How to motivate patients who are struggling with psychiatric disorders to exercise.
Start with an assessment: Educate the patient on the potential effects of exercise on their disorder and how it fits on the menu of other treatment options.
Make clear recommendations: There is a lot of evidence in areas such as smoking cessation and in the addiction literature showing that a substantial subset of people will respond to very clear recommendations.
Offer motivational tools: A behavioral planner, for instance, that allows for goal setting, or connecting a patient with an exercise group can be helpful.
Consider the patient’s current activity capacity in recommending a regimen: Average beneficial exercise is 30-50 minutes per day, 3 to 7 days a week.
Help the patient find an activity that works best for them: Do not recommend anything specific.
Help guide the patient to educational resources: Information sources or books such as John Ratey’s Spark: The Revolutionary New Science of Exercise and the Brain.
Suggestions offered by Douglas Noordsy, MD.
SAN DIEGO, California – The benefits of exercise in nearly every aspect of physical health are well known, but evidence in recent years suggests a unique effect on some psychiatric disorders, prompting mental health clinicians to rethink treatment strategies and to consider the possibility of exercise not just in therapy but as therapy.
“Above and beyond the standard benefits of exercise in healthy living and general well-being, there is strong evidence demonstrating the ability of exercise to in fact treat mental illness and have significant benefits on a neurotrophic, neurobiologic basis,” Douglas Noordsy, MD, told delegates attending Psych Congress 2012: US Psychiatric and Mental Health Congress.
Some of the strongest evidence is seen in depression, where psychiatric benefits from exercise have been shown in some cases to match those achieved with pharmacologic interventions and to persist to prevent remission in the long term. Dr. Noordsy referenced a study from researchers at Duke University in which 156 patients with major depressive disorder (MDD) were randomly assigned either to aerobic exercise, sertraline therapy (50 mg to 200 mg), or both for 4 months. sertraline therapy (50 mg to 200 mg), or both for 4 months.
Other studies have shown equally impressive results in exercise for a variety of populations, including pregnant women with depression, who have a high interest in avoiding medications, people with HIV, and even patients with heart failure, who showed not only a significant reduction in depression related to exercise but also reduced mortality ( Am J Cardiol 2011;107:64-68).
The evidence in relation to anxiety, although not as strong, still suggests a benefit, and the rigors of a cardiovascular workout seem particularly suited to addressing the physiologic effects associated with anxiety.
Dr. Noordsy said. “We know that with anxiety, the heart rate goes up, you start breathing fast, and it kind of snowballs with more anxiety, and that can trigger a panic attack,” he explained. “So one of the important positive effects of physical exercise is it allows people to become conditioned to having their heart rate and respiratory rate increase when they’re not associated with anxiety, thereby addressing the triggers.”
The evidence on the benefits of exercise in cognitive function disorders, such as dementia and Alzheimer’s disease, is much more extensive, with as many as 8 strong studies on dementia alone in the last 3 years showing improvements with activities such as walking and strength training on memory and executive function.
Importantly, discussing the role of exercise in the context of human evolution might be a more effective approach with patients than the standard recommendation to get some exercise. “Instead of ‘this is something you ought to be doing,’ we might instead say, ‘this is something humans are designed to do, and when we don’t do it, our bodies and brains fall apart’.”Another important component in helping patients benefit from exercise is simply to improve awareness among clinicians, Dr. Noordsy added.
“We see evidence on the benefits of exercise for psychiatric conditions coming together, and there is a need to increase awareness of this among clinicians as well as reinforce the research community to be taking a more careful look at physical exercise,” he said.”This may not have as much of an industrial backing as some of the other interventions we use, but I think it’s quite exciting.”
Psych Congress 2012: US Psychiatric and Mental Health Congress. Presented November 9, 2012.
Lifestyle change does equal a change of lifestyle. Psychiatrists are now looking for ways to incorporate exercise as a MUST for cognitive behavioral therapy to work.
Submitted by Dr. Collin Ross