Exercise Recommendation for Patients with Depression

Exercise Recommendation for Patients with Depression

Different hypotheses have been advanced to support exercise as a non-pharmacological intervention for people with depression. For example, the anthropological hypothesis posits that the human body is genetically structured to be physically active. However, today, many people lead sedentary lifestyles, thus causing different health problems like depression. The endorphin hypothesis asserts that during exercise, the body produces chemicals called endorphins, which are associated with reduced depression. Other proposed hypotheses include the monoamine and mastery hypotheses, which associate exercise with enhanced brain neurotransmitters and a feeling of mastery in respective sessions (Lox et al., 2019). Achievement of desired outcomes through exercise among depression patients is dependent on multiple factors like exercise type, total length, and frequency.

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The Type of Recommended Exercise

Aerobic exercises are linked with the most desired outcomes for patients with depression. They include physical exercises that promote cardiovascular conditioning by keeping the heart pumping. Aerobic exercises require increased oxygen to supply working muscles, thus causing an increase in breathing and heart rate. There are different forms of aerobic exercises, such as swimming, brisk walking, cycling, and running. For a person with depression, running would serve as an effective exercise intervention. There are several health benefits associated with running. Regular running is associated with boosting feelings of happiness, hence making the body and mind feel better (Brennan, 2021). During running, endocannabinoids are released in the body, flooding the bloodstream and moving into the brain, thereby providing feelings of calmness and reduced stress. Running also helps reduce depression by increasing blood circulation to the brain, thus impacting the part of the brain that improves an individual’s mood. Running also generates chemicals that encourage the body to relax and encourage deep sleep, improving a person’s mental health (Brennan, 2021).

The Frequency, Intensity, and Duration of the Exercise

Total lengths and frequency of exercise also impact the desired outcomes among persons with depression. Since aerobic exercise involves cardiovascular conditions, over-exercising may trigger more stress and negatively impact one’s mental health. For maximum health outcomes, it is recommended that persons with depression exercise at least three to five times for at least ten weeks (Lox et al., 2019). The exercise also needs to be moderately intense, characterized by 50% to 85% of the individual’s maximal heart rate. It is also recommended that the duration should be between 30 to 60 minutes per session (Lox et al., 2019). In the case of running exercise, one needs to be gentle with one’s body. In the beginning, one can run for thirty minutes at least three times a week. Moving on and depending on the body resistance, the frequency can be increased to at least four times a week while maintaining the total duration at thirty minutes. Research has shown that a 30-minute workout can be effective in helping relieve symptoms of depression (Citroner, 2021). The routine should be consistent for at least eight continuous weeks.

Conclusion

A regular running routine can significantly improve the health outcomes for persons with depression. Research has proven that running is associated with improved cognitive development, improved mood, and better stress management. It also changes a person’s ways of thinking, thus minimizing feelings of fatigue, distress, and anxiety. In addition, running helps the mind process things differently and boosts brain power by creating new brain cells. Nevertheless, it is important to consider effective duration, frequency, and exercise type to achieve desired health outcomes for persons with depression.

References

Brennan, D. (2021). Mental Health Benefits of Running. WebMD. https://www.webmd.com/fitness-exercise/how-running-affects-mental-health/

Citroner, G. (2021). A 30-Minute Workout May Help Relieve Some Symptoms of Depression. Healthline. https://www.healthline.com/health-news/a-30-minute-workout-may-help-relieve-some-symptoms-of-depression

Lox, C. L., Ginis, K. A. M., Gainforth, H. L., & Petruzzello, S. J. (2019). The Psychology of Exercise: Integrating Theory and Practice. Routledge.

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Week 4 Assignment:

If you were to prescribe exercise to an individual suffering from depression, what would your prescription entail (i.e., type, frequency, intensity, duration)?

Lox, C. L., Ginis, K.A. M., Gainforth, H. L., & Petruzzello, S. J. (2019). The Psychology of Exercise (5th ed.). Taylor & Francis. https://online.vitalsource.com/books/9781000011999

Chapters: 10-12

Weblinks:

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How reinvesting in your fitness business impacts three important KPIs:

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Lecture Notes Week 4
Psychology of Exercise

Lecture 4

Slide 1

Anxiety and exercise

Slide 2

Welcome to this week’s lecture! In this lesson, we will learn how anxiety, depression, and emotional well-being influence exercise.

