SHORT GUIDE:
ANXIETY, DEPRESSION AND EXERCISE @ THE_MOVEMENT_LAB
SHORT GUIDE:
ANXIETY, DEPRESSION AND EXERCISE BY THE_MOVEMENT_LAB
I hope you enjoy this short guide. Please feel free to get in touch with any questions. Email: the movement.lab@outlook.com
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THE ROLE OF EXERCISE IN REDUCING ANXIETY AND DEPRESSION Statistics from the World Health Organization (WHO) estimate 300 million people suffer from depression worldwide, with depression ranked the number one contributor to global disability. Bebbington, (2006) stated one in six adults in the United Kingdom suffers from a mental health condition, such as depression or anxiety. Statistics like this highlight the importance of effective treatment. Anti-depression medication is often prescribed to treat depression, but compliance with taking these medications is often poor and they can lead to negative side effects (Hopker, 2001). Treatment protocols for depression primarily focus on pharmacological interventions and/or psychological therapies. However, based on prevalent figures, exercise can now be considered as a viable allied or alternative therapeutic strategy within the mental health treatment process (Pederson, et al. 2015).
KEY BENEFITS OF PHYSICAL ACTIVITY
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Exercise is associated with increased mental alertness Exercise can lead to an increase in energy and positive mood Exercise can lead to an increase in selfesteem Exercise results in the reduction of stress and anxiety Exercise can prevent the development of mental health Exercise can improve the quality of life of those who experience mental health problems.
“EXERCISE GIVES YOU ENERGY. IT WILL LIFT YOUR MOOD AND METAL STATE AND MAKE YOU FEEL GOOD” Joe Wicks (The Body Coach), 2020.
DEFINING PHYSICAL ACTIVITY Physical Activity means any movement of your body that uses your muscles and expends energy. One of the great things about physical activity is that there are many activities to explore.
The main thing is to find a physical activity that you enjoy and are likely to adhere to. Accepting there may be days where you don’t want to exercise is completely normal. Some days you may be more motivated to do exercise, but remember you will likely feel better after taking part in physical activity.
ACSM- PHYSICAL ACTIVITY QUALITY & QUANTITY GUIDELINES Cardiorespiratory Exercise: Adults should get at least 150 minutes of moderate-intensity exercise per week. Exercise recommendations can be met through 30 to 60 minutes of moderate-intensity exercise five days per week or 20 to 60 minutes of vigorous-intensity exercise three days per week. One continuous session and multiple shorter sessions of at least 10 minutes are both acceptable to accumulate the desired amount of daily exercise. Resistance Exercise: Adults should train each major muscle group two or three days each week using a variety of exercises and equipment. Very light or light intensity is best for older individuals or previously sedentary adults just starting to exercise. Two to four sets of each exercise, with anywhere between eight and 20 repetitions, will help adults improve strength and power. Flexibility Exercise: Adults should do flexibility exercises at least two or three days each week to improve range of motion. Each stretch should be held for 10 to 30 seconds, to the point of tightness or slight discomfort. Repeat each stretch two to four times, accumulating 60 seconds per stretch. Neurometer Exercise: Neuromotor exercise, also referred to as "functional fitness training," is recommended two or three days per week. Exercises should involve motor skills (balance, agility, coordination and gait), proprioceptive exercise training, and multifaceted activities (yoga) to improve physical function and prevent falls in older adults. Between 20 and 30 minutes per day is appropriate for neuromotor exercise.
UNDERSTANDING MOTIVATION By now we have an understanding of what physical activity is and the benefits physical activity can have on depression and anxiety. Implementing forms of physical activity can often be easier said than done. Individuals may find it easier or more difficult to exercise, which ultimately stems from motivation. Motivation underlies all aspects of human behaviour and can help to explain why people do what they do. At times, though, it may be difficult to understand your own motivation. Sometimes you will have a clear idea of what you are intending to achieve by your behaviour and the motivation behind it. There may be other times, however, when your motivations are less clear. A classic textbook definition of motivation is given by Mullins, (2002), who says that motivation is a ‘driving force’ through which people strive to achieve their goals and fulfil a need or uphold a value. The important words here are ‘needs’, ‘values’ and ‘goals’ and these are the building blocks of motivation that lead to actions: needs are basic requirements for survival and may be physical or psychological, for example, hunger, thirst, love or friendship. Values are the things that we consider to be most important, for example, family, health or wealth. Goals are the outcomes that we are working towards. It is important to understand some of the theories behind motivation. The interaction view is the most popular approach to motivation as it considers both personality and situation.
