In light of recent changes in life span expectancy related to poor mental health in the United States, it is imperative for practitioners to understand the importance of promoting physical activity as a way to enhance mental well-being. According to the Centers for Disease Control and Prevention Director, Robert R. Redfield, M.D., the life expectancy in the United States has fallen during the past few years in part because of increased rates of drug overdoses and suicide (1). The greatest significant changes in age-specific death rates for 2017 occurred in young adults ages 25 to 44 years (2). The unfavorable changes in U.S. life expectancy should propel individuals of all ages to engage in activities that enhance mental health to lessen the risk of self-imposed, nonnatural causes of death (i.e., drug overdose and suicide). This is especially important for young as well as middle-aged adults.
There is strong evidence that consistent engagement in physical activity leads to positive physiological changes that reduce the risk of morbidity and mortality, which has contributed to improved quality of life and life expectancy across time in the U.S. (3). In essence, physical activity acts as a preventive measure against chronic disease, and much of the scientific literature has highlighted the importance of motivating the public to use movement as a way to enhance physical well-being and longevity (3). However, noting that the recent decline in average life span in America is related to poor mental health, researchers and practitioners also must highlight the preventive and ameliorative function of exercise on mental well-being. The recently updated Physical Activity Guidelines for Americans has included “brain health benefits” as part of the updated evidence-based benefits of physical activity since the original guidelines were published in 2008 (3, p. 14). The guidelines state that physical activity can lead to improvements in cognitive function and sleep, as well as reductions in anxiety and depression risk, all of which contribute to an improved quality of life (3).
CHRONIC EFFECTS OF EXERCISE ON MENTAL HEALTH
The effect of exercise on mental health is twofold; it has both cumulative and acute effects. Chronically, it may reduce the risk of developing mood and anxiety disorders. A recent meta-analysis of prospective cohort studies reported that across the life span, individuals who engage in higher levels of physical activity significantly reduce the risk of developing incident depression and major depression compared with those with lower levels of physical activity (4). Specifically, meeting the weekly recommended physical activity levels of 150 minutes of moderate- to vigorous-intensity physical activity was associated with 22% and 21% reduced risk of incident depression in adults and older adults, respectively (4). Physical activity also has been associated with reduced risk of experiencing anxiety for children, adults, and older adults; individuals who report higher physical activity levels are 26% less likely to develop anxiety compared with those who are less active (5). Regular physical activity not only contributes to the prevention of psychological distress but also alleviates enduring episodes of depression and trait anxiety.
Evidence supports the use of physical activity to modify anxiety and depression levels of individuals experiencing long-lasting psychological disturbances. People who experience chronic depression and anxiety may seek alternative therapies, such as exercise, to improve their mental health. Habitual exercise has been shown to be an effective and accessible strategy to positively affect both depression (6) and anxiety (7). Exercise can be self-administered and has fewer negative side effects compared with medication; therefore, researchers have explored the efficacy of exercise in alleviating depression symptoms compared with traditional medication. An experiment by Blumenthal and colleagues (8) provides evidence that medication may deliver quicker reductions in depression symptoms for individuals with major depression; however, exercise is equally effective in the long term (i.e., 16 weeks) and contributes to a lower likelihood of relapse (9). It should be noted that the benefits of physical activity on mental health are not limited to clinical populations that have been professionally diagnosed with a psychological disorder; nonclinical populations that experience anxiety and depression symptoms also experience reductions in symptoms from repeated bouts of exercise (7,10). These findings highlight the importance of using exercise as part of a multifaceted approach to alleviate persistent psychological distress due to the positive, cumulative effects of multiple bouts of exercise.
Habitual exercise has been shown to be an effective and accessible strategy to positively affect both depression (6) and anxiety (7). Exercise can be self-administered and has fewer negative side effects compared with medication; therefore, researchers have explored the efficacy of exercise in alleviating depression symptoms compared with traditional medication.
