Exercise/Exercise-Based Treatment
Exercise/Exercise-Based Treatment
Anxiety, depression, substance/alcohol abuse
Alzheimer’s disease, dementia, cognitive disorders
Co-occurring disorders and other illnesses
Definition
Exercise is any physical movement that conditions a part or parts of the human body. This includes the central nervous system, especially the brain and with it, the mind. Successful exercise used as an adjunct treatment for mental disorders retrains the body and the mind by (1) creating a more positive body image that increases self esteem, (2) increasing certain chemicals produced by the body that create a more positive mental perspective and body health, (3) increasing the metabolism to allow the reduction of prescribed medications and thus, the incidence of negative side effects, and (4) changing how a patient thinks to patterns that include healthier mental processes. Exercise as treatment is well planned, structured, and repetitive in nature for short-term and long-term mental health status. This type of exercise improves and maintains mental fitness and endurance, improves social skills and socialization that lead to better mental well-being, and facilitates mental rehabilitation from several mental illnesses.
Applications
Exercise is a preventative and treatment measure in the management of mental illnesses. Of the disorders listed in the 2000 edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association, exercise is a successful adjunct treatment or preventive measure in the following disorders: alcohol abuse, Alzheimer’s disease, anxiety , chronic pain disorder , cognitive dysfunction, co-occurring disorders, eating disorders, dementias, depression , and substance abuse.
Anxiety, depression, substance/alcohol abuse
Exercise increases the overall metabolism and the production of endorphins in the human body. These endorphins are chemicals released in the brain that cause a feeling of well-being. When exercise is used as an adjunct treatment in cases of anxiety, depression, and substance and/or alcohol abuse, the increased levels of endorphins can replace the need or desire for some psychiatric medications, pain medications, and substances or alcohol. In addition, in physical and substance abuse rehabilitation programs from the early 1980s to the present, exercise has enhanced the positive results of most prescribed medications, allowing physicians to reduce or eliminate dosages.
Researchers have also found that because exercise, especially aerobic exercise, increases body metabolism and waste elimination, states of anxiety and depression can reduce in intensity and frequency. These disorders increase the levels of stress hormones secreted in the body, while exercise acts against these stress hormones. Exercise helps to eliminate these hormones by (1) reducing their production and (2) speeding their elimination, while raising endorphin levels in their place.
Alzheimer’s disease, dementia, cognitive disorders
Aerobic exercise is well known to increase the body’s ability to use oxygen efficiently, increasing oxygenation to the central nervous system, most notably the brain. Increased levels of oxygen increase the positive function of the brain’s cognitive operations. Increased oxygen use aids in problem solving, memory, logic, general reasoning, and abstract thinking. Increased oxygen levels also reduce the occurrence of dementias and may prohibit the formation of the physical anomalies of plaques and tangles in the brain that are commonly seen in Alzheimer’s disease.
Co-occurring disorders and other illnesses
Co-occurring disorders respond best to a holistic retinue of therapies that often include exercise as a treatment. Depression is the most common co-disorder occurring with substance/alcohol type disorders in these dual diagnoses. Exercise can help alleviate depressive symptoms, as well as anxieties that co-occur, as described above. Similarly, exercise may benefit patients with eating disorders by reducing the anxiety and depression that relate to these conditions, unless compulsive exercise is a component of the eating disorder. In that case, the patient can learn to use exercise in a healthier way to reduce anxiety and depression and to build self esteem. Exercise may also benefit other mental disorders by providing a method to increase self-esteem and metabolism and is prescribed on an individual basis.
Supervision
Before beginning exercise treatment, an individual needs to have a complete health evaluation, including physical and mental dimensions. The client’s physician and/or treatment team will examine the client to determine whether strenuous exercise will benefit or harm the individual. They will then establish what type of exercise will benefit the mental health issues present. It is important that the type, frequency, and duration of exercises chosen will work well within the overall client treatment plan and not work against other elements of it. Because exercise increases body metabolism, the use of any prescribed medications, over-the-counter remedies, and nutritional supplements must be well monitored during the course of treatment. Exercise treatment must be well planned and consistently supervised by the client’s physicians and counselors. If physical or mental symptoms occur during exercise, the client should stop and call the physician to discuss such symptoms before resuming exercise. Symptoms that need to be
KEY TERMS
Adjunct treatment —A treatment that enhances the primary treatment or treatments and is not used alone. It can include exercise, massage, biofeedback, drama therapy, art/music therapy, dance therapy, journaling, creative writing, and others.
Aerobic exercise —Exercise that uses oxygen and provides sufficient cardiovascular overload to increase cardiac output.
Dementia —A mental condition in which there occur hallucinations, delusions, and memory loss, along with disorientation as to person, place, and thing (who, where, and what).
Isokinetics —A form of strength training that uses exercise machines to control the speed of muscle contraction.
Isometrics —Exercises used in strength training that contract the muscles without moving the joints.
