Getting a Mental Lift From Exercise

Many dedicated exercisers say they work out not just for their body, but also for their mind. In our high-stress society, slamming tennis balls, shooting hoops or stepping out for a walk are all socially acceptable ways to relieve tension and adjust attitude--just as Grandma knew when she advised taking out your anger on the woodpile.

Now a growing body of research suggests that telling someone under stress to “take a hike” or “go soak their head” in the swimming pool may be a dose of good medicine.

“Exercise has a very positive effect on mental health from a number of perspectives,” says Dr. John Docherty, a psychiatrist and director of the Center for Innovation in Behavioral Health at New York Hospital / Cornell Medical Center. “We know exercise helps regulate biorhythms, which improves sleep, and it enhances energy level and vigor. Exercise is also very important in maintaining physical health and controlling weight, which impacts on self-esteem.”

There is no definitive research that proves the effects of physical activity on psychological health the way studies evaluate the impact of a drug on heart disease. But a significant body of evidence links regular exercise with components of improved mental health, such as brighter mood, reduced anxiety and enhanced self-efficacy.

And in some physicians’ offices as well as in health clubs and on biking trails, people are turning to exercise as a way to relieve symptoms of depression and anxiety.

Docherty, for example, prescribes exercise to all his patients, but cautions that “the science needs to be stronger” in helping physicians determine how much and what kind of exercise works best for varied psychological conditions. “With a pill, I know specifics such as what dose to prescribe and what percentage of patients will respond. We don’t have that level of data with exercise yet.”

A consensus is growing that “physical activity may protect against the development of depression,” as the U.S. Surgeon General’s Report on Physical Activity and Health noted in 1996.

“In general, persons who are inactive are twice as likely to have symptoms of depression than are more active persons,” according to the report. In addition, regular exercisers are less likely to report symptoms of depression and anxiety than are people who do little or no physical activity. On the other hand, “persons who have good mental health may simply be more likely to be active,” the report pointed out.

Yet the exercise-mood connection is strong enough to bring psychiatrists and psychologists together with exercise specialists to explore the ways in which regular activity might be used as therapy. In a society where depression affects an estimated 10% of the population, many experts are embracing the idea of “sweat therapy” as a powerful adjunct to standard treatment, which is typically antidepressant medication and / or psychotherapy.

A few small studies even suggest that, in cases of mild to moderate depression, exercise may be as effective as standard therapies. A major study funded by the National Institutes of Mental Health is examining whether aerobic exercise alone can be an effective treatment for depression.

“Not everyone responds to medications or the other treatments we have available for depression,” says psychiatrist Dr. Madhukar Trivedi of the University of Texas Southwestern Medical Center.

Not a Cure By Itself

Doctors caution that exercise is not a substitute for medical care. People suffering from depression, they say, should be evaluated by a mental health specialist to determine an appropriate treatment regimen. ‘Exercise is not a panacea,” says Norwegian psychiatrist Dr. Egil Martinsen, an authority on the link between exercise and depression. “You can’t replace psychotherapy with exercise.”

But it can be an important adjunct therapy, he says, noting that “it doesn’t seem to be necessary to have the fitness gains to experience mental health gains.”

For many people, exercise may be more accessible than traditional therapies, especially if they can’t tolerate drugs or afford psychotherapy. With limits on insurance coverage for mental illness, many patients cannot pay for standard treatments. And some avoid seeking professional help because they fear the stigma of mental illness.

Good for Others Too

Easy to administer, readily available, inexpensive and low risk, exercise holds great promise for helping nondepressed people too, as they fight the daily battle of the bummers--such as ordinary life stresses, frustrations and bad moods.

“With every aerobic exercise bout, there is at least a temporary period of calmness lasting from two to four hours,” says Jack Raglin, associate professor of kinesiology at Indiana University.

Although the connection between exercise and psychological well-being is firmly established, further studies also are needed to identify the mechanisms by which exercise appears to exert these effects. Popular theories point to exercise’s effect on brain chemicals, on body temperature and on “psychosocial” factors, such as being with other people or getting away from problems.

“It seems so simple that people feel better after exercise,” says Brad Hatfield, associate professor of kinesiology at the University of Maryland in College Park. “But it’s actually a very complex dynamic” involving a person’s current level of physical conditioning, mental health status and personality traits.

