# data[].attributes.attachment_link.title
Brain Fitness: The Easy Way of Keeping Your Mind Sharp Through Qigong

# data[].attributes.attachment_link.description
Brain Fitness: The Easy Way of Keeping Your Mind Sharp Through Qigong [Kuhn C.M.D DIPL. OBT., Dr. Aihan] on Amazon.com. *FREE* shipping on qualifying offers. Brain Fitness: The Easy Way of Keeping Your Mind Sharp Through Qigong

# data[].attributes.attachment_link.title
The Joy of Movement: How exercise helps us find happiness, hope, connection, and courage

# data[].attributes.attachment_link.description
The Joy of Movement: How exercise helps us find happiness, hope, connection, and courage [McGonigal, Kelly] on Amazon.com. *FREE* shipping on qualifying offers. The Joy of Movement: How exercise helps us find happiness, hope, connection, and courage

# data[].attributes.headline
How Exercise Impacts on The Brain & Our Mental Health

# data[].attributes.subject
How Exercise Impacts on The Brain & Our Mental Health

# data[].attributes.attachment_link.readable_text
We chat to doctor and researcher at King's College London, Dr Brendan Stubbs, about the impact exercise has on mental wellbeing, how important the 10,000 daily steps are and what else we can do with our bodies to help our minds.

# data[].attributes.attachment_link.title
How Exercise Impacts on The Brain & Our Mental Health · Podcast · deliciously ella

# data[].attributes.attachment_link.description
We chat to doctor and researcher at King's College London, Dr Brendan Stubbs, about the impact exercise has on mental wellbeing, how important the 10,000 daily steps are and what else we can do with our bodies to help our minds.

# data[].attributes.headline
Exercise as a Drug for Mental Health and Longevity

# data[].attributes.subject
Exercise as a Drug for Mental Health and Longevity

# data[].attributes.attachment_link.readable_text
Annabel Kuhn, M.D., Yenifer Aponte, M.D., David Puder, M.D.
Dr. Seiler, Dr. Kuhn, Dr. Aponte and Dr. Puder have no conflicts of interest.

In this episode, Dr. Puder speaks with Dr. Stephen Seiler about the connection between mental health and physical activity.

Dr. Seiler grew up in Texas and Arkansas. As a child, Dr. Seiler was so passionate about science that he set up a laboratory under the staircase of his parents' home. Meanwhile, the young Dr. Seiler also loved sports. When he was 15 years old, he stumbled upon a book chapter titled "The Scientist of Sport"; it was then that he realized his two passions can coexist. Now, Dr. Seiler is known as one of the top exercise physiologists in the world and works in Norway.

Physical activity has been shown to reduce stress reactivity and reduce all cause mortality. Physical activity also results in decreased psychosocial stress. Today we explore this intersection and discuss the significance of incorporating physical exercise as a part of a robust mental health care plan.

Physical Activity Reduces All-Cause Mortality

A study from 2018 explored the association between cardiorespiratory fitness and long-term mortality. The study followed a group of 122,000 patients over 8.4 years, and it demonstrated that performance on a treadmill test predicted all-cause mortality. Of the 120,000 patients, 13,637 died by 8.4 year follow up. Of those that died, 23.7% (6,904) were in the "low performance" group on the treadmill test, and only 2.6% (93) were in the "elite" group on the treadmill test. Being an elite performer as opposed to a low performer resulted in a raw 10-fold reduction in all-cause mortality. The hazard ratio going from elite performance to low was 5.04, meaning there would be a 500% increase in risk of death if an elite performer became a low performer. To highlight how significant of a risk this truly is, in this study the hazard ratio for smoking was 1.41, which would mean that smoking causes a 40% increase risk in all-cause mortality.

Dr. Seiler states that this 2018 study is representative and reinforces most or all of the research that has been done on physical activity and physical wellbeing. The London Transport Workers Study (published in 1953) was one of the first studies to explore the connection between physical activity and overall health. The study explored differences in health between tour bus drivers and tour bus guides. The bus drivers sat most of the day, whereas the guides are constantly getting off and on the bus. The guides demonstrated greater overall health. We have 60-70 years worth of studies and data that proves that human bodies are meant to be physically active.

One does not have to fall into the "elite performer" category to achieve health benefits. Dr. Seiler says that a reasonably consistent physical activity plan is beneficial, even if it is not extremely intense. Increasing the duration of moderate exercise is a great way to achieve the health benefits.

Mind-Body Connection During Exercise

Progressive physiologic stress helps us handle psychological stress. When we exercise, the brain is receiving an amazing amount of information from the body. This is known as afferent feedback-the body tells the brain where our limbs are in space and tells us about the chemical state around the muscles. There is also the perception of effort that occurs in a feed-forward and feed-back loop. The feed-forward arm involves the brain's awareness of how much muscle it is recruiting to do the physical action. Feedback signals from the muscles doing the work influence the brain and inform how much energy is being expended.

Signaling during movement and exercise promotes a conversation between mind and body, where the brain and body are asking one another, "How do I feel?", or "How much longer can I go at this intensity?". Teleoanticipation is defined as "the anticipation of the end of a physical task that allows more efficient expenditure of energy". Ask yourself to find a fairly difficult running pace that you could maintain for an hour. The brain learns quite rapidly about the body and is usually able to find this pace within 5-8 minutes of exercise. The brain is projecting out some rate of fatigue. The brain is learning to build physical courage, and you become more comfortable with the discomfort. In anticipation of fatigue, the brain develops strategies to handle or resist the negative feedback from the muscles. Thus, long-term athletes develop not only better ways for their bodies to physiologically process stress, but also develop ways to psychologically process discomfort.

Exercise Decreases Stress Reactivity

Stress reactivity is defined as the magnitude of the reaction to acute mental stress (). Mucke and colleagues found 7 out of 12 studies showed that higher fitness levels had less adrenocortical stress reactivity. A 2010 meta-analysis demonstrated that a higher stress reactivity was associated with higher risk of subsequent cardiovascular complications. Fortunately, there is a way to reduce stress reactivity. One can increase physical activity in order to reduce stress reactivity and therefore reduce risk of cardiovascular complications. A meta-analysis from 2006 found that study participants with increased cardiorespiratory fitness levels showed lower cardiovascular reactivity. Specifically, they reported point estimates of - 1.84 ( p < 0.005) for HR, and - 3.69 ( p<0.001) for systolic blood pressure. These findings suggest that higher fitness levels are associated with a blunted stress reactivity.

How Do Elite Athletes Exercise?

Dr. Seiler and his colleagues published a study in 2006 which quantified the daily distribution of training intensity in a group of well-trained junior cross-country skiers. This paper studied twelve male cross country skiers between ages 17-18. The athletes performed a continuous treadmill test to voluntary exhaustion to determine a heart rate and VO2 corresponding to ventilatory thresholds (VT1, VT2), maximal oxygen consumption (VO2max), and maximum heart rate. VT1 and VT2 as well as blood lactate measurements were used to delineate three intensity zones.

In our podcast, Dr. Seiler describes zone 1 as a "talking pace" level of aerobic exercise. Zone 2 is a "threshold zone", in which the intensity is too difficult to hold a conversation. Zone 3 represents a high intensity of exercise at which individuals fatigue quickly.

Let's first explore the zones in terms of lactate concentration. Zone 1 corresponds to ≤2.0mM lactate, zone 2, >2.0 and <4.0mM lactate, and zone 3, ≥4.0mM lactate. Seiler's 2006 study analyzed 60 consecutive training sessions of athletes, 71% were performed with ≤2.0mM blood lactate, 7% between 2 and 4mM, and 22% with over 4mM (mean=9.5±2.8mM).

Next, let's examine fitness zones in terms of heart rate. Intensity distribution across endurance training sessions ( n=318) was similar when based on heart rate analysis (75±3%, zone 1; 8±3%, zone 2; 17±4%, zone 3) or session RPE (76±4%, zone 1; 6±5%, zone 2; 18±7%, zone 3).

It might surprise you that elite endurance athletes train primarily in zone 1. According to Dr. Seiler, for elite athletes, 80% to 90% of training sessions are actually spent in zone 1 where there is purposeful but reasonably comfortable intensity. There are indeed times when elite athletes train in zones 2 and 3, and those sessions are important, but the ratio of maintaining a high percentage of zone 1 exercise to zones 2 and 3 seems to be important for physical fitness.

In Seiler's 2010 review he concludes that frequent, low intensity (≤2.0mM blood lactate), longer duration training is effective in stimulating physiological adaptations.

Measuring Maximum Heart Rate

As discussed above, it is useful to know your own maximum heart rate. Many people believe 220 minus your age is equivalent to a maximum heart rate; however, this is not accurate on an individual level. More accurate and personalized measures of maximum heart rate can be calculated based on an individual's own factors, such as their actual heart rate at maximum exercise. Dr. Seiler says that maximum heart rate does not have correlation with performance. Dr. Seiler says that it is also useful to know your resting heart rate. When you have your maximum and resting heart rate, now you know your range. If you want to stay at 65% of your maximum aerobic capacity, you multiply the range by .65. This will give you a number that you add to your resting heart rate. For example, Dr. Puder's maximum heart rate is 170 and his resting heart rate is 50, so his range is 170-50 = 120. Then multiplying .65 X 120 = 78, which you add to his resting heart rate of 50. So Dr. Puder's 65% of his maximum aerobic capacity is a heart rate of 128. Endurance athletes spend 80-90% of their workouts at a heart rate that is 60-70% of their aerobic capacity. For Dr. Puder this would be training around 122-134 beats per minute. You can check your resting heart rate by measuring your heart rate first thing in the morning. You can check your maximum heart rate with a heart rate monitor and do an intensive workout (like a treadmill with increasing the intensity every 1 minute till you can't go any longer) or going to an exercise laboratory test. As always, consult your physician before attempting something like this!

How Consistent Exercise Changes Our Physiology

San-Millán et al,, 2018 compared blood lactate levels (in millimoles per liter) and workload (in Watts) during bicycle exercise. The paper explored three groups, the first group was composed of individuals with diabetes mellitus or metabolic syndrome, the second group was made of individuals who are moderately active (three hours of exercise per week), and the third group was professional endurance athletes. Let's compare the absolute workload of the three groups at a blood lactate of 2 mmol/L. On average, individuals with metabolic syndrome produce around 125 Watts. On average, moderately active individuals produce 175 watts. Professional endurance athletes produce 275-300 watts, which is a phenomenal difference from the other two groups. What is happening on a cellular level?

Endurance exercise promotes mitochondrial proliferation. Muscle fibers synthesize more mitochondria and more mitochondrial enzymes that aerobically metabolize and use fuel to produce ATP. Essentially, you pack muscle fibers with more mitochondria and they become much more efficient at processing fats and carbohydrates. Mitochondria becomes particularly efficient at metabolizing carbohydrates because lactate is not produced.

Lactate is a small molecule that the body can use to essentially "transport" energy sources around the body. Lactate produced in one muscle fiber can be transported into another fiber where it can be converted into pyruvate and finally transported into the mitochondria of a cell in the muscle fiber. There is a beautiful interplay of fuel sources across fibers and in athletes with a high mitochondrial density there is a significant amount of lactate transportation and conversion into energy. Energy utilization is more efficient within the fibers because of the increased mitochondrial density.

There are three main energy sources that our muscles use: fat, carbohydrates, and stored carbohydrates (known as glycogen). Muscles use all three sources for energy during exercise. The muscles of a professional endurance athlete are optimized to use fat, glycogen, and glucose an excessive lactate production. The combination is that high performance athletes have very flat lactate curves (as seen above in Fig. 1 from San-Millán 2018 ), where the intensity of exercise continues to increase, but the blood lactate level remains low. Finally, at 300 Watts, the lactate begins to increase. 300 Watts is the maximum capacity of most individuals, at which their blood lactate levels might be around 10 millimoles per liter, whereas an endurance athlete's blood lactate would be 3 millimolars per liter at this absolute workload. This phenomenal difference is a result of tremendous levels of low basic ("level 1") aerobic exercise over time.

After doing prolonged low intensity training, individuals become more efficient at using fat as a fuel source. This is a valuable adaptation. Let's say you are running a marathon (42.195km or 26.219 miles). Many people will "hit a wall", often at about the 30km mark or 18.64 miles. This occurs due to the muscle running out of glycogen as a fuel source. Every individual will "hit a wall" at some point when exercising, but the more experienced athletes will get to such a point much later than others. This is because endurance athletes spare their glycogen by using more fat for fuel.

Dr. Puder rowed on his ergometer, took his average heart rate, average watts and measured his lactate every 5 minutes. His goal was to understand his corresponding heart rate for his lactate blood level of 2 mmol/L.

Dr. Seiler states that the first two data points on 1/26/22 are clear indicators that Dr. Puder is in a nice aerobic zone (zone 1) with no increase in blood lactate. There is a clear change from 209 to 247 watts, where Dr. Puder's blood lactate is now 4.17 mmol/L (the beginning of zone 3). In order for Dr. Puder to achieve optimal aerobic exercise, he should aim for a maximum absolute workload of 215 Watts, at which point his blood lactate will be below 2 until he fatigues. This is consistent with his goal of 60-70% HR zone (122-134) which would be a lactate level just below 2 mmol of lactic acid. Over time the hope would be to produce more watts at a lower heart rate while producing less lactic acid. Optimizing the body's health will impact both longevity, mental wellness and cognitive function.

Conclusion

Optimizing our bodies ability to perform in exercise increases longevity, wellness and decreases our stress reactivity. Most of us think that we need to enter into the red zone every workout to achieve results, whereas elite performers only do that around 10% of the time. With my personal training program, I enter into a heart rate zone of 60-70% for the majority of my workouts to optimize long-term performance enhancements. This optimal zone occurs when we produce less than 2 mmol lactic acid. We should be able to talk, but not sing, during this zone 1 training level. I prescribe exercise in this zone to clients along with strength training for optimization of mood and total wellness. Ideally, some of this time is spent in nature and out of a gym.

References:

Chida, Y., & Steptoe, A. (2010). Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence. Hypertension, 55(4), 1026-1032.

Forcier, K., Stroud, L. R., Papandonatos, G. D., Hitsman, B., Reiches, M., Krishnamoorthy, J., & Niaura, R. (2006). Links between physical fitness and cardiovascular reactivity and recovery to psychological stressors: A meta-analysis. Health Psychology, 25(6), 723.

Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605

Morris, J. N., Heady, J. A., Raffle, P. A. B., Roberts, C. G., & Parks, J. W. (1953). Coronary heart-disease and physical activity of work. The lancet, 262(6796), 1111-1120.

Mücke, M., Ludyga, S., Colledge, F., & Gerber, M. (2018). Influence of regular physical activity and fitness on stress reactivity as measured with the trier social stress test protocol: A systematic review. Sports Medicine, 48(11), 2607-2622.

San-Millán, I., & Brooks, G. A. (2018). Assessment of metabolic flexibility by means of measuring blood lactate, fat, and carbohydrate oxidation responses to exercise in professional endurance athletes and less-fit individuals. Sports medicine, 48(2), 467-479.
Seiler, K. S., & Kjerland, G. Ø. (2006). Quantifying training intensity distribution in elite endurance athletes: is there evidence for an "optimal" distribution?. Scandinavian journal of medicine & science in sports, 16(1), 49-56. Seiler, S. (2010). What is best practice for training intensity and duration distribution in endurance athletes?. International journal of sports physiology and performance, 5(3), 276-291.

Annabel Kuhn, M.D., Yenifer Aponte, M.D., David Puder, M.D.
Dr. Seiler, Dr. Kuhn, Dr. Aponte and Dr. Puder have no conflicts of interest.

In this episode, Dr. Puder speaks with Dr. Stephen Seiler about the connection between mental health and physical activity.

Dr. Seiler grew up in Texas and Arkansas. As a child, Dr. Seiler was so passionate about science that he set up a laboratory under the staircase of his parents' home. Meanwhile, the young Dr. Seiler also loved sports. When he was 15 years old, he stumbled upon a book chapter titled "The Scientist of Sport"; it was then that he realized his two passions can coexist. Now, Dr. Seiler is known as one of the top exercise physiologists in the world and works in Norway.

Physical activity has been shown to reduce stress reactivity and reduce all cause mortality. Physical activity also results in decreased psychosocial stress. Today we explore this intersection and discuss the significance of incorporating physical exercise as a part of a robust mental health care plan.

Physical Activity Reduces All-Cause Mortality

A study from 2018 explored the association between cardiorespiratory fitness and long-term mortality. The study followed a group of 122,000 patients over 8.4 years, and it demonstrated that performance on a treadmill test predicted all-cause mortality. Of the 120,000 patients, 13,637 died by 8.4 year follow up. Of those that died, 23.7% (6,904) were in the "low performance" group on the treadmill test, and only 2.6% (93) were in the "elite" group on the treadmill test. Being an elite performer as opposed to a low performer resulted in a raw 10-fold reduction in all-cause mortality. The hazard ratio going from elite performance to low was 5.04, meaning there would be a 500% increase in risk of death if an elite performer became a low performer. To highlight how significant of a risk this truly is, in this study the hazard ratio for smoking was 1.41, which would mean that smoking causes a 40% increase risk in all-cause mortality.

Dr. Seiler states that this 2018 study is representative and reinforces most or all of the research that has been done on physical activity and physical wellbeing. The London Transport Workers Study (published in 1953) was one of the first studies to explore the connection between physical activity and overall health. The study explored differences in health between tour bus drivers and tour bus guides. The bus drivers sat most of the day, whereas the guides are constantly getting off and on the bus. The guides demonstrated greater overall health. We have 60-70 years worth of studies and data that proves that human bodies are meant to be physically active.

One does not have to fall into the "elite performer" category to achieve health benefits. Dr. Seiler says that a reasonably consistent physical activity plan is beneficial, even if it is not extremely intense. Increasing the duration of moderate exercise is a great way to achieve the health benefits.

Mind-Body Connection During Exercise

Progressive physiologic stress helps us handle psychological stress. When we exercise, the brain is receiving an amazing amount of information from the body. This is known as afferent feedback-the body tells the brain where our limbs are in space and tells us about the chemical state around the muscles. There is also the perception of effort that occurs in a feed-forward and feed-back loop. The feed-forward arm involves the brain's awareness of how much muscle it is recruiting to do the physical action. Feedback signals from the muscles doing the work influence the brain and inform how much energy is being expended.

