Q&A: Physical activity is 'an effective intervention for mental health conditions'

Key takeaways:

• An umbrella review revealed that physical activity was linked to a 43% reduction in mental health symptoms.
• PCPs should encourage their patients to find an activity that they enjoy and exercise more.

Physical activity was associated with improvements in mental health conditions compared with usual care, and primary care physicians should discuss the benefits of it with their patients, according to researchers.

Ben Singh, PhD, a research fellow at the University of South Australia, and colleagues conducted an umbrella review to synthesize the evidence on the impacts of physical activity on symptoms of anxiety, depression and psychological distress among adults.

They included 97 systematic reviews with meta-analyses of randomized controlled trials involving a total of 128,119 participants.

Healio spoke with Singh to learn more about the study, mechanisms underlying the findings, what PCPs need to know and more.

Healio: Why did you decide to research this subject?

Singh: I decided to research this subject because I was interested in the potential benefits of physical activity for mental health. There has been a growing body of evidence in recent years that suggests that physical activity can be an effective intervention for depression, anxiety and other mental health conditions. I wanted to take a systematic look at the research to see what we know about the effectiveness of physical activity interventions for improving mental health. Furthermore, during the COVID-19 pandemic, there were increases in the rates of mental health conditions worldwide. Therefore, I felt it was important to evaluate an intervention that was cost-effective and accessible for individuals.

Healio: Will you briefly describe your findings and their importance?

Singh: Findings:

• Physical activity is effective for reducing symptoms of depression, anxiety and psychological distress.
• The effects of physical activity are similar across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease.
• Higher intensity physical activity is associated with greater improvements in symptoms.
• The effectiveness of physical activity interventions diminishes with longer duration interventions.

Importance:

• These findings provide strong evidence that physical activity is an effective intervention for mental health conditions.
• This is important because depression and anxiety are common mental health conditions that can have a significant impact on people's lives.
• Physical activity is a safe and inexpensive intervention that can be easily implemented in primary care settings.

The findings of the review showed that physical activity is effective for reducing symptoms of depression, anxiety and psychological distress. The median effect size for physical activity interventions was –0.43, which means that physical activity was associated with a 43% reduction in symptoms compared with usual care. This is a medium effect size, which is considered to be a clinically significant effect.

The review also found that the effects of physical activity are similar across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. However, the largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women and in healthy individuals.

The review also found that higher intensity physical activity was associated with greater improvements in symptoms. This is consistent with previous research, which has shown that moderate-to-vigorous intensity physical activity is more effective for improving mental health than low-intensity physical activity.

Finally, the review found that the effectiveness of physical activity interventions diminishes with longer duration interventions. This is likely because the benefits of physical activity plateau after a certain amount of time.

Overall, the findings of this umbrella review provide strong evidence that physical activity is an effective intervention for mental health conditions. This is important because depression and anxiety are common mental health conditions that can have a significant impact on people's lives. Physical activity is a safe and inexpensive intervention that can be easily implemented in primary care settings.

Healio: What are the mechanisms underlying the associations here?

Singh: The mechanisms underlying the associations between physical activity and mental health are not fully understood. However, there are a number of possible mechanisms that have been proposed. It is likely that a combination of these mechanisms is responsible for the beneficial effects of physical activity on mental health.

Here are some specific examples of how physical activity can improve mental health:

• Improved mood: Studies have shown that physical activity can increase levels of endorphins, which are hormones that have mood-boosting effects. Endorphins are released during physical activity, and they can help to reduce feelings of pain, stress and anxiety.
• Reduced stress: Physical activity can help to reduce stress levels by increasing heart rate and respiration, which can help to flush out stress hormones from the body. Physical activity can also help to distract people from stressful thoughts and feelings.
• Improved sleep: Physical activity can help to improve sleep quality by making it easier to fall asleep and by increasing the amount of time spent in deep sleep. Deep sleep is important for mood regulation and cognitive function.
• Increased social interaction: Physical activity can help people to connect with others by participating in group activities or by joining a sports team. Social interaction is important for mental health, as it can help to reduce loneliness and isolation.
• Changes in brain chemistry: Physical activity can lead to changes in brain chemistry, such as increased levels of neurotransmitters that are involved in mood regulation. For example, physical activity can increase levels of serotonin, which is a neurotransmitter that is associated with feelings of well-being.

Healio: What should PCPs take away from the study? Is there anything they should be telling their patients?

Singh: PCPs should take away from this study that physical activity is an effective intervention for mental health conditions. They should be encouraged to discuss the benefits of physical activity with their patients and to refer patients to physical activity programs.

Here are some specific things that PCPs can tell their patients:

• Physical activity can help to improve your mood.
• Physical activity can help to reduce your stress levels.
• Physical activity can help you to sleep better.
• Physical activity can help you to connect with others.
• Physical activity is a safe and inexpensive intervention that can be easily implemented in your daily life.

PCPs should also be aware of the following:

• The benefits of physical activity are cumulative. The more physical activity you do, the greater the benefits.
• Any amount of physical activity is better than none. Even a short walk can have a positive impact on your mental health.
• It is important to find an activity that you enjoy and that fits into your lifestyle. If you don't enjoy an activity, you are less likely to stick with it.
• There are many different ways to be physically active. You don't have to run a marathon to reap the benefits of physical activity. You can walk, swim, bike, dance or do any other activity that you enjoy.

Overall, physical activity is a safe and effective way to improve mental health. PCPs should encourage their patients to be physically active and to find an activity that they enjoy.

Healio: Is there anything else you would like to add?

Singh: Exercise should not be seen as a replacement for current treatments such as medications but instead be seen as an adjunct treatment. That is, a comprehensive treatment approach for a patient may include a combination of medications, counseling plus exercise. Although exercise can offer numerous physical health benefits, it also has positive effects on mental well-being. Regular physical activity has been shown to have a positive impact on mood, reduce stress, alleviate symptoms of anxiety and depression and improve overall psychological well-being.

However, it's essential to understand that exercise should not be considered a standalone treatment for severe mental health conditions. If someone is struggling with significant mental health challenges, such as severe depression, bipolar disorder or any other mental illness, it is crucial to seek professional help from qualified mental health practitioners. Professional treatment might involve therapy, counseling, medication or a combination of these approaches, depending on the individual's needs.

In many cases, exercise can complement and enhance the effects of professional mental health treatment. It can serve as a supportive tool to manage symptoms, improve self-esteem, and promote a sense of accomplishment and routine, all of which can contribute positively to a person's overall mental health. It's always essential for individuals to consult with their healthcare providers and mental health professionals to develop a comprehensive treatment plan tailored to their specific needs and conditions.

Reference:

• Singh B, et al. Br J Sports Med. 2023;doi:10.1136/bjsports-2022-106195.