When it comes to inpatient treatment of a range of mental health and mood disorders – from anxiety and depression to schizophrenia, suicidality and acute psychotic episodes — a new study advocates for exercise, rather than psychotropic medications, as the primary prescription and method of intervention.
Findings from the study reveal that physical exercise is so effective at alleviating patient symptoms that it could reduce patients’ time admitted to acute facilities and reliance on psychotropic medications.
“The general attitude of medicine is that you treat the primary problem first, and exercise was never considered to be a life or death treatment option.
Now that we know it’s so effective, it can become as fundamental as pharmacological intervention,” explains David Tomasi, a lecturer at the University of Vermont, psychotherapist and inpatient psychiatry group therapist at the University of Vermont Medical Center and lead researcher of the study.
In this era of exponential growth of the “metabolic syndrome” and obesity, lifestyle modifications could be a cost-effective way to improve health and quality of life.
Lifestyle modifications can assume especially great importance in individuals with serious mental illness.
Many of these individuals are at a high risk of chronic diseases associated with sedentary behavior and medication side effects, including diabetes, hyperlipidemia, and cardiovascular disease.1
An essential component of lifestyle modification is exercise.
The importance of exercise is not adequately understood or appreciated by patients and mental health professionals alike.
Evidence has suggested that exercise may be an often-neglected intervention in mental health care.2
Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression.3
These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, thus, on the physiologic reactivity to stress.3
This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation.
Other hypotheses that have been proposed to explain the beneficial effects of physical activity on mental health include distraction, self-efficacy, and social interaction.4
While structured group programs can be effective for individuals with serious mental illness, lifestyle changes that focus on the accumulation and increase of moderate-intensity activity throughout the day may be the most appropriate for most patients.1 Interestingly, adherence to physical activity interventions in psychiatric patients appears to be comparable to that in the general population.
Exercise improves mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function.2
Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal.3
Exercise is especially important in patients with schizophrenia since these patients are already vulnerable to obesity and also because of the additional risk of weight gain associated with antipsychotic treatment, especially with the atypical antipsychotics.
Patients suffering from schizophrenia who participated in a 3-month physical conditioning program showed improvements in weight control and reported increased fitness levels, exercise tolerance, reduced blood pressure levels, increased perceived energy levels, and increased upper body and hand grip strength levels.5
Thirty minutes of exercise of moderate intensity, such as brisk walking for 3 days a week, is sufficient for these health benefits. Moreover, these 30 minutes need not to be continuous; three 10-minute walks are believed to be as equally useful as one 30-minute walk.
Health benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients include the following:
- Improved sleep
- Increased interest in sex
- Better endurance
- Stress relief
- Improvement in mood
- Increased energy and stamina
- Reduced tiredness that can increase mental alertness
- Weight reduction
- Reduced cholesterol and improved cardiovascular fitness
Mental health service providers can thus provide effective, evidence-based physical activity interventions for individuals suffering from serious mental illness.
Further studies should be done to understand the impact of combining such interventions with traditional mental health treatment including psychopharmacology and psychotherapy.
Practitioners at inpatient psychiatric facilities – often crowded, acute settings in which patients experience severe distress and discomfort – typically prescribe psychotropic medications first, rather than natural remedies like physical exercise, to alleviate patients’ symptoms such as anger, anxiety and depression.
In fact, Tomasi estimates that only a handful of inpatient psychiatric hospitals in the U.S. provide psychotherapist-supported gym facilities exclusively for these patients.
Instead, practitioners rely on classical psychotherapeutic and pharmacological frameworks to treat psychiatric symptoms, which they monitor to determine when a patient is ready to be discharged from the facility.
Tomasi, in collaboration with UVMMC’s Sheri Gates and Emily Reyns, built a gym exclusively for roughly 100 patients in the medical center’s inpatient psychiatry unit, and led and introduced 60-minute structured exercise and nutrition education programs into their treatment plans.
The psychotherapists surveyed patients on their mood, self-esteem and self-image both before and after the exercise sessions to gauge the effects of exercise on psychiatric symptoms.
Patients reported lower levels of anger, anxiety and depression, higher self-esteem, and overall improved moods.
Tomasi, Gates and Reyns found an average of 95 percent of patients reported that their moods improved after doing the structured exercises, while 63 percent of the patients reported being happy or very happy, as opposed to neutral, sad or very sad, after the exercises.
An average of 91.8 of patients also reported that they were pleased with the way their bodies felt after doing the structured exercises.
David Tomasi, Sheri Gates and Emily Reyns built a gym exclusively for roughly 100 patients in University of Vermont Medical Center’s inpatient psychiatry unit, and led and introduced 60-minute structured exercise and nutrition education programs into their treatment plans.
“The fantastic thing about these results is that, if you’re in a psychotic state, you’re sort of limited with what you can do in terms of talk therapy or psychotherapy.
It’s hard to receive a message through talk therapy in that state, whereas with exercise, you can use your body and not rely on emotional intelligence alone” explains Tomasi.
“The priority is to provide more natural strategies for the treatment of mood disorders, depression and anxiety,” he adds.
“In practice, we hope that every psychiatric facility will include integrative therapies – in our case, exercise in particular – as the primary resource for their patients’ psycho-physical wellbeing.”
University of Vermont
Kaitie Catania – University of Vermont
The image is credited to David Tomasi.
Original Research: Open access
“Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry”. David Tomasi, Sheri Gates, MA, GT, Emily Reyns, MA, R-DMT, MHC, GT.
Global Advances in Health and Medicine. doi:10.1177/2164956119848657