Awareness of the need to protect our mental health has never been higher. Whether this is due to the pandemic, increased media coverage and high-profile celebrities being more open about their mental health struggles, or just through the tireless campaigning of charities and health professionals, it is more accepted than ever before that we should be investing in our minds as much as our bodies.

The good news for both fitness enthusiasts and professionals is that there is overwhelming evidence that regular physical activity improves mood and is associated with lower risk of common mental health disorders such as depression and anxiety. For example, a large study of over 1 million adults in the USA[1] indicated that individuals who exercised had on average 1.5 fewer ‘bad mental health days’ per month, compared to those who did not. Those who benefitted most from this protective effect were those participating in cycling, aerobic & gym activities, or team sports. Additionally, research in Europe[2] has suggested that even small amounts of activity, of any intensity, provides protection against depression, estimating that 12% of future cases of depression could be prevented by as little as one hour of physical activity participation per week.

The exact mechanisms for this link between being physical activity and better mental health is not entirely clear. Several biochemical pathways have been identified, such as endorphins, reduced cortisol levels[3], and reduced inflammatory response[4] in more active individuals. There is also increasing evidence that regular exercise directly affects the brain, by altering neurotransmitter function and promoting growth of the hippocampus, producing similar effects to those of antidepressant medications.

Moreover, people with depression who exercise report that it acts as a diversion from negative thoughts and gives a sense of purpose. For many, there is also undoubtedly a positive effect from the social contact that goes along with exercise. Whether it is working out in a group exercise class or with a personal trainer, playing team sports, or just a nod to a fellow runner in the park, connecting with similar people is likely to increase the positive effects of exercise on our mental wellbeing.

Of course, we should be mindful that there is also the potential for negative effects of exercise on mental health. Exercise dependence describes a form of behavioural addiction, where individuals may experience diminished control over their exercise behaviour, i.e. they may persist with exercise, despite awareness of negative consequences. This dependence may manifest in one or more of the following ways[5]:

Tolerance: increasing the amount of exercise in order to feel the desired effect, be it a “buzz” or sense of accomplishment;
Withdrawal: in the absence of exercise the person experiences negative effects such as anxiety, irritability, restlessness, and sleep problems
Lack of control: unsuccessful at attempts to reduce exercise level or cease exercising for a certain period of time;
Intention effects: unable to stick to one’s intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount;
Time: a great deal of time is spent preparing for, engaging in, and recovering from exercise;
Reduction in other activities: as a direct result of exercise social, occupational, and/or recreational activities occur less often or are stopped;
Continuance: continuing to exercise despite knowing that this activity is creating or exacerbating physical, psychological, and/or interpersonal problems.

It is easy to see how some of these might be dismissed by casual observers as simply signs of commitment, or dedication to fitness and health goals. However, behavioural addiction can produce similar harmful effects to substance addiction, both physically and psychologically. Therefore, fitness professionals should be alert to these signs as part of their overall duty of care for their clients. Unfortunately, more work needs to be done to understand exercise dependence and identify support strategies for those who develop it. However, simple strategies can be effective at reducing the risks of dependence, such as promoting a balanced lifestyle which includes time spent on non-fitness activities and encouraging appropriate rest and recovery in response to fatigue or injury.

Compulsive exercise may also be associated with other psychological issues, such as body dissatisfaction or body dysmorphia, and eating disorders. In fact, the relationship between exercise and body image is complex. For example, regular exercisers consistently report better body image than non-exercisers, and while it is tempting to assume that improved body image is a result of regular exercise, this association could also be attributed to people with poorer body image being less likely to attend gyms or sports clubs, through embarrassment or stigma. Research indicates that body image concerns can work both as a motivator and a de-motivator to engaging in exercise, and that adherence to exercise is lower among those with appearance-focused goals compared to health/fitness goals. This suggests that operators and coaches will likely retain clients for longer if they emphasise the health benefits rather than promising an aspirational physique.