We will start by learning about anxiety, which just about everyone has had at some point in their lives. Anxiety is not necessarily a mental illness, though. Mental health and mental illness can be thought of as the ends of a spectrum, with health on one end of the spectrum and illness on the other. The reality is that most mental health disorders are not severe or prolonged enough to be diagnosed as mental illnesses. Most people’s anxiety would fall somewhere closer to the middle of the spectrum.

Slide 3

According to the US Department of Health and Human Services, anxiety is the “pathological counterpart of normal fear” and includes “disturbances of mood”. Most people experience anxiety in their lives but is generally not considered “clinical anxiety” unless the individual exhibits behavioral or cognitive changes without a triggering event, or has disproportionate and unmanageable responses to anxiety-producing stimuli.

Slide 4

Anxiety disorders are the most prevalent mental health disorders affecting people today. Anxiety can take many forms, including panic disorder and agoraphobia, social anxiety disorder, specific phobias, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.

Slide 5

Anxiety disorders are more prevalent than you might think. In any given year, roughly 18% of the US adult population will experience an anxiety disorder, with prevalence higher among females and non-Hispanic white people.

Slide 6

The symptoms of anxiety disorder can vary from person to person, but in general, anxiety is associated with unpleasant feelings, bodily symptoms such as muscle tension or hyperactivity, changes in cognitions such as irrational fears, changes in behavior, and hyper vigilance for danger or problems.

Slide 7

Traditional treatments for anxiety have typically come in the form of medication or psychotherapy. While both methods can be incredibly effective in treating anxiety disorders, they can be costly, psychotherapy is time consuming, and medications can have unwanted side effects.

Slide 8

In more recent years, studies have shown that exercise can help to reduce anxiety. This alternative is gaining more traction in both the prevention and treatment of anxiety disorders.

Slide 9

We can classify anxiety as state anxiety, representing anxiety in the current moment, or trait anxiety, which means that anxiety is a trait of someone’s personality. State anxiety is characterized by immediate feelings of apprehension about a specific scenario, and can include physical components such as sweaty hands and increased heart rate. Trait anxiety is more general, and refers to a person’s tendency to be anxious in just about any scenario.

Slide 10

We explored some ways in which mental health disorders can be measured in last week’s lesson. Here again we can see that there are two main ways of measuring anxiety, with psychological measures and physiological measures. Psychological measures usually take the form of self-reporting, and rely on the individual to accurately and honestly assess their own mental state. Physiological measures are more concrete: muscle tension, blood pressure, heart rate, skin responses, and the central nervous system can all give us clues about someone’s anxiety levels.

Slide 11

In the previous slide we mentioned that psychological measures are usually performed as self-assessments. The survey you see here is a good example of the type of self-assessment that someone could use to determine if they have high anxiety.

Slide 12

Last week we learned that studies have not come to a consensus on whether or not exercise reduces stress. However, studies have shown that exercise reduces symptoms of anxiety and depression, and that physically fit individuals have less anxiety than unfit individuals.

Slide 13

Unfortunately, very few clinical studies have been conducted examining the treatment of anxiety with exercise. The studies that have been performed either show that exercise is better than other treatment methods, or roughly the same as other treatment methods.

Slide 14

Studies examining the relationship between anxiety and exercise show that aerobic exercise is much better at alleviating anxiety than anaerobic exercise, even though the latter still does have some effect. More specifically, state anxiety, where the individual is anxious about a particular situation, is reduced following acute exercise. Trait anxiety, where anxiety is a part of the individual’s personality, is reduced following chronic exercise.

Slide 15

Researchers have not been able to pinpoint the source of anxiety reduction in exercise, but a handful of hypotheses have emerged. The thermogenic hypothesis proposes that as body temperature rises, as with exercise, the brain sends signals to the rest of the body to relax. Other ways of increasing body temperature, such as saunas, have also been correlated with reduced anxiety, so it is certainly plausible that exercise can have the same effect.

The distraction/time-out hypothesis proposes that simply distracting the mind from the source of anxiety reduces anxiety. Studies showed that people who exercised, read quietly, or meditated for 10-20 minutes all had similar reductions in anxiety.

