The evidence that exercise improves mental health isn’t just strong –it’s staggering (The Exercise Effect, APA, 2011). There’s no question among scientists and mental health experts. Physical activity of any sort benefits both our bodies and our emotions.

But when looking at the psychology of fitness (most importantly, how our minds can limit our body’s abilities) things get complicated.

In theory, treating mental illness with a fitness regimen should be a straightforward process. But people with mental health problems face many barriers. Symptoms, time limitations, cost, and low energy can deter those who most desperately need exercise

What are the realities for people struggling with mental illness and lack of physical activity? And how do we make it more accessible?

 

Mental Health and Exercise

The Evidence:

Everything from depression to ADHD to addiction disorders are proven to be more manageable with exercise. That’s any type, in any amount (though research suggests 30 minutes, 3-5 times a week has the best result). People who exercise often experience a reduction in symptoms. Life expectancy, sex drive, body fat, work productivity, social life, sleep cycles, and life expectancy are all markedly improved.

If the mental benefits of fitness activity were available in a pill, it would certainly be the most expensive drug on the market. Studies suggest jogging and weight lifting are better than some anti-depressants. The World Heath Organisation now reports depression as the leading cause of ill health and disability worldwide (WHO, 30 March 2017). And yet, treating mental illness with fitness hasn’t progressed much further recommending patients “try to stay active”.

So what does Trying To Stay Active mean in real terms?

Mental Health and Exercise

The Reality:

“Trying to stay active” requires motivation. It requires information, energy, and sometimes cost. All these factors may be impaired for people with anxiety, depression or mood disorders. Doctors can prescribe medication… but they are not yet able to write a script for a personal trainer. They can advise patients to try the gym. But they can’t be there to supervise them. Or to help find alternatives when conventional exercises aren’t suitable. Medication and counselling only go so far.

As a result, people with mental illnesses can miss out on the mood-balancing benefits of exercise (ADAA, Managing Stress & Anxiety). They’re also likely to face other health risks from lack of physical activity. Chronic mental illness is associated with higher chance of weight gain, loss of muscle mass, circulation problems and heart disease. Exercise provides some protection from these life-threatening side effects of psychological problems.

And yet, mentally ill people often struggle achieving the levels of activity needed to keep them alive — let alone feel better. This can be very isolating. Depression and anxiety sufferers are often aware they would benefit from working out. The issue is not a lack of knowledge… It’s a lack of accessibility, motivation, and support.

The Healthy Options

For people with mental illness, the subject of fitness can be a vital but uncomfortable discussion. Nothing depletes motivation like being aware and constantly told you “should” be doing something… yet still unable to do it.

“There’s one thing that never, ever helps people who are dealing with situational or clinical depression: telling them that exercise will help.” — Sarah Kurchak

Sensitivity and flexibility is vital for helping mentally unwell people exercise. Health insurance funds are widening their range of services for psychological treatments. From dietitians, to exercise physiologists, to health retreats. More allied health professionals take a holistic approach, giving patients better options. And many fitness instructors are becoming educated on talking to their clients about mental health.

Essentially, we need to manage our expectations about what exercise mentally ill people can realistically do. This means centring goals around individual needs. Everyone is unique — two people with the same diagnosis may have differing lifestyles and impairments. So a cooky-cutter approach won’t do. “Life Hacks” and “Gains” are concepts which don’t serve the mentally ill, and may even make things worse.

Back To Basics

Aaron* is a fitness instructor and disability support worker in Brisbane. He has a simple method of talking to clients with psycho-social diseases. He starts by asking how much time they could commit per day to exercise. And most people find it hard to even think of a number.

“What about 20 seconds?” Aaron asks “20 seconds a day, of any exercise you choose”. By setting goals to a minimum, it’s easier to be consistent and eliminate fear of failure. And it gets easier every day — often his clients find they can do more than their 20-second commitment. Eventually, they might do two minutes of push ups. This means enjoying the mental reward of meeting and exceeding their daily target.

Aaron believes one of the biggest obstacles with fitness and mental health is the stress associated with not reaching desired goals. Getting started is hard, but maintaining a routine is even harder for people whose lives are unregulated by anxiety, depression and other psychological issues.

Perfection and Perspective

Sarah Kurchak–a qualified personal trainer who has depression–shares a similar view. The key is making exercise fit the person, not the other way around. A Tough Love approach won’t encourage mentally ill people to work out. She suggests finding a style that works, breaking it down to small pieces, and letting go of feeling obligated or striving for perfection.

“If you can find an activity that safely works with both your abilities and your mindset, go with that. If you can’t come up with a single plan where the risk won’t outweigh any benefit, then don’t do it. Take a break from the very idea of exercise and come back at it again in a few days to see if your perspective has changed. If not, repeat as necessary.” (Depression-Busting Exercise Tips For People Too Depressed To Exercise – 2016)

The Way Forward

We should re-think our approach to treating mental illness with physical activity. If 10 minutes of lifting weights isn’t feasible, five squats will do. If you are too tired for intense jog, a walk is just fine. For people so impaired by depression they can barely get out of bed, stretching the limbs is a reasonable option.

There is no wrong way to do exercise when you have mental health setbacks. But there is a wrong way to think and talk about it. Finding the right kind of professional support makes all the difference.