On Exercise and Mental Health
Life is not an endurance race, but it often feels like it is, not necessarily in a competitive sense—although, hey, sure—but just in the effort we must exert.
The endurance aspect comes from the constant, moderate-intensity steady state effort just to get by day to day. Then, there are periods where we have to crank up the output, as if we’re going uphill; maybe it starts to rain, so our focus needs to increase so that we don’t slip, fall, and get injured. Maybe the terrain stays more or less even, and then obstacles come out of nowhere, like hurdles we have to jump. Sometimes, it’s like an obstacle course, like American Ninja Warrior or Wipe Out.
It helps to know that life is seasonal and cyclical. No period is everlasting. Hard times will end, and easy times will ramp up into more difficult ones. As a college teacher, I’ve had many conversations over the years with students about these patterns, reminding them of it all, helping them to know what to expect with the hope of mitigating some of the distress they’re likely to experience.
One problem is that we often don’t know which season we’re in until we’re in the middle of it. With a college schedule, it’s a little easier to identify. College coursework has a requisite level of moderate-intensity needed as a baseline, and then there are tentpole assignments, papers, and exams that mark the several peaks of the mountain range. In real life, the seasons are more difficult to identify because there are not often those strict and stark delineations.
I often remind students of these cycles because it affects their mental health, and as we approach the middle of the semester, these issues become more salient.
Last month, I wrote about how to lose weight, what to expect, considerations for successful outcomes, some of its effects, and what to do about problems that may arise. Body changes should also be seen as seasonal: periods of weight loss, weight maintenance, and even weight gain, and neither weight loss nor weight gain should be looked at as open-ended or indefinite.
This month, I’ve examined the benefits of exercise, hopefully in ways that we don’t often think about: as a vehicle for stimulating repair molecules that work on brain and nerve cells; for mitigating chronic health conditions; and as a tool if not a weapon to combat aging and frailty.
Then, how does exercise fare with mental health? That is, does it help? If so, how much or how little? Is it neutral; that is, is there no effect?
One systematic review1 looks at these very questions.
Researchers pooled together 97 reviews, consisting of over 1,000 trials and almost 130,000 participants. Participants included healthy adults, as well as adults with chronic health conditions and mental health conditions. The researchers noted that they wanted to have a large and representative sample of the total population, as opposed to just studying the effects of exercise on a certain subgroup.
They also looked at different forms of exercise as well as different frequencies (days/week), durations (session times), and intensities. (Think of intensity as level of effort exerted—sprinting versus walking, for example.)
Here are some of the key takeaways that the researchers found:
“PA [physical activity] interventions are effective in improving symptoms of depression and anxiety.”
“PA was effective at reducing depression and anxiety across all clinical conditions, though the magnitude of the benefit varied between clinical groups.”
“The larger effect sizes observed in clinical populations may reflect that these populations experience above-average symptoms of depression and anxiety and have low PA levels, and, therefore, have a greater scope for improvement compared with non-clinical populations.”
Specifically, regarding exercise protocols, the researchers found that:
“All PA modes were beneficial, including aerobic, resistance, mixed-mode exercise and yoga.”
They noted how different forms of activities result in different physiological and psychological effects.
For depression, resistance exercise has the strongest effects.
For anxiety, yoga and similar mind/body exercises activities has the strongest effects.
For intensity, “moderate-intensity and high-intensity PA modes were more effective than lower intensities.”
I’m also someone who has endured many prolonged bouts of both anxiety and depression, but it wasn’t until the last couple of years that I even realized it, and like identifying those difficult seasons, these situations aren’t always obvious to us when we’re in the middle of them. Fortunately, exercise is a way to harness and expel some of that energy.
It’s not the clinical definition, but constant low-grade anxiety is feeling like the world is slowly coming down on you. Severe anxiety is feeling like you’re in an emergency situation, both of which often manifest physiologically in elevated heart rates and adrenaline pulses. It’s not hyperbole to say that the body’s fight-or-flight mechanisms kick in. Another problem is that these physical symptoms are coupled with negative thoughts, which are often the triggers too.
It’s difficult to focus on these thoughts when you have a couple hundred pounds on your back, in your hands, and over your head. It’s difficult to focus on these thoughts when you’re trying to cover some distance as fast as you can. It’s not impossible, just difficult.
