Physical Activity and Mental Health

Original Editor - Rebecca Wilson

Top Contributors - George Prudden, Wendy Walker, Tony Lowe, Michelle Lee and Vidya Acharya  

Description

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Physical activity is a world-wide recognised health topic. Individuals and health professionals are becoming increasingly aware of its benefits as well as the implications faced through inactivity. Along with the physical benefits research has shown physical activity to have a positive impact on individual’s mental health. People with mental health disorders experience higher rates of disability and mortality[1], further research in this area is required.

Definition

The World Health Organisation (WHO) define mental health to be; ‘A state of complete physical, mental and social well-being, and not merely the absence of disease’.[2]

Looking specifically at mental disorders the World Health Organisation (WHO) define this to be; ‘A broad range of problems, with different symptoms’.[3]

NICE (National Institute and Care Excellence) guidelines suggest that the most common mental health disorders range from depression to anxiety disorders. These conditions are recognised as ‘common’ as they affect more people than any other mental health conditions.[4] 

Prevalence

  • 1 in 4 people in the UK experience mental health problems in any year.
  • Mental health disorders relate to the largest source of global economic burden projected to cost £1.6 trillion[5]
  • Half of all mental disorders start before the age of 14
  • Approximately only 50% people diagnosed with mental health disorders receive professional help[6]
  • In England women presented with a higher prevalence of common mental disorders than men (19.7% compared to 12.5%)[7]

Benefits of Physical Activity 

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Social

Many people find physical activity to be enjoyable, it can increase confidence and help gain back a sense of control. Physical activity can also encourage social interaction by being in situations with likeminded people.[8] It can help bring about social support which in turn can improve individual’s confidence and sense of achievement,[9]

Mood

Studies have been found to show the positive impact physical activity can have on individuals overall mood.[10] Levels of a neurotransmitter called serotonin which affects mood are shown to increase following exercise. This rise in serotonin is suggested to help prevent the development of some physical or mental disorders.[11]

Self-Esteem

Physical activity is shown to improve levels of self-esteem and acceptance. Studies suggest patients should participate in activities which have low levels of stress and competitiveness to help improve their psychological well-being.[12]

Depression

Evidence shows that exercise is effective in improving depressive symptoms.[13] Aerobic exercise, resistance and strength training have been found beneficial in improving an individual’s condition.[14] Physical activity is reported to have effects in both clinical and non-clinical settings. A greater improvement is recognised in a clinical environment with those suffering with serious mental illness.[15]

Physical

Participants of physical activity benefit from improved cardiovascular and muscle fitness. Maintaining bone strength and aiding functional health. It can reduce individual’s risk of developing several conditions such as hypertension, chronic heart disease, stroke, diabetes, breast/colon cancer and depression.[16]

Mechanism of effect

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There are numerous hypotheses that attempt to determine the mechanism of effect of physical activity on mental health. These can be identified as being psychological or physiological. Research on the hypotheses is limited and it is thought that the true effect is though a combination of psychological and physiological mechanisms.

Psychological

Distraction

Distraction thought to be achieved through individuals moving away and diverting themselves from stressful stimuli which in turn achieves the improved affect associated with exercise.[17]

Self-efficacy

Many people find physical activity to be challenging. By getting into a routine involving physical activity individuals mood and self-confidence will improve.[17]

Physiological

Monoamines

This is thought to be where exercise increases the availability of neurotransmitters in the brain. Research is limited in this area.[18]

Endorphins

Physical activity releases endogenous opioids.[19] Physical activity positively impacts common mental disorders and depressive symptoms through the increased release of beta endorphins following exercise. Endorphins are connected to a positive mood and an overall greater sense of well-being.[18]

Thermogensis

Thermogenesis relates to the production of body. Physical activity increases body temperature. Exercise is thought to release a greater sense of relaxation and improved mood.[9]

Barriers to Physical Activity

Even with knowing the benefits of physical activity and how it can improve lives, many people still face barriers preventing them from doing it. Barriers can be recognised as either physical, psychological or socio-ecological.[20][21][22]

Physical Psychological Socioeconomic

Physical illness

Fatigue/tiredness

Distress

Depression

Poor motivation

Low self-confidence

High cost

Lack of access to facilities

Lack of time

Lack of social support

Insufficient information/knowledge

Poor environment

High crime rates

We all put up barriers to exercise even when we are aware of the potential benefits. Those suffering with mental illness are no different, however there are additional factors that may prevent an individual engaging with physical activity.

