Chapter 10: Psychology of Physical Activity

By Laura Ellingson-Sayen, PhD

Learning Objectives

• Evaluate the effectiveness of physical activity and structured exercise in preventing and managing mental health conditions, including depression and anxiety.

• Identify common barriers to the implementation of physical activity interventions in clinical practice, including patient-level and systemic socio-ecological factors.

• Describe the relationship between mental health disorders and physical health issues, including comorbid conditions such as cardiovascular diseases and diabetes.

Chapter Content

Mental health is a growing concern in the United States. Data from the State of Mental Health in America 2023 Report highlighted that approximately 21% of the U.S. adult population reported experiencing a mental health disorder. This equates to over 50 million Americans. Moreover, on average 16% of youth (>2.7 million individuals) reported experiencing at least one major depressive episode over the past year. Here in Oregon, the state of mental health is nearly the worst in the nation – Oregon ranks 50^th out of 51 states (including Washington DC) with respect to the overall mental health ranking; only Kansas is worse off. This is based on higher rates of mental illness among adults (27.3% of state population) and among youth (21% reporting a major depressive episode) in combination with low rates of access to mental healthcare.

Mental health is complex and no treatment is universally effective. The most commonly prescribed treatments are medication and psychotherapy. However, these therapies are not effective for everyone and lack of access as well as stigma against receiving treatment results in a large number of individuals who live with mental health conditions. Fortunately, there is solid research evidence that physical activity can be effective for treating, and perhaps even preventing, several mental health conditions.

Below is a summary of a narrative review published in 2021 by Felipe Schuch and Davy Vancampfort regarding the state of the science with respect to using physical activity as a treatment for mental health disorders

Physical Activity, Exercise, and Mental Disorders: It is Time to Move On

by Felipe Barreto Schuch and Davy Vancampfort

Introduction

Physical activity (any bodily movement that results in energy expenditure) and exercise (its structured form) are crucial for public health, preventing and treating numerous physical conditions such as metabolic and cardiovascular diseases, and obesity. They also play a significant role in mental health. This article reviews evidence on the preventive effects of physical activity on mental health conditions like depression and anxiety, its role in promoting physical health among people with mental health conditions, and its efficacy in managing mental health symptoms. It also discusses the challenges and barriers to implementing exercise in clinical practice.

Mental Health Burden and Current Treatments

Mental health conditions affect approximately 12% of the global population, contributing to about 5% of disability-adjusted life years and 16% of years lived with disability worldwide. People with mental health conditions like depression, bipolar disorder and generalized anxiety disorder, among others, often have comorbid health conditions, leading to a shorter life expectancy by 15 to 20 years compared to the general population. Factors contributing to this include genetic vulnerabilities, side effects of treatments, and unhealthy lifestyles.

Spending on mental health care, especially pharmacological treatments, has increased significantly, but the prevalence of mental health conditions remains stable or even rising among younger generations. Pharmacological treatments are still the primary strategy, but their long-term effectiveness is questioned due to side effects and limited clinical improvement, highlighting the need for additional approaches.

Preventive Effects of Physical Activity

Physical activity is a modifiable protective factor against some mental health conditions. A meta-analysis (a study of studies) including 49 prospective studies with over 260,000 participants showed that higher physical activity levels reduce the likelihood of developing depression. This finding is supported by Mendelian randomization studies which use knowledge of genetics to examine whether participation in physical activity protects individuals with a predisposition to mental health conditions. Results from these studies suggest a causal protective effect of physical activity against depression.

Similarly, physical activity has protective effects against anxiety. A meta-analysis of 11 prospective studies with over 69,000 participants demonstrated that higher levels of physical activity significantly reduced incident anxiety. However, evidence on the protective effects of physical activity against other conditions like bipolar disorder and schizophrenia is limited and conflicting.

Physical Health Benefits for People with Mental Health Conditions

People with severe mental health conditions are often more sedentary and less physically active than the general population, leading to higher rates of physical health issues like diabetes and cardiovascular diseases. Exercise programs can reduce body weight, waist circumference, and improve lipid profiles in people with depression and schizophrenia. Additionally, exercise increases aerobic capacity, reducing the risk of cardiovascular mortality.

Managing Mental Health Symptoms

International guidelines now recommend incorporating physical activity and exercise into mental health care. Exercise has been shown to significantly reduce depressive symptoms in people with depression, improve cognitive function, and enhance quality of life. It also reduces anxiety symptoms and improves total symptoms, positive symptoms, and negative symptoms in people with schizophrenia.

Barriers to Implementation

Despite the benefits, translating these findings into clinical practice is slow due to various barriers. Mental health professionals often do not prescribe exercise, believing it to be the responsibility of exercise professionals. A multidisciplinary approach is needed, where all healthcare providers collaborate to promote physical activity.

Patient-level barriers include poor physical health, fatigue, high stress, and lack of motivation. Cognitive-behavioral strategies that enhance autonomous motivation can help overcome these barriers. Systemic socio-ecological barriers like lack of social support and access to exercise facilities also hinder the adoption of physical activity interventions.

In conclusion, increasing physical activity levels at the population level can reduce the prevalence of mental health conditions. For people with these conditions, regular physical activity can significantly improve physical health and reduce mental health symptoms. Implementing these interventions requires a multidisciplinary approach involving all mental health professionals. Training for healthcare providers on exercise prescription and mental health care is crucial for effectively integrating these interventions into routine care.