Signaling during movement and exercise promotes a conversation between mind and body, where the brain and body are asking one another, "How do I feel?", or "How much longer can I go at this intensity?". Teleoanticipation is defined as "the anticipation of the end of a physical task that allows more efficient expenditure of energy". Ask yourself to find a fairly difficult running pace that you could maintain for an hour. The brain learns quite rapidly about the body and is usually able to find this pace within 5-8 minutes of exercise. The brain is projecting out some rate of fatigue. The brain is learning to build physical courage, and you become more comfortable with the discomfort. In anticipation of fatigue, the brain develops strategies to handle or resist the negative feedback from the muscles. Thus, long-term athletes develop not only better ways for their bodies to physiologically process stress, but also develop ways to psychologically process discomfort.

Exercise Decreases Stress Reactivity

Stress reactivity is defined as the magnitude of the reaction to acute mental stress (). Mucke and colleagues found 7 out of 12 studies showed that higher fitness levels had less adrenocortical stress reactivity. A 2010 meta-analysis demonstrated that a higher stress reactivity was associated with higher risk of subsequent cardiovascular complications. Fortunately, there is a way to reduce stress reactivity. One can increase physical activity in order to reduce stress reactivity and therefore reduce risk of cardiovascular complications. A meta-analysis from 2006 found that study participants with increased cardiorespiratory fitness levels showed lower cardiovascular reactivity. Specifically, they reported point estimates of - 1.84 ( p < 0.005) for HR, and - 3.69 ( p<0.001) for systolic blood pressure. These findings suggest that higher fitness levels are associated with a blunted stress reactivity.

How Do Elite Athletes Exercise?

Dr. Seiler and his colleagues published a study in 2006 which quantified the daily distribution of training intensity in a group of well-trained junior cross-country skiers. This paper studied twelve male cross country skiers between ages 17-18. The athletes performed a continuous treadmill test to voluntary exhaustion to determine a heart rate and VO2 corresponding to ventilatory thresholds (VT1, VT2), maximal oxygen consumption (VO2max), and maximum heart rate. VT1 and VT2 as well as blood lactate measurements were used to delineate three intensity zones.

In our podcast, Dr. Seiler describes zone 1 as a "talking pace" level of aerobic exercise. Zone 2 is a "threshold zone", in which the intensity is too difficult to hold a conversation. Zone 3 represents a high intensity of exercise at which individuals fatigue quickly.

Let's first explore the zones in terms of lactate concentration. Zone 1 corresponds to ≤2.0mM lactate, zone 2, >2.0 and <4.0mM lactate, and zone 3, ≥4.0mM lactate. Seiler's 2006 study analyzed 60 consecutive training sessions of athletes, 71% were performed with ≤2.0mM blood lactate, 7% between 2 and 4mM, and 22% with over 4mM (mean=9.5±2.8mM).

Next, let's examine fitness zones in terms of heart rate. Intensity distribution across endurance training sessions ( n=318) was similar when based on heart rate analysis (75±3%, zone 1; 8±3%, zone 2; 17±4%, zone 3) or session RPE (76±4%, zone 1; 6±5%, zone 2; 18±7%, zone 3).

It might surprise you that elite endurance athletes train primarily in zone 1. According to Dr. Seiler, for elite athletes, 80% to 90% of training sessions are actually spent in zone 1 where there is purposeful but reasonably comfortable intensity. There are indeed times when elite athletes train in zones 2 and 3, and those sessions are important, but the ratio of maintaining a high percentage of zone 1 exercise to zones 2 and 3 seems to be important for physical fitness.

In Seiler's 2010 review he concludes that frequent, low intensity (≤2.0mM blood lactate), longer duration training is effective in stimulating physiological adaptations.

Measuring Maximum Heart Rate

As discussed above, it is useful to know your own maximum heart rate. Many people believe 220 minus your age is equivalent to a maximum heart rate; however, this is not accurate on an individual level. More accurate and personalized measures of maximum heart rate can be calculated based on an individual's own factors, such as their actual heart rate at maximum exercise. Dr. Seiler says that maximum heart rate does not have correlation with performance. Dr. Seiler says that it is also useful to know your resting heart rate. When you have your maximum and resting heart rate, now you know your range. If you want to stay at 65% of your maximum aerobic capacity, you multiply the range by .65. This will give you a number that you add to your resting heart rate. For example, Dr. Puder's maximum heart rate is 170 and his resting heart rate is 50, so his range is 170-50 = 120. Then multiplying .65 X 120 = 78, which you add to his resting heart rate of 50. So Dr. Puder's 65% of his maximum aerobic capacity is a heart rate of 128. Endurance athletes spend 80-90% of their workouts at a heart rate that is 60-70% of their aerobic capacity. For Dr. Puder this would be training around 122-134 beats per minute. You can check your resting heart rate by measuring your heart rate first thing in the morning. You can check your maximum heart rate with a heart rate monitor and do an intensive workout (like a treadmill with increasing the intensity every 1 minute till you can't go any longer) or going to an exercise laboratory test. As always, consult your physician before attempting something like this!

How Consistent Exercise Changes Our Physiology

San-Millán et al,, 2018 compared blood lactate levels (in millimoles per liter) and workload (in Watts) during bicycle exercise. The paper explored three groups, the first group was composed of individuals with diabetes mellitus or metabolic syndrome, the second group was made of individuals who are moderately active (three hours of exercise per week), and the third group was professional endurance athletes. Let's compare the absolute workload of the three groups at a blood lactate of 2 mmol/L. On average, individuals with metabolic syndrome produce around 125 Watts. On average, moderately active individuals produce 175 watts. Professional endurance athletes produce 275-300 watts, which is a phenomenal difference from the other two groups. What is happening on a cellular level?

Endurance exercise promotes mitochondrial proliferation. Muscle fibers synthesize more mitochondria and more mitochondrial enzymes that aerobically metabolize and use fuel to produce ATP. Essentially, you pack muscle fibers with more mitochondria and they become much more efficient at processing fats and carbohydrates. Mitochondria becomes particularly efficient at metabolizing carbohydrates because lactate is not produced.

Lactate is a small molecule that the body can use to essentially "transport" energy sources around the body. Lactate produced in one muscle fiber can be transported into another fiber where it can be converted into pyruvate and finally transported into the mitochondria of a cell in the muscle fiber. There is a beautiful interplay of fuel sources across fibers and in athletes with a high mitochondrial density there is a significant amount of lactate transportation and conversion into energy. Energy utilization is more efficient within the fibers because of the increased mitochondrial density.

There are three main energy sources that our muscles use: fat, carbohydrates, and stored carbohydrates (known as glycogen). Muscles use all three sources for energy during exercise. The muscles of a professional endurance athlete are optimized to use fat, glycogen, and glucose an excessive lactate production. The combination is that high performance athletes have very flat lactate curves (as seen above in Fig. 1 from San-Millán 2018 ), where the intensity of exercise continues to increase, but the blood lactate level remains low. Finally, at 300 Watts, the lactate begins to increase. 300 Watts is the maximum capacity of most individuals, at which their blood lactate levels might be around 10 millimoles per liter, whereas an endurance athlete's blood lactate would be 3 millimolars per liter at this absolute workload. This phenomenal difference is a result of tremendous levels of low basic ("level 1") aerobic exercise over time.

After doing prolonged low intensity training, individuals become more efficient at using fat as a fuel source. This is a valuable adaptation. Let's say you are running a marathon (42.195km or 26.219 miles). Many people will "hit a wall", often at about the 30km mark or 18.64 miles. This occurs due to the muscle running out of glycogen as a fuel source. Every individual will "hit a wall" at some point when exercising, but the more experienced athletes will get to such a point much later than others. This is because endurance athletes spare their glycogen by using more fat for fuel.

Dr. Puder rowed on his ergometer, took his average heart rate, average watts and measured his lactate every 5 minutes. His goal was to understand his corresponding heart rate for his lactate blood level of 2 mmol/L.

Dr. Seiler states that the first two data points on 1/26/22 are clear indicators that Dr. Puder is in a nice aerobic zone (zone 1) with no increase in blood lactate. There is a clear change from 209 to 247 watts, where Dr. Puder's blood lactate is now 4.17 mmol/L (the beginning of zone 3). In order for Dr. Puder to achieve optimal aerobic exercise, he should aim for a maximum absolute workload of 215 Watts, at which point his blood lactate will be below 2 until he fatigues. This is consistent with his goal of 60-70% HR zone (122-134) which would be a lactate level just below 2 mmol of lactic acid. Over time the hope would be to produce more watts at a lower heart rate while producing less lactic acid. Optimizing the body's health will impact both longevity, mental wellness and cognitive function.

Conclusion

Optimizing our bodies ability to perform in exercise increases longevity, wellness and decreases our stress reactivity. Most of us think that we need to enter into the red zone every workout to achieve results, whereas elite performers only do that around 10% of the time. With my personal training program, I enter into a heart rate zone of 60-70% for the majority of my workouts to optimize long-term performance enhancements. This optimal zone occurs when we produce less than 2 mmol lactic acid. We should be able to talk, but not sing, during this zone 1 training level. I prescribe exercise in this zone to clients along with strength training for optimization of mood and total wellness. Ideally, some of this time is spent in nature and out of a gym.

References:

Chida, Y., & Steptoe, A. (2010). Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence. Hypertension, 55(4), 1026-1032.

Forcier, K., Stroud, L. R., Papandonatos, G. D., Hitsman, B., Reiches, M., Krishnamoorthy, J., & Niaura, R. (2006). Links between physical fitness and cardiovascular reactivity and recovery to psychological stressors: A meta-analysis. Health Psychology, 25(6), 723.

Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605

Morris, J. N., Heady, J. A., Raffle, P. A. B., Roberts, C. G., & Parks, J. W. (1953). Coronary heart-disease and physical activity of work. The lancet, 262(6796), 1111-1120.

Mücke, M., Ludyga, S., Colledge, F., & Gerber, M. (2018). Influence of regular physical activity and fitness on stress reactivity as measured with the trier social stress test protocol: A systematic review. Sports Medicine, 48(11), 2607-2622.

San-Millán, I., & Brooks, G. A. (2018). Assessment of metabolic flexibility by means of measuring blood lactate, fat, and carbohydrate oxidation responses to exercise in professional endurance athletes and less-fit individuals. Sports medicine, 48(2), 467-479.
Seiler, K. S., & Kjerland, G. Ø. (2006). Quantifying training intensity distribution in elite endurance athletes: is there evidence for an "optimal" distribution?. Scandinavian journal of medicine & science in sports, 16(1), 49-56. Seiler, S. (2010). What is best practice for training intensity and duration distribution in endurance athletes?. International journal of sports physiology and performance, 5(3), 276-291.

# data[].attributes.attachment_link.title
Episode 142: Exercise as a Drug for Mental Health and Longevity - Psychiatry & Psychotherapy Podcast

# data[].attributes.attachment_link.description
Annabel Kuhn, M.D., Yenifer Aponte, M.D., David Puder, M.D. Dr. Seiler, Dr. Kuhn, Dr. Aponte and Dr. Puder have no conflicts of interest. In this episode, Dr. Puder speaks with Dr. Stephen Seiler about the connection between mental health and physical activity.

# data[].attributes.attachment_link.title
How Exercise Benefits Your Brain - Exercise and The Brain (animated)

# data[].attributes.headline
How to Exercise When Suffering With Depression/Anxiety

# data[].attributes.subject
How to Exercise When Suffering With Depression/Anxiety

# data[].attributes.attachment_link.title
HOW TO EXERCISE WHEN SUFFERING WITH DEPRESSION/ANXIETY

# data[].attributes.headline
The Best Types of Exercise for Mental Health

# data[].attributes.subject
The Best Types of Exercise for Mental Health

# data[].attributes.attachment_link.readable_text
You have probably heard time and time again that exercise is beneficial for your mental health.

It's true. Regular exercise can help manage depression symptoms, boost overall mood, reduce cognitive issues, and alleviate anxiety and stress, along with many other mental benefits of exercise.

This is because physical activity directly affects the brain. Exercise increases blood circulation and the production of Brain Derived Neurotrophic Factor (BDNF), a protein found in parts of the brain that aids in thinking, memory, and learning, all of which may help provide relief for mental illness.

What are the mental health benefits of exercise?

In addition to the scientific reasons that working out can improve your mental health, there are many other benefits that may not be as obvious or measurable.

Some of the ancillary benefits of exercise on mental health may include improved body image, routine, and a sense of pride and accomplishment. Even if you are not exercising primarily for weight loss or muscle gain, results including feeling stronger and having more physical capacity may indirectly benefit your sense of self-worth and overall well-being.

Once you commit to exercising regularly, your workouts become routine. For instance, if you jump rope every day at 8 am, it will soon become a standard practice and you will no longer have to spend time debating if/when/how you might exercise that day. There are many other benefits of having a routine.

Having scheduled time dedicated to your health may improve the stresses many people feel when making decisions.

"Carrying out routine activities reduces stress by making the situation appear more controllable and predictable," according to Indumathi Bendi, M.D., a primary care physician at Piedmont an in article by Piedmont Health Care. "Preparedness is a key way to prevent stress."

How does exercise help depression and anxiety?

For many, working out is a way to set and conquer personal goals. Whether you're interested in running a marathon or doing a pushup, setting attainable and measurable objectives is a way to maintain control and keep your interest in physical activity.

Anxiety and depression symptoms can rob you of the power and/or control you have over your environment or your life. By setting and reaching physical goals for yourself, you gain a sense of pride, accomplishment, and control.

Rewarding yourself for surpassing these goals can provide great incentive to continue to work towards your ideal physical fitness level and set new, harder-to-achieve goals. Goals should be personal - you can decide exactly what you are working for and why, and how to reward yourself accordingly.

Depression and anxiety: Exercise may ease symptoms

Feeling proud and grateful for your body and its capabilities can particularly help people who struggle with mental health issues. By pushing yourself to improve your physical abilities, you grow a connection between mind and body and an appreciation of your physical form.

"Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin," according to an article in HelpGuide.org. "By adding this mindfulness element - really focusing on your body and how it feels as you exercise - you'll not only improve your physical condition faster, but you may also be able to interrupt the flow of constant worries running through your head."

This appreciation is especially important to those who struggle with mental health disorders that take a more tangible toll on your body.

While improvements in mental health can be subtle, improvements through exercise are far more perceptible and are a great way to mark success on your overall journey towards well-being.

What exercise is best for mental health?

While most people think "exercise = running," there are many other options to get the heart pumping.

The four kinds of exercise are cardiovascular, strength training, balance, and flexibility.

And within those categories there are even more options. There's yoga and Pilates. There's basketball, cycling, dancing, weight training, bowling, gymnastics, golf, boxing, swimming, barre, and so much more.

A study published in Lancet Psychiatry explored which forms of exercise best improve mental health. In the study, researchers evaluated survey information that asked respondents to list what activity they participated in along with how many poor mental health days they experienced in the past month. While the researchers found that all types of exercise were beneficial for mental health, team sports had the best percentage for the least amount of bad mental health days.

Team sports such as basketball, soccer, baseball, and volleyball can be beneficial to mental health from a physical activity and social perspective. Forming friendships through hobbies has been known to help with depression and ease social anxiety. Similarly, these activities require you to spend time in a new environment, breaking up your typical routine or surroundings and potentially helping you out of unhealthy patterns.

Exercises for individuals who have mental health conditions

Team sports not for you? The Lancet Psychiatry study found the following exercises that can be done on an individual basis may be beneficial for mental health:

- According to an article on the American Psychological Association website, "yoga may help strengthen social attachments, reduce stress and relieve anxiety, depression and insomnia." Reducing stress levels may be beneficial for those who have uncontrollable negative thoughts, which can occur in people with anxiety, depression, and other mental illnesses.

- According to an article on the bikebiz.com, cycling has multiple mental health benefits, including reducing stress, anxiety, and depression. The article also notes that cycling can help you with your mindfulness practice, make improvements to your self-esteem, defend against cognitive decline, and help you to socialize.

- A documentary photographer, Martin Eberleen, found running to be the right exercise for him after he was diagnosed with ADHD. He explained to BBC News: "Running helps me control my thoughts, it slows me down, and gives me the opportunity to focus on the things I need to focus on." Additionally, a review article published in the International Journal of Environmental Research and Public Health found that, "overall, studies suggest that running bouts of variable lengths and intensities, and running interventions can improve mood and mental health."

Aerobic or gym exercise - The Lancet Psychiatry study found that aerobic or gym exercise helped promote good mental health. Examples of this type of exercise include rope skipping, boxing, weightlifting, or using a rowing or elliptical machine.

Do the exercise that's best for you

If you're interested in using exercise to improve your mental health, this list of activities can serve as a good place to start when figuring out what type of exercise best suits your lifestyle and mentality.

However, everyone has different interests and needs, so don't feel limited to these options or discouraged if an activity doesn't meet your expectations. It may take some time to find the right fit, but your mental health is worth it. It is important to choose an activity that you will be able to do consistently; if it is too challenging then you will be less likely to incorporate it into your routine and appreciate its full benefits.

The key is to do what is most enjoyable for YOU. You got this!

Like this post? Here are a few more you may find informative:
* Please consult with your healthcare provider prior to starting an exercise program.
https://genesight.com/blog/patient/physio-genomics-genes-may-modulate-exercise-benefits-in-depression/
https://genesight.com/blog/patient/how-exercise-eases-depression-symptoms/
https://genesight.com/blog/patient/4-ways-to-keep-your-depression-symptoms-in-check/

# data[].attributes.attachment_link.title
The Best Types of Exercise for Mental Health - GeneSight

# data[].attributes.attachment_link.description
You have probably heard time and time again that exercise is beneficial for your mental health. It's true. Regular exercise can help manage depression symptoms, boost overall mood, reduce cognitive issues, and alleviate anxiety and stress, along with many other mental benefits of exercise. This is because physical activity directly affects the brain.

