Is exercise better for your mental health than medications?

While most people agree that exercise is good for the body, evidence is growing that it is also important for maintaining good mental health. In fact, a new study shows that physical activity is 1.5 times more effective than counseling or medication for improving signs of depression, anxiety and distress.

The recent review study of 1,039 trials with 128,000 participants published in the British Journal of Sports Medicine recommends that exercise be the mainstay approach for managing depression and anxiety.

This doesn’t surprise mental health occupational therapist Diane Stitt or psychiatric nurse practitioner, Ellen Carty, NP, who both work as part of the Cape Cod Healthcare Behavioral Health Team.

“The previous research that I have seen has shown that physical activity not only helps physical health, but overall mental health,” Stitt said. “Physical activity naturally increases the production of endorphins, which are our brain’s feel-good neurotransmitters. It decreases the level of cortisol and adrenaline, which are the body’s stress hormones. Physical activity also helps individuals regulate and manage their emotions and their body’s response to sensory stimulation, which occupational therapists focus on.”

Mental Health Components

Carty agrees that there is plenty of data that supports the effectiveness of exercise on mental health, especially depression and anxiety. But she cautions that mental health has many components. She believes that exercise should be used as a complement not a replacement for other treatments, especially for people with other underlying mental health or chronic health conditions.

She used the example of Pennsylvania Senator John Fetterman, who suffered from a stroke while he was running for office. Even though he won the election, he checked into a mental health facility afterwards for treatment for severe depression.

“That is very common,” Carty said. “You have a major life event and your life as you know it changes. So, I think it’s important to consider things like that as well.”

Carty also points out that the signs of depression can be subtle, like drinking more than usual. That is usually a sign that someone is self-medicating.

Other symptoms of depression, Carty listed include:

• Changes in sleep
• Changes in appetite
• Irritability
• Not wanting to get out of bed in the morning
• A lack of interest in activities that usually bring joy
• Fewer interactions with friends and family
• Isolating more
• Feelings of worthlessness

“A lot of people get to the end of their rope and then they go to the ER seeking help,” she said. “Usually those are the folks that exercise is not going to help. They’ve been depressed for months and they are finally seeking assistance. Many are at the point where they are actively suicidal.”

That doesn’t mean that at some point they won’t benefit from adding exercise to their mental health treatment. Figuring out how is part of what occupational therapists working in mental health do.

Help Getting Back to Exercise

“We help our clients work through their mental health challenges by re-engaging them in their daily meaningful activities,” Stitt said. “And in order to help re-engage our clients in their meaningful activities, we examine their daily routines, and provide them with a combination of client-centered strategies to help them regulate their emotions and modulate their sensory input.”

As part of that process, Stitt helps clients examine their daily schedule to see where they can realistically incorporate physical activity into their schedule in a way that works for them. That includes examining both time and which actual activity will work best for each client. For some, it might be a walk with a friend. Others might prefer a YouTube video of yoga or core exercises.

The idea is to make it possible for the client to create a habit so they can remain consistent. It might also include starting slowly, Stitt said.

“When I was getting back into working out, doing an hour workout in my daily routine seemed daunting,” she said. “So being an OT and learning how to break things into small pieces, I started just doing ten minutes at a time. And then after I was successful doing ten minutes, I added another ten minutes. And that’s what we as OTs do – we break things up in a way that it’s manageable so you’re successful.”

Even before the pandemic hit, mental health disorders, especially depression and anxiety, were a leading global health problem. The COVID-19 pandemic exasperated an already serious problem.

Nurse practitioner Carty recently heard a talk given by psychiatrist and neuroscientist Dan Seigel, MD, that really resonated with her. Dr. Seigel talked about the multiple pandemics that occurred all at the same time as COVID over the past few years.

Carty described them and their effects on our mental health:

• The pandemic of fear: There has been a widespread fear that creates negative social cohesion and isn’t conducive to mental health.
• The pandemic of isolation: We need to connect with other human beings to stay emotionally healthy. We are not meant to be alone.
• The pandemic of uncertainty: Uncertainty creates anxiety. Most of us are uncertain about what will happen next, with our health, our finances, our jobs, politics and a possible recession.
• The pandemic of economics: Economic disparity in this county is getting wider and that isn’t helpful for mental health and wellness.

Other Options

In addition to exercise, Carty advises patients to eat a healthy diet, connect with other human beings and try to get outdoors as often as possible, even if it is just for a five- or 10-minute walk. She also points out that 30 to 40 percent of patients do find medication helpful.

If they are interested, Carty encourages patients to journal and just “dump out all that stuff in your brain so there is room to create something new and wonderful.” She also teaches meditation.

“The meditation in our program is designed to try to get people to be present to what is going on in their bodies with no judgement,” she said. “There’s nothing to fix. What is in the moment is in the moment.”