Exercise for Mental Health

Sir: In this era of exponential growth of the “metabolic syndrome” and obesity, lifestyle modifications could be a cost-effective way to improve health and quality of life. Lifestyle modifications can assume especially great importance in individuals with serious mental illness. Many of these individuals are at a high risk of chronic diseases associated with sedentary behavior and medication side effects, including diabetes, hyperlipidemia, and cardiovascular disease.¹ An essential component of lifestyle modification is exercise. The importance of exercise is not adequately understood or appreciated by patients and mental health professionals alike. Evidence has suggested that exercise may be an often-neglected intervention in mental health care.²

Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression.³ These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, thus, on the physiologic reactivity to stress.³ This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation.

Other hypotheses that have been proposed to explain the beneficial effects of physical activity on mental health include distraction, self-efficacy, and social interaction.⁴ While structured group programs can be effective for individuals with serious mental illness, lifestyle changes that focus on the accumulation and increase of moderate-intensity activity throughout the day may be the most appropriate for most patients.¹ Interestingly, adherence to physical activity interventions in psychiatric patients appears to be comparable to that in the general population.

Exercise improves mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function.² Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal.³ Exercise is especially important in patients with schizophrenia since these patients are already vulnerable to obesity and also because of the additional risk of weight gain associated with antipsychotic treatment, especially with the atypical antipsychotics. Patients suffering from schizophrenia who participated in a 3-month physical conditioning program showed improvements in weight control and reported increased fitness levels, exercise tolerance, reduced blood pressure levels, increased perceived energy levels, and increased upper body and hand grip strength levels.⁵ Thirty minutes of exercise of moderate intensity, such as brisk walking for 3 days a week, is sufficient for these health benefits. Moreover, these 30 minutes need not to be continuous; three 10-minute walks are believed to be as equally useful as one 30-minute walk.

Health benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients include the following:

1. Improved sleep

2. Increased interest in sex

3. Better endurance

4. Stress relief

5. Improvement in mood

6. Increased energy and stamina

7. Reduced tiredness that can increase mental alertness

8. Weight reduction

9. Reduced cholesterol and improved cardiovascular fitness

Mental health service providers can thus provide effective, evidence-based physical activity interventions for individuals suffering from serious mental illness. Further studies should be done to understand the impact of combining such interventions with traditional mental health treatment including psychopharmacology and psychotherapy.