# data[].attributes.headline
Exercise boosts the brain - and mental health

# data[].attributes.subject
Exercise boosts the brain - and mental health

# data[].attributes.attachment_link.title
Mindful Movement: A Quick, Simple Workout with Michelle of the A.S.S. Class!

# data[].attributes.attachment_link.title
Gym Meditation/ Fitness - Mindfulness Workout

# data[].attributes.attachment_link.readable_text
We often focus on the physical benefits of working out-improved heart health, stronger muscles, management of all kinds of health conditions. But there are powerful mental health benefits of exercise as well. For example, there is evidence to suggest that exercise can reduce stress, elevate your mood, and even improve your memory.

However, there's also a chance that your workout is increasing your stress. According to research conducted by Jennifer Heisz, PhD, that she presents in her new book Move the Body, Heal the Mind, dialing things back and doing lower-intensity workouts like walking might actually be what the brain needs.

The benefits of low-intensity exercise

In recent years, high-intensity interval training (HIIT) has garnered a groundswell of attention. The busier we get, the more appealing it is to have our workout time be as efficient as possible.

While HIIT and other high-intensity exercise like running can be beneficial, Dr. Heisz, an associate professor in the department of kinesiology at McMaster University, says that the physical stress of intense activity can be counterproductive for some people.

"To be clear, stress is not inherently bad. We need some stress in our lives to help us adapt and grow into a stronger version of ourselves," she explains. "However, too much stress damages the body and mind. Research from my NeuroFit lab shows that chronic stress can lead to mental health issues in people who have never had a diagnosis before."

Our bodies perceive all types of stress the same way, regardless of the origin or type of stress. Whether you are racing against a deadline at work, trying to come up with enough money to meet your bills, or pushing your body to its limits in an indoor cycling workout, your body's stress response will be triggered.

Chronic activation of cortisol, a stress hormone, is not only fatiguing, but it can also increase weight gain, limit your ability to exercise as vigorously as you would like to, and lead to heart problems.

Dr. Heisz says people with anxiety are particularly prone to finding vigorous exercise intolerable. "People with anxiety sensitivity (which is literally the fear of fear itself) become afraid, often to the point of panic, when they experience the physical sensations brought on by anxiety, including a racing heart and shortness of breath," she explains. "These physical sensations of anxiety are evoked by vigorous exercise and so many people with anxiety sensitivity often avoid intense exercise because they are afraid of how it makes them feel."

"These physical sensations of anxiety are evoked by vigorous exercise." -Dr. Jennifer Heisz

In contrast, research from the NeuroFit lab suggests that 30 minutes of light-to-moderate exercise three times per week reduces anxiety, especially for people who are highly anxious. Moreover, just 10 minutes of light exercise can boost anyone's mood, and those effects increase for every additional 10 minutes (up to one hour).

How does low-intensity exercise improve mental health?

No matter the current state of your mental health, there are a few potential mechanisms by which low- and moderate-intensity exercise can reduce anxiety and boost your mood.

It increases neuropeptide Y, which helps protect the brain from trauma.

It stimulates the production of endocannabinoids, the body's natural cannabis, which activates the reward system to release dopamine (aka the "happy hormone").

It increases brain-derived neurotrophic factor, which aids in the growth, function, and survival of brain cells, especially those in the hippocampus, a brain region that is largely responsible for stress regulation and memory.

How to maximize the mental health benefits of walking

Committed to making actionable advice from her research findings, Dr. Heisz shares some of her top tips to maximize the mental health benefits of walking or other low-intensity exercise:

1. Break up your sitting time

If you're able, Dr. Heisz suggests taking a two-minute walking break after 30 minutes of sitting. "These short bursts of movement are enough to counteract the deleterious effects of prolonged sitting, which starves the brain of the vital nutrients it needs to thrive," she explains.

2. Walk mindfully

To really reduce anxious thoughts, try to focus on connecting to your body while walking instead of ruminating on your anxious thoughts. Dr. Heisz says this helps create space between you and your negative thoughts. It also allows for your prefrontal cortex, the rational part of your brain, to soothe the anxious amygdala, the brain region generating your fears.

3. Intermittently pick up the pace

Although we are talking about relatively low-intensity exercise, your walk doesn't need to be a gentle stroll. "Research from my NeuroFit lab shows that interval walking improves memory more than regular walking," says Dr. Heisz. To reap the benefits, intersperse periods of brisk walking ("you'll know you're walking fast enough when it becomes too difficult to carry on a conversation," she says) with a more relaxed pace.

4. End with a sprint

Dr. Heisz recommends doing a "Fear Buster Workout," which is her term for adding a very short sprint (10 seconds or so) at the end of your walk. "It is like exposure therapy for people with anxiety sensitivity," she notes. "It exposes them to the physical sensations of anxiety that they fear, but in a safe and controlled way with exercise."

5. Aim for consistency

We often feel like there's no point in exercising if we don't have at least an hour or so, but Dr. Heisz says consistency is more important than length, and that every minute counts. See if you can commit to just 10 minutes a day to start. Make it a routine and try to get your walk in daily. Your body and brain will thank you.
Walking not for you? Try this low-intensity chair yoga for another brain-boosting workout:
Oh hi! You look like someone who loves free workouts, discounts for cutting-edge wellness brands, and exclusive Well+Good content. Sign up for Well+, our online community of wellness insiders, and unlock your rewards instantly.

# data[].attributes.attachment_link.title
The Best Exercise For Mental Health? Something Low-Key | Well+Good

# data[].attributes.attachment_link.description
We often focus on the physical benefits of working out-improved heart health, stronger muscles, management of all kinds of health conditions. But there are powerful mental health benefits of exercise as well. For example, there is evidence to suggest that exercise can reduce stress, elevate your mood, and even improve your memory.

# data[].attributes.attachment_link.readable_text
Current evidence suggests physical activity and exercise benefit mental health. In June 2021, the John W. Brick Foundation released their Move Your Mental Health Report, a scoping review of studies conducted over the last thirty years. This article outlines the key findings of the report, what this data means for fitness industry professionals.

As the world continues to slowly emerge from the COVID-19 pandemic, the long-term impacts of the last 18 months on physical and mental health are yet to be determined. Some mental health experts fear a "tsunami" of mental health issues to emerge in the near future. Investment in strategies to improve and address mental health has never been more prescient.

There has long been data to suggest physical activity and exercise benefit mental health. In June 2021, the John W. Brick Foundation released their Move Your Mental Health Report, which provides a scoping review of over 1,000 studies conducted over the last thirty years. The research cast a wide net, including studies on any variety of physical activity, exercise, or movement type and any mental health outcome published between 1990 and 2020.

The findings were overwhelmingly positive. Out of 1,158 studies examined, 89% found a statistically significant, positive association between physical activity or exercise and mental health. The top three exercise types linked to mental health benefits where:

general physical activity (a broad category representing any movement),

cardiovascular/aerobic physical activity, and

When considering solely randomized controlled trials (RCTs)-often thought of as the gold standard and most rigorous study type-87% found statistically significant positive associations between physical activity or exercise and mental health.

Exercise and Mental Health

This review found statistically significant and beneficial links between several types of physical activity and depression, general anxiety, mood, general mental health, quality of life, stress, and well-being.

The strongest associations across the board were for depression. A review cited in the report and published in the Journal of the American Medical Association, including 39 trials, found that exercise was associated with reduced depression symptoms when compared with no treatment and placebo and active control groups. Additional studies found that the effects of exercise were not different from psychotherapy or antidepressants.

Research also suggests exercise is beneficial for anxiety. Meta-analyses of studies have shown that exercise is more effective in treating anxiety than control group settings. Exercise improved anxiety symptoms in people with an anxiety diagnosis or other stress-related disorder and those with "clinically raised" anxiety. A growing body of evidence suggests physical activity can provide immediate anxiety relief following a session. The evidence shows that exercise can be a long-term solution and also a potential immediate coping mechanism for people with anxiety.

The evidence thus far suggests an effective exercise regimen for depression and anxiety includes both aerobic and resistance training across four to five 30-45 minute sessions each week. Exercise should also be supervised by a trained fitness professional and be mindful of participants' enjoyment, community, and culture to maximize adherence. People with anxiety also benefit from adding more mindful forms of exercise like yoga, Tai Chi, and Qigong one or two times per week.

Exercise and Mental Illness

While exercise cannot cure mental illness, it can still provide important benefits to overall well-being.

For example, the report highlights evidence suggesting aerobic exercise can lower psychiatric symptoms and improve cognition in people with schizophrenia type disorders. A study including 39 trials found that physical activity interventions had a significant effect on lower depression symptoms and schizophrenia symptoms. Interventions also improved quality of life in people with mental illness.

The report also points to a 19 study meta-analysis, which found that yoga was better for depressive symptoms in contrast to no treatment or treatment as usual for people with:

In this analysis, the authors noted a link between a higher frequency of yoga and a greater reduction in symptoms.

Less evidence was available for serious mental illnesses like bipolar disorder and schizophrenia. Although, research suggests that physical activity is more beneficial for controlling "negative" symptoms-such as withdrawal and apathy-than for "positive" symptoms-as in hallucinations or confused thoughts. Another added benefit of physical activity for people with serious mental illness is its role in preventing and managing cardiometabolic diseases, which can often accompany these illnesses, increase disease risk, and reduce longevity.

Key Recommendations

According to the report, the benefits of exercise and physical activity for mental health are most apparent when:

intensity is moderate to vigorous,

it occurs several times per week,

engaging in a combination of aerobic and resistance training, and

it includes mindfulness-based activities like yoga, Tai Chi, and Qigong.

It's important to remember that more is not always best. The evidence suggests a U-shaped curve, with peak benefits at a regimen of moderate-vigorous exercise three to five times weekly. In alignment with global and U.S. physical activity guidelines recommendations, combining cardiovascular training with resistance or muscular strengthening exercise was more beneficial than either one alone.

Related Articles & Publications

Lori Deemer, M.D., concludes that social isolation, decreased physical activity, and loss of function-all factors of the pandemic-are leading Americans to an unhealthy future.

The COVID-19 pandemic has elevated collective awareness around mental health and wellness. This article highlights research and evidence showing the effect of COVID-19 on mental health, the benefits of physical activity, and the role fitness centers can play.

America was unhealthy before the pandemic, now it's out of control. One expert hopes to see healthcare reform by promoting physical activity in the future.

Alexandra Black Larcom, MPH, RD, LDN, is the Senior Manager of Health Promotion & Health Policy for IHRSA. She spends her days working on resources and projects that help IHRSA clubs offer effective health programs in their communities, and convincing lawmakers that policies promoting exercise are an excellent idea. Outside the office you'll most likely find Alex at the gym, running on the Charles River, or, in the fall, by a TV cheering on the Florida Gators.

# data[].attributes.attachment_link.title
New Report: Exercise Plays Key Role in Mental Health & Well-being

# data[].attributes.attachment_link.description
Current evidence suggests physical activity and exercise benefit mental health. In June 2021, the John W. Brick Foundation released their Move Your Mental Health Report, a scoping review of studies conducted over the last thirty years. This article outlines the key findings of the report, what this...

# data[].attributes.attachment_link.readable_text
Mental health disorders such as depression and anxiety aren't easy to treat. Medications help many but have a high failure rate and may bring nasty side effects. Talk therapy is time-consuming and expensive. And neither approach is suited to preventing the disorders from developing in the first place. But many people overlook another option that, when it works, can be one of the most effective, least disruptive and cheapest ways of managing mental health disorders: exercise.

It's hardly news that exercise is good for your physical health, and has long been extolled for mental health as well. But researchers are now making progress in understanding how, exactly, exercise may work its mental magic.

Exercise, they are learning, has profound effects on brain structure itself, and especially in regions most affected by depression and schizophrenia. It also provides other, more subtle benefits such as focus, 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 pay big dividends for mental health.

"It's a very potent intervention to be physically active," says Anders Hovland, a clinical psychologist at the University of Bergen in Norway.

But that knowledge has barely begun to percolate into practice, says Joseph Firth, a mental health researcher at the University of Manchester in the UK. Just ask a hundred people receiving mental health care how many are getting exercise prescriptions as part of that care. "You wouldn't find many," Firth says.

Exercise - a tool against depression

Some of the strongest evidence for the mental benefits of exercise centers on depression. In 2016, Hovland and his colleagues searched the published literature and identified 23 clinical trials that tested the effectiveness of exercise in treating depression. Exercise was clearly effective and, in few studies, on par with antidepressant drugs, the researchers concluded.

And exercise offers several advantages. For one thing, antidepressant medications generally take several weeks or months to show their full effect. Exercise can improve mood almost immediately, making it a valuable supplement to frontline treatments such as drugs or therapy, notes Brett Gordon, an exercise psychology researcher at the Penn State College of Medicine. Plus, he says, exercise can counteract some of the unpleasant side effects of antidepressants, such as weight gain.

In addition, exercise has few of the negative side effects that are so common in drug therapies for depression and other disorders. "Many people who have mental health concerns are not enthusiastic about starting a medication for the rest of their lives, and are interested in pursuing other options. Exercise might be one of those options," says Jacob Meyer, an exercise psychologist at Iowa State University.

There's now emerging evidence that exercise also seems to help in treating or avoiding anxiety disorders, including post-traumatic stress disorder (PTSD), and possibly other serious psychotic conditions as well. "The more we do these studies, the more we see that exercise can be valuable," says Firth.

There's a flip side to this coin that's especially relevant during the Covid-19 pandemic: If exercise stabilizes mental health, then anything that prevents people from working out is likely to destabilize it. To test this, Meyer and his colleagues surveyed more than 3,000 Americans about their activity before and during the pandemic. Those who became less active because of Covid reported more depression and poorer mental health, they found. (Ironically, those who had not exercised regularly pre-Covid didn't report much change. "When you're already at zero, where do you go?" says Meyer.)

But researchers are still figuring out exactly how muscular exertion acts on the brain to improve mental health. For most biomedical questions like this, the first stop is animal experiments, but they aren't as useful in studies of mental health issues. "Psychological health is so uniquely human that it can be hard to make a good jump from animal models," says Meyer.

Exercise and a healthy brain

Scientists have come up with a few ideas about how exercise enhances mental health, says Patrick J. Smith, a psychologist and biostatistician at Duke University Medical Center in North Carolina, who wrote about the subject in the 2021 Annual Review of Medicine with his Duke colleague Rhonda M. Merwin. It doesn't seem to have much to do with cardiovascular fitness or muscular strength - the most obvious benefits of exercise - since how hard a person can work out is only weakly associated with their psychological health. Something else must be going on that's more important than mere fitness, says Smith.

One likely possibility is that exercise buffs up the brain as well as the body. Physical exercise triggers the release of a protein known as brain-derived neurotrophic factor (BDNF). BDNF is one of the key molecules that encourage the growth of new brain cells - including, possibly, in the hippocampus, a brain region important in memory and learning. Since the hippocampus tends to be smaller or distorted in people with depression, anxiety and schizophrenia, boosting BDNF through exercise may be one way physical activity might help manage these conditions.

Sure enough, studies show that people with depression have lower levels of BDNF - and, notably, one effect of antidepressant drugs is to increase production of that molecule. Researchers have not yet shown directly that the exercise-associated increase in BDNF is what reduces depressive symptoms, but it remains one of the most promising possibilities, says Hovland.

Exercise may also help anxiety disorders. The brain changes prompted by BDNF appears to enhance learning, which is an important part of some anti-anxiety therapies. This suggests that exercise may be a useful way of improving the effectiveness of such therapies. One of the standard therapies for PTSD, for example, involves exposing patients to the fear-causing stimulus in a safe environment, so that the patients learn to recalibrate their reactions to trauma-linked cues - and the better they learn, the more durable this response might be.

Kevin Crombie, an exercise neuroscientist now at the University of Texas at Austin, and his colleagues tested this idea in the lab with 35 women with PTSD. 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, so that they would learn that the stimulus was now safe. A few minutes later, half the volunteers did 30 minutes of moderate exercise - jogging or uphill walking on a treadmill - while the other half did only light movement, not enough to breathe heavily.

The following day, those who had exercised were less likely to anticipate a shock when they saw the "trigger" shape, Crombie found - a sign that they had learned to no longer associate the trigger with danger. Moreover, those volunteers who showed the greatest exercise-induced increases in BDNF also did best at this relearning.

Although the evidence is not yet definitive, a few studies have suggested that regular exercise may lead to better outcomes in patients with schizophrenia too. Vijay Mittal, a psychologist at Northwestern University, wondered whether working out also might prevent people from developing the disorder in the first place.

Mittal works with teenagers who are at high risk of psychotic disorders such as schizophrenia, but who have not yet progressed to the full-on disorder. In the past two decades, researchers have gotten much better at recognizing such individuals just as they begin to display the earliest signs of illness, such as seeing shadows out of the corner of their eye or hearing indistinct voices when no one is home.

For about 10 percent to 33 percent of these teens, these early signs turn into something more serious. "A shadow might turn into a person," says Mittal. "A whisper might turn into words. A suspicion that someone is following them might turn into the belief that the government is after them."

Previously, Mittal had found that the hippocampus is different in at-risk teens who later slid down this slippery slope than in those who didn't. He wondered whether exercise might help bolster the hippocampus and avert the slide. So his team tested this notion in a sample of 30 high-risk teens, half of whom followed a regimen of aerobic exercise twice a week for three months. (The other half, the control group, were told they were on the wait list for the exercise program.) The researchers used brain scans to look at participants' hippocampus before and after the program.

The experiment has just concluded, and Mittal is still analyzing the results, which he calls promising. He cautions, however, that exercise is not a panacea. Schizophrenia is a diverse disease, and even if physical activity proves to be protective for some at-risk people, not all are likely to respond to it in the same way. "It's really important to remember that these disorders are complicated. I've worked with people who exercise a lot and still have schizophrenia," he says.

If Mittal's work pans out, exercise may allow mental health workers to help a group that isn't easily treated with drugs. "Someone who's just at risk of a psychotic disorder, you can't just give them medication, because that has risks too," says Firth. "It would be fantastic to have something else in our arsenal."

Exercise almost certainly has other effects on the brain, too, experts agree. For example, exercise stimulates the release of endocannabinoids, molecules that are important in modifying the connections between brain cells, the mechanism that underlies learning. This may provide another way of enhancing the learning that underlies successful treatment for depression, PTSD and other mental disorders. Indeed, Crombie's study of exercise in a simplified model of PTSD therapy measured endocannabinoids as well as 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, both of which could plausibly help improve brain health in people with mental illness. "We have just scratched the surface," says Hovland.

