Mary suffered a stroke during an operation to repair a broken hip. When we first met Mary, she had just started standing with physical assistance and was only able to tolerate sitting for short periods. She could only get out of the house in a wheelchair.
Here we are again talking about the wonderful benefits of exercise, this time turning our attention to mental health disorders which affect so many people. As Exercise Physiologists, we can help support the exercise and lifestyle components of treatment for people with a mental health condition. This has been proven to improve quality of life for those suffering from mental illness such as depression, anxiety, post-traumatic stress disorder (PTSD) and much more.
Mental health disorders are multifactorial and each need to be addressed to achieve optimal outcomes. So, what are the factors that an Exercise Physiologist can help with?
1. Negative balance in BDNF and neurotransmitters (endorphins) such as dopamine, serotonin, GABA, Acetylcholine (Ach), adrenaline and noradrenaline in the central nervous system (CNS)
2. Negative lifestyle beliefs and behaviour
3. Promote motivation through support, knowledge and accountability
BDNF AND THE ENDORPHINS
Endorphins are neurotransmitters that help regulate emotion, stress, anxiety and pain, while BDNF acts as the fertiliser of the brain that helps maintain and grow the brain circuits which allow neurotransmitters to travel. Low levels of BDNF have been associated with depression, anxiety, schizophrenia, OCD and poor memory. Decreased levels of serotonin and noradrenaline are related to depression and anxiety. Decreased levels of dopamine have been linked to schizophrenia, ADHD and low motivation. Interestingly, reduced GABA levels are evident in people with personality and social disorders. All this may seem alarming but don’t worry, the good news is that there is an abundance of research showing how exercise can increase and sustain levels of BDNF and endorphins. In some instances, even more so than medication.
Aerobic exercise has been shown to best increase levels of BDNF in our bodies, as little as 30 min of jogging 3 days a week has been shown improve brain functioning. Even better gains have been shown with complex activity that require you to acquire a skill. For example, exercises that challenge your balance and thinking. Other research has shown that after 2 weeks of daily exercise, BDNF levels were 150% of baseline! Increased BDNF levels have also been shown to improve serotonin production which can be effective in treating depression. Not only does exercise increase levels of BDNF but also results in a rush of endorphins such as serotonin and dopamine. The message here is that aerobic exercise is essential in increasing levels of BDNF which in return results in improved signalling pathways for endorphins to work and transmit their happy signals.
My primary role as an Exercise Physiologist is to work with the patient to come up with strategies and goals together that will improve overall lifestyle. Patients with mental health disorders present with negative lifestyle beliefs and behaviour, either as cause (causing the disorder) or effect (result of the disorder), and this has several implications. Firstly, it’s easy to say that you need to exercise and it has all these benefits that will help you, but it’s no good if I can’t get the patient to exercise. Compliance can be a very difficult aspect in dealing with these patients and this is because of their negative attitude and belief towards exercise as well as the low motivation and apathetic nature of some of these mental health conditions. Secondly, negative attitude and beliefs result in poor behaviours such as not exercising, because of this it’s seen that people with mental illness are more likely to experience chronic health conditions such as diabetes, cardiovascular disease (CVD) or asthma. For example, people with schizophrenia have been found to be twice as likely to be diagnosed with cardiovascular disease than the broader Australian population. As such, CVD is a major cause of death for those with mental illness.
Ok, so we know that we have to get this population of patients to exercise and maintain a regular routine but how can we do it? Exercise Physiologists are not psychologists, but they are trained in sport/health psychology and motivational interviewing. One such technique we can apply to achieve positive behaviours is Cognitive Behavioural Therapy (CBT). CBT is an effective treatment for a range of mental health issues such as depression and anxiety. It helps the person identify negative thoughts and implement self-help strategies to reach their goals, i.e. desired behaviour (exercise). The main principle behind CBT is that thoughts and feelings dictate behaviour. Therefore, if we can change the way a person thinks about an issue into more positive then we can teach the person techniques and skills to alter their behaviour. For example, a person might think that if they ask how to use a treadmill that they may be ridiculed or asked about their condition and therefore will not use the treadmill. CBT will challenge that thought to a positive one and give a strategy of asking a trainer how to use it. Can also give strategy on how to respond if they are asked about their condition and don’t want to disclose some of it. The end behaviour is healthy safe use of the treadmill. Lack of motivation to exercise can also be due negative beliefs. Education is essential in changing one’s attitude and thoughts towards certain behaviours. Also, activity diary’s, step counts and proper goal setting are strategies implemented by exercise physiologists to change negative lifestyle behaviours.
Take home message is that many people with a mental illness are unaware of how important exercise is in treating their condition when combined with appropriate medication, therefore it is crucial that Doctors and patients are acknowledging the importance of Accredited Exercise Physiologists as part of a multidisciplinary treatment program. Exercise Physiologists help implement, support, guide and progress tailor made exercise programs promoting complience, enjoyment and promoting longevity and therefore influencing results!
ARC's Exercise Physiologists can come to you at home or your local gym to assess you and start a regular exercise program.
Meet Robert! An enthusiastic and witty ex-yachtsman approaching his 89th year.