And when you’re finished with the exercise, even if you’re thoughts return to those negative places, you’re physically tapped out. It’s like the body says, “Sorry. I can’t serve those feelings at this time. Please try again later.”
What might also add to the mental health benefits of exercise are the social effects.
Like most people, I’m a kind of a lone wolf in the gym—not anti-social by any means but just minding my business and doing my work—but I see plenty of others who work out in pairs, with friends or romantic partners. And there have been times when I’ve run into people I know, as well as had short conversations with fellow gym-goers. Even if you’re not necessarily interacting with people, it helps to be around others, especially if you’re all doing something that you all value.
Then, there are opportunities for more bonding in social groups. Many gyms offer group classes, such as cycling and aerobics like Zumba. There are also types of skill-based workouts, dance classes like ballet, yoga classes, gymnastics, and various martial arts and combat sports.
There’s also CrossFit, which sort of redefined workout communities. Often, CrossFit boxes—their name for gyms—will have partner and/or team WODs (workout-of-the-day). These are mini-competitions and races between groups. In the CrossFit games, there are also team competitions, and some of the events require the whole team to move a load together, like a group deadlift with a load that’s too heavy for any individual. Such a movement requires coordination and communication. Teamwork.
On the topic of sport, another systematic review looked at “mental health through sport”.2 The authors found that adults who participate in any kind of sport, individual or team-based, have better mental health outcomes, and team sports had better outcomes over individual ones.
The evidence indicates that participation in sport (community and elite) is related to better mental health, including improved psychological well-being (for example, higher self-esteem and life satisfaction) and lower psychological ill-being (for example, reduced levels of depression, anxiety, and stress), and improved social outcomes (for example, improved self-control, pro-social behavior, interpersonal communication, and fostering a sense of belonging).
To further illustrate the efficacy and potency of exercise on our mental wellbeing, another systematic review3 looked at exercise interventions and compared them to antidepressant interventions among adults with non-severe depression. (“Non-severe” is a clinical distinction, but any level of depression is serious and severe to the person experiencing it. “Non-severe depression was defined as a diagnosis of major depressive disorder with mild-to-moderate symptoms.”)
This review included 21 randomized control trials with over 2,500 participants. The authors concluded that there is “no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression.”
To add my two cents to all this, there’s also the satisfaction of making progress, being able to cover more distance in a shorter time, to be able to move heavier loads, move a given load more times, or even to be able to do any of these with lower perceived effort.
As I’ve mentioned from time to time, sometimes it’s also a little scary—in a good way—to try and attempt something that challenges your physical limits, and when you succeed, there’s a sense of accomplishment. It’s gratifying and rewarding.
More than the satisfaction and the accomplishment is simply knowing that you succeeded at doing something hard, and you’re better and stronger, physically and mentally, for having done so.
If I were going to prescribe an exercise routine that focuses on just mental health outcomes, I’d program some cardio work that involves a day of moderate-intensity work and another that focuses on high-intensity; I’d include at least a couple of days of resistance training; I’d also want to put in a session or two or dedicate some time after the other workouts to mobility and flexibility work, like yoga. Finally, I’d want to put in at least a day of some class or group-based work.
Actually, that’s not too far off from what I personally do, not that that’s the only way to do things. It includes a lot of what I like and works towards my fitness goals. As I mostly aim for physical results, though, I also know that there are benefits towards my mental health.
The great thing is that we don’t have to just focus on mental or physical health outcomes with exercise. There’s a lot of overlap between the two, and sometimes, they align right on top of each other, like a stencil lining up with a drawing.
We all experience hard times. That’s what it means to be human. Just remember, it’s seasonal, but sometimes those seasons are longer than we feel like we can handle, and sometimes those hard seasons come in a series.
Exercise and physical activity are not a panacea, a cure-all, but it’s a great place to start. With prescription medications, there are always side effects, but with exercise, the side effects are feeling good, getting jacked, and maybe even making some friends.
Like pushing a stalled car, the hardest part with exercise is getting started, that initial push where we overcome the stopped weight. We don’t need a perfect push or a perfect start. We just need to get it going, and once the car is rolling, it’s a lot easier to maintain the momentum, and we might actually catch a slight decline at some point, and we can jump on just go for a ride.