Slide 16

While we might not know exactly how exercise reduces anxiety, we do know that aerobic exercise in particular is effective in treating anxiety disorders. Regular exercise or physical activity can help to alleviate anxiety, as well as protect against anxiety that comes about as a result of busy lives.

Slide 17

Depression and exercise

Slide 18

Depression is a mental disorder characterized by changes in mood, specifically, beyond the usual variations between sadness and happiness.

Slide 19

Depression can be classified into four categories. Major depressive disorder is characterized by a depressed mood and a loss of interest and loss of pleasure in life. The symptoms of major depressive disorder cause significant impairment in the individual’s social life, work, and self-care. Bipolar disorder is characterized by one or more episodes of mania followed by depression. Mania can range from euphoria to irritability, and is often associated with racing thoughts and excessive overindulgence. Dysthymia is a chronic form of depression defined as having fewer than five persistent symptoms. Dysthymia is not as disruptive to one’s life as major depressive disorder, but can last much longer. Finally, cyclothymia is a less severe form of bipolar disorder, marked by less intense manic and depressive states.

Slide 20

Many psychological and physiological feelings accompany depression, from feelings of sadness and guilt, to disturbances in appetite and sleep patterns. People who are depressed lack energy, have difficulty concentrating, lose interest in activities, and in severe cases, have memory problems, thoughts of suicide, and hallucinations.

Slide 21

How can we determine if someone is suffering from major depressive disorders? Most of the criteria come from self-reported assessments of mood, interest, weight loss or gain, and insomnia. Other indicators include fatigue, feelings of guilt, inability to concentrate, and thoughts of suicide.

Slide 22

Mental illnesses have become so prevalent that they rank 2nd in industrialized nations in “disease burden”, which relates to the number of years of life lost due to a disease. Only cardiovascular disease reduces our lifespan by more years than mental illness. Roughly a fifth to a quarter of adults in the US alone suffer from some diagnosable form of mental illness, and has been a tremendous economic burden.

Slide 23

The causes of depression are not well understood. Research has suggested that depression is the result of a number of interactions of physiological and psychosocial factors, and responses to stressful events vary greatly among individuals. Depression is influenced by heredity, inherent coping skills, and the individual’s social support network.

Slide 24

Depression is often left undiagnosed and untreated. Most often, if major depressive disorder is diagnosed, medical professionals will treat the individual with a combination of pharmaceuticals and psychotherapy. However, data generally supports the idea that modest aerobic exercise does improve mood and helps alleviate depression.

Slide 25

The measurement of depression and other mental disorders has been standardized by the American Psychological Association in the Diagnostic and Statistical Manual of Mental Disorders. The manual details over 400 mental disorders and is used by therapists and psychiatrists to diagnose patients. Additionally, standardized self-reporting assessments such as the Beck Depression Inventory and the Zung Self-Rating Depression scale can provide us with further insights into an individual’s mental health.

Slide 26

Here we can see an example of a self-reporting assessment that can be used to evaluate a person’s mental health status. You will notice that most of the survey questions ask the person how they felt during a particular situation. The questions have been refined over the years to provide mental health professionals with the data they need to begin diagnostics.

Slide 27

We briefly touched on some of the benefits of exercise as a treatment for depression. Research shows that exercise results in decreased depression, and can be as effective or more effective than traditional therapies like medication and psychotherapy.

Slide 28

While some studies have shown that any amount or type of exercise reduces depression, the most effective exercise “dosages” for clinical depression are fairly standardized. The type of exercise is not important, but the total length and frequency are. Participants should expect to exercise three to five times per week for at least 10 weeks to maximize the effect of exercise on their depression. Aerobic exercise should be intense enough for the participant’ heart rate to be 50% to 85% of their maximal heart rate. Additionally, higher intensity resistance training is more effective than lower intensity resistance training. No matter the mode, the duration should last from 30 to 60 minutes per session.

Slide 29

In the previous section on anxiety, we learned about two hypotheses to explain why exercise reduces anxiety. Much like with anxiety, researchers have not been able to prove why exercise improves depression. However, several hypotheses have emerged, which we will examine in the following sections.

Slide 30

The anthropological hypothesis claims that our bodies are genetically predisposed to be physically active. However, due to modern technology, we have mostly sedentary lifestyles, and our bodies have not had the time to evolve and adjust, and we end up facing a host of health problems, including depression, as a result.