Isotonics —A form of strength training that uses weight lifting or rubberized exercise bands for resistance training.
Muscle load —The work that is produced by a muscle when it is strained with a movement (exercise).
Range of motion exercise —Exercises that increase movement of specific joints for flexibility and freedom.
Stress hormones —Chemicals secreted by the human body to produce energy for action when confronted by the fight-or-flight circumstances. They include corticotropin releasing factor, or CRF, and adrenaline, epinephrine, and cortisol.
reported include dizziness, nausea, blurred vision, disorientation, headache, unusual shortness of breath, panic attacks, hallucinations , unusual body pains, or any chest pain.
Types
Strength training slightly strains a muscle further than average, increasing “muscle load” (workload) to stimulate muscle protein growth at the cellular level. This increases muscle mass and strength, bone strength, and metabolism. It helps to achieve good body image and self-esteem. Strength training can be accomplished via isometrics, isotonics, and isokinetics, along with range of motion.
Range of motion exercise increases movement of specific joints for flexibility and freedom. Isometric exercises contract the muscles, but joints do not move during contraction. Isotonics uses weight lifting or rubberized exercise bands for resistance training, and isokinetics uses exercise machines, such as stationary bikes, to control the speed of muscle contraction.
Risks
Neglected or improper warm-up procedures can lead to injuries that will increase anxiety that is counterproductive to therapy. Overworking the body without enough downtime between exercise sessions for physical and mental rest can also lead to injury, unnecessary pain, and/or avoidance of future exercise that will work against recovery. If exercise becomes boring or routine, exercise burnout can cause individuals to stop their exercise programs and lose the benefit of treatment, possibly resulting in depression and relapse of other symptoms. In the course of some mental disorders, exercise can become a compulsive set of behaviors. This reinforces the need for consistent professional monitoring of exercise treatment. Overall, the total client treatment plan must be monitored to ensure that exercise and other components are not working together to create unwanted or unexpected physical or mental issues.
Resources
CONFERENCES
Hays, Kate, PhD. “Working It Out: Using Exercise in Psychotherapy.” From the Conference Getting Healthy: Psychology’s Response to Life’s Stages. Reported in the New York State Psychology Association’s NYSPA Notebook. July-Aug. 2003: 16–18.
PERIODICALS
Chow, Atlantis, CM, and Kirby Singh, MF. “An Effective Exercise-Based Intervention for Improving Mental Health and Quality of Life Measures: A Randomized Trial.” Preventive Medicine 39.2 (2004): 424–34.
George, Steven Z., Joel E. Bialosky, and Julie M. Fritz. “Physical Therapist Management of a Patient with Acute Low Back Pain and Elevated Fear-A voidance Beliefs.” Physical Therapy 84.6 (2004): 538–49.
Keller, Joy. “U.S. to Introduce New Physical Activity Guidelines: IDEA Members Share Their Visions for What the Recommendations Should Include.” IDEA Fitness Journal 4.1 (2007): 16–17.
Kim, Doyeon, and Len Kravitz. “Childhood Obesity: Prevalence, Treatment and Prevention: Become an Advocate for Kids by Taking a Leadership Role in the War on Obesity.” IDEA Fitness Journal 4.1 (2007): 22–24.
Read, Jennifer, and Richard Brown. “The Role of Physical Exercise in Alcoholism Treatment and Recovery.” Professional Psychology: Research and Practice 34.1 (2003): 49–56.
Read, Jennifer, PhD, Richard Brown, PhD, Bess Marcus, PhD, Christopher Kahler, PhD, Susan Ramsey, PhD, Mary Ellen Dubreuil, PhD, Jon Jakicic, PhD, and Caren Francione, BA. “Exercise Attitudes and Behaviors among Personas in Treatment for Alcohol Use Disorders.” Journal of Substance Abuse Treatment 21.4 (2001): 199–206.
Sander, Ruth. “Exercise is Associated with a Delayed Onset of Dementia.” Nursing Older People 18.12 (2007): 39–40.
Yu, Fang, Ann M. Kolanowski, Neville E. Strumpf, and Paul J. Eslinger. “Improving Cognition and Function Through Exercise Intervention in Alzheimer’s Disease.” Journal of Nursing Scholarship 38.4 (2006): 358–65.
ORGANIZATIONS
Mayo Clinic, Rochester, MN. <http://www.mayoclinic.com/health/depression-and-exercise/MH00043>.
The President’s Council on Physical Fitness and Sports. Department W., 200 Independence Avenue SW, Room 738-H, Washington, DC 20201. Telephone: (202) 690-9000. <http://www.fitness.gov>.
YMCA of the USA. 101 North Wacker Drive, Chicago, IL 60606. Telephone: (800) 872-9622. <http://www.ymca.net>.
YWCA USA. 1015 18th Street NW, Suite 1100, Washington, DC 20036. Telephone: (202) 467-0801. <http://www.ywca.org>.
Patty Inglish, MS