  • Physical image - Specifically regarding, excessive body weight. Susceptibility to gain weight may not be from inactivity but can stem from medications.[23][24]
  • Fatigue - Evidence has identified that tiredness and fatigue can be due to medications.[23]
  • Environment - People fear they will be recognised by others in their neighbourhood or community for their mental disorder and fear stigmatisation.[24]

Treatment

Medication

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Those with common mental health disorders are found to have symptoms which reduce the likelihood of physical activity.[25] Side effects of medications can also be a barrier to physical activity. There are a variety of different medications individuals can take for their mental health conditions; antidepressants, anti-anxiety, stimulants, antipsychotics and mood stabilisers.

Possible side effects associated with medication are: nausea, vomiting, weight gain, sleepiness, loss of appetite, headaches and blurred vision.[26] Both typical and atypical drugs are identified with affecting certain neurotransmitters within the brain which can cause individuals to increase in weight.[27] Determining the correct medications for individuals can sometimes be a long process especially when trying to identify doses. In several cases individuals report being in periods of sedation this increases times of physical inactivity.[24]

Cognitive Behavioural Therapy

Cogntive behavioural therapy (CBT) is a form of talking therapy which helps individuals change the way they think and what they do. It is shown to have positive effects on a variety of mental health disorders[28]. The approach is split into 5 areas; situation, thoughts, emotions, physical feelings and actions.[29] This therapy can stop the negative cycle many individuals may find themselves in and allow them to manage their conditions better.[30]

Many individuals with depression find their behaviours relate to increased time of inactivity, this in turn can lower mood. CBT therapy can help alter behaviours and see an increase in levels of physical activity by doing things which are likely to bring about pleasure and feelings of achievement.[31]

Public health

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Public health interventions are implemented to try and tackle physical inactivity, there are numerous ways in which this can achieved, for example:

Point-of-Decision prompts

Information provided directly to individuals through signs. These are generally found in stairwells or next to elevators.[32] These signs can be motivational, educational and inspirational.[33]

Community campaigns

Communities are engaged to take up exercise through media, activities and other strategies. Support groups and risk factor screening are employed by community projects.[34]

Mass media campaigns

Campaigns use media, television, radio, cinemas and the internet to encourage physical activity.[32]

Classroom-based health education

Interventions conducted in an educational environment such as school, university or work. These classes attempt to educate individuals about the importance of physical activity and the implications of being inactive.[32]

Resources

A number of different tools/interventions have been developed to help tackle physical inactivity.

Scot-PASQ (Scottish Physical Activity Screening Question)

Determines an individual's thoughts around physical activity and what they currently do. If individuals show acceptance to increase physical activity to determine if either brief advice or intervention are implemented. Those who are not ready are given information through physical activity leaflet.[35]

National Physical Activity Pathway

Following Scot-PASQ screening health professionals can use to this pathway to provide advice or implement an intervention to help encourage inactive individuals to increase the level of physical activity they complete.[36]

Lester Positive Cardiometabolic Health Resource

This framework is for individuals with psychosis who are taking antipsychotic medication, it helps to recognise any risk these individuals may have with cardiovascular and type 2 diabetes.[37]

Examples

Walking Football groups

These groups see individuals 50 years and older compete in football. The walking style of the game allows those with even mobility issues to take part. Improves both physical and mental health.[38]

Get Active

Aims here involve improving individuals self-esteem, work within communities help develop social inclusion and see that recreational facilities are equipped to support people with mental disorders.[39]

Jogscotland

Scottish Mental Health Association are working to educate leaders to become more informed in mental health and be able to publicise how exercise can improve individual’s mental health.[39]

Branching out

A programme which has been developed involving Scottish forestry. Those individuals who use mental health services can attend a 12 week course in which physical activity is encouraged. Individuals learn about conservational work and bushcraft techniques. Skills such as photography are also developed.[40]

Resources

The Motivate2Move website, created by Wales Deanery, has a comprehensive section on physical activity and Mental Health.

