Subscribe to Clinical Compass™ Volume 3, Issue 16 - July 29, 2008

Exercise and Mental Health

by Eleanor Roberts, PhD

With the Olympics coming up we can all marvel at athletes in peak fitness competing for the highest honors. To them, exercise is a vital part of what they do. Interestingly, studies have suggested that physical exercise may also be a vital therapeutic part of many aspects of psychiatric disorders. These benefits can be psychological—in that exercise can improve a person’s everyday quality of life; physical—for instance in the case of controlling weight gain for those with schizophrenia; and for symptom improvement—such as the finding that scores on scales of obsessive-compulsive disorder (OCD) can be reduced through physical exercise. However, “despite a large body of literature suggesting improvements in depression and anxiety with regular aerobic exercise,” says Alison Phillips, MD, of the Hestia Institute Center for Women and Children, Wellesley, MA, “such counseling has not been incorporated into routine psychiatry practice.”

One study of general mental health investigated its correlation to physical activity. Hammer et al, 2008(1) surveyed 19,842 people and classified 3,200 of them as showing “psychological distress.” This measure was gained using the 12-item General Health Questionnaire (GHQ-12),(2) which poses questions including have you recently: 1) lost much sleep over worry, 2) felt constantly under strain, 3) felt capable of making decisions about things, and 4) been feeling reasonably happy, all things considered, all rated on a 4-item scale. They found that compared to people who exercised less than 20 minutes a week, responders who carried out light exercise, including housework and walking, had a 13% to 20% reduction in risk for psychological distress, and those who carried out a more vigorous sporting activity had around a 33% reduction in risk. The authors postulated that: “physical activity may improve mental health through reducing biological stress reactivity.” Factors such as chronic illness, obesity, and tobacco use were found to be independent of this risk reduction. This indicates that encouraging patients with a psychiatric disorder to exercise can be psychologically beneficial even when they have continuing issues with weight control and smoking cessation.

Patients with schizophrenia are at a higher than average risk for obesity and of the medical complications that arise as a result.(3) This can be due to a low level of fitness and poor dietary choices, as well as being linked to the propensity to gain weight brought about by some antipsychotics.(4) An increasing number of studies are investigating the contribution of weight reduction programs to address obesity in people with schizophrenia. One such program was detailed in a recent study by Lee et al, 2008.(5) They carried out a multicenter trial where 232 patients between the ages of 13 and 60 took part in a 12-week diet and exercise program. Results showed a mean reduction in BMI score of 0.98 ± 1.01 kg/m², and in body weight of 2.54 ± 2.75 kg, both of which were significantly different from baseline (p < .001). Not surprisingly, compliance was significantly associated with weight loss (p < .001), but decreases were not linked to age, gender, pre-intervention weight, or a particular drug.

Exercise has also been used as a therapy to directly address psychiatric symptoms. Brown et al, 2007, used exercise as a means to control symptoms of OCD.(6) Their study group consisted of 14 people with an average Yale-Brown obsessive-compulsive scale (Y-BOCS) score of 22.9 ± 5.6 (severe OCD), despite receiving treatment for at least 3 months. Participants were rated as “sedentary” at baseline and they undertook a 12-week moderate-intensity aerobic exercise program. The investigators found that the mean Y-BOCS score was 15.2 ± 5.6 (mild OCD) at the end of treatment (p < .001), with only a slight rise, to 16.0 ± 8.2, at 6 months follow-up (p < .05; mild-moderate OCD). Quality of life ratings also significantly rose from “fair”, to near “good” (p < .01) by the end of the program. Thus, exercise can not only help with general psychological and physical problems, it can also lead to symptom reduction in specific psychiatric disorders.

These studies suggest that the benefits of exercise to people with psychiatric disorder are wide-ranging, and support the advice of Alison C. Phillips, MD, to the American Psychiatric Association's Institute on Psychiatric Services, that “exercise counseling should be part of routine psychiatric practice.”

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References

  1. Hamer M, Stamatakis E, Steptoe A. Dose response relationship between physical activity and mental health: The Scottish Health Survey. Br J Sports Med Apr 10 2008.
  2. Goldberg DP, Williams P. A User's Guide to the General Health Questionnaire. Windsor, UK: NFER-Nelson; 1988.
  3. Cohen D, Stolk RP, Grobbee DE, Gispen-de Wied CC. Hyperglycemia and diabetes in patients with schizophrenia or schizoaffective disorders. Diabetes Care Apr 2006;29:786-791.
  4. Marder SR, Essock SM, Miller AL, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry Aug 2004;161:1334-1349.
  5. Lee SJ, Choi EJ, Kwon JS. A naturalistic multicenter trial of a 12-week weight management program for overweight and obese patients with schizophrenia or schizoaffective disorder. J Clin Psychiatry Apr 2008;69:555-562.
  6. Brown RA, Abrantes AM, Strong DR, et al. A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder. J Nerv Ment Dis Jun 2007;195:514-520.

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