Moving the body, engaging the mind

But changing the structure of the brain isn't the only way physical activity can be beneficial for those suffering from mental health conditions. The habit of exercise can itself be beneficial, by altering people's thought patterns, says Smith.

For people with mental health issues, simply doing something - anything - can be helpful in its own right because it occupies their attention and keeps them from ruminating on their condition. Indeed, one survey of the published literature found that placebo exercise - that is, gentle stretching, too mild to cause any physiological effect - had almost half the beneficial effect on mental health as strenuous exercise did.

Besides just occupying the mind, regular workouts also give exercisers a clear sense of progress as their strength and fitness improves. This sense of accomplishment - which may be especially notable for weight training, where people make quick, easily measurable gains - can help offset some of the burden 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 a similar way. But exercise does more than that, making it one of the best choices for managing mental health. "You can see benefits from doing anything, but the exercise may confer greater benefits," says Firth.

For one thing, relatively strenuous exercise teaches people to put up with short-term discomfort for long-term gain. People who suffer from anxiety disorders such as PTSD or panic attacks often show a reduced ability to tolerate mental discomfort, so that experiences most people would cope with result in uncontrolled anxiety instead. There's now emerging evidence that regular exercise builds tolerance for internal discomfort, and this may explain part of its benefit in managing these conditions, Smith says.

Using exercise as a mental health treatment brings some challenges, however. "People with mental illness are also at higher risk of struggling with low motivation," Firth says. This can make it difficult to organize and stick with an exercise program, and many patients need additional support.

This is often difficult, because psychologists, psychiatrists and other mental health workers are often already overburdened. Plus, prescribing and supervising exercise hasn't traditionally been within these practitioners' purview. "We're telling people, 'Hey, exercise is helpful,' but we're telling it to people who can't really incorporate it because they often don't get any training," Firth says. Exercise referral schemes, which link patients with fitness specialists and structured programs at community leisure centers, have been used in the UK and other places to encourage exercise in people with physical conditions such as obesity and diabetes. A similar approach could be valuable for mental health conditions, Firth says.

Therapists can also help patients persist for the long term by tailoring their exercise prescriptions to each individual's capabilities. "I always tell patients that doing anything is better than doing nothing, and the best exercise for you is the one you'll actually do," Smith says.

The secret, he suggests, is to make sure people stop exercising before they've done so much it makes them feel exhausted afterward. "When you feel like crap after exercise, you're not going to want to do it," he says, because the brain tags the activity as something unpleasant. It's far better to have the patient quit while they still have a positive feeling from the workout. "Without even realizing it, their brain tends to tag that activity as something more pleasurable. They don't dread it."

Even light activity - basically just moving around now and then during the day instead of sitting for hours at a time - may help. In one study of more than 4,000 adolescents in the UK, Aaron Kandola, a psychiatric epidemiologist at University College London, and his colleagues found that youths who undertook more light activity during the day had a lower risk of depressive symptoms than those who spent more time sitting.

"What we really need are big exercise trials where we compare different amounts against each other," says Kandola. "Instead, what we have are different studies that used different amounts of activity." That makes precise recommendations difficult, because each study varies in terms of its patient populations and methods, and follows results for a different length of time. As researchers learn more about the mechanisms linking exercise to mental health, they should be able to refine their exercise prescriptions so that patients are best able to manage their illnesses.

And exercise has powerful benefits for people with mental illness that go beyond its effects on the illnesses themselves. Many struggle with related issues such as social withdrawal and a reduced capacity for pleasure, says Firth. Standard medications reduce some symptoms but do nothing to address these other problems. Exercise - especially as part of a group - can help boost their mood and enrich their lives.

Even more important, people with serious mental illnesses such as severe depression and schizophrenia also are more likely to have significant physical health issues such as obesity, heart disease and other chronic diseases, and as a result their life expectancy is 10 to 25 years lower than that of unaffected people.

"Reducing those health risks is really paramount at the moment," says Kandola. "That's the big appeal of exercise: We already know it can improve physical health. If it does have mental health benefits as well, it can be quite an important addition to treatment."
Knowable Magazine is an independent journalistic endeavor from Annual Reviews.

# data[].attributes.attachment_link.title
How Exercise Boosts the Brain and Improves Mental Health

# data[].attributes.attachment_link.description
Mental health disorders such as depression and anxiety aren't easy to treat. Medications help many but have a high failure rate and may bring nasty side effects. Talk therapy is time-consuming and expensive. And neither approach is suited to preventing the disorders from developing in the first place.

# data[].attributes.attachment_link.readable_text
It's one thing knowing that exercise is good for us , physically and mentally, but actually doing it when we're exhausted and fighting depression... Well, that's a whole different ball game.

The benefits of exercise, for those with mild to moderate depression, have been well documented. But when your energy tank is on empty, exercise feels impossible. In fact, those with severe depression are likely to be struggling to get out of bed and to function. And sometimes, not exercising might be the absolute right decision for you.

Do what works for you

As we've touched on above, depression affects us all in different ways. What works for one, may not work for another. And that's okay. It doesn't mean that you're 'rubbish' at this exercise malarkey or a 'failure'. The best exercise is the type that feels like fun - things you can do by yourself or with others, indoors or outdoors, and as much or as little as you like.

It might take a little trial and error before you find something you like doing, that fits into your lifestyle and how unwell you are. Don't compare yourself to other people - this is about what you can do, and when you can do it.

Indoors or outdoors?

There are various benefits to exercising outdoors, including fresh air and natural light. If walking is your favourite kind of exercise, you can combine it with other activities, such as wildlife watching and photography, or even Pokemon Go.

But sometimes depression prevents us from going out. Here are some things we've tried that you could try doing at home:

Stairs workout - while you could invest in an exercise bike or treadmill, the free alternative is to use your stairs, either by walking up and down the stairs or by doing step-ups on your bottom step.

Dancing to music - listening to music can help with our mood, and dancing to it can help us exercise. Double whammy!

YouTube yoga - yoga can help with fitness and relaxation, but you might not be able to attend a class - no problem, you can follow videos on YouTube instead. The same goes for pilates and tai chi.

Exercise DVDs - there's plenty of choice, particularly at this time of year. Alternatively, the internet can help you out again, with plenty of exercise videos available online.

Games consoles - with a Wii or Xbox (or other games consoles of your choice) you can work up a sweat and release pent-up tension by boxing, playing tennis, and all kinds of other sporting activities without leaving your living room.

Alone or with someone?

There's no right or wrong way, only what feels right for you. You might prefer to exercise alone, do something with a friend or partner, or join a class, club or team, where people can support each other. You might want to do a mixture to get the best of both worlds - many sports can be done either on your own or with someone else, such as walking, running, swimming and cycling.

If we're exercising alone, listening to music can help us find our rhythm, lift our mood and distract us from any unhelpful thoughts. Try compiling a playlist of songs that inspire you.

Setting Targets: Should You?

In the beginning, targets aren't always particularly helpful. Especially if you're still trying to find a way to exercise that you like. Sometimes it can help to have a target - something that encourages and motivates us. If you do decide to set yourself targets (whether that's time, quantity, speed, distance or whatever), make them small and achievable, and build towards something bigger. We're more likely to stick with something if we can see the progress we're making, but more likely to get discouraged if we set ourselves big, difficult targets straight away. If you are setting yourself targets, be sure to reflect on your achievements, to give yourself a pat on the back. Many people feel so frustrated that they're not as close to their target as they'd like to be, that they don't look back and appreciate how far they've come.

Targets don't work for everyone, though - they can overwhelm us, or we might end up using them as a stick to beat ourselves with. We won't get much out of exercise if we feel like it's a form of punishment.

Please take care of yourself

Whatever you decide to do, there are some basic steps you can take to look after yourself. Drink plenty of water to keep hydrated, and do warm-ups and cool-downs - they help prevent injuries.

And don't over-do it - it's better to do little and often than to exhaust yourself. Small steps compound.

"A journey of a thousand miles begins with a single step." Lao-Tzu

Exercise can be a tool to increase our feelings of wellbeing but it's not a catch-all solution and there are circumstances and situations where we need to be cautious; for example, a study carried out by Bristol University and the Peninsula College of Medicine and Dentistry at Exeter University showed that exercise might not help those with severe depression. If exercise is making you feel worse or is something that you're punishing yourself with, then stop. Take a break, take time to recoup, and revisit when you feel ready to.

Also remember; what you see on social media isn't a fair representation of the reality of life. Images are snapshots of a micro-second in time and can easily be edited too. Try not to compare your exercising with what other people appear to be doing, we're all different and we're all juggling different balls. You know what feels right or wrong for you, and that's truly what matters.
Do you have any top exercising tips? What works best for you? Let us know - your suggestions might help someone to get started. Sharing is caring: please share this post to help others, you never know who might need it.

# data[].attributes.attachment_link.title
Depression and exercise: tips on how (and if) to get started

# data[].attributes.attachment_link.description
It's one thing knowing that exercise is good for us , physically and mentally, but actually doing it when we're exhausted and fighting depression... Well, that's a whole different ball game. The benefits of exercise, for those with mild to moderate depression, have been well documented.

# data[].attributes.attachment_link.readable_text
Cite this

American Psychological Association. (2020, April 24). How and why to get children moving now. http://www.apa.org/topics/covid-19/children-exercise-strategies

Families isolating inside together are juggling a lot--new distance learning for kids, work demands or new unemployment for parents, and, for everyone, adjustment to life in the era of COVID-19. Amidst all those pressures, exercise can feel like one more daunting item on the family to-do list.

But encouraging children to move their bodies is important, not only for physical health, but for mental health and cognitive development, too.

"There are so many benefits to exercise, and we keep discovering more," says Melissa Santos, PhD, a pediatric psychologist at the University of Connecticut School of Medicine and clinical director of the obesity clinic at Connecticut Children's Hospital. "There's no part of a body that doesn't benefit from physical activity."

Essential benefits

Mental health

Physical activity has a small but significant effect on the mental health of children and adolescents ages 6 to 18, according to a review of 114 studies. On average, young people who exercise more have lower levels of depression, stress and psychological distress, and higher levels of positive self-image, life satisfaction and psychological well-being (Rodriguez-Ayllon, M., et. al., Sports Medicine, Vol. 49, No. 9, 2019). Exercise may also protect children's mental health over time: One study found that 6- to 8-year-olds who got more exercise had fewer symptoms of major depressive disorder two years later (Zahl, T., et. al., Pediatrics, Vol. 139, No. 2, 2017).

Behavior

Regular exercise can improve behavior, including those with behavioral health disorders like autism, attention-deficit/hyperactivity disorder, anxiety and depression. In a study of children with behavioral health disorders in Kindergarten through 10th grade, those who participated in a cycling program for 30-40 minutes 2 days a week experienced significantly better self-regulation and fewer disciplinary time-outs (Bowling, A., et. al., Pediatrics, Vol. 139, No. 2, 2017).

Attention and academic performance

In the short term, children are better able to pay attention after they've been physically active, according to a review of research in children ages 6 to 12. And kids who are regularly active over the long term have better academic performance, on average (de Greeff, J.W., et. al. Journal of Science and Medicine in Sport, Vol. 21, No. 5, 2018).

Cognitive development

Exercise and physical fitness are linked to better thinking skills. An analysis of studies in children ages 7 to 12 found regular exercise was linked to a small but measurable improvement in executive function, the set of skills used for learning, solving problems and self-control (Jackson, W. Journal of Neurosurgical Anesthesiology, Vol. 28, No. 4, 2016). A review of research in children under age 5 also found preliminary evidence that physical activity may benefit cognitive development in early childhood (Carson, V., et. al., Journal of Science and Medicine in Sport, Vol. 19, No. 7, 2016).

Establishing exercise habits

The Centers for Disease Control and Prevention (CDC) recommends children and adolescents get at least 60 minutes of activity daily. But don't despair if you're nowhere near that goal. "Moving around doesn't have to be an ambitious exercise plan," says Kimberly Guion Reynolds, PhD, ABPP, a pediatric psychologist at the Institute on Development and Disability at Oregon Health & Science University.

Here are seven strategies to get you started.

1. Stay safe.

It's important to move safely, especially during this public health crisis. "Physical distancing continues to be important, and you should also consider the risk of accidental injury," Reynolds says. "Make sure you're watching children around streets and driveways, and monitor them whenever climbing is involved."

2. Walk the walk.

Kids are more likely to exercise when they see caregivers being active. "That doesn't mean you have to do the same activities as your child, but modeling physical activity is a really important motivator for kids and teens," says Reynolds. You'll likely find it helps you, too. "Instead of thinking of exercise as an extra thing you have to do, it can help to think of movement as one of the coping skills we can use to get through this time," she adds.

3. Make it a family affair.

You'll all benefit--and probably get less push-back from kids---if you make exercise part of your family's routine. "When taking a daily walk together is just something we do as a family, it becomes non-negotiable," Santos says.

4. Find the hook.

Figure out what activities your child is most likely to enjoy. If you have competitive teens, make it a challenge to see who takes the most steps in a day. If your child loves music, find some dance videos to wiggle to. Exercise should be fun, especially for kids.

5. Consider rewards.

Rewards can motivate kids to move. Younger kids might be inspired by small daily prizes like stickers in exchange for active time. Older kids might benefit from working toward a weekly activity goal, with prizes like picking the film for movie night, or 30 minutes of extra screen time.

6. Start slow.

If your family isn't used to exercising regularly, start with small goals. Instead of forcing your kids to do an hourlong exercise video, plan a few 10-minute breaks throughout the day to stretch or walk. As it becomes routine, you can increase the time and intensity.

7. Forget perfect.

Any movement is better than none, so don't throw up your hands if your kids don't achieve the recommended 60 minutes a day. "We have to be realistic. This isn't normal times, and the last thing we want to do is put pressure on ourselves to be perfect," Santos says. "We know any physical activity is helpful, so just do your best."

# data[].attributes.attachment_link.description
Cite this American Psychological Association. (2020, April 24). How and why to get children moving now. http://www.apa.org/topics/covid-19/children-exercise-strategies Families isolating inside together are juggling a lot--new distance learning for kids, work demands or new unemployment for parents, and, for everyone, adjustment to life in the era of COVID-19.

# data[].attributes.headline
Exercise for Mental Health with Dr. Brendon Stubbs

# data[].attributes.subject
Exercise for Mental Health with Dr. Brendon Stubbs

# data[].attributes.attachment_link.readable_text
Details

This week I talk to Dr Brendon Stubbs, Head of Physiotherapy at the South London and Maudsley NHS Foundation Trust and Clinical Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, Kings College London.

Brendon's research focuses on physical activity, mental health and the mind-body interface.

Brendon and his team have published over 400 academic papers, and in 2016 he was identified in the journal 'Nature' (one of the biggest journals) - as one of the most productive scientists over all disciplines in the world.

In this episode, we talked about inflammation, we talked about diets, we talked about movement and how increasing physical activity rather than just focusing on specific exercise regimes, can all have benefits to our overall wellbeing and in particular our mood.

These are all topics that I talk about in my new book Eat to Beat Illness - in the section on 'Mood' where I talk about nutritional science but also lifestyle features, that can improve and preserve our brains, our cognition as well as our psychological wellbeing.

And you can find all of this information and more at www.thedoctorskitchen.com and don't forget to subscribe to the newsletter for weekly science based recipes and listen to the end of the pod for a summary of our discussion.

Summary
'People with mental health conditions, such as schizophrenia, or major depression or bi-polar disorder are dying on up to average, 15-20 years earlier than people in the general population who don't have those conditions'.
Dr Brendon Stubbs

What an incredible episode and guest we had on the show today. Dr Brendon Stubbs is such a fountain of knowledge in this field and I'm so excited that he's pioneering the research looking at exercise based interventions for mental health illness.

We talked about Brendon's book Exercise Based Intervention for Mental Illness and I highly recommend that health practitioners in particular go and get this book.

One thing to re-iterate from our conversation with Brendon, and something that he agrees with. It would be naive and reductionist to think that we can reverse all our symptoms of depression or other mental health issues with just one intervention alone, be that diet or movement or pharmaceutical. And in many cases, patients require more than a collection of foods or an exercise regime to treat something as complicated as mental health issues. So it's not simply a case of a Neurochemical imbalance that needs boosting - and its really really important to keep sight of that fact.
Making sure that you get the right help and interventions from your doctor and other health professionals is key and Psychotherapy as well as exercise, as well as diet, as well as pharmaceutical interventions on occasion, can all have an important role to play.
Guest: Dr Brendon Stubbs

Dr Brendon Stubbs is Head of Physiotherapy at the South London and Maudsley NHS Foundation trust and a clinical lecturer at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London.

Brendon's research focuses on physical activity and mental health and the mind-body interface. Brendon has published over 400 academic papers and in 2016 was identified in the journal "Nature" as one of the most productive scientists across all disciplines in the world (top 0.001% of all published authors).

Brendon's research has been featured in the New York Times, TIME magazine, CNN, Men's Health, BBC news, BBC Radio, ITV news and Sky News (among others). Brendon is lead author of the recently published European Psychiatric Association guidelines and position statement on the use of exercise for mental illness and senior author on a forthcoming Lancet commission to improve the physical health of people with mental disorders.

Brendon was recently (2018) awarded the Schizophrenia International Research Society (SIRS) senior investigator award for his research investigating physical activity and schizophrenia. Brendon has worked in mental health services for over 15 years and continues to greatly cherish and learn from patients in his weekly physiotherapy clinic in a secure forensic hospital.

The book that Brendon has published - Exercise Based Interventions for Mental Illness focuses on physical activity as a treatment for mental health conditions and is a great resource.

Finally, by clicking on this link you will be able to view all of Dr Brendon's research papers for reference

# data[].attributes.attachment_link.title
#25: Exercise for Mental Health with Dr Brendon Stubbs | The Doctor's Kitchen

# data[].attributes.attachment_link.description
This week I talk to Dr Brendon Stubbs, Head of Physiotherapy at the South London and Maudsley NHS Foundation Trust and Clinical Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, Kings College London. Brendon's research focuses on physical activity, mental health and the mind-body interface.