Thankfully, the majority of regular exercisers experience only positive effects. Yet those with mental health disorders are typically less likely to meet recommended physical activity levels than the general population, and often accumulate significant amounts of sedentary time.  Common barriers among individuals with mood or anxiety disorders include physical condition, time constraints/too busy, and lack of willpower/self-discipline[6]. When considering the symptoms of common mental health disorders, it is evident that the experience of these can make physical activity seem more challenging and less appealing. For example, those with depression may experience; low self-esteem, feeling worthless, fatigue and sleep disturbance. While anxiety can produce significant physical effects such as dizziness, headaches, nausea and sleep problems. However, the beneficial impact of exercise on mental health is sufficient that it is recommended by the NHS as a first line treatment for less severe depression, as well as being encouraged alongside other treatments strategies, such as medication, for most common mental health disorders. Thus as fitness providers and professionals, we have the opportunity to make a significant contribution, given that it is estimated that 1 in 6 UK adults will be experiencing a mental health problem in any given week[7].

Here are a few tips to help you to encourage more people with mental health issues to engage in fitness services, and to maximise the mental health benefits of exercise for everyone:

1. Operators should put a policy in place to outline how they will ensure that individuals with mental health disorders will have equal access to their facilities, and what they expect of staff to implement this, just as they should for physical health conditions. Mental health first aid training will increase staff’s understanding and confidence when working with people experiencing mental health conditions. Having these things in place could give a strategic advantage over the competition, and open up a large potential market.

2. Starting a new activity is daunting for anyone, but this can be worse for someone with anxiety or low self-confidence. Make sure sessions are welcoming and there is no pressure to keep up or perform at a high level, with coaches instead emphasising fun and enjoyment.

3. Many people with poor mental health can struggle to stick to a regular exercise routine. Offering flexible payment options and ‘pay as you go’ sessions mean individuals can attend as and when they feel able.

4. Positive reinforcement of just getting involved, and of efforts made rather than goals reached, can boost mood and build self-confidence. Encouraging participants to track their mood and energy levels, alongside their exercise, can help to bring home the benefits of being active, and maintain motivation in the long term.

5. Incorporate breathing and relaxation work into sessions – not just yoga! Warm ups, cooldowns, and recovery periods are great opportunities to teach simple muscle relaxation techniques and develop diaphragmatic breathing. These can be used to manage stress, as well as being used to help people cope with anxiety and panic attacks. They are also shown to improve performance in many sports, so win-win!

 


 

Dr. Lou Atkinson is a Lecturer in Psychology at Aston University, UK, and a Senior Master Instructor for Core Health & Fitness.

References:
1. Chekroud, S.R.; Gueorguieva, R.; Zheutlin, A.B.; Paulus, M.; Krumholz, H.M.; Krystal, J.H.; Chekroud, A.M. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study. The Lancet Psychiatry 2018, 5, 739-746, doi:10.1016/S2215-0366(18)30227-X.
2. Harvey, S.B.; Øverland, S.; Hatch, S.L.; Wessely, S.; Mykletun, A.; Hotopf, M. Exercise and the Prevention of Depression: Results of the HUNT Cohort Study. The American journal of psychiatry 2018, 175, 28-36, doi:10.1176/appi.ajp.2017.16111223.
3. Blake, H. Physical activity and exercise in the treatment of depression. Front Psychiatry 2012, 3, 106, doi:10.3389/fpsyt.2012.00106.
4. Hamer, M.; Endrighi, R.; Poole, L. Physical Activity, Stress Reduction, and Mood: Insight into Immunological Mechanisms. In Psychoneuroimmunology: Methods and Protocols, Yan, Q., Ed. Humana Press: Totowa, NJ, 2012; 10.1007/978-1-62703-071-7_5pp. 89-102.
5. Freimuth, M.; Moniz, S.; Kim, S.R. Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. International journal of environmental research and public health 2011, 8, 4069-4081, doi:10.3390/ijerph8104069.
6. Pelletier, L.; Shanmugasegaram, S.; Patten, S.B.; Demers, A. Self-management of mood and/or anxiety disorders through physical activity/exercise. Health Promot Chronic Dis Prev Can 2017, 37, 149-159, doi:10.24095/hpcdp.37.5.03.
7. McManus, S.; Bebbington, P.; Jenkins, R.; Brugha, T. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. NHS Digital: 2016.