Can exercise help with mental health?

Exercise and Mental Health: Benefits and Implementation

Exercise is highly effective for improving mental health and should be recommended as a complementary treatment for various mental disorders, particularly depression and anxiety. 1

Evidence for Exercise in Mental Health

Benefits for Specific Mental Health Conditions

• Depression:

  • Meta-analyses in adults with depression show positive effects of exercise on depressive symptoms 1
  • A Cochrane review reported a large clinical effect with a standardized mean difference of −0.82 of physical exercise on depressive symptoms 1
  • Exercise interventions using at least 90 minutes of moderate to vigorous activity per week significantly reduce symptoms in people with schizophrenia and other psychotic disorders 1

• Anxiety:

  • Regular exercise reduces anxiety symptoms, with benefits comparable to meditation or relaxation 2
  • Acute anxiety tends to respond better to exercise than chronic anxiety 2

• Cancer-related distress:

  • Aerobic exercise for patients with hematologic malignancies may reduce depression (standardized mean difference 0.25; 95% CI, 0.00–0.50; P=.05) 1
  • Exercise during and after cancer treatment improves cardiovascular fitness, strength, balance, body composition, and quality of life 1

• Post-stroke depression:

  • Exercise appears to have a small beneficial effect on depressive symptoms across both subacute and chronic stages of stroke recovery 1
  • Meta-analysis of 13 studies found that depressive symptoms after stroke were lower after ≥4 weeks of exercise (standardized mean difference=−0.13 [95% CI, −0.26 to −0.01]) 1

Physiological Mechanisms

Exercise may improve mental health through several mechanisms:

1. Hormonal regulation:

   • Improved regulation of hypothalamic-pituitary-adrenal responses, which are often dysregulated in depression 1
   • Positive effects on endorphins and neurotransmitters 3

2. Immune function:

   • Regular exercise serves as a nonpharmacological stimulus for enhancing immune function 1
   • Reduces inflammation via several different processes 3

3. Cognitive benefits:

   • Improves global cognition in schizophrenia 1
   • May enhance cognitive function in older adults 4

Psychological Mechanisms

1. Social interaction:

   • Social contact through group exercise may be beneficial for individuals with depression 1
   • Can improve social skills 5

2. Self-perception:

   • Enhances self-esteem and physical self-perceptions 4
   • Improves body image 5

3. Mood enhancement:

   • Both aerobic and resistance exercise enhance mood states 4
   • Reduces state and trait anxiety 4

Exercise Prescription for Mental Health

Recommended Exercise Parameters

• Duration and frequency:

  • At least 90 minutes of moderate to vigorous activity per week for significant mental health benefits 1
  • Regular, consistent exercise shows better outcomes than sporadic activity

• Type of exercise:

  • Both aerobic exercise and resistance training show benefits for mental health 1
  • Muscular strength and resistance training may improve mental health with effects that persist over and above aerobic exercise alone 1

• Supervision:

  • Supervised exercise interventions delivered by trained exercise professionals show better outcomes 1
  • Can be delivered within mental health services or through referral to community-based programs 1

Implementation Considerations

• Initial assessment:

  • Evaluate baseline physical fitness and mental health symptoms
  • Consider any physical limitations or contraindications

• Progression:

  • Start with manageable goals and gradually increase intensity and duration
  • Focus on consistency rather than intensity initially

• Monitoring:

  • Regular follow-up to assess both physical and mental health outcomes
  • Be aware that benefits may not persist after exercise is terminated 1

Important Caveats and Considerations

• Sustainability:

  • Effects of exercise on depressive symptoms may not be retained after exercise is terminated, highlighting the importance of ongoing activity 1

• Individual variation:

  • Large variations in response suggest that subgroups might benefit differently from exercise interventions 1

• Overtraining risk:

  • Excessive physical activity may lead to overtraining and generate psychological symptoms that mimic depression 2

• Complementary approach:

  • Exercise should be considered as part of a comprehensive treatment plan that may include pharmacotherapy and psychotherapy when appropriate 1

• Special populations:

  • Exercise appears beneficial for adolescents and older adults with depression or anxiety, though studies have been limited 2

Exercise represents a cost-effective, accessible intervention with minimal side effects that can significantly improve mental health outcomes across various conditions. The evidence strongly supports incorporating structured physical activity into treatment plans for individuals with mental health concerns.