ACUTE EFFECTS OF EXERCISE ON MENTAL HEALTH
In addition to the enduring effects of repeated bouts of exercise, single bouts of exercise can lead to reprieve from acute psychological disturbances immediately. Daily stressors may modify current mood or state anxiety. Fortunately, research indicates that physical activity leads to enhanced mood and anxiety reductions immediately postexercise (11,12). Reductions in anger, confusion, depression, and tension are often experienced after a single bout of exercise (12), and feelings of energy significantly improve (13). This is of particular importance for high-demand work environments that may provoke mood disturbances. Individuals who schedule physical activity throughout a workday or at lunchtime can experience both mood enhancements and cognitive benefits. Observed cognitive benefits immediately postexercise include enhanced memory, processing speed, and executive function (14). These improvements may be facilitated by exercise-induced changes in arousal levels; this, coupled with increased feelings of energy, could lead to greater productivity and time on task at work. As a result, further improvements in anxiety and mood could occur as a result of perceiving oneself as being more productive.
EXERCISE PRESCRIPTION FOR ENHANCING MENTAL WELL-BEING
There is abundant research to support the preventative, long-term, and immediate effects of exercise on anxiety, mood state, and mood disorders. Despite the overwhelming evidence, specific parameters for exercise prescription have yet to be developed. The dose-response effects of exercise on psychological outcomes are still being explored; however, the variety of exercise parameters (i.e., mode, intensity, duration, and frequency) coupled with individual differences (e.g., physical activity history, personal preferences, and severity of psychological distress) may prevent researchers from developing definitive physical activity guidelines for mental health for the general population. For example, some experiments have shown that high-intensity aerobic exercise is more effective at alleviating psychological disturbances compared with lower intensities; however, high-intensity exercise is often coupled with lower adherence and greater dropout rates (15,16). This is particularly important to remember: an effective, evidence-based exercise program will not affect an individual who does not follow or adhere to it. Ultimately, it is our job as practitioners to use methods that encourage clients to commit to consistent exercise habits, which requires balancing client preferences with evidence-based practices.
As practitioners, how do we overcome this challenge of not having well-defined physical activity guidelines for enhancing mental health? Simply continue to encourage movement and engage individuals in physical activity. The majority of research examining the psychological effects of exercise has focused on aerobic exercise; however, various other exercise modalities have been observed to be effective as well (e.g., resistance training and mind-body exercise). This allows for less rigidity in exercise prescription when seeking to enhance psychological well-being. For example, mind-body exercise (e.g., yoga, tai chi, and qigong) has been shown to improve symptoms of depression and anxiety as well as enhance attention, processing speed, executive function, and memory (17). Continuing to prescribe exercise that aligns with the American College of Sports Medicine (ACSM) guidelines for developing and maintaining physical fitness will provide ample opportunity for individuals to enhance mental well-being (18). This includes engaging in 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week, as well as incorporating 2 to 3 days of resistance exercises using all major muscle groups and integrating flexibility and neuromotor (e.g., balance and agility) exercises a few times per week.
The literature suggests that the weekly accumulation of physical activity that meets the ACSM physical activity guidelines is more important than frequency of physical activity; however, 4 to 5 days of physical activity may lead to better psychological outcomes compared with only 1 day per week (19,20). In addition, as little as 10 to 15 minutes of aerobic exercise can enhance mood, but longer bouts lasting at least 20 minutes can have a greater effect on anxiety and mood (12,21,22). Similarly, low-, moderate-, and vigorous-intensity exercise positively affects anxiety and mood; however, greater intensities may lead to larger improvements compared with lower intensities (6,11,23). As practitioners, the main benefit of not having definitive physical activity guidelines for eliciting the greatest mental health benefits is flexibility of program design. Developing exercise programs that align with the ACSM Physical Activity Guidelines (18) and incorporate client goals for overall well-being should positively affect both physical and mental health (Table 1).
