Exercise & Mental Health

In a review article published in August last year, scientists in Australia and Macedonia analysed research and tests underpinning the "growing body of literature that recognizes the positive effects of exercise on mood states such as anxiety, stress and depression, through physiological and biochemical mechanisms." The article does a masterful job of breaking down and analysing prior tests that have been performed, as well as results, which indicate that those of us who live with an anxiety disorder and depression can chart physiological and psychological improvements in our lives with the addition of aerobic and non-aerobic exercise regimes. What I want to stress at the outset is that I do not subscribe to the notion that all mental health sufferers need to do is exercise and take one’s mind off anxious and depressive thoughts. Personally, I know that exercise has to go hand-in-hand with medicine and psychological assistance.

I am not a health professional, so I will cite the research I have undertaken and encase this piece around my lived experience.

• 5:15 Wake up
• 5:20 Feed Otto
• 5:22 Put kettle on
• 5:25 Fetch 10kg dumbbell
• 3x/10 bicep curl
• 3x/10 cross body hammer curl
• 3x/10 shoulder press
• 3x/10 tricep kickback
• 6:00 Put kettle on. Again
• 6:05 Coffee & read

This is how I start my weekdays. (I aspire to start getting up at 4:30 so that I can add walk Otto to my routine. Dare to dream, eh?) I implemented this routine a month after starting my most recent job as I found mornings bleak, especially when I was woken throughout the night by Lily (our baby). Being able to start my day this way also allows me to gain a natural high. There's something satisfying about lifting weights early in the AM when others are sleeping. I grunt, sweat and enjoy the pain!

While the majority of studies that ascertain the effects of exercise on mental health have focused on aerobic exercise (cardiovascular exercises, such as running, swimming and cycling, which focus on strengthening the heart and lungs), those which also focus on non-aerobic exercise (where the focus is on improving muscle strength and flexibility) have demonstrated that anxiety and depression scores improve similarly:

"[In an exercise study that included 91 inpatients with major depression, who were] randomly assigned to aerobic and non-aerobic exercise regimes for eight weeks, depression scores reduced in both groups. There were no differences between the groups, hence, the anti-depressive effects noted are not restricted to the aerobic physical activity regime."

Full disclosure: I've tried my fair share of drugs. I'm not just referring to those kinds of drugs. Since 2014, I have been on three different anti-depressants (Zoloft, Cymbalta, Effexor), a couple of sleeping pills and briefly an anti-psychotic drug. (Taken in small dosages, anti-psychotic medication isn't as extreme as it may sound. That said, these aren't your grandmother's natural remedies.) What I'm trying to say is that even with these drugs floating around in my system I still hold to the belief that endorphins are effective and worth the physical effort. They are also free. And as a journal article informed me, "The principal function of endorphins is to aid the body to endure pain in periods of prolonged pain and stress." Ask an athlete and there’s a good chance you’ll hear the words euphoria and analgesia thrown around when it comes to endorphin-related experiences and feelings.

The Harvard Mental Health Letter  (2000) concluded what an increasing number of health professionals preach today, that exercise is "a healthful, inexpensive, and insufficiently used treatment for a variety of psychiatric disorders." Furthermore, Roger Walsh of the University of California, Irvine College of Medicine, explains that in terms of "therapeutic benefits," exercise assists in dealing with "depression, anxiety, eating, addictive, and body dysmorphic disorders."

Three weekday evenings and on Saturday and Sunday I run, jog and incline walk at a gym near home. I started this routine while rehabbing my reconstructed knee in 2008. Ten years on and I'm still at it. In fact, one of my favourite times of the day is spent at the gym. My anxiety and cluttered thoughts dissipate like smoke from a chimney, and I listen to music/podcasts and sweat out my depressive ruts. It is at this point that I feel the endorphins and neurotransmitters kick into overdrive! Here are a few academic lines to back me up:

"Depression is successfully managed in some patients with selective serotonin reuptake inhibitors (SSRI) which work to prevent the reuptake of monoamines such as serotonin and noradrenaline, thereby, increasing the availability of these in the brain. It is thought that exercise can also increase serotonergic and adrenergic levels in the brain, effectively acting in the same way as the SSRI antidepressants. ... Hence, exercise appears to work in much the same way as anti-depressants."