MOTIVATION APPROACHES NAME
BRIEF APPLICATION EXPLANATION
CRITICISM
Traitcentred view
Motivation is due to a persons individual characteristic s e.g personality
Personality will predict whether or not they will be motivated
Ignores the influence the situation may have on the individual
Situationcentred view
Theory says that motivation is determined by the situation
The environment needs to be constructed to ensure the individual is motivated
Some individuals will remain motivated despite a negative environment
Interaction al View
To understand motivation fully, you need to consider both personality and the situation and how they interact
Different personalities will respond in different ways depending on the demands of the environment.
Some personalities will remain unaffected by changing environments
EXERCISE MODALITIES Inactivity and increased sitting time are associated with numerous diseases such as obesity, type 2 diabetes, hypertension, and metabolic syndrome (Shmitz, et al. 2004). Individuals who are affected by an anxiety disorder tend to have large amounts of sedentary time and fail to meet exercise guidelines which puts them at an increased risk of chronic diseases associated with low physical activity. Therefore, a carefully designed exercise program should include goals that are specific to improving fitness, decreasing muscle tension, improving cardiovascular risk factors, mood, and decreasing the negative effects of anxiety disorders (Callaghan, 2004). Exercise should be carefully planned to avoid any increase in anxiety.The avoidance of physical activity and exercise may result in the individual having a lower fitness level and increased fatigue on exertion, thereby inducing a negative impact on health. It should be further added that a carefully planned program will reduce the likelihood of injury and will likely support adherence. A zero to one hundred approach is not recommended. The following section will discuss some of the science linking aerobic exercise, strength and yoga & flexibility training and the effects of mental health.
AEROBIC EXERCISE Broocks et al. (2007) investigated the efficacy of aerobic exercise, Clomipramine, and a placebo pill in a group of subjects suffering from moderate to severe panic disorder. Treatment was randomised, and results of the study revealed a significant improvement in anxiety scores for aerobic exercise. In addition, patients taking Clomipramine along with aerobic exercise demonstrated the greatest improvement in anxiety scores. In another study, researchers demonstrated an improvement in mood in patients with post-traumatic stress syndrome after completing 30 minutes of moderate intensity exercise (70–75% maximum heart rate). Other investigations using interval training as the exercise mode have documented improvements in aerobic capacity and lower depression scores (Brown, 2005).
RESISTANCE TRAINING Resistance training is an exercise modality that has a positive influence on muscular strength, endurance, bone density, and body composition. Cassilhas, (2017) states individuals who are coping with an anxiety disorder that partake in resistance exercise training have responded well with a decrease in anxiety, improved mood, decreased worry, decreased depression, increased cognition, and reductions in cardiovascular responses to mental stress. Research has found that when state anxiety levels are elevated before exercise, there is a resulting decrease in state anxiety independent of intensity. Strickland, (2009) suggest using a low to moderate intensity (70% one repetition maximum [1RM]) load to improve feelings of anxiety. Cavaretta et al also suggest using lower intensity (50– 70% 1RM). However, Sjogren et al. (2006) found a light intensity of 30% 1RM was too low to reduce anxiety, which suggests a threshold may exist for resistance training to improve anxiety. longer rest periods seem to be more effective on psychological states than shorter rest periods. Reevaluating 1RM every 8 weeks and adjusting percentage of 1RM to new 1RM value is advised to continue overload. Comparison of intensity has demonstrated highintensity progressive resistance training had a greater effect on mental states than low-intensity progressive resistance training or standard care (pharmacotherapy and/or counselling) from a general practitioner (Brown, 2005).
YOGA AND FLEXIBILITY Yoga is an alternative form of exercise consisting of various physical postures, breathing techniques, and meditation. Individuals who are dealing with an anxiety disorder who participated in yoga have reported reduced anxiety, mental stress, and depression while experiencing positive swings in moods, memory, and overall quality of life (Gangadhar, et al 2016). Gangadhar, et al. (2016) furthermore suggest, participating in yoga with or without taking medications has reportedly better therapeutic effects than taking medications alone. It has been hypothesized that breathing patterns associated with yoga may influence autonomic function, thereby improving emotion, stress, and cognition (Brown, 2008). Yoga and meditation have the benefits of being low cost, can be performed at home, and have a positive effect on symptoms associated with anxiety. Flexibility is also an important component of health and fitness. Poor flexibility often results in limited range of motion, tight muscles, and poor balance. Research regarding improvements in anxiety and depression scores as a result of stretching is lacking. In a randomised controlled study, static stretching consisting of a 20-second stretch and 40- second relaxation period, resulted in a 22% reduction in anxiety scores (Brown, 2005).
