Promoting mental health through physical activity: examples from practice

Journal of Mental Health Promotion, Mar 2004 by Jones, Martin, O'Beney, Carol

ABSTRACT

The physical health benefits of exercise are well established but there is also growing research evidence of links between physical activity and mental health benefits, including mood elevation, better cognitive functioning and improved self-perception, self-esteem and self-efficacy. Physical activity has also been shown to enhance the effectiveness of psychological therapies and to have a role in improving quality of life and symptom management for people with a wide range of mental health problems. Physical activity has a double benefit, since people with mental health problems are also at increased risk of a range of physical health problems, including cardiovascular disease, endocrine disorders and obesity. However referral to a physical activity specialist is rarely available in psychiatric settings. This paper gives two examples of how provision of physical activity facilities and programmes staffed by qualified specialists can contribute towards improving mental health and quality of life for people with mental health problems.

The Department of Health (1996) emphasises that physical activity is an important health-related behaviour. Subsequently there has been a plethora of information and research indicating that exercise has health-related benefits. The case for exercise and health has largely been made on grounds that it has an impact on coronary heart disease, obesity and diabetes. However in recent years there has also been an increased interest in research into the role of exercise in both the treatment and promotion of mental health.

Physical activity appears to relieve symptoms of depression and anxiety and improve mood. Regular physical activity may also reduce the risk of developing depression. Reviews of the literature have indicated the potential benefits of exercise as a treatment for clinical or sub-clinical depression or anxiety, and of physical activity as a means of improving quality of life through enhanced self-esteem, improved mood states, reduced state and trait anxiety, resilience to stress and improved sleep (Fox, 1999). Although data on levels and type of physical activity among mental health inpatients are limited (see Brown et al, 1999), exercise may help alleviate some of the negative symptoms of schizophrenia, may be an effective coping strategy for symptoms such as hallucinations and may also help to improve quality of life for people with mental health problems (Faulkner & Biddle, 1999). Given the prevalence of mental health problems (they are expected to account for 15% of all chronic diseases by 2020: a larger proportionate increase than that for cardiovascular diseases (Murray & Lopez, 1996)), the potential of physical activity as a preventive intervention is also attracting increasing interest. Approximately 25% of the population per year needs medical help for mental health problems and the NHS and social services spend almost �4 billion a year on the treatment of mental health problems (DoH, 2001). Including physical activity in prevention and treatment regimes for both physical and mental health problems therefore has considerable potential for reducing health costs.

The research base on physical activity and mental health is relatively recent in comparison with the volume produced on the effects of activity on physical health and disease. Significantly, only a passing reference is made to physical activity in the national service framework for mental health (DoH, 1999a).

Evidence exists of links between physical activity and reduced anxiety and depression, elevated mood, better cognitive functioning, and improved physical self-perception, self-esteem and self-efficacy (Biddle et al, 2000; Skrinar, 2003). The strongest link is found in the treatment of clinical depression, in both the short and long term (Mutrie, 2000). People who exercise regularly report that they feel better following a programme of physical activity. A survey by the mental health charity Mind found that 59% of people thought exercise could help prevent mental health problems such as depression and over 60% said it helped reduce stress and anxiety (Baker, 2001). Further evidence is highlighted by Fox (1999), who found that exercise was as effective as psychotherapeutic interventions in the treatment of depression. Similarly, Faulkner and Biddle (2001) also suggest that exercise can enhance the effectiveness of behavioural modification programmes such as cognitive behavioural therapy (CBT). The evidence is sufficiently persuasive to encourage further scrutiny.

People with mental health problems are generally less active and more sedentary than the general population, especially hospital patients, where opportunities for activities may be lacking (Grant, 2000). Despite the potential health benefits, the systematic prescription of therapeutic exercise is rare in mental health settings. Martinson (2000) notes that the cost of pharmacological and psychological treatments is escalating and care systems will soon be unable to meet the need for these treatments. In comparison, exercise therapy is simple and inexpensive, and on physical health grounds alone there is a strong case for including physical activity as one of a range of treatment options. People with mental health problems are at much greater risk of cardiovascular disease, obesity, diabetes and respiratory problems than the general population (Brown et al, 1999; Phelan et al, 2001; Harris & Barraclough, 1998; Barr, 2001). A person with schizophrenia can expect to live ten years less than someone without a mental health problem and around half of this excess mortality is caused by physical health problems (Brown et al, 2000). Lack of exercise and poor diet are likely to be contributory factors (Musselman et al, 1998). Currently, routine referral to a physical activity or dietary specialist is not commonplace in psychiatric settings (such as psychiatric hospitals), although some research suggests that people with mental health problems would very much value such opportunities (Friedli & Dardis, 2002; Faulkner et al, 2003).