# data[].attributes.headline
How Exercise can Beat the Symptoms of Depression

# data[].attributes.subject
How Exercise can Beat the Symptoms of Depression

# data[].attributes.attachment_link.readable_text
The symptoms of depression can vary from person to person, however strong evidence is mounting that exercise may just be the answer to treating this common mental illness. Not only that, several studies are also finding that our physical activity may even outperform medication designed to treat the symptoms of depression. For years we have all known that diet and exercise can help prevent chronic physical illnesses such as heart disease, obesity and diabetes, but now the focus is on the effects exercise has on our mental health and the results are optimistic.

Depression is a serious problem worldwide
One in six New Zealanders and Australians will experience serious depression at some point in their lives. One in four British adults experience at least one diagnosable mental health problem in any one year and in the U.S one in eight adults have being diagnosed with clinical depression.

Over 121 million people worldwide currently suffer from the symptoms of depression with the war-torn country, Afghanistan reporting the highest prevalence. Overall, women have high rates of depression than men often the risk increasing in the weeks after having a baby.
But it's not just adults being overcome by the mental illness. Worldwide, it is estimated 1.3 million adolescents died in 2012 with the top three causes of death being road traffic injuries, HIV/AIDS and suicide. For adolescent girls alone, the second-biggest killer after suicide was complications during childbirth.

The statistics on depression are scary and they are not getting any better. Globally, it is responsible for more 'years lost' to disability than any other condition including chronic lung disease, diabetes and alcohol related disorders. Switzerland is a country which offers some of the best support in mental health with more than 40 psychiatrists per 100,000 people, however it has a higher rate of depression than the U.S.

A report prepared by the UN agency has suggested that over half the people who develop mental disorders have their first symptoms of depression by the age of 14. It appears better mental health care and knowledge of mental illness seems to not be reducing these stats. In fact, the World Health Organisation estimates that by the year 2020, depression will be the second most common cause of ill health and premature death worldwide.

Could exercise be the best drug in treating the symptoms of depression?
I'm sure you know that going for a run or taking a yoga class can be a great way to alleviate stress after a tough day. We all hear that the rush of endorphins released when we exercise is responsible for lifting our mood and making us feel more positive about life.

But researchers at the Karolinska Institute in Sweden have found that exercise actually detoxes harmful chemicals from our body and in turn can alleviate the symptoms of depression. During exercise, the muscles start to act similarly to the kidneys or liver and produce an enzyme which is essential to purging a molecule linked to causing the brain harm and depression.

Dr Jorge Ruas, principal investigator at the Department of Physiology and Pharmacology stated their "initial research hypothesis was that trained muscle would produce a substance with beneficial effects on the brain".

What they found during their study was the opposite. "Well-trained muscle produces an enzyme that purges the body of harmful substances. So the muscle's function is reminiscent of that of the kidney or the liver" says Ruas.

Their results even pointed to the type of exercise which could have the biggest impact on reducing the symptoms of depression, lifting mood and reducing stress. Ruas says cardiovascular exercise was seen to have the strongest effect although "it is possible that other kinds of exercise will also have an effect, like resistance training such as weight lifting. But our results support the use of aerobic exercise like biking and running."

In the same study, the researchers looked at why those who do not regularly exercise end up feeling sluggish, show signs of depression and are more prone to chronic diseases. "Skeletal muscle appears to have a detoxification effect that, when activated, can protect the brain from mental illness" Ruas says.

It was previously known that the protein called PGC-1α1 increases within the skeletal muscle as the individual exercises, but the reason why was unclear. By observing mice, researchers found that after five weeks of being exposed to a stressful environment of flashing lights and loud noises one group of mice were displaying strong symptoms of depression.

The other group of mice with high levels of the protein appeared to be protected from experiencing mental illness. This is thought to be due to the protein producing an enzyme called KAT, which is responsible for converting the harmful kynurenine molecule into kynurenic acid. This is a harmless substance that can be easily passed out of the body.

Exercise vs medication in beating depression
Exercise has been long recommended as a therapy for treating mild symptoms of depression or as an adjunct therapy for those on anti-depressive medication. But could it be just as effective as prescribed medication?

Neuroscientist at Duke University, James Blumenthal, specialises in depression and published a very interesting study in the Journal of Biobehavioral Medicine. In this study Blumenthal split a group 156 adults who had mild or moderate cases of depression into three.

One group was prescribed the antidepressant drug, sertraline. The second group was prescribed sertraline and given an exercise regime three times a week for 45 minutes. This regime consisted of a 10 minute warm up, 30 minutes of jogging or walking at a pace that would keep their heart rate at 80 to 90 percent of their maximum and then a 5 minute cool down to finish.
Group three were only given the exercise regime above as treatment for their symptoms of depression.

The results were surprising. Over the 16 week period, the participants were supervised by the researchers and professional staff. They found that all three treatments delivered equal results. Treating the participants with exercise alone was just as effective as treating those with sertraline, yet the risks weren't as high. Sertraline has been linked to a wide range of concerning side effects, including major depressive disorder, obsessive-compulsive disorder, and social and panic anxiety.

The long-term impact was where the results were really profound. After 16 weeks of treatment 83 percent of the participants were considered to be in remission and free from any symptoms of depression. When the study had concluded, participants were able to continue with the treatment received or try something new. Researchers followed up with the patients six months later and found...

38 percent of the participants on prescribed medication relapsed into depression.
31 percent of the participants who exercised and took medication relapsed into depression.
Just 8 percent of the participants who only exercised relapsed into depression.
Blumenthal described the differences between exercise and medication in this statement. "One of the positive psychological benefits of systematic exercise is the development of a sense of personal mastery and positive self-regard, which we believe is likely to play some role in the depression-reducing effects of exercise."

Regular exercise should be the focus rather than intensity or duration in treating depression
A review published in the Journal of Clinical Psychiatry looked into the benefits of exercise for the clinically depressed. Researchers of the Division of Psychiatry at Boston University School of Medicine found positive association with exercise in alleviating the symptoms of depression.

It was suggested that it is likely a "combination of biological, psychological, and sociological factors influence the relationship between exercise and depression". This is consistent with the view on current treatments for depression involving pharmacotherapy and psychotherapy.

While we regularly focus on the intensity when we train, the research interestingly suggests this focus can be overwhelming to someone who is depressed. Current recommendations for most countries is that adults exercise at least 30 minutes a day at moderate-vigorous intensity. Based on the findings from this review, those who are experiencing depression are better of exercising for 20 minutes a day, three times a week at a moderate intensity. According to the researchers, this is significant enough to reduce the symptoms of depression.

What I also found interesting was that while depression may be an additional risk factor for exercise noncompliance, it was reported drop-out rates among depressed patients were not too different from those in the general population who were not suffering a mental illness.

Unhealthy lifestyle driving an increase in chronic diseases and mental illness globally
The evidence is there in front of us that an unhealthy lifestyle is driving an increase in the burden of chronic diseases and mental illnesses like depression worldwide. Research suggests that by just including an hour of walking per week into your life can reduce your risk of developing depression by 50 percent.

Promoting physical health within the communities vulnerable to developing depression is a valuable mental health care strategy. But let's be honest. Statistics suggest we are all vulnerable of experiencing the symptoms of depression at some point in our lives. While there is growing acceptance that the mind-body connection is very real, I think we tend to forget how powerful maintaining good physical health can be at reducing our risk of suffering from a mental illness.

While some studies suggest aerobic exercise is the best therapy for those depressed, there is plenty of evidence to suggest any form of exercise that gets your heart rate up and blood pumping is beneficial. The best advice is to find an exercise routine you enjoy and can partake in consistently. Practice yoga, meditation or go for a swim if high intensity exercise is not for you. Run, box or cycle if you like to sweat it out a bit more.

Whatever it is, a healthy lifestyle is one of the simplest ways to treat the symptoms of mild to seasonal depression and maintain good mental health. If you think you are suffering from depression, it's time to speak to someone. Follow the advice of your physician, but it might be worth your while to ask about trying natural lifestyle changes before or instead of anti-depressant medication.

Podcast: Play in new window | Download

# data[].attributes.attachment_link.title
Podcast # 98 - How Exercise Can Help Beat The Symptoms Of Depression

# data[].attributes.attachment_link.description
The symptoms of depression can vary from person to person, however strong evidence is mounting that exercise may just be the answer to treating this common mental illness. Not only that, several studies are also finding that our physical activity may even outperform medication designed to treat the symptoms of depression.

# data[].attributes.attachment_link.readable_text
We all know that exercise is good for our physical health, but exercise can be just as powerful for our mental health.

Feel Better Live More Bitesize is my new weekly podcast for your mind, body and heart. Each week I'll be featuring inspirational stories and practical tips from some of my former guests.

Today's clip is from episode 97 of the podcast with clinical-academic physiotherapist, Brendon Stubbs.

His work is helping to provide much needed evidence of what we know instinctively - physical activity makes us feel good.

In this clip he explains why movement is not just good for our body, but also for our mind and why you don't need to exercise for hours to feel the benefits. Just 10 minutes of light exercise a day can result in meaningful changes happening within your brain.

Show notes and the full podcast are available at drchatterjee.com/97

Follow me on instagram.com/drchatterjee/

Follow me on facebook.com/DrChatterjee/

Follow me on twitter.com/drchatterjeeuk

DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

See acast.com/privacy for privacy and opt-out information.

# data[].attributes.attachment_link.title
Feel Better, Live More with Dr Rangan Chatterjee - #166 BITESIZE | How 10 Minutes of Exercise a Day Can Improve Mental Health | Dr Brendon Stubbs

# data[].attributes.attachment_link.description
We all know that exercise is good for our physical health, but exercise can be just as powerful for our mental health. Feel Better Live More Bitesize is my new weekly podcast for your mind, body and heart. Each week I'll be featuring inspirational stories and practical tips from some of my former guests.

# data[].attributes.attachment_caption
Social and Emotional Benefits of Physical Activity / Exercise

# data[].attributes.headline
Social and Emotional Benefits of Physical Activity

# data[].attributes.subject
Social and Emotional Benefits of Physical Activity

# data[].attributes.attachment_link.title
1.1.1 - Social and Emotional Benefits of Physical Activity / Exercise

# data[].attributes.headline
Emotional and Mental Benefits of Exercise

# data[].attributes.subject
Emotional and Mental Benefits of Exercise

# data[].attributes.attachment_link.title
Emotional and Mental Benefits of Exercise

# data[].attributes.headline
Conquering Depression and Anxiety Through Exercise

# data[].attributes.subject
Conquering Depression and Anxiety Through Exercise

# data[].attributes.body
by Keith W. Johnsgard, Ph. D.

# data[].attributes.attachment_link.readable_text
One out of every two Americans will suffer from some mental disorder during their lifetimes, with depression being the most common problem. How do most of us cope? Usually, we turn to overeating, drinking, and smoking. In short, we treat our unhealthy mental reactions to the American lifestyle with even unhealthier physical habits.Clinical psychologist Keith Johnsgard ― an inveterate runner who is in his 70's! ― proposes a better solution in this uplifting book. Why not turn to exercise ― one of the healthiest aspects of American lifestyle ― as a means of improving not just our physical well-being but our state of mind as well? Though usually associated with losing weight and physical fitness, exercise does in fact offer many mental health benefits. Johnsgard inspires us to put on a pair of sneakers and start moving. He draws from a lifetime of clinical experience, research on the psyche of the athlete, and personal experience as an athlete to make a convincing case that exercise can greatly enhance our mental outlook. Further, physical activity decreases the symptoms of depression as well as psychotherapy and drugs, and with only positive side effects! Exercise not only reduces depression and anxiety, but also boosts your energy level and self-esteem.If depression and anxiety have overshadowed your life, or you just want to improve your mental outlook while enhancing your physical fitness, this book is a superb motivator to help you help yourself through the healthiest, least expensive, and simplest method available.

# data[].attributes.attachment_link.title
Conquering Depression and Anxiety Through Exercise

# data[].attributes.attachment_link.description
Conquering Depression and Anxiety Through Exercise [Keith Johnsgard] on Amazon.com. *FREE* shipping on qualifying offers. Conquering Depression and Anxiety Through Exercise

# data[].attributes.attachment_caption
The Exercise Prescription For Depression And Anxiety

# data[].attributes.headline
The Exercise Prescription for Depression and Anxiety

# data[].attributes.subject
The Exercise Prescription for Depression and Anxiety

# data[].attributes.body
by Keith W. Johnsgard, Ph. D.

# data[].attributes.attachment_link.readable_text
Johnsgard (psychologist-San Jose State U., and marathoner) argues for the psychological therapeutic value of physical exercise. A popular book that deserves and justifies the attention of professionals. Annotation copyright Book News, Inc. Portland, Or.

# data[].attributes.attachment_link.title
The Exercise Prescription For Depression And Anxiety And Anxiety*the

# data[].attributes.attachment_link.description
Johnsgard (psychologist-San Jose State U., and marathoner) argues for the psychological therapeutic value of physical exercise. A popular book that deserves and justifies the attention of professionals. Annotation copyright Book News, Inc. Portland, Or.

# data[].attributes.headline
Exercising Your Way to Better Mental Health

# data[].attributes.subject
Exercising Your Way to Better Mental Health

# data[].attributes.body
by Larry M. Leith

# data[].attributes.attachment_link.readable_text
This is the first book of its kind to reveal the link between physical fitness and psychological well-being. Dr. Larry Leith, renowned exercise scientist, shares with the reader how exercise can fight depression, ease stress, and brighten one's mood. The book includes many practical strategies designed to improve the reader's enjoyment of and adherence to an exercise program.

# data[].attributes.attachment_link.title
Exercising Your Way to Better Mental Health: Fight Depression and Alleviate Stress Through Exercise

# data[].attributes.attachment_link.description
This is the first book of its kind to reveal the link between physical fitness and psychological well-being. Dr. Larry Leith, renowned exercise scientist, shares with the reader how exercise can fight depression, ease stress, and brighten one's mood. The book includes many practical strategies de...

# data[].attributes.body
by Russ Williams

# data[].attributes.attachment_link.title
How to Walk yourself Healthy & Happy: Why Walking Exercise Boosts Physical And Mental Health

# data[].attributes.attachment_link.description
Walking is aerobic exercise; it is also the 'Superfood' of exercise.Most of us do it every day to varying degrees and many of us do not fully appreciate the many proven benefits for the body and mind that you can get simply by taking regular walks.Author Russ Williams - a UK based broadcaster - h...

# data[].attributes.headline
8 Keys to Mental Health Through Exercise

# data[].attributes.subject
8 Keys to Mental Health Through Exercise

# data[].attributes.body
by Christina G. Hibbert

# data[].attributes.attachment_link.readable_text
Inspiring strategies from a wellness expert for keeping fit, relieving stress, and strengthening emotional well-being. We all know that exercise is good for physical health, but recently, a wealth of data has proven that exercise also contributes to overall mental well-being. Routine exercise alleviates stress and anxiety, moderates depression, relieves chronic pain, and improves self-esteem.

In this inspiring book, Christina Hibbert, a clinical psychologist and expert on women's mental health, grief, and self-esteem, explains the connections between exercise and mental well-being and offers readers step-by-step strategies for sticking to fitness goals, overcoming motivation challenges and roadblocks to working out, and maintaining a physically and emotionally healthy exercise regimen. This book will help readers to get moving, stay moving, and maintain the inspiration they need to reap the mental health benefits of regular exercise. The 8 keys include improving self-esteem with exercise, exercising as a family, getting motivated, changing how you think about exercise, and the FITT principle for establishing an effective exercise routine.

# data[].attributes.attachment_link.title
8 Keys to Mental Health Through Exercise

# data[].attributes.attachment_link.description
8 Keys to Mental Health Through Exercise [Hibbert, Christina, Rothschild, Babette] on Amazon.com. *FREE* shipping on qualifying offers. 8 Keys to Mental Health Through Exercise

# data[].attributes.headline
Therapist's Guide to Exercise and Mental Health

# data[].attributes.subject
Therapist's Guide to Exercise and Mental Health

# data[].attributes.attachment_link.readable_text
Exercise is a powerful tool for increasing emotional and physical wellbeing and is an effective evidence-based treatment for many mental health conditions. Unfortunately, many people fail to meet the recommended target of 150 minutes of moderate physical activity per week [1] and rates of exercise in people suffering from mental health problems are even lower than average [2]: this means that motivating your patients to engage in exercise is a valuable therapeutic skill. In this article we will review the evidence linking exercise and mental health and discuss practical strategies that you can use to motivate your clients to get active.

What is exercise and physical activity?

Physical activity is defined as any movement produced by the skeletal muscles and exercise is defined as a structured form of physical activity that has the intention of improving a health-related outcome [3]. Exercise can be categorized according to the nature of the activity, or the health-related outcome it is intended to improve. For example, resistance exercise increases muscular strength or endurance by applying resistance to bodily motions, whereas aerobic exercise involves our aerobic respiratory system by working at a low intensity over a sustained period of time (e.g. long-distance running).

What does exercise do for the mind and body?

Exercise has been associated with positive effects upon multiple markers of physical and mental wellbeing:

Exercise increases our energy levels. Increased physical activity is associated with reduced feelings of low energy or fatigue [4]. A 2013 meta-analysis found that acute exercise participation enhances feelings of energy [5] and multiple randomized controlled trials have indicated that increasing physical activity leads to an increase in self-perceived energy compared to non-active controls [6,7].

Exercise leads to better sleep. Many forms of exercise have been demonstrated to be beneficial for improving sleep quality [8,9,10]. Exercise has even been suggested as an alternative or complimentary form of therapy for clients with sleeping problems [9]. Research seems to suggest that doing exercise 4 to 8 hours before bedtime is likely optimal for improving sleep quality, although some exercise at any time of day seems to be beneficial [8].

Exercise is associated with greater self-esteem. People who take part in regular physical activity tend to have a higher level of physical self-worth, improved body image, and a higher level of self-esteem [11]. Physical activity was also found to be directly and indirectly associated with self-esteem and advocated as an adjunct treatment for adults with lower self-esteem [12].