References

  1. World Health Organisation, 2013. Mental Health Action Plan 2013-2020 [online]. World Health Organisation. [viewed 24 August 2016]. Available from: http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf?ua=1
  2. World Health Organisation, 2016. Health Topic – Mental Health [online]. World fckLRHealth Organisation. [viewed 24 August 2016]. Available from: http://www.who.int/topics/mental_health/en/
  3. World Health Organisation, 2016. Health Topic – Mental Disorders [online]. World Health Organisation. [viewed 24 August 2016]. Available from: http://www.who.int/topics/mental_disorders/en/
  4. NICE, 2011. Common mental health problems: identification and pathways to care [online]. National Institute of Health for Care and Excellence. [viewed 24 August 2016]. Available from: https://www.nice.org.uk/guidance/CG123/ifp/chapter/Common-mental-health-problems
  5. Mental Health Foundation, 2015. Fundamental Facts about Mental Health [online]. Mental Health Foundation. [viewed 24 August 2016]. Available from: https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-15.pdf
  6. World Health Organisation, 2016. WHO Regional Committee for Europe 63rd session [online]. World Health Organisation. [viewed 24 August 2016]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0004/215275/RC63-Fact-sheet-MNH-Eng.pdf?ua=1
  7. McManus, S. et al., 2009. Adult psychiatric morbidity in England, 2007; Household survey [online]. National Centre for Social Research. [viewed 24 August 2016]. Available from: http://digital.nhs.uk/catalogue/PUB02931/adul-psyc-morb-res-hou-sur-eng-2007-rep.pdf
  8. Royal College of Psychiatry, 2012. Physical Activity and Mental Health [online]. Royal College of Psychiatrists. [viewed 24 August 2016]. Available from: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/physicalactivity.aspx
  9. 9.0 9.1 Fox, K. R. 1999. The Influence of physical activity on mental well-being. Public Health Nutrition. 2(3A), pp. 411-418. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10610081
  10. Penado, F. J. & Dahn, J. R. 2005. Exercise and well-being: a review of mental and physical health benefits associated with Physical Activity. Current Opinion Psychiatry [online]. 18(2), pp. 189-193. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16639173
  11. Young, S. N. 2007. How to Increase serotonin in the human brain without drugs. Journal of Psychiatry and Neuroscience [online], 32(6), pp. 394-399. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/
  12. Shamus, E. & COHEN, G. 2009. Depressed, Low Self-Esteem: What Can Exercise Do for You? Internet. Journal of Allied Health Sciences and Practice [online]. 7(2), Article 7. [viewed 24 August 2016]. Available from: http://nsuworks.nova.edu/ijahsp/vol7/iss2/7/
  13. BLUMENTHAL, J. A., SMITH, P. J. & HOFFMAN, B. M. 2012. Is exercise a viable treatment for depression? ACSM’s Health and Fitness Journal [online]. 16(4), pp. 14-21. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/
  14. Blackdog Institute, 2012. Exercise and Depression [online]. Blackdog Institute. [viewed 24 August 2016]. Available from: http://www.blackdoginstitute.org.au/docs/ExerciseandDepression.pdf
  15. Rebar, A. L., et al., 2015. A Meta-analysis of the effect of Physical activity on depression and anxiety in non-clinical adult populations. Health Psychology Review [online]. 6(3), pp. 366-378. [viewed 25 August 2016]. Available from: fckLRhttp://www.ncbi.nlm.nih.gov/pubmed/25739893
  16. World Health Organisation, 2016. Media Centre - Physical Activity [online]. World Health Organisation. [viewed 24 August 2016]. Available from: http://www.who.int/mediacentre/factsheets/fs385/en/
  17. 17.0 17.1 Morgan, W. P. 1985. Affective beneficence of vigorous physical activity, Medicine and science in sports and exercise [online]. 17(1), pp. 94-100. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3157040
  18. 18.0 18.1 Craft, L. L. & Perna, F. M. 2004. The Benefits of exercise for the clinically depressed, The Primary Care Companion to the Journal of Clinical Psychiatry [online]. 6(3), pp. 104-111. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/
  19. Peluso, M. A. M. & Guerra De Andrade, L. H. S. 2005. Physical Activity and Mental Health: the association between exercise and mood. Clinics [online]. 60(1), pp. 61-70. [viewed 24 August 2016]. Available from: http://www.scielo.br/pdf/clin/v60n1/23108.pdf
  20. Firth, J. et al., 2016. Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis. Psychological Medicine [online]. 9, pp. 1-13. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27502153
