases tolerance for internal discomfort, and this may explain some of its benefits in managing these conditions, Smith says. However, using exercise as a mental health treatment presents some challenges. "People with mental illness are also more at risk of struggling with low motivation," Firth says. This can make organizing and adhering to an exercise program difficult, and many patients need additional support. This is often difficult, because psychologists, psychiatrists and other mental health professionals are often already overloaded. Furthermore, exercise prescribing and supervision were traditionally not within the remit of these professionals. “We tell people, 'Hey, exercise is useful,' but we tell people they can't really get into it because they often don't get any training,” Firth says. Exercise reference schemes, which connect patients with fitness specialists and structured programs at community recreation centers, have been used in the UK and elsewhere to encourage exercise in people with physical conditions such as obesity and diabetes. Such an approach could be invaluable for mental health conditions, Firth says. Therapists can also help patients with long-term persistence by tailoring their exercise prescriptions to each individual's abilities. “I always tell patients that doing anything is better than nothing and that the best exercise for you is what you actually do,” says Smith. The secret, he suggests, is to make sure people stop exercising before they've done so much that they feel exhausted afterward. "When you feel bad after exercising, you don't want to do it," he says, because the brain labels the activity as unpleasant. It is much better for the patient to quit smoking while having a positive feeling from the workout. “Without realizing it, your brain tends to label that activity as something more enjoyable. They don't fear it. ”Even light activity - basically moving around from time to time during the day instead of sitting for hours - can help. In a study of over 4,000 teenagers in the UK, Aaron Gondola, a psychiatric epidemiologist at the University College London, and colleagues found that young people who did lighter activities during the day had a lower risk of depressive symptoms than those who spent more session time.
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