8 WEEK COMPREHENSIVE PLAN MODE
INTESNIT Y
FREQUECNY
DURATION
PROGRESSION
Aerobic: Cycling, Swimming laps, Rowing, Running
Moderat e40-70% HRR or low30-50% HRR
3 days per week
3 min moderate intensity following 2 min low, 3 min moderate and 2 min low
After 4 weeks, increase moderate time to 5 min and add 3rd set after additional 2 week>10min
Strength/ Resistance: Leg press, Leg curl, Leg extension, Row, Lat pull down, Shoulder press, Heel raise, Abdominal crunches
30-40% 1RM, 2 sets of 8-12 repetitio ns, or failure with 3min rest between sets
2 days per week, 48 hours between workouts
8 weeks
Increase percent 1RM by 10%
Flexibility: Quads stretch, Trunk flex, Towel stretch, Neck rotations
Static stretches to just below pain threshold
Dailypreferably after cooldown
4 repetitions for 10 seconds per stretch
Increase duration for each stretch by 2 seconds every 2 weeks
Warm-up/ cool down
Low intensity
Before & after 10 mins workout
N/A
8 WEEK SECOND WEEK PLAN MODE
INTESNITY
FREQUECN Y
DURATION
PROGRESSION
Aerobic: Cycling, Swimming laps, Rowing, Running
Low30-40% HRR, Moderate40-70, Heavy65-80% HRR
3 days per week
30 min moderate intensity
After 4 weeks, increase intensity to heavy and decrease duration by 5 minutes
Strength/ Resistance: Leg press, Leg curl, Leg extension, Row, Lat pull down, Shoulder press, Heel raise, Abdominal crunches
50-70% 1RM, 2 sets of 8-12 repetitions , or failure with 3-min rest between sets
2 days per week, 48 hours between workouts
8 weeks
Increase percent 1RM by 10%
Flexibility: Quads stretch, Trunk flex, Towel stretch, Neck rotations
Static stretches to just below pain threshold
Dailypreferably after cooldown
4 repetitions for 20 seconds per stretch
Increase duration for each stretch by 2 seconds every 2 weeks until 2 min in duration per stretch
Warm-up/ cool down
Low intensity
Before & after workout
10 mins
N/A
CONCLUSION Exercise has demonstrated positive effects in various chronic conditions associated with autonomic nervous system disorders, such as chronic fatigue and postural orthostatic tachycardia syndrome, including anxiety disorders. Based on the scientific literature, light-intensity exercise is preferred because of the state anxiety response compared with moderate and high-intensity exercise. Multiple modalities can be incorporated to improve aerobic capacity, strength, bone density, body composition, and flexibility. Carefully considering frequency, intensity, duration, and progression should be advised. A carefully prescribed exercise program will alternate heavy and light training days to help prevent injuries while improving health and decreasing state anxiety.
REFERENCES Atkinson, J.W. (1974) ‘The mainstream of achievement oriented activity’ in Atkinson, J.W. and Raynor, J.O. (eds) Motivation and Achievement, New York, Halstead. McClelland, D. (1961) The Achieving Society, New York, Free Press. Broocks A, Bandelow B, Pekrun G, George A, Meyer T, Bartmann U, Hillmer-Vogel U, and Ruther E. Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. Am J Psychiatry 155: 603–609, 1998. Brown RP and Gerbarg PL. Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression: Part II— Clinical applications and guidelines. J Alt Complement Med 11: 711–717, 2005. Cassilhas RC, Antunes HK, Tufik S, and de Mello MT. Mood, anxiety, and serum IGF-1 in elderly men given 24 weeks of high resistance exercise. Percept Mot Skills 110: 265–276, 2010. Callaghan P. Exercise: A neglected intervention in mental health care? J Psychiatr Men Health Nurs 11: 476–483, 2004. Cooper, C. and Bebbington, P. (2006) ‘Mental health’ in Bajekal, M., Osborne, V., Yar, M. and Meltzer, H. (eds) Focus on Health, Basingstoke, Palgrave Macmillan. Corbin, C.B., Welk, G.J., Corbin, W.R. and Welk, K.A. (2008) Concepts of Physical Fitness: Active Lifestyles for Wellness (14th edn), London, McGraw-Hill.
Gangadhar B, Naveen G, Rao M, Thirthalli J, and Varambally S. Positive antidepressant effects of generic yoga in depressive out-patients: A comparative study. Indian J Psychiatry 55: 369, 2013. Lawlor, D.A. and Hopker, S.W. (2001) ‘The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials’, British Medical Journal (Clinical Research edn), vol. 322, no. 7289, pp. 763–7 Mullins, L.J. (2002) Managing People in Organisations, Milton Keynes, The Open University. Schmitz N, Kruse J, and Kugler J. The association between physical exercises and health-related quality of life in subjects with mental disorders: Results from a cross-sectional survey. Prev Med 39: 1200–1207, 2004. Weiner, B. (1985) ‘An attribution theory of achievement motivation and emotion’, Psychological review, vol.92, pp. 548-73. World Health Organization (2015) “Phycical Activity: Factsheet no. 385” Available at: HHTTP:// www.who.int/mediacantre/