Practitioners should be mindful of client preferences and individual differences when developing exercise programs that aim to improve overall well-being. It is important to balance client preferences with evidence-based exercise prescription to increase the likelihood of adherence, as well as to optimize the physical and mental benefits. There is evidence that physical activity enjoyment can influence the psychological response to exercise; however, psychological benefits can still be experienced in absence of exercise enjoyment (21,24). It also should be noted that in times of mental angst, it may be challenging to engage in physical activity because of lack of motivation, feelings of apathy, reduced feelings of energy, and the desire to withdraw from others (25,26). Therefore, it is important for practitioners to identify key barriers that an individual perceives as being challenging to overcome, such as joining a fitness center or seeking out a fitness community, and aid in those endeavors (26). It also is important for practitioners to discuss coping mechanisms for clients to use if they are not able to engage in their “ideal” physical activity (26). For example, if a distressed client planned to attend an indoor cycling class, but their schedule does not allow for it, they may believe that any other sort of activity is inferior due to all-or-none thinking. As a result, the practitioner should aid the client in developing a list of alternative modes of exercise that could be engaged in instead of the planned activity. Lastly, because lack of confidence is often a barrier to exercise with individuals who are depressed, challenging yet achievable goals should be developed that will allow them to be successful (25). It is crucial that practitioners regularly follow up with clients on their progress toward their goals to help motivate, encourage, and keep them accountable; these techniques can increase the likelihood of adherence to the physical activity program for individuals experiencing mental distress (26) (Table 2).
EFFECTS OF EXERCISE ON SUICIDALITY
As leaders in the fitness industry, it is important to discuss physical activity not only as a tool for preventing and managing chronic diseases that manifest physically but also for psychological distress and disorders. Developing consistent physical activity habits will help improve mental health and ideally protect against negative mental health outcomes such as drug overdoses and suicides, which have contributed to recent reductions in average life span in the United States. Adults and adolescents who meet the minimal physical activity guidelines of 150 minutes of moderate activity or 75 minutes of vigorous activity per week are less likely to experience suicidal ideation compared with those not meeting the recommended activity levels (27). The inverse association between physical activity and suicidality also has been observed in adolescents who have experienced bullying (20). Sibold and colleagues reported a significant reduction in suicidal ideation and attempts by 23% in bullied adolescents who engaged in physical activity 4 to 5 times per week compared with those who only reported being physically active for 0 to 1 day per week (20). This suggests that physical activity could contribute as a coping technique and protective mechanism to ameliorate the likelihood of experiencing sadness and attempting suicide. This is especially important in this young population that experiences a high rate of suicide compared with other causes of death. Exercise professionals should be aware of local resources that can aid individuals experiencing mental anguish in case a client discloses the intent to harm themselves or others, as well as general requests for information about other methods of enhancing psychological well-being.
Unfavorable changes in life span expectancy in the United States will continue unless effective and accessible approaches (e.g., physical activity) are promoted to enhance psychological well-being. Continuing to encourage physical activity across the life span to enhance both physical and mental well-being is crucial. Practitioners must inspire individuals to use exercise and physical activity as part of a comprehensive, multifaceted approach to prevent, alleviate, and improve anxiety, mood states, and mood disorders. Ideally, meeting the minimal physical activity guidelines set forth by the American College of Sports Medicine for aerobic, resistance, flexibility, and neuromotor exercise will lead to enhancement in both physical and mental longevity.
BRIDGING THE GAP
Exercise should be incorporated as part of a multifaceted approach to enhancing mental health and well-being. Although specific physical activity guidelines for mental health have not been established, following the current American College of Sports Medicine guidelines for enhancing physical fitness should provide ample opportunities for individuals to enhance mental well-being. Research indicates that aerobic, resistance, and mind-body exercises are effective strategies for improving anxiety, mood disturbances, and cognitive function.