  21. Justine, M. et al., 2013. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Medical Journal [online]. 54(10), pp. 581-586. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24154584
  22. Schutzer, K. A. & Graves, B. S. 2004. Barriers and motivations to exercise in older adults. Preventive Medicine [online]. 39(5), pp. 1056-1061. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15475041
  23. 23.0 23.1 National Institute of Mental Health, 2016. Mental Health Medications [online]. National Institute of Mental Health. [viewed 24 August 2016]. Available from: http://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml
  24. 24.0 24.1 24.2 Shor, R. & Shaler, A. 2014. Barriers to Involvement in Physical Activity of personal with Mental Illness. Health Promotion International [online]. 31(1), pp.116-123. [viewed 27 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25204451
  25. McDevitt, J. et al., 2006. Perceptions of Barriers and Benefits to Physical Activity Among Outpatients in Psychiatric Rehabilitation. Journal of Nursing Scholarship [online]. 38(1), pp. 50-55. [viewed 27 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16579324
  26. Harvey, S. B. et al., Physical Activity and common mental disorders, The British Journal of Psychiatry [online]. 197(5), pp. 357-364. [viewed 24 August 2016]. Available from: http://bjp.rcpsych.org/content/197/5/357
  27. Robson, D. & Gray, R. 2007. Serious Mental Illness and physical health problems: A discussion paper, International Journal of Nursing Studies [online]. 44, pp. 457-466. [viewed 24 August 2016]. Available from: http://www.rcpsych.ac.uk/pdf/physical_health_paper-1%20copya.pdf
  28. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012;36(5):427-440.
  29. Royal College of Psychiatry, 2013. Cognitive Behavioural Therapy [online]. Royal College of Psychiatrists. [viewed 27 August 2016]. Available from: http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherap fckLRy.aspx
  30. Mental Health Foundation, no date. Cognitive Behavioural Therapy [online]. Mental Health Foundation. [viewed 27 August 2016]. Available from: https://www.mentalhealth.org.uk/a-to-z/c/cognitive-behavioural-therapy-cbt
  31. Martinsen. E. W. 2008. Physical Activity in the prevention and treatment of anxiety and depression, Nordic Journal of Psychiatry [online]. 62(S47), pp. 25-29. [viewed 27 August 2016]. Available from: http://www.tandfonline.com/doi/abs/10.1080/08039480802315640
  32. 32.0 32.1 32.2 Kahn, E. B. et al., 2002. The Effectiveness of Interventions to Increase Physical Activity: A Systematic Review, American Journal of Preventative Medicine [online]. 22(4 supplement), pp.73-107. [viewed 24 August 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11985936
  33. CDC, 2015. Motivational Signs [online]. Centres for Disease Control and Prevention. [viewed 24 August 2016]. Available from: http://www.cdc.gov/physicalactivity/worksite-pa/toolkits/stairwell/motivational_signs.htm
  34. CDC, 2011. Strategies to Prevent Obesity and other Chronic Diseases – The CDC Guide to Strategies to Increase Physical Activity in the Community [online]. Centres for Disease Control and Prevention. [viewed 24 August 2016]. Available from: http://www.cdc.gov/obesity/downloads/PA_2011_WEB.pdf
  35. Physical Activity and Health Alliance, 2012. Scottish Physical Activity Screening Question (Scot-PASQ) [online]. Physical Activity and Health Alliance. [viewed 24 August 2016]. Available from: http://www.paha.org.uk/Resource/scottish-physical-activity-screening-question-scot-pasq
  36. NHS Health Scotland, 2012. NHS Physical Activity Pathway: Practitioner Guidance [online]. NHS Health Scotland. [viewed 24 August 2016]. Available from: http://www.healthscotland.com/uploads/documents/20387-PractitionerGuide.pdf
  37. RCPSYCH, 2014. NAS Resources [online]. Royal College of Psychiatrists. [viewed 24 August 2016]. Available from: http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement/nationalclinicalaudits/schizophrenia/nationalschizophreniaaudit/nasresources.aspx#CMH
  38. Paths for All, no date. Walking football [online]. Paths for All. [viewed 27 August 2016]. Available from: http://www.pathsforall.org.uk/pfa/projects/walking-football.html
  39. 39.0 39.1 SAMH, no date. Get Active [online]. Scottish Association for Mental Health. [viewed 27 August 2016]. Available from: https://www.samh.org.uk/our-work/national-programmes/get-active
  40. Foresty Commission Scotland, no date. Branching Out [online]. Forestry Commission Scotland. [viewed 27 August 2016]. Available from: http://scotland.forestry.gov.uk/supporting/strategy-policy-guidance/health-strategy/branching-out