Exercise lowers your risk of death. Physical inactivity is estimated to cause 9% of all premature deaths [13]. In the USA, research has suggested that men and women over 50 who change their physical activity status from inactive to active increase their life expectancy by between 1.3 - 3.7 and 1.5 - 3.5 years respectively [14].

Exercise lowers your risk of ill-health. Regular physical activity is strongly associated with a decreased risk of many physical health conditions such as diabetes, stroke, and cancer [15,13]. Oftentimes, these health-related benefits occur in the absence of weight changes and therefore clients who make little progress in achieving their weight-loss goals should be reminded of the profound impact that exercise can have on their health regardless [16].

Exercise is associated with improved brain function. Exercise is shown to have a positive association with cognitive performance [17,18]. Exercise has also been found to improve concentration, reduce levels of irritability [3], and may slow the deterioration in balance and mobility in patients with Alzheimer's disease [19].

"Physical activity is one of the most fundamental factors necessary for maintaining health and warding-off risk factors" [20]

How can exercise help with mental health conditions?

Exercise has been investigated as both a standalone intervention and as part of comprehensive treatment packages for a variety of mental health conditions. When high-quality studies are reviewed the evidence for introducing exercise as an intervention for people struggling with mental health problems is mostly very encouraging. We will review the evidence for the effects of exercise upon a variety of conditions including depression, anxiety, psychosis, addiction, and ADHD.

Exercise and Depression

Depression is a disorder primarily characterized by a low mood and a lack of interest in activities that were previously pleasurable. Depression is the leading cause of disability worldwide, with around 300 million people affected globally [21]. Major depressive disorder (MDD) is associated with an increased likelihood of school dropout, chronic physical diseases, and extended periods off work [22]. Despite the availability of effective treatments for depression, only a minority receive professional help [22].

Given the impact depression can have upon people's lives and the extensive costs associated with the disorder, it is encouraging that research consistently finds exercise to be an effective treatment for depression, with a magnitude of effect similar to other established forms of treatment such as CBT and medication[3,23,24]. An additional benefit of exercise is that it is not associated with the side effects and discontinuation problems associated with antidepressant medication, nor is it as costly as psychotherapy.

What is the evidence for encouraging people with depression to exercise?

In 2016 Felipe Schuch and colleagues published a high-quality meta-analysis in the Journal of Psychiatric Research [25]. A meta-analysis is a 'study of studies' and theirs included data from 1487 adults with depression who had taken part in 25 randomized controlled trials. Half of the participants had been randomized to receive 'non-active control treatment' (such as a waiting list, usual, care, or placebo pills). The other half of the participants received an exercise intervention which they defined as "planned, structured, repetitive and purposeful physical activity". Further, the authors adjusted their results to pay more attention to the high-quality studies. They found "large antidepressant effects of exercise on depression when compared to non-active control conditions". They observed larger effects in outpatients compared to inpatients and when exercise was supervised by qualified exercise professionals, and cautiously observed that moderate or vigorous exercise was more effective than light to moderate exercise. They conclude that "our results provide robust evidence that exercise can be considered an evidence-based treatment for the management of depression."

Earlier meta-analyses are consistent with Schuch and colleagues' findings. A 2012 meta-analysis published by the Cochrane foundation showed a moderate effect of exercise on symptoms of depression compared to a waitlist or placebo condition [23] with the effect size for the exercise intervention found to be of similar magnitude to the effect size for cognitive-behavioral therapy (CBT). They concluded "it is reasonable to recommend exercise to people with depressive symptoms and to those who fulfil diagnostic criteria for depression".

What type of exercise is most effective for treating depressive symptoms?

Several RCTs have indicated a dose-dependent relationship between exercise and depressive symptoms, suggesting that a moderate to high intensity is most effective. Aerobic, non-aerobic, and resistance training were all found to be helpful [26,27]. This position is tentatively supported by the Schuch (2016) meta-analysis, although other meta-analyses found that a lower intensity aerobic exercise program 3-5 times per week was optimal for mood improvements [28] and even low intensity exercises such as walking have been shown to have a large and significant effect on depressive symptoms [29]. The take-home messages are that some exercise is much better than none when it comes to depression, more seems to be better, and all types of exercise seem to be effective.

Exercise and Anxiety

Around 1 in 3 Americans will develop an anxiety disorder at some point in their lifetime [30]. Common anxiety-related mental health problems include generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). There is interesting evidence that exercise can be an effective treatment for anxiety disorders with acute as well as long-term effects. Even in non-clinical populations, physical activity has been shown to reduce symptoms of anxiety [31]. Evidence from epidemiological studies indicates that those who take part in regular physical activity have a reduced likelihood of developing an anxiety disorder [32,33].

Acute effects of exercise upon anxiety

A single bout of aerobic exercise can have a powerful anxiolytic effect [34,35]. In a 2015 study by LeBouthillier and Amundson [34], forty-one participants were randomized to complete 30 minutes of aerobic exercise or 30 minutes of stretching. They found that participants who completed aerobic exercise, but not those who did stretching, experienced significant reductions in anxiety sensitivity, intolerance of uncertainty, and increases in distress tolerance. Higher levels of trait anxiety sensitivity are associated with the development and maintenance of anxiety disorders, particularly those with a body-focus and so exercise appears to be a promising intervention with immediate effects.

The effects of exercise as a stand-alone treatment for anxiety

A 2017 meta-analysis by Brendon Stubbs and colleagues published in Psychiatry Research [36] examined the effects of exercise upon anxiety in people with anxiety or stress-related disorders (including panic disorder, PTSD, GAD, and social anxiety). They included data from six high-quality trials totalling 262 adults. Compared to a non-active control condition (e.g. usual care, wait-list, or placebo pills) exercise was associated with a medium effect size. The authors conclude that "exercise should be considered an evidence-based option for anxiety symptoms among people with anxiety / stress related disorders."

The effects of adding exercise to other treatments for anxiety

The evidence appears to indicate that exercise can be considered a standalone, evidence-based treatment for anxiety [37,38,36]. But what about combining exercise with other medical and psychological treatments? A number of interesting studies have examined exercise as an additive intervention to conventional treatments. One RCT examined how a 12-week exercise program added to usual care would compare to usual care alone for reducing PTSD symptoms in a group of 81 participants, where usual care consisted of psychotherapy, pharmaceutical interventions, and group therapy [39]. Clinically significant improvements were seen in PTSD symptoms (as well as depressive symptoms and physical characteristics) in the exercise intervention group compared to usual care alone. For patients with panic disorder with or without agoraphobia, 8 weeks of aerobic exercise had an additive anxiolytic effect to CBT alone [40]. Across a variety of anxiety disorders (GAD, social anxiety disorder, and panic disorder), similar results have also been observed when walking is added as an intervention to group CBT [41]. Summarizing a systematic review of exercise for anxiety, Javakody and colleagues conclude that " exercise seems to be effective as an adjunctive treatment for anxiety disorders"[42].

What types of exercise are most effective for treating anxiety symptoms?

The anxiolytic effects of exercise have been examined in a number of trials. Interesting questions are "which exercise is most helpful for reducing anxiety?" and "do different anxiety disorders respond to different forms of exercise?". Evidence addressing these questions is fairly limited. There is growing support for the idea that individuals with panic disorder benefit from aerobic exercise such as running, particularly as an adjunct to psychological therapy [43]. A 2011 study examined the effectiveness of aerobic and resistance exercise for the treatment of GAD and found that both groups had similar reductions in trait anxiety after a 6-week intervention [3]. When looking at the exercise intensity, several RCTs have indicated a benefit of moderate/hard intensity over low intensity exercise on anxiety symptoms [40,44]. A fair summary of the current research is that exercise appears to be helpful for anxiety disorders, but more data is needed to determine which exercise type and intensity is most helpful for each individual condition.

Exercise and psychosis

People diagnosed with psychosis and schizophrenia experience symptoms including hallucinations and delusions. Standard psychiatric treatment for schizophrenia is antipsychotic medication, which is somewhat effective at managing the positive symptoms such as hallucinations and delusions, although it is less effective at treating the negative symptoms such as anhedonia, emotional flattening, and behavioral withdrawal [45,46,3,47]. Antipsychotic medications are also associated with side effects including weight gain, lipid abnormalities, and metabolic syndrome. For these reasons among others, adherence to medication is often poor [47,3].

A growing body of research supports the use of exercise interventions to augment standard treatment and improve negative symptoms in patients with schizophrenia (e.g. [46,48,49,3]). In 2015 Elisa Vera-Garcia and colleagues published a systematic review in Psychiatry Research [50] which considered the effectiveness of physical therapy interventions within the multi-disciplinary management of schizophrenia. Their review included 13 randomized controlled trials representing 549 participants. Specifically, they looked at studies which included aerobic exercises, strength exercises, relaxation training, body awareness exercises, or a combination of all of these. Their results clearly demonstrate that aerobic, strength exercises and yoga reduce psychiatric symptoms while improving health-related quality of life. They conclude that "There is currently sufficient scientific evidence to conclude that aerobic exercise reduces negative symptomatology and improves cardiorespiratory fitness." [3]

Exercise and addiction

There is substantial evidence to suggest that acute exercise participation can reduce cravings, improve withdrawal symptoms, and attenuate triggers in heavy cigarette smokers [51,52,53]. Exercise may also help individuals resist urges to use other substances such as alcohol, high-energy foods, and psychoactive drugs [54,55]. Although evidence supporting the effect of exercise for those with problematic alcohol use appears to be more mixed, with Hallgren and colleagues [56] reaching the conclusion that "exercise appears not to reduce alcohol consumption but has significant improvements in other health outcomes including depression and physical fitness".

Attention Deficit/Hyperactivity Disorder and Exercise

Individuals with attention deficit hyperactivity disorder (ADHD) display symptoms of inattention, hyperactivity, and impulsivity and are often treated with a combination of medication and psychosocial interventions. It is one of the most frequently diagnosed neurodevelopmental disorders in school-aged children, with a worldwide prevalence rate of 5.29% [57]. Medication is largely effective at improving behavioral symptoms, executive functioning, and productivity [58] although it is associated with side effects such as sleep difficulties and mood changes [59].

In 2016 Ruta Vysniauske and colleagues published a meta-analysis in the Journal of Attention Disorders [60] exploring the effects of physical exercise on children who met criteria for ADHD. Ten studies with a total of 300 participants were included in the analyses, with the average age of participants being 9.3 years old. Compared to no-exercise conditions they found a significant and medium-sized effect of physical exercise upon functional outcomes in ADHD. Similarly, a 2015 systematic review and meta-analysis published in Child Care Health and Development concluded that "The main cumulative evidence indicates that short‐term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD" [61].

Mechanisms by Which Exercise May Influence Mental Health

So we know that exercise can be an effective way of improving mental health, but why is it effective? A useful way of understanding why is to systematically consider the biopsychosocial factors.

Biological mechanisms by which exercise improves mental health

There are several biological pathways by which exercise may improve mental health. These include:

Brain Derived Neurotrophic Factor (BDNF). BDNF is a protein that is thought to play a role in neurogenesis, neuroprotection, synaptic transmission [3], and is an important component in the extinction of fear [62]. Exercise has been shown to increase resting BDNF levels with aerobic exercise leading to greater increases than resistance exercise [63].

Increased stress tolerance. Exercise is thought to decrease activity of the sympathetic nervous system and activity in the hypothalamic-pituitary-adrenal (HPA) axis [64]. The effect of this is that individuals are less reactive to stress and are therefore thought to be more resilient to daily stressors.

Inflammation. There are a number of theories which posit that depression in some individuals is underpinned by inflammation which results in 'sickness behaviors' [65,66]. Aerobic exercise can be used to reduce inflammation in both the periphery and the brain [67] and "Exercise is a promising intervention for the prevention and treatment of various diseases characterized by chronic inflammation" [3].

Endorphins / endocannabinoids. Traditionally the mood changes resulting from aerobic exercise such as running have been attributed to the increase in endorphins [68]. However, more recent research suggests that endocannabinoids (eCBs) could largely explain the anxiolytic and analgesic effects of aerobic exercise [69]. eCBs bind to the same cannabinoid receptors as the psychoactive component in cannabis or marijuana, therefore making the term 'runners high' somewhat appropriate [70].

Psychological mechanisms by which exercise improves mental health

There are several psychological pathways by which exercise may improve mental health. These include:

Exercise promotes a sense of mastery and achievement. Depression is a state of inertia and people who are depressed tend to have lower than usual levels of activity and achievement. Physical activity is a behavioral 'antidote': patients increase their activity levels with the resulting opportunity to increase self-mastery and sense of achievement.

Exercise assists the expenditure of anxious energy. Anxiety is characterized by avoidance and an overactive 'fight or flight' response. When the sympathetic nervous system is activated during a state of anxiety, the body gears up to expend energy by fighting or running away. Exercise is a safe and socially acceptable way of expending this energy in order for the parasympathetic nervous system to activate and bring the body back to a relaxed state.

Exercise promotes development of improved self-esteem. Exercise can lead to an improved body image, body satisfaction or acceptance through a perceived increase in physical competence and ability in different aspects of fitness. All of which can positively influence self-esteem or self-estimation and promote a sense of autonomy and control [71,11].

Social mechanisms by which exercise improves mental health

There are several social pathways by which exercise may improve mental health. These include:

opportunities to mix with other people through engagement in social activities such as exercise classes or running clubs;

improved sense of belonging and significance through relationships with exercise leaders or others in the exercise group [11].

increased social skills, social interest, and social communication resulting from group exercise [72].

What are the benefits of using exercise as a treatment for mental health conditions?

Exercise comes with a number of benefits when compared with other interventions for mental health difficulties:

Exercise can be low-cost. Exercise does not come with the considerable costs associated with psychological or medical treatments. "The evidence reveals that especially brief exercise training counselling is an efficient, effective, and cost-effective means to increase physical activity... and to bring considerable clinical benefits to various patient groups." [73]

Exercise leads to physical health benefits. Exercise comes with a host of other beneficial effects and can often mitigate some of the adverse side effects of medication. These benefits include a lower risk of death and many non-communicable diseases such as cancer, stroke, and coronary heart disease.

Exercise can be done independently by clients. Exercise interventions do not require expert medical assistance and can be performed alone, with friends, or a qualified exercise professional. Some patients may feel empowered when they understand that they have the capacity to improve their mental health difficulties with physical exercise.

Exercise is non-stigmatizing. Some people may feel embarrassed about receiving therapy or medication for mental health problems but "exercise does not carry the same stigma as psychotherapy or medications; indeed most people are proud to say they exercise" [62]

Exercise has social benefits. Physical activity can be a social activity. Group exercise therapy and classes can provide clients with a means of ongoing group interaction and represents a form of exposure therapy for those with social anxiety disorder.

Innovative ways of integrating physical exercise into psychological treatment plans

A number of studies have integrated exercise into psychological treatment programmes. Some innovative uses of exercise as an additive intervention are worth reviewing.

Exercise in the treatment of PTSD

A 2018 study by Van Woudenberg and colleagues, published in the European Journal of Psychotraumatology [74] integrated physical exercise sessions into a treatment program for PTSD. Notable features include:

Three hundred and forty-seven individuals with PTSD were invited to attend and intensive 8-day treatment program over 2 weeks (4 days per-week).

Psychological treatment consisted of prolonged exposure (PE) in the morning and EMDR therapy in the afternoon. Daily physical exercise sessions were also offered alongside an evening psycho-education program. The physical activity on offer included walking, badminton, archery, and for physically impaired patients, table tennis. Patients were instructed to choose their own exercise intensity level.

At the end of the study 82.9% of patients reported clinically significant improvements in their PTSD symptoms and over half (54.9%) no longer met criteria for PTSD.

The authors concluded that their results show "that an intensive treatment format combining PE, EMDR, physical activity, and psycho-education is a potentially effective and safe treatment alternative for patients suffering from severe PTSD, complex trauma histories, and multiple comorbidities".

Exercise in the treatment of PTSD

A 2016 study by Rosenbaum and colleagues published in Acta Psychiatrica Scandinavica [39] augmented usual care for PTSD with exercise:

The researchers allocated forty-two patients to usual care alone and thirty-nine patients to usual care with an exercise intervention.

Usual care consisted of psychotherapy, pharmaceutical interventions and group therapy and treatment length was around 3 weeks for an in-patient group and several months for the larger out-patient group. The exercise intervention consisted of a weekly supervised exercise session, two unsupervised home-based sessions, and individualized daily step count targets using a pedometer for 12 weeks

Compared to the usual care group the exercise group demonstrated an additional moderate and significant reduction in PTSD symptoms. Large and significant reductions in waist circumference and depressive symptoms were also observed in the exercise group compared to the non-active controls.

The researchers concluded that "the findings of the current controlled trial provide support for the use of structured exercise as an augmentation strategy for the treatment of people with PTSD."

Exercise in the treatment of binge eating disorders

In 2004 Fossati and colleagues published a study comparing a traditional cognitive behavioral approach for treating binge eating disorders with the addition of a nutritional and physical activity program [75].

Sixty-one women who met criteria for binge eating disorder were split into three groups: 13 in a traditional CBT group, 23 in a nutritional-CBT group, and 25 women in a nutritional-CBT with physical activity group.

The CBT consisted of 12 weekly 90-minutes sessions which included the use of daily food records, the creation of eating schedules, and cognitive restructuring. The nutritional-CBT group received nutritional education designed to reduce the amount of fat consumed alongside the CBT treatment. Those in the physical activity group were also given physical activity recommendations such as taking the stairs instead of the elevator and advised to plan 30 minutes of structured activity three times per week, every week.

They found that the addition of physical activity and nutritional education to CBT led to the greatest reductions in eating disorder scores, and that participants in these groups lost significantly more weight than the other two approaches. The largest reductions in measures of anxiety and depression were also observed in the physical activity group.

Practical ways that therapists can integrate exercise into their psychological treatments

Exercise is a helpful and evidence-based intervention for anxiety, depression, and as an augmentation therapy for a range of other disorders. There are lots of helpful ways that psychological therapists can recommend and integrate exercise into their client's treatment programs.