1. Centers for Disease Control and Prevention. CDC Director's Media Statement on U.S. Life Expectancy
. U.S. Department of Health and Human Services; 2018. [cited 2019 August 14]. Available from: https://www.cdc.gov/media/releases/2018/s1129-US-life-expectancy.html
2. Murphy SL, Xu J, Kochanek KD, Arias E; Mortality in the United States. NCHS Data Brief, 328
. Hyattsville (MD): National Center for Health Statistics; 2017. p. 2018.
3. US Department of Health and Human Services. Physical Activity Guidelines for Americans
. 2nd ed. Washington (DC): U.S. Department of Health and Human Services; 2018.
4. Schuch FB, Vancampfort DV, Firth J, et al. Physical activity and incident depression
: a meta-analysis of prospective cohort studies. Am J Psychiatry
5. Schuch FB, Stubbs B, Meyer J, et al. Physical activity protects from incident anxiety
: a meta-analysis of prospective cohort studies. Depress Anxiety
6. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression
: a meta-analysis adjusting for publication bias. J Psychiatr Res
7. Herring MP, Lindheimer JB, O'Connor PJ. The effects of exercise training on anxiety
. Am J Lifestyle Med
8. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression
. Arch Intern Med
9. Babyak M, Blumenthal JA, Herman S, et al. Exercise treatment for major depression
: maintenance of therapeutic benefit at 10 months. Psychosom Med
10. Conn VS. Depressive symptom outcomes of physical activity interventions: meta-analysis findings. Ann Behav Med
11. Ensari I, Greenlee TA, Motl RA, Petruzzello SJ. Meta-analysis of acute exercise effects on state anxiety
: an update of randomized controlled trials over the past 25 years. Depress Anxiety
12. Berger BG, Motl RW. Exercise and mood: a selective review and synthesis of research employing the profile of mood states. J Appl Sport Psychol
13. Loy BD, O'Connor PJ, Dishman RK. The effect of a single bout of exercise on energy and fatigue states: a systematic review and meta-analysis. Fatigue
14. Lambourne K, Tomporowski P. The effect of exercise-induced arousal on cognitive task performance: a meta-regression analysis. Brain Res
15. Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety
in general practice – a systematic review and meta-analysis. BMC Health Serv Res
16. Chu IH, Buckworth J, Kirby TE, Emery CF. Effect of exercise intensity on depressive symptoms in women. Ment Health Phys Act
17. Gothe NP, McAuley E. Yoga and cognition: a meta-analysis of chronic and acute effects. Psychosom Med
18. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc
19. Dunn AL, Trivedi MH, Kampert JB, et al. Exercise treatment for depression
: efficacy and dose response. Am J Prev Med
20. Sibold J, Edwards E, Murray-Close D, Hudziak JJ. Physical activity, sadness, and suicidality in bullied U.S. adolescents. J Am Acad Child Adolesc Psychiatry
21. Berger BG, Darby LA, Zhang Y, Owen DR, Tobar DA. Mood alteration after 15 minutes of preferred intensity exercise: examining heart rate, perceived exertion, and enjoyment. J Sport Behav
22. Randolph DD, O'Connor PJ. Stair walking is more energizing than low dose caffeine in sleep deprived young women. Physiol Behav
23. Meyer JD, Koltyn KF, Stegner AJ, et al. Influence of exercise intensity for improving depressed mood in depression
: a dose-response study. Behav Ther
24. Raedeke TD. The relationship between enjoyment and affective response to exercise. J Appl Sport Psychol
25. Searle A, Calnan M, Lewis G, et al. Patients' views of physical activity as treatment for depression
: a qualitative study. Br J Gen Pract
26. Seime RJ, Vickers KS. The challenges of treating depression
with exercise: from evidence to practice. Clin Psychol
27. Vancampfort D, Hallgren M, Firth J, et al. Physical activity and suicidal ideation: a systematic review and meta-analysis. J Affect Disord