My current treadmill goal:

• 2km - 12.0kph = 10 minutes
• 3km - 11.0kph = 16:08 minutes
• 2km - 10.0kph = 18 minutes
• 3km - 7.5kph = 24 minutes
• TOTAL = 10km / 64 minutes

Unfortunately, I find it hard to spare 60+ minutes these days. Between work, baby, wife, sleep, reading, chores and socialising, it has become increasingly difficult to carve out that sort of time. It has also taken years to work myself up to this point in my cardio routine. At times, I'll trade the treadmill in for seated rowing (a killer workout!) or the stationary bike, but the treadmill remains my cardio-Goliath. What I've found is that for a handful of hours post-workout I am uber productive and possess a radiant outlook.

I encourage you to try this out. It doesn't have to be at a gym, so long as you measure your outcomes, set out reasonable goals and continue to improve your physical, mental and emotional performance. Why don't you create regular exercise times and journal about workouts and mindfulness? What is stopping you? Health professionals suggest that you need to exercise 20 minutes each day. I suggest finding aerobic and non-aerobic exercises that are right for you and start striving for something more interesting than walking home from the train station or bus stop.

Another area health professionals and scientists are producing more research and insight on are the psychological mechanisms of exercise on mood states. One of the mechanisms that I have found tremendously helpful is the idea of mastery/self-efficacy. Since my 9-to-5 isn't challenging or particularly interesting, one way I combat lacklustre and depressing feelings is by striving for mastery in exercise and weight/muscle goals.

"The self-efficacy/mastery hypothesis theory states that the physiological effects of completing an important and effortful task such as, an exercise session brings about a feeling of mastery which, in itself, elevates mood. Self-efficacy or one's belief in one's ability to succeed has been positively associated with exercise participation and negatively related to depressive symptoms. The theory of self-efficacy highlights the importance of self-regulation. The higher the level of perceived self-efficacy the more likely an individual will maintain adherence to self-set goals."

This maps out the complex effects of exercise to improve anxiety and depression. Source:  http://dx.doi.org/10.1016/j.maturitas.2017.09.003

Let me leave you with some practical steps and tips that you can apply to your everyday life when it comes to exercising and creating regimes: 

• Start by choosing an aerobic/non-aerobic activity you enjoyed in the past.
• Consider how you can make exercise part of your everyday life.
• Consider whether you enjoy exercising in the morning, afternoon or evening.
• Consider whether you want to exercise by yourself, with others or a mix of both.
• Be realistic and set attainable goals.
• Increase your intensity as you go.
• Make sure you have instructions and assistance when it comes to weightlifting.
• Practice mindfulness to avoid depressive mindsets that leave you feeling sluggish. (I know how difficult this is!)
• Keep a journal and jot down your exercise regimes, performances, goals and successes and failures.
• Consult a GP or health professional for recommended exercise regimes and complementary dietary plans.
• Check whether private healthcare can assist with exercise-related costs. Also make sure you consult a GP about whether a mental health plan can assist.
• Read through the Black Dog Institute's 'Managing depression with exercise' fact-sheet.
• Enjoy the exercise and the benefits! 

Sources: 

• Black Dog Institute. 'Exercise & depression.' Accessed 22 June 2018. https://www.blackdoginstitute.org.au/docs/default-source/factsheets/exercise_depression.pdf?sfvrsn=8.
• Black Dog Institute. 'Managing depression with exercise.' Accessed 20 June 2018. https://www.blackdoginstitute.org.au/docs/default-source/factsheets/managingdepressionwithexercise.pdf?sfvrsn=16.
• Black Dog Institute. 'One hour of exercise a week can prevent depression.' Accessed 27 June 2018. https://blackdoginstitute.org.au/news/news-detail/2017/10/04/one-hour-of-exercise-a-week-can-prevent-depression.
• Faulkner, Guy et al. Exercise, health and mental health. London: Routledge, 2005.
• Harvard Medical School. 'The Harvard Mental Health Letter'. Harvard Health Publication Group. Harvard: Harvard University Press, 2000.
• Johnson, Cathy. 'Exercise for mental health: a no brainer?' Accessed 22 June 2018. http://www.abc.net.au/health/features/stories/2014/08/26/4074904.htm.
• Mikkelsen, Kathleen et al. 'Exercise and mental health'. Maturitas. 10 (2017): 48-56.
• Morgan, Amy J. 'Exercise and Mental Health: An Exercise and Sports Science Australia Commissioned Review.' Journal of Exercise Physiology. 16, 4 (2013): 64-70. 
• Walsh, Roger. 'Lifestyle and Mental Health'. American Psychologist. 66, 7 (2011): 579-592.