Lorna Rothery spoke to the European Psychiatric Association’s President, Professor Peter Falkai, about the benefits of exercise for mental health.
While exercise has often been seen as an activity for improving physical health, an increasing number of studies have shown the positive effects of exercise for mental health. As well as reducing stress levels, regular exercise has proved to be a valuable intervention for those suffering from mental health conditions including depression, anxiety, and ADHD. One organisation delving further into the mental health benefits of exercise is the European Psychiatric Association (EPA). Founded in 1983, the EPA is the main association representing and promoting psychiatry-related research, treatment, and teaching in Europe and acts as a key mediator at policy level between practitioners, official councils and public authorities on matters relating to mental health. Lorna Rothery spoke to the organisation’s President, Professor Peter Falkai, about the biological processes that occur when we exercise and the interventions that he feels could benefit those suffering from mental health problems, as well as the wider population.
Why is physical activity linked to better mental health? What happens in our brains when we exercise?
When we discuss the impact of exercise on mental health, we refer to the plasticity processes or synaptic plasticity which influence how we learn, communicate, process, and store information. Improved plasticity has been shown to aid concentration as well as short-term memory. Our research shows that this plasticity is myelin based; it is not only small cells communicating within a network but long-ranging connectivity from one area to the other, which is improved through exercise.
Are there certain types of exercise that are associated with improved mental health? How much exercise is necessary to derive the benefits?
Exercising large muscle groups will have the greatest impact; sitting down and playing chess, for example, would not be enough. We have just finished a series of studies called Exercise 3 and we found that small-scale movements are not enough to affect outcome parameters and symptoms related to cognition or mood. As part of this large-scale study, we compared indoor cycling with balance and toning exercises like yoga. If you do bigger moves and use bigger muscle groups that is more beneficial.
In terms of duration, the WHO recommends a minimum of 75 minutes and a maximum of 150 minutes of exercise per week. I always tell my patients that adopting simple, 15 minutes habits per day is a good starting point, like taking the stairs and walking to work, which can amount to a lot of time and become a sustainable part of their routine. At the same time, these short, gentle movements are not going to greatly affect cognition; 30 to 45 minutes of movement three times a week is recommended to see acute improvement in symptoms.
What are some of the key barriers to performing physical activity for people with poor mental health?
Firstly, it is important to note that barriers are often very similar to those of healthy people. Even though we know that there are benefits of exercise for mental health and metabolism, many people do not do it. Literature on this topic often references the impact of upbringing on one’s attitude to exercise; if you are part of a family that has always been active, you likely make exercise or sports part of your weekly routine. Learning from the model early on is important.
Another influencing factor relates to where you exercise and how it is presented. For example, if you exercise as part of a group, or have a personal trainer who can help you reach an optimal level and give you positive feedback, that can be beneficial. I very much support the idea of variables and individuals being able to measure their progress, for instance, setting themselves a goal to reach 10,000 steps per day.
Framing exercise as something that needs to be done regularly can put people off as they think it takes up too much time, especially if they have other responsibilities. It is better to frame it as part of your routine that you do two to three times per week as opposed to a daily chore. Start small and make those small changes like walking to work or taking the stairs; it is about transitioning to being a more active person and generally moving more. People with severe mental illness can often default to sedentary behaviour which can make leading an active life more difficult, so starting with small changes can help.
How can exercise be incorporated alongside other interventions to improve mental wellbeing and what is the interplay between exercise, nutrition, and sleep?
I call this a health package. Leading a healthy lifestyle includes eating varied and nutritious food, getting enough sleep (ideally between six and eight hours) and generally trying to be less sedentary, so standing instead of sitting during your commute in the morning would enable you to keep some tension in your muscles, for example.
Social contact is also hugely influential for our long-term health. Positive social connections are defined in studies as having people in your life who would be willing to help you if asked. If you have a network of 25 to 30 people, including friends online, and you are in contact regularly, this can be hugely beneficial for your mental health.
We are seeing increases in levels of sedentary behaviour and poor mental health, and often people avoid exercising at times when it could have the greatest benefit. How can policymakers and stakeholders across healthcare help to change the narrative around exercise?
I would say there are two things that we are lacking; firstly, we need to have programmes which are actually evaluated. From a research point of view-and this is one of my next focus areas – we need to understand how such programmes could be made more accessible. For example, how can we effectively encourage people to incorporate small, 15-minute daily habits which are easy to monitor and provide them with feedback so they can track their progress? I think this level of supervision could especially benefit those suffering from mental ill health.
As patients start to recover, very simple changes to their daily routine can make a big difference, so it might be that they have goals or prompts like getting out of bed before 9am, remembering to drink enough fluids, taking their medication or meeting with friends. Social contact is really important for people who are unable to work because of their mental health, and equally for retired people who could benefit from more structure in their day. Lack of routine can be detrimental for people, and I think we need programmes that support people at different phases of their lives – from childhood through to retirement age. We should look at the minimum level of sports in schools that could help prevent depression in later life, because we know from large studies that exercise can prevent the condition. Often when people leave education and have other responsibilities like owning a house, going to work, looking after children etc., exercise becomes secondary, we need health programmes that support people to exercise throughout their lives.
Are there any notable developments or current issues in this area of research that you would like to highlight?
Besides the aforementioned variables, something like a stress ring which can measure your cortisol levels would be beneficial because a lot of people are stressed but have no way of measuring or monitoring how they feel. For me, the next step besides the programmes is really about honing in on things like emotional wellbeing or blood pressure and enabling people to monitor those on a day-to-day basis. Such interventions must be easy for people to use and not feel overwhelming.
I am personally interested in understanding why exercise for mental health is beneficial on a molecular level, and this is something myself and my team are currently focused on. Once we understand the biology underlining exercise, it is easier to explain the benefits of exercise for mental health to patients. Only 50% of people benefit from exercise, so we need to target and identify that other 50% early on and help them implement changes and decipher what type of exercise and dosage would benefit them.
Prof Dr Med Peter Falkai
President
European Psychiatric Association
https://fr.linkedin.com/company/european-psychiatric-association
https://www.facebook.com/europsy/
https://twitter.com/euro_psychiatry
https://www.instagram.com/euro_psychiatry/
This article is from issue 24 of Health Europa Quarterly. Click here to get your free subscription today.