Increase client's motivation to exercise

Exercise takes effort and some of the gains are not immediate. It is helpful to build your client's motivation to begin exercising, and to persist despite the short-term discomfort that can result. Some ways to increase your client's motivation to exercise include:

Provide information. Provide clear information about the physical and mental health benefits of exercise, particularly written information. There is evidence from multiple research studies that "exercise prescription or motivational messages in printed form or by computer are more effective than face-to-face counselling alone" [76]

Think about goals and values. Discuss your patient's short, medium, and long-term goals and values. A useful acronym to remember when goal-setting is SMART: are the goals specific, measurable, achievable, realistic, and time bound? Is being physically and mentally healthy consistent with their values? Helping your patients to remind themselves of their values is a proven approach to help them 'stay on course'.

Monitoring progress. Exercise is Medicine (EIM), a global health initiative urges health-care providers to assess their patients' level of physical activity at every clinical visit. "The more often a provider discusses physical activity with their patient, the more likely that person is to both recall such advice and to engage in regular physical activity. [77]. Record whether tasks are being attempted, whether goals are being met, and monitor current physical activity levels. A useful framework for assessing your clients current physical activity levels is the Physical Activity Vital Sign (PAVS).

Correct misperceptions. Take the time to understand how your patient thinks about the relationship between exercise and energy and correct any misperceptions. Some patients think about exercise according to a 'resource depletion' model, a bit like liquid in a cup: they think that exercise will deplete their resources, leaving them less to do other things. Although intuitively appealing this metaphor is wrong, it is more helpful to think of exercise as being like an elastic band in a child's toy: exercise 'winds up' the elastic band storing more energy in it. This approach is supported by the research - exercising regularly leads people to have more energy [5]

Use technology. Some clients may find that integrating technologies such as pedometers, smart watches, and smart phone applications is helpful for them. Wearable technologies represent affordable and accessible ways to constantly remind clients about the importance of regular exercise and applications can help increase levels of physical activity through healthy competition and effective monitoring (e.g. Strava and MyFitnessPal).

Don't underestimate your motivational role. Engaging in psychological therapy is often a time when clients are motivated to change and receptive to new ideas. Having a therapist be interested in their experience of exercise and being willing to check-in, monitor, and explore difficulties can be extremely motivating. Also consider your position as a role model, "If we are going to talk the talk, then we must consistently walk the walk. When our patients observe us adhering to longevity enhancing health behaviors they are much more likely to do the same." [77]

Identify barriers to exercise and help your clients to overcome them

Clinicians are used to working with their patient's 'barriers to change' in therapy. When trying to help clients to engage in beneficial exercise it can be helpful to conceptualize 'barriers to engaging in exercise' as being similar to 'barriers to completing homework tasks'. Interventions to help your patients overcome their barriers to exercise include:

Make the implicit explicit. Make sure to discuss your client's potential barriers to change, or potential barriers to integrating exercise into their lives. Forearmed is forewarned!

Take a collaborative approach. Making life changes can be difficult, and change can be met with resistance. It is helpful to 'sit alongside' clients and to collaboratively problem-solve ways of making exercise fit into their lives.

Think about obstacles. Try to consider practical obstacles (location, equipment), financial obstacles (money for the gym), and psychological obstacles (too anxious to leave the house, worried about being 'the fat person' in the gym, worried about people looking at me).

Set reasonable 'no-fail' expectations. Some clients have rigid or black-and-white views about success and failure. The research appears to indicate that any exercise is better than none, and so any moves towards integrating exercise should be encouraged and rewarded. "Individuals should be informed that 30 minutes of moderate-intensity physical activity on most days of the week is a target and not a threshold required for achieving health benefits" [77]

Barriers to exercise Ways to overcome the barrier

Lack of knowledge

Understand client's position on physical health and how important it is to them
Provide psychoeducation about physical and mental health benefits of exercise

Fatigue

Educate about physical vs. mental fatigue
Reinforce the idea that physical exercise will give you more energy

Negative past experiences

Choose different activities
Take part in fun and motivating classes which focus on enjoyment rather than outcome

"Ultimately the key to motivating patients to exercise is to help them understand why exercise will benefit them. If they understand why exercise will benefit them, then most patients will find the means to do it." [77]

References

[1] Troiano, R. P., Berrigan, D., Dodd, K. W., Masse, L. C., Tilert, T., & McDowell, M. (2008). Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise, 40(1), 181-188.

[2] Harris, M (2018). The relationship between physical inactivity and mental wellbeing: Findings from a gamification-based community-wide physical activity intervention. Health Psychology Open. 5(1), 1-8.

[3] Budde, H., & Wegner, M. (Eds.). (2018). The Exercise Effect on Mental Health: Neurobiological Mechanisms. CRC Press.

[4] Puetz, T. W. (2006). Physical activity and feelings of energy and fatigue. Sports Medicine, 36(9), 767-780.

[5] Loy, B. D., O'Connor, P. J., & Dishman, R. K. (2013). The effect of a single bout of exercise on energy and fatigue states: a systematic review and meta-analysis. Fatigue: Biomedicine, Health & Behavior, 1(4), 223-242.

[6] Bergouignan, A., Legget, K. T., De Jong, N., Kealey, E., Nikolovski, J., Groppel, J. L., ... & Bessesen, D. H. (2016). Effect of frequent interruptions of prolonged sitting on self-perceived levels of energy, mood, food cravings and cognitive function. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 113

[7] Thayer, R. E. (1987). Energy, tiredness, and tension effects of a sugar snack versus moderate exercise. Journal of Personality and Social Psychology, 52(1), 119.

[8] Buman, M. P., & King, A. C. (2010). Exercise as a treatment to enhance sleep. American Journal of Lifestyle Medicine, 4(6), 500-514.

[9] Yang, P. Y., Ho, K. H., Chen, H. C., & Chien, M. Y. (2012). Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. Journal of Physiotherapy, 58(3), 157-163.

[10] Reid, K. J., Baron, K. G., Lu, B., Naylor, E., Wolfe, L., & Zee, P. C. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Medicine, 11(9), 934-940.

[11] Biddle, S. J., Fox, K., & Boutcher, S. (Eds.). (2003). Physical activity and psychological well-being. Routledge.

[12] Sani, S. H. Z., Fathirezaie, Z., Brand, S., Pühse, U., Holsboer-Trachsler, E., Gerber, M., & Talepasand, S. (2016). Physical activity and self-esteem: Testing direct and indirect relationships associated with psychological and physical mechanisms. Neuropsychiatric Disease and Treatment, 12, 2617.

[13] Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Lancet Physical Activity Series Working Group. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet, 380(9838), 219-229.

[14] Franco, O. H., de Laet, C., Peeters, A., Jonker, J., Mackenbach, J., & Nusselder, W. (2005). Effects of physical activity on life expectancy with cardiovascular disease. Archives of Internal Medicine, 165(20), 2355-2360.

[15] Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., ... & Cercy, K. (2016). Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. British Medical Joural, 354, i3857.

[16] Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Current Opinion In Psychiatry, 18(2), 189-193.

[17] Etnier, J. L., Nowell, P. M., Landers, D. M., & Sibley, B. A. (2006). A meta-regression to examine the relationship between aerobic fitness and cognitive performance. Brain Research Reviews, 52(1), 119-130.

[18] Lambourne, K., & Tomporowski, P. (2010). The effect of exercise-induced arousal on cognitive task performance: a meta-regression analysis. Brain Research, 1341, 12-24.

[19] Suttanon, P., Hill, K. D., Said, C. M., Williams, S. B., Byrne, K. N., LoGiudice, D., ... & Dodd, K. J. (2013). Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer's disease: a pilot randomized controlled trial. Clinical Rehabilitation, 27(5), 427-438.

[20] Schuler, G., Adams, V., & Goto, Y. (2013). Role of exercise in the prevention of cardiovascular disease: results, mechanisms, and new perspectives. European heart journal, 34(24), 1790-1799.

[21] Holden, C. (2000). Global survey examines impact of depression. Science, 288(5463), 39-40.

[22] Kessler, R. C., Merikangas, K. R., & Wang, P. S. (2008). The prevalence and correlates of workplace depression in the national comorbidity survey replication. Journal of Occupational and Environmental Medicine, 50(4), 381.

[23] Rimer, J., Dwan, K., Lawlor, D. A., Greig, C. A., McMurdo, M., Morley, W., & Mead, G. E. (2012). Exercise for depression. Cochrane Database of Systematic Reviews, (7).

[24] Cooney, G. M., Dwan, K., Greig, C. A., Lawlor, D. A., Rimer, J., Waugh, F. R., ... & Mead, G. E. (2013). Exercise for depression. Cochrane Database of Systematic Reviews, (9).

[25] Schuch, F. B., Vancampfort, D., Richards, J., Rosenbaum, S., Ward, P. B., & Stubbs, B. (2016). Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. Journal of Psychiatric Research, 77, 42-51.

[26] Dunn, A. L., Trivedi, M. H., Kampert, J. B., Clark, C. G., & Chambliss, H. O. (2005). Exercise treatment for depression: efficacy and dose response. American Journal of Preventive Medicine, 28(1), 1-8.

[27] Singh, N. A., Stavrinos, T. M., Scarbek, Y., Galambos, G., Liber, C., Fiatarone Singh, M. A., & Morley, J. E. (2005). A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. The Journals of Gerontology: Series A, 60(6), 768-776.

[28] Reed, J., & Buck, S. (2009). The effect of regular aerobic exercise on positive-activated affect: A meta-analysis. Psychology of Sport and Exercise, 10(6), 581-594.

[29] Robertson, R., Robertson, A., Jepson, R., & Maxwell, M. (2012). Walking for depression or depressive symptoms: a systematic review and meta-analysis. Mental Health and Physical Activity, 5(1), 66-75.

[30] Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015). Exercise as treatment for anxiety: systematic review and analysis. Annals of Behavioral Medicine, 49(4), 542-556.

[31] Rebar, A. L., Stanton, R., Geard, D., Short, C., Duncan, M. J., & Vandelanotte, C. (2015). A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychology Review, 9(3), 366-378.

[32] Goodwin, R. D. (2003). Association between physical activity and mental disorders among adults in the United States. Preventive Medicine, 36(6), 698-703.

[33] Meng, X., & D'Arcy, C. (2013). The projected effect of increasing physical activity on reducing the prevalence of common mental disorders among Canadian men and women: A national population-based community study. Preventive Medicine, 56(1), 59-63

[34] LeBouthillier, D. M., & Asmundson, G. J. (2015). A single bout of aerobic exercise reduces anxiety sensitivity but not intolerance of uncertainty or distress tolerance: A randomized controlled trial. Cognitive Behaviour Therapy, 44(4), 252-263.

[35] Ströhle, A. (2009). Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission, 116(6), 777.

[36] Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., ... & Schuch, F. B. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatry Research, 249, 102-108.

[37] Bartley, C. A., Hay, M., & Bloch, M. H. (2013). Meta-analysis: aerobic exercise for the treatment of anxiety disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 45, 34-39.

[38] Wipfli, B. M., Rethorst, C. D., & Landers, D. M. (2008). The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. Journal of Sport and Exercise Psychology, 30(4), 392-410.

[39] Rosenbaum, S., Sherrington, C., & Tiedemann, A. (2015). Exercise augmentation compared with usual care for post‐traumatic stress disorder: a randomized controlled trial. Acta Psychiatrica Scandinavica, 131(5), 350-359.

[40] Gaudlitz, K., Plag, J., Dimeo, F., & Ströhle, A. (2015). Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depression and Anxiety, 32(3), 221-228.

[41] Merom, D., Phongsavan, P., Wagner, R., Chey, T., Marnane, C., Steel, Z., ... & Bauman, A. (2008). Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders-a pilot group randomized trial. Journal of Anxiety Disorders, 22(6), 959-968.

[42] Jayakody, K., Gunadasa, S., & Hosker, C. (2014). Exercise for anxiety disorders: systematic review. British Journal of Sports Medicine, 48(3), 187-196.

[43] Sardinha, A., Araújo, C. G. S., Soares-Filho, G. L. F., & Nardi, A. E. (2011). Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy. Expert Review of Cardiovascular Therapy, 9(2), 165-175.

[44] Esquivel, G., Díaz-Galvis, J., Schruers, K., Berlanga, C., Lara-Muñoz, C., & Griez, E. (2008). Acute exercise reduces the effects of a 35% CO2 challenge in patients with panic disorder. Journal of Affective Disorders, 107(1-3), 217-220.

[45] Vancampfort, D., Probst, M., Helvik Skjaerven, L., Catalán-Matamoros, D., Lundvik-Gyllensten, A., Gómez-Conesa, A., ... & De Hert, M. (2012). Systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia. Physical Therapy, 92(1), 11-23.

[46] Wang, P. W., Lin, H. C., Su, C. Y., Chen, M. D., Lin, K. C., Ko, C. H., & Yen, C. F. (2018). Effect of aerobic exercise on improving symptoms of individuals with schizophrenia: a single blinded randomized control study. Frontiers in Psychiatry, 9, 167.

[47] Mueser, K. T., Deavers, F., Penn, D. L., & Cassisi, J. E. (2013). Psychosocial treatments for schizophrenia. Annual Review of Clinical Psychology, 9, 465-497.

[48] Gorczynski, P., & Faulkner, G. (2010). Exercise therapy for schizophrenia. Cochrane Database of Systematic Reviews, (5).

[49] Firth, J., Cotter, J., Elliott, R., French, P., & Yung, A. R. (2015). A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychological Medicine, 45(7), 1343-1361.

[50] Vera-Garcia, E., Mayoral-Cleries, F., Vancampfort, D., Stubbs, B., & Cuesta-Vargas, A. I. (2015). A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: an update. Psychiatry Research, 229(3), 828-839.

[51] Roberts, V., Maddison, R., Simpson, C., Bullen, C., & Prapavessis, H. (2012). The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis. Psychopharmacology, 222(1), 1-15.

[52] Haasova, M., Warren, F. C., Ussher, M., Janse Van Rensburg, K., Faulkner, G., Cropley, M., ... & Taylor, A. H. (2013). The acute effects of physical activity on cigarette cravings: systematic review and meta‐analysis with individual participant data. Addiction, 108(1), 26-37.

[53] Taylor, A., & Katomeri, M. (2007). Walking reduces cue-elicited cigarette cravings and withdrawal symptoms, and delays ad libitum smoking. Nicotine & Tobacco Research, 9(11), 1183-1190.

[54] Wang, D., Wang, Y., Wang, Y., Li, R., & Zhou, C. (2014). Impact of physical exercise on substance use disorders: a meta-analysis. PloS one, 9(10), e110728.

[55] Ledochowski, L., Ruedl, G., Taylor, A. H., & Kopp, M. (2015). Acute effects of brisk walking on sugary snack cravings in overweight people, affect and responses to a manipulated stress situation and to a sugary snack cue: A crossover study. PloS one, 10(3), e0119278.

[56] Hallgren, M., Vancampfort, D., Giesen, E. S., Lundin, A., & Stubbs, B. (2017). Exercise as treatment for alcohol use disorders: systematic review and meta-analysis. British Journal of Sports Medicine, 51(14), 1058-1064.

[57] Polanczyk, G., De Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry, 164(6), 942-948.

[58] Prasad, V., Brogan, E., Mulvaney, C., Grainge, M., Stanton, W., & Sayal, K. (2013). How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 22(4), 203-216.

[59] Tobaiqy, M., Stewart, D., Helms, P., Williams, J., Crum, J., Steer, C., & McLay, J. (2011). Parental reporting of adverse drug reactions associated with attention-deficit hyperactivity disorder (ADHD) medications in children attending specialist paediatric clinics in the UK. Drug Safety, 34(3), 211-219.

[60] Vysniauske, R., Verburgh, L., Oosterlaan, J., & Molendijk, M. L. (2016). The effects of physical exercise on functional outcomes in the treatment of ADHD: a meta-analysis. Journal of Attention Disorders, 1087054715627489.

[61] Cerrillo‐Urbina, A. J., García‐Hermoso, A., Sánchez‐López, M., Pardo‐Guijarro, M. J., Santos Gómez, J. L., & Martínez‐Vizcaíno, V. (2015). The effects of physical exercise in children with attention deficit hyperactivity disorder: A systematic review and meta‐analysis of randomized control trials. Child: Care, Health and Development, 41(6), 779-788.

[62] Powers, M. B., Asmundson, G. J., & Smits, J. A. (2015). Exercise for mood and anxiety disorders: the state-of-the science. Cognitive Behavior Therapy, 44(4), 237-239.

[63] Dinoff, A., Herrmann, N., Swardfager, W., Liu, C. S., Sherman, C., Chan, S., & Lanctôt, K. L. (2016). The effect of exercise training on resting concentrations of peripheral brain-derived neurotrophic factor (BDNF): a meta-analysis. PLoS One, 11(9), e0163037.

[64] Tsatsoulis, A., & Fountoulakis, S. (2006). The protective role of exercise on stress system dysregulation and comorbidities. Annals of the New York Academy of Sciences, 1083(1), 196-213.

[65] Miller, A. H., & Raison, C. L. (2016). The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nature Reviews Immunology, 16(1), 22.

[66] Kiecolt-Glaser, J. K., Derry, H. M., & Fagundes, C. P. (2015). Inflammation: depression fans the flames and feasts on the heat. American Journal of Psychiatry, 172(11), 1075-1091.

[67] Petersen, A. M. W., & Pedersen, B. K. (2005). The anti-inflammatory effect of exercise. Journal of Applied Physiology, 98(4), 1154-1162.

[68] Wildmann, J., Krüger, A., Schmole, M., Niemann, J., & Matthaei, H. (1986). Increase of circulating beta-endorphin-like immunoreactivity correlates with the change in feeling of pleasantness after running. Life Sciences, 38(11), 997-1003.

[69] Heijnen, S., Hommel, B., Kibele, A., & Colzato, L. S. (2016). Neuromodulation of aerobic exercise-a review. Frontiers in Psychology, 6, 1890.

[70] Mackie, K. (2008). Cannabinoid receptors: where they are and what they do. Journal of neuroendocrinology, 20, 10-14.

[71] Daley, A. J. (2002). Exercise therapy and mental health in clinical populations: is exercise therapy a worthwhile intervention? Advances in Psychiatric Treatment, 8(4), 262-270.

[72] Acil, A. A., Dogan, S., & Dogan, O. (2008). The effects of physical exercises to mental state and quality of life in patients with schizophrenia. Journal of Psychiatric and Mental Health Nursing, 15(10), 808-815.