Slide 31

The endorphin hypothesis proposes that during stress, including exercise, the body produces chemicals known as endorphins, which are natural painkillers. Increased endorphin production may be linked to reduced depression.

Slide 32

The monoamine hypothesis proposes that exercise alters the brain neurotransmitters such as serotonin, norepinephrine, and dopamine, which all help regulate emotions.

Slide 33

The mastery hypothesis states that the psychological effects of exercise are derived from feelings of accomplishment or mastery, not from any physiological response. The hypothesis is based on the idea that mastery gives us a greater sense of self-worth, and thus reduces the effects of depression.

Slide 34

As stated previously, not enough research has been performed to form a scientific conclusion as to why exercise effects depression. The most plausible scenario is that all of the hypotheses contribute in some way, but how much each contributes has yet to be determined.

Slide 35

Emotional well-being and exercise

Slide 36

So far, we’ve studied the effects of exercise on mental disorders. Now let’s take a look at how exercise affects emotional well-being. First, we need to define emotional well-being, which is a greater amount of positive than negative affect. Emotional well-being is associated with favorable thoughts and satisfaction with life.

Slide 37

Exercise has been shown to have a positive effect on emotional well-being. Exercise reduces negative emotions and increases positive emotions, which results in self-confidence and self-esteem, and leads to improved cognitive function.

Slide 38

Going forward, we will be discussing three concepts that we need to differentiate. Exercise psychology literature tends to conflate these terms to mean the same thing, when in reality they are different. First, emotions are short lived high-intensity responses to stimulus, and include fear, guilt, or pride. Moods last longer than emotions, and can be more difficult to identify the source of. Examples of moods include feelings like irritation or cheerfulness. Finally, affect comes from the primitive mind and does not require thought processes to precede it. Affect includes feelings of tension or calmness.

Slide 39

Several generalized measures have been developed to measure emotional well-being, including the Profile of Mood States, the Positive and Negative Affect Schedule, and the Activation-Deactivation Adjective Check List. These generalized measures do not have any specific applications in exercise, and were not sensitive enough to exercise stimuli to notice a difference. In short, existing generalized measures failed to detect unique properties of exercise.

Slide 40

In the 1990’s and early 2000’s, researchers came up with several measures specifically designed to record how exercise affects emotional well-being. Unfortunately, the measures were developed without a guiding theoretical framework, making the results suspect, and even then, the results did not satisfactorily address the concerns we had with general measures in the previous slide.

Slide 41

So far we have mostly extolled the benefits of exercise on mental health and emotional well-being. While this certainly holds true in the long run, the timing of our measurements plays an important role in determining the correct exercise program for an individual. Someone’s affect experienced during exercise can be radically different than their experience before and after exercise. Imagine for a moment a middle-aged man who started an exercise routine last month that includes running for 30 minutes, five times per week. He knows the exercise is good for him, and he has noticed his anxiety and depression have lessened. However, if you asked him how he feels 20 minutes into his run, he might tell you he’s fatigued, exhausted, in pain, or any number of other negative feelings. Now imagine if you asked him to run a little faster, increasing the intensity of the exercise. All the feelings he just described would probably become even more negative. This will inform your exercise prescription. You don’t want to make it so hard that the individual experiences negative affect in every session, but you want it to have the correct intensity to produce benefits.

Slide 42

Sometimes, exercise can have negative consequences on emotional well-being. Overtraining can lead to fatigue and exhaustion and to reduced affective states, and even to depression. Some people experience exercise dependence syndrome. They become obsessed with exercise to the point that their social and life functions become impaired. In primary exercise dependence, the individual seeks exercise itself as the goal. Secondary exercise dependence is usually associated with other disorders such as anorexia, where exercise is a means to lose weight, rather than the goal itself.

Slide 43

To conclude this lecture, we will examine some practical recommendations based on our understanding of exercise and emotional well-being. Individuals should become more aware of how they feel when they exercise or do not exercise. Schedule exercise time during periods of the day when one usually experiences low energy. The amount of exercise required for emotional well-being is not currently known, but we do know that excessive exercise can lead to mental health disorders. A general rule of thumb is “can you carry on a conversation while exercising?” If the answer is no, then your intensity might be too high. And the rule of common sense applies as well. Moderate amounts of exercise generally leads to improved mental health and emotional well-being.