'Moving medicine' for mental health

Over the last few weeks I have been reading a lot about health and well being issues associated with lockdown. Everyone’s circumstances are different and will therefore have their own experience whether good or bad. However, one issue seems to be more prevalent than others, that of mental health. Research has shown that exercise has a positive impact on mental health related issues, as Hippocrates once said 'walking is man's best medicine'!

A survey by the charity MIND revealed that lockdown has had a dramatic effect on mental health (whether it's anxiety, depression, stress, fear, anger) regardless of whether it was pre-existing . The main drivers being social isolation, jobs and financial loss, housing security and quality, working in a front line service, loss of usual coping mechanisms, reduced access to health services (The Health Foundation UK). Of course some of these may improve with the easing of lockdown but not necessarily and certainly not for everyone.

Office for National Statistics (ONS) figures show that more than 1/3 of the shielding population reported an increase in mental health and wellbeing issues. This is a group that has certainly been hit hard particularly if they had pre-existing conditions. Whilst most people will see the easing of lockdown as providing long awaited positive opportunities, those who have been shielding may see it very differently. After all they have been conditioned to having to stay at home, unable to go out or mix with others, but now they are expected to do just that! This is still an anxious time for this group (although not limited to) who maybe fearful of returning to pre lockdown activities.

So if you are trying to take back control of your life after lockdown, now is a good time to find new routines, stay connected with those you feel comfortable with, try and eat a healthy diet and fit in some regular exercise. This will stand you in good stead too if any lockdown easing is reversed.

The benefits associated with exercise for those who maybe struggling mentally at the moment include: improved mood (releasing our natural feel good hormones); improved self-esteem; decreased depression and anxiety; improved social networks . It can help us regulate our responses to stress, feel more confident and more resilient in dealing with our daily lives. Social prescription (also known as natural/green prescription) is the name of the game – you can easily refer yourself to physical activity and exercise, it can be as simple as just walking in the countryside and let’s face it Surrey has plenty of that! The charity MIND promotes ‘ecotherapy’ which is wide range of programmes focusing on incorporating nature into therapeutic activities. Obviously some activities will not be available at the moment but there are some good ideas there and getting out and doing something will go a long way to help with, for example, social isolation and loneliness. The Patchworking Garden Project in Dorking is a great example of bringing change to people's lives through friendship and gardening. Gardening is a great way to increase physical activity, improving strength and flexibility whilst boosting your mood.

Exercise has been found to be as effective as other forms of treatment for mental health conditions, particularly engaging in aerobic exercise (1). Don't worry you don't have to take up marathon running (although never say never)! Studies have shown that mood is enhanced after a relatively short bout of exercise, with sessions of 20-30 minutes of moderate to intense aerobic exercise being optimal for reducing anxiety (think walking with purpose or anything that raises the heart rate and gets you sweating a bit). In fact this has been shown to be as effective as meditation or anti-anxiety medication in reducing anxiety levels.

Aerobic exercise programmes lasting several months appear also to reduce the symptoms of chronic stress (2).

Likewise similar positive affects are seen in the treatment of depression, again being as effective as anti-depressants or psychological treatments. The National Institute for Clinical Excellence (NICE) recommends that people with mild to moderate depression should engage in an exercise programme comprising three sessions a week (lasting 45 minutes to an hour) for a period of 10-14 weeks (3). Remember we should all be doing at least 150 minutes per week of moderate aerobic exercise anyway, for general health benefits.

The benefits of outdoor activity has been found to improve self esteem, perhaps more than in a gym environment and if you can exercise in a location where greenery is combined with water then even better! Again you don't need to hit the outdoor boot camps or HIIT sessions, as low to moderate intensity physical activity shows greater improvements in self esteem than high intensity (4). This is likely because it is about being comfortable in our abilities, taking small but positive steps to accomplish our goals. We don't have to go all out right from the start trying to compete with others who maybe further along the line than us or are just different in what they do and how they do it. The message here is not to compare but do what feels good for you.

If you don't have access to green space, then some simple bodyweight exercises will be a good start - squats, lunges, star jumps. Equally crank up the music and dance round the kitchen whilst making dinner! It doesn't matter what you do, increased physical activity does not have come in the form of structured exercise. Although obviously depending on what you're trying to achieve then this maybe an important part of your journey and why wouldn't I not promote specific training programmes (cardio, resistance, strength, flexibility, posture and balance) - I'd be out of a job otherwise!

I'm not saying it is easy nor that exercise is the golden ticket to all things healthy but it certainly has an important part to play whether as a standalone treatment or as part of a healthcare package and is a very easy way to get things moving.

References:

(1) Skrinar, G.S. and Hutchinson, D.S. (2009) Mental Illness in Durstine et al editors ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities Third Edition Human Kinetics, Champaign, Illinois

(2) Hand, G.A, Jaggers, J.R., Dudgeon, W.D. (2009) Stress and Anxiety Disorders in Durstine et al editors ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities Third Edition Human Kinetics, Champaign, Illinois

(3) NICE (2009) Treating depression in adults National Institute for Health and Clinical Excellence, London

(4) Barton, J and Pretty, J. (2010). What is the best dose of nature and green exercise for improving mental health? A multi study analysis.