[73] Vuori, I. M., Lavie, C. J., & Blair, S. N. (2013, December). Physical activity promotion in the health care system. In Mayo Clinic Proceedings (Vol. 88, No. 12, pp. 1446-1461). Elsevier.

[74] Van Woudenberg, C., Voorendonk, E. M., Bongaerts, H., Zoet, H. A., Verhagen, M., Lee, C. W., ... & De Jongh, A. (2018). Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder. European Journal of Psychotraumatology, 9(1), 1487225.

[75] Fossati, M., Amati, F., Painot, D., Reiner, M., Haenni, C., & Golay, A. (2004). Cognitive-behavioral therapy with simultaneous nutritional and physical activity education in obese patients with binge eating disorder. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 9(2), 134-138.

[76] Richardson, C. R., Faulkner, G., McDevitt, J., Skrinar, G. S., Hutchinson, D. S., & Piette, J. D. (2005). Integrating physical activity into mental health services for persons with serious mental illness. Psychiatric services, 56(3), 324-331.

[77] Sallis, R., Franklin, B., Joy, L., Ross, R., Sabgir, D., & Stone, J. (2015). Strategies for promoting physical activity in clinical practice. Progress in Cardiovascular Diseases, 57(4), 375-386.

APA reference for this article

Jeavons, M. (2019). The therapist's guide to exercise and mental health. Psychology Tools. Retrieved on [date], from https://www.psychologytools.com/articles/the-therapists-guide-to-exercise-and-mental-health/

# data[].attributes.attachment_link.title
The Therapist's Guide To Exercise And Mental Health - Psychology Tools

# data[].attributes.attachment_link.description
Exercise is a powerful tool for increasing emotional and physical wellbeing and is an effective evidence-based treatment for many mental health conditions. Unfortunately, many people fail to meet the recommended target of 150 minutes of moderate physical activity per week [1] and rates of exercise in people suffering from mental health problems are even lower than average [2]: this means that motivating your patients to engage in exercise is a valuable therapeutic skill.

# data[].attributes.headline
Look After Your Mental Health Using Exercise

# data[].attributes.subject
Look After Your Mental Health Using Exercise

# data[].attributes.attachment_link.title
How to look after your mental health using exercise

# data[].attributes.attachment_link.readable_text
Tell us more

What do you want to tell us about?

Note:

Please don't include personal details like your name or email address. If you do, data protection law means we'll have to delete your comments.

Unfortunately we can't reply to this. If you want a response from us, see our Contact us page.

If you are in crisis right now and want to talk to someone urgently then you could call Samaritans on 116 123 (freephone). Our pages on crisis services have more options.

# data[].attributes.attachment_link.description
Tell us more What do you want to tell us about? Note: Please don't include personal details like your name or email address. If you do, data protection law means we'll have to delete your comments. Unfortunately we can't reply to this. If you want a response from us, see our Contact us page.

# data[].attributes.attachment_link.readable_text
Physical activity can improve your mental wellbeing. Being physically active means moving your body and working your muscles: for example, by walking, running, dancing, swimming, doing yoga or gardening.
*Last updated 8 April 2021
Physical activity is not only good for your body, it's also great for your mind

Being active releases chemicals in your brain that make you feel good - boosting your self-esteem and helping you concentrate as well as sleep well and feel better. Not bad for something many of us can do for free!

Being active doesn't have to mean taking out an expensive gym membership or running marathons. Finding an activity you enjoy can give you a goal to aim for and a sense of purpose. It can also be a great way to meet people, have a break from daily life and gain confidence. Other benefits include:

less tension, stress and mental fatigue

a natural energy boost

a sense of achievement

more focus and motivation

feeling less angry or frustrated

a healthy appetite

having fun.

It's even better if you're able to get active outdoors. Research shows that being in nature can make us feel happier, feel our lives are more worthwhile, and reduce our levels of depression and anxiety. Nature doesn't have to mean forests or national parks either: walking to a local common, visiting a friend's garden or simply noticing trees and flowers planted by the roadside can boost your mental wellbeing.

For some of us it can be hard to be active, perhaps because we have a mental or physical disability or health condition. Our tips below on things to consider before starting exercise may help . The NHS has a webpage about getting active if you have a disability or health condition, with tips on building activity into your day and finding accessible activities and classes.

How active do I need to be?

Any amount of physical activity is better than none. Finding an activity you like and are able to do regularly is more important than pushing yourself to do something you don't enjoy. You could try brisk walking, mowing the lawn, dancing, swimming, following an exercise video or online class, trying a new sport or anything that gets your body moving.

Government guidelines suggest adults aim to do 150 minutes of moderate activity a week or 75 minutes of vigorous activity a week. The NHS website has different examples of activities you could try. This might sound like a lot but don't be put off if you don't feel you can manage this now. If you don't do much physical activity, start small and build up slowly.

Think about your current fitness levels, how much time you have to exercise, and what feels realistic to you. Anything you do to get active and reduce the amount of time you spend sitting or lying down is good.

If you have a mental health condition, there may be factors that affect the amount or type of physical activity you can do. Here are some things you may need to consider.

I take regular medication.

Certain medications can affect the exercise you can do. For example, taking betablockers will mean your heart works harder when exercising, so you may need to adjust the type or amount of exercise you do. If you take lithium, losing fluid from your body through sweating can increase the concentration of lithium in your blood to a harmful level. Talk to your doctor before you start exercising or if you change your medication.

My medication and/or mental health condition makes me feel tired and lethargic.

Work with your body and your mood. For example, if you know your medication makes you feel tired in the mornings, plan to get active later in the day. If you feel unmotivated all day, try just going for a walk. Even a short walk can clear your mind and boost your energy level. If there are times when you just don't have the motivation or energy to exercise, be kind to yourself. It's ok to slow down, do less or take a break. Do what you can, when you can.

I have / am recovering from an eating disorder.

While exercise can be a positive part of recovery, some people with an eating disorder find they are over-exercising. Talk to your GP before starting to get active.

I have anxiety or experience panic attacks.

The way you feel when you get active - breathless, hot, sweaty, a fast heart rate - can feel similar to the symptoms of anxiety or panic attacks. This can be distressing and may then cause a panic attack or increased anxiety.

If this happens to you, try a lower impact activity such as yoga or pilates. When this feels ok, build up the intensity slowly and notice the difference between the effects of physical activity and a panic attack. Exercising with someone else may help you feel reassured that help is available if you feel anxious.

# data[].attributes.attachment_link.description
Physical activity can improve your mental wellbeing. Being physically active means moving your body and working your muscles: for example, by walking, running, dancing, swimming, doing yoga or gardening. *Last updated 8 April 2021 Being active releases chemicals in your brain that make you feel good - boosting your self-esteem and helping you concentrate as well as sleep well and feel better.

# data[].attributes.headline
Exercise for Mental Health: How Much is Too Much?

# data[].attributes.subject
Exercise for Mental Health: How Much is Too Much?

# data[].attributes.attachment_link.readable_text
Many studies suggest that exercising can help people deal with mental health issues and boost well-being. A new observational study - the largest of its kind to date - confirms this, but it also extends a caution: too much exercise may negatively affect mental health.

Share on Pinterest
New research finds that you can get too much exercise and explains how much physical activity will actually benefit your mental health.

Recently, researchers from Yale University in New Haven, CT, have analyzed the data of 1.2 million people all across the United States to gain a better understanding of how exercise affects a person's mental health, and which types of excercise are best for a mood boost.

More importantly, they also asked how much exercise is too much.

The researchers found that different kinds of team-oriented sports, cycling, and aerobic exercise are the most beneficial to mental health. They report this finding, and others, in a now published in The Lancet Psychiatry.

"Depression is the leading cause of disability worldwide, and there is an urgent need to find ways to improve mental health through population health campaigns," notes study author Dr. Adam Chekroud.

"Exercise," he adds, "is associated with a lower mental health burden across people no matter their age, race, gender, household income, and education level."

"Excitingly, the specifics of the regime, like the type, duration, and frequency, played an important role in this association. We are now using this to try and personalize exercise recommendations, and match people with a specific exercise regime that helps improve their mental health."

Dr. Adam Chekroud

The study participants were recruited from across the U.S. and had all participated the Behavioural Risk Factor Surveillance System survey in 2011, 2013, and 2015.

For their analysis, the researchers used not only demographic information, but also data about the participants' mental and physical health, as well as their health-related behaviors. The only specific mental health disorder that the researchers took into account, however, was depression.

As for the types of exercise included in the study, the researchers looked at many different kinds of activities, including performing childcare, doing housework, cycling, going to the gym, and running.

The volunteers provided estimates of how often they had faced poor mental health during the past 30 days. They also reported how often they had exercised over the same period, and for how long.

Dr. Chekroud and team adjusted the results of their analysis for any potentially impacting factors, including the study participants' age, race, and biological sex, as well as their marital status, income, education level, and body mass index ( BMI).
On average, the participants reported experiencing 3.4 days of poor mental health per month. However, compared with people who did not engage in any type of exercise, those who did exercise had 1.5 fewer days of poor mental health per month.
Moreover, the difference was even more obvious when it came to people with a previous diagnosis of depression, as those who exercised had 3.75 fewer bad days per month than their non-exercising peers.

Any and all types of exercise seemed to help manage mental health issues. However, the ones that appeared to be more useful were team sports, cycling, aerobic exercise, and gym-based exercise.

Nevertheless, even activities that may not usually be thought of as "exercise," such as doing chores around the house, were linked with better mental health.

The scientists also found that the association between better mental health and exercise - which amounts to a 43.2 percent reduction in instances of poor mental health - was greater than the association between it and other modifiable factors.

People with a college education experienced a 17.8 percent reduction in bad mental health days compared with those with no college education; those with a healthy-range BMI experienced a 4 percent reduction compared with people with obesity; and people with higher earnings saw a 17 percent reduction of poor mental health days compared with participants with low-salary ranges.

Dr. Chekroud and colleages found that an important factor for mental health was how often people exercise, and for how long. Also, the researchers noted, there really is such a thing as too much exercise.

Of the cohort whose data they analyzed, the team saw that those who exercised two to three times per week tended to have better mental health than both those exercised more infrequently and than those who exercised more often.
The researchers found that the participants who benefited most in terms of mental health were those who exercised for 30-60 minutes three to five times per week.
People who were physically active for over 90 minutes every day also saw some improvement in their mental health. However, participants who exercised for over 3 hours actually had worse mental health than those who did not exercise at all.

"Previously, people have believed that the more exercise you do, the better your mental health, but our study suggests that this is not the case," says Dr. Chekroud.

However, "Doing exercise more than 23 times a month, or exercising for longer than 90 minute sessions is associated with worse mental health," he adds.

This, the researchers believe, may be because people who exercise for many hours at a time and who do so frequently may be exhibiting obsessive behaviors associated with poor psychological and emotional outcomes.

# data[].attributes.attachment_link.title
Exercise for mental health: How much is too much?

# data[].attributes.attachment_link.description
Many studies suggest that exercising can help people deal with mental health issues and boost well-being. A new observational study - the largest of its kind to date - confirms this, but it also extends a caution: too much exercise may negatively affect mental health.

# data[].attributes.attachment_link.description
On this page When you go for a walk it's not just your body that benefits, the way you think and feel changes too. The world can look better and brighter. So, how does walking bring happiness?

# data[].attributes.headline
How Exercise Affects Depression and Anxiety

# data[].attributes.subject
How Exercise Affects Depression and Anxiety

# data[].attributes.attachment_link.readable_text
Depression and anxiety: Exercise eases symptoms

Depression and anxiety symptoms often improve with exercise. Here are some realistic tips to help you get started and stay motivated.
By Mayo Clinic Staff
When you have depression or anxiety, exercise often seems like the last thing you want to do. But once you get motivated, exercise can make a big difference.

Exercise helps prevent and improve a number of health problems, including high blood pressure, diabetes and arthritis. Research on depression, anxiety and exercise shows that the psychological and physical benefits of exercise can also help improve mood and reduce anxiety.

The links between depression, anxiety and exercise aren't entirely clear - but working out and other forms of physical activity can definitely ease symptoms of depression or anxiety and make you feel better. Exercise may also help keep depression and anxiety from coming back once you're feeling better.

How does exercise help depression and anxiety?

Regular exercise may help ease depression and anxiety by:

Releasing feel-good endorphins, natural cannabis-like brain chemicals (endogenous cannabinoids) and other natural brain chemicals that can enhance your sense of well-being

Taking your mind off worries so you can get away from the cycle of negative thoughts that feed depression and anxiety

Regular exercise has many psychological and emotional benefits, too. It can help you:

Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence. Getting in shape can also make you feel better about your appearance.

Get more social interaction. Exercise and physical activity may give you the chance to meet or socialize with others. Just exchanging a friendly smile or greeting as you walk around your neighborhood can help your mood.

Cope in a healthy way. Doing something positive to manage depression or anxiety is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how you feel, or hoping depression or anxiety will go away on its own can lead to worsening symptoms.

Is a structured exercise program the only option?

Some research shows that physical activity such as regular walking - not just formal exercise programs - may help improve mood. Physical activity and exercise are not the same thing, but both are beneficial to your health.

Physical activity is any activity that works your muscles and requires energy and can include work or household or leisure activities.

Exercise is a planned, structured and repetitive body movement done to improve or maintain physical fitness.

The word "exercise" may make you think of running laps around the gym. But exercise includes a wide range of activities that boost your activity level to help you feel better.

Certainly running, lifting weights, playing basketball and other fitness activities that get your heart pumping can help. But so can physical activity such as gardening, washing your car, walking around the block or engaging in other less intense activities. Any physical activity that gets you off the couch and moving can help improve your mood.

You don't have to do all your exercise or other physical activity at once. Broaden how you think of exercise and find ways to add small amounts of physical activity throughout your day. For example, take the stairs instead of the elevator. Park a little farther away from work to fit in a short walk. Or, if you live close to your job, consider biking to work.

How much is enough?

Doing 30 minutes or more of exercise a day for three to five days a week may significantly improve depression or anxiety symptoms. But smaller amounts of physical activity - as little as 10 to 15 minutes at a time - may make a difference. It may take less time exercising to improve your mood when you do more-vigorous activities, such as running or bicycling.

The mental health benefits of exercise and physical activity may last only if you stick with it over the long term - another good reason to focus on finding activities that you enjoy.

How do I get started - and stay motivated?

Starting and sticking with an exercise routine or regular physical activity can be a challenge. These steps can help:

Identify what you enjoy doing. Figure out what type of physical activities you're most likely to do, and think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening, start your day with a jog, or go for a bike ride or play basketball with your children after school? Do what you enjoy to help you stick with it.

Get your mental health professional's support. Talk to your doctor or mental health professional for guidance and support. Discuss an exercise program or physical activity routine and how it fits into your overall treatment plan.

Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think realistically about what you may be able to do and begin gradually. Tailor your plan to your own needs and abilities rather than setting unrealistic guidelines that you're unlikely to meet.

Don't think of exercise or physical activity as a chore. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise or physical activity schedule the same way you look at your therapy sessions or medication - as one of the tools to help you get better.

Analyze your barriers. Figure out what's stopping you from being physically active or exercising. If you feel self-conscious, for instance, you may want to exercise at home. If you stick to goals better with a partner, find a friend to work out with or who enjoys the same physical activities that you do. If you don't have money to spend on exercise gear, do something that's cost-free, such as regular walking. If you think about what's stopping you from being physically active or exercising, you can probably find an alternative solution.

Prepare for setbacks and obstacles. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you can't maintain an exercise routine and might as well quit. Just try again the next day. Stick with it.

Do I need to see my doctor?

Check with your doctor before starting a new exercise program to make sure it's safe for you. Talk to your doctor to find out which activities, how much exercise and what intensity level is OK for you. Your doctor will consider any medications you take and your health conditions. He or she may also have helpful advice about getting started and staying motivated.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, see your doctor or mental health professional. Exercise and physical activity are great ways to ease symptoms of depression or anxiety, but they aren't a substitute for talk therapy (psychotherapy) or medications.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Email field is required

Include a valid email address

Learn more about Mayo Clinic's use of data.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

Show references

Cooney GM, et al. Exercise for depression. JAMA. 2014;311:2432.

Peterson DM. The benefits and risks of exercise. https://www.uptodate.com/contents/search. Accessed Sept. 15, 2017.

Greer TL, et al. Improvements in psychosocial functioning and health-related quality of life following exercise augmentation in patients with treatment response but nonremitted major depressive disorder: Results from the TREAD study. Depression and Anxiety. 2016;33:870.

Schuch FB, et al. Exercise as treatment for depression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research. 2016;77:42.

Understand physical activity, exercise and your heart. Society for Cardiovascular Angiography and Interventions. http://www.secondscount.org/healthy-living/physical-activity-exercise#.WbGhPWeWzRF. Accessed Sept. 7, 2017.

Physical activity and health. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Accessed Sept. 7, 2017.

Exercise for mental health: 8 keys to get and stay moving. National Alliance on Mental Illness. https://www.nami.org/Blogs/NAMI-Blog/May-2016/Exercise-for-Mental-Health-8-Keys-to-Get-and-Stay. Accessed Sept. 7, 2017.

Exercise for stress and anxiety. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety. Accessed Sept. 7, 2017.

Zschucke E, et al. Exercise and physical activity in mental disorders: Clinical and experimental evidence. Journal of Preventive Medicine and Public Health. 2013;46:512.

Anderson E, et al. Effects of exercise and physical activity on anxiety. Frontiers in Psychiatry. 2013;4:1.

Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 19, 2017.

See more In-depth

# data[].attributes.attachment_link.title
Depression and anxiety: Exercise eases symptoms

# data[].attributes.attachment_link.description
Research on depression and anxiety shows that exercise and other physical activity can help improve mood, reduce anxiety and improve other health problems.

# data[].attributes.attachment_link.title
The Mental Health Benefits of Exercise - HelpGuide.org

# data[].attributes.attachment_link.description
From depression and anxiety to stress and ADHD, exercise is one of the most effective ways to improve your mental health. Learn how to get started.

# data[].attributes.attachment_link.title
The effects of exercise on mental illness