“One of the players in the orchestra are neurotransmitters, like serotonin and endorphins, that are released as a result of physical activity,” Hatfield says. These brain chemicals can have a powerful, mood-enhancing effect.

Exercise also raises body temperature, which may relax muscles and calm body and mind. “Any kind of repetitive rhythmic stimulus applied to the brain stem--such as walking, swimming laps or cycling--can have a tranquilizing effect on the nervous system, like rocking a baby,” he says. Plus, exercise enhances sleep, allowing people to “recharge their batteries” more fully.

And simply escaping temporarily from problems, accomplishing a goal, being in the fresh air and sunshine, mastering a new skill, interacting socially or getting away alone are all possible reasons exercise improves mood. Exercise is generally something people can control, which boosts self-confidence and feelings of competence, says Hatfield, who admits that his personal workout is “sometimes the only thing in the day that makes any sense.”

“I can’t think of any condition that physical activity wouldn’t be good for,” adds Dr. William Stockton, psychiatrist and clinical professor of psychiatry at George Washington University.

“When I get out and walk my 2 1/2 miles in Rock Creek Park, it’s the only time of the day when I feel in charge of my life,” he says. “I can take one foot and put it in front of the other and I’m not in a struggle with the forces of the world. It’s not going to solve any long-term problems. But I feel better.”

Some experts speculate that regular exercise, which is a type of physiologic stress, may help people develop a more efficient biochemical mechanism for handling life’s pressures. Over time, exercisers may develop a kind of “stress hardiness” that protects them from depression.

“We know that rats who exercise are more resistant to stress,” notes Keith Johnsgard, an emeritus professor of psychology at San Jose State University and author of “The Exercise Prescription for Depression and Anxiety” (Plenum Press, 1989). “It’s possible that exercise might protect us from the kind of stress response that would bring on depression.”

Too Much Exercise

Despite the upbeat effect of exercise, too much of a good thing can have a downside. While regular physical activity appears to boost mental health, excessive exercise can lead to mood disturbances such as loss of libido and appetite, fatigue and lethargy.

Known as “overtraining,” excessive exercise can be a problem for some competitive athletes who must learn to walk the fine line between commitment and compulsion. In addition, a small proportion of recreational athletes take their healthful habit to an unhealthy extreme, becoming “exer-holics” who use sport as a way of escaping from their lives.

For both conditions, overtraining and exercise addiction, cutting back on physical activity can relieve symptoms and restore health. Compulsive exercisers also may find therapy helpful in examining whether they are running toward health or running away from problems.

The complexity of the exercise-mood connection presents a challenge for researchers, who are studying a broad array of topics.

One of the most perplexing questions, which some experts consider the most important, is: “If exercise makes people feel good, why do so many people remain sedentary?” Typically, humans tend to do things that feel good and avoid things that feel bad--an observation Freud called “the pleasure principle.”

Yet even though exercise has a well-documented “feel good” effect, the majority of Americans get little or no regular physical activity. And half of all people who start a new exercise program quit within six months.

The reason, suggests Bill Morgan, a professor of kinesiology at the University of Wisconsin, Madison, is that “exercise must be purposeful, as opposed to getting on a treadmill to nowhere. Most people in adult fitness programs drop out before it becomes meaningful to them.”

He adds, “If people find an activity that they enjoy and need, so that it has meaning, it can provide a sense of accomplishment.”

Regular exercisers come to rely on this boost they get from their activity “fix.” In a study published in the journal Medicine & Science in Sports & Exercise, habitual exercisers who were deprived of their regular workout for three days reported a variety of mood disturbances, including tension, depression, anger, fatigue and confusion. This is why many committed exercisers say they work out regularly.

Exercise doesn’t need to be strenuous to have mental health benefits, says Norway’s Martinsen. Even easy activity, like a casual stroll, can help people feel better. “Doing anything is better than doing nothing,” he says.

Especially when people are hospitalized for mental illness, he says, “we must not let the body get worse while we try to restore the soul.”

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Carol Krucoff is a veteran health care journalist. She writes a regular column about health and fitness for the Washington Post.