Most of us know that physical exercise is beneficial and necessary for attaining and prolonging good physical health. Exercising helps with maintaining and reducing weight and body fat, improving cholesterol, and reducing the chance of developing cardiovascular disease and type II diabetes, among many other physical health benefits.

The question that has come up in recent decades, and one particularly salient for mental health professionals, is whether exercise helps with our mental health as well, and if so, how?

How Exercise Physiologically Affects Mental Health

Recent research highlighting the empirical evidence on the use of physical exercise for the improvement of mental health and well-being has been readily studied [1 – 6].

This research suggests that exercise is highly efficacious in improving depression, anxiety, and stress, among a list of other mental health concerns.

Several theories exist that help explain how and why exercise is helpful for improving mental health. Neurophysiological driven theories have noted that exercise can improve mental well-being by aiding in the production of antioxidants, DNA repair, and protein-degrading enzymes, increasing neurotrophic factors such as brain-derived neurotrophic factors (BDNF) and insulin-like growth factor I (IGF-I), which are crucial for optimal mental health, neurogenesis, and brain plasticity [2, 7].

Exercise impacts several neurotransmitters in our brains such as serotonin, dopamine, acetylcholine, and norepinephrine [2], which are the chemical neurobiological factors that make one feel good (e.g., “runner’s high”). Exercise has many other neurobiological effects on the brain, such as increasing levels of Cerebral Spinal Fluid (CSF), which aids in the cooling of the brain from excessive heat as a result of oxidative stress [2, 8].

Other theories such as self-determination theory, driven by psychological concepts, state that exercise can help improve mental well-being by giving people a sense of autonomy, competence, and increased intrinsic motivation [9, 10].

Current recommendations state that individuals receiving mental health services should aim to complete 30 minutes or more of moderate to physical exercise, three to five days a week for a total of 90-150 minutes, using a combination of aerobic and resistance training [4, 11].

These recommendations are identical to the public health recommendation guidelines for physical exercise set by the American College of Sports Medicine (ACSM) [11].

Why Don’t Therapists Incorporate Exercise into Psychotherapy?

With tremendous evidence highlighting the usefulness of exercise for mental health, and studies outlining specific behavioral recommendations that align with already established physical health recommendations for exercise [4], it raises the question of whether mental health professionals are utilizing exercise as part of psychotherapy and the mental health care of their clients.

Limited research exists on the topic and that which does illustrates that many psychologists and mental health providers alike are interested and willing to incorporate exercise as part of psychotherapy, but many lack the confidence to monitor and or tailor their advice to clients [12].

Current research suggests that large percentages of both US and Australian psychologists (83%) are enthusiastic and willing to recommend exercise to their clients [12, 13]. However, only about a fourth of them are regularly incorporating exercise as part of therapy [12].

A similar study with a different group of mental health professionals found lower percentages, with only 40% encouraging clients to exercise despite reporting that they were aware of the therapeutic potential of incorporating exercise into counseling [14].

Similarly, Barrow, English, and Pinkerton (1987) found that only 53% of psychologists in the US occasionally recommended exercise to clients, with only 10% of psychologists doing it consistently.

Other studies, aimed at evaluating how the exercise habits of clinicians impacted exercise recommendation in therapy, indicated that if therapists exercised themselves, estimated at 71%, [15], they were more likely to recommend it to their clients [12, 15, 16].

It seems that the general consensus is that mental health professionals believe in the benefits of exercise but are reluctant to recommend it consistently to clients [13, 15, 16].

It has been noted that psychologists generally don’t incorporate exercise into treatment plans, and that graduate programs rarely teach students how to help clients increase motivation and determination for exercising [17].

This has created a gap between the science and the practice of psychology for mental health. This can be seen as troublesome with recent trends and emphasis on clinicians providing evidenced based treatment (EBT)

6 Tips for Incorporating Exercise into Your Clients’ Therapy

So how can mental health professionals help clients increase mental well-being through the use of exercise?

Below are six suggestions:

1. Educate Yourself

Educate yourself further on the benefits of exercise on mental health and how to help clients exercise while in psychotherapy by seeking out workshops, webinars, and formal trainings in your area.

2. Add Screening Questions to Intake Paperwork

Inquire about clients’ exercise habits at time of intake or initial screening by adding some questions to intake paperwork.

Example Questions:

• Have you been seen by a physician and gotten a physical in the past year?
• Have you been cleared healthy enough to engage in exercise? Are there any injuries, disabilities, or issues that would hinder your exercising?
• How many days per week do you exercise?
• When you do engage in exercise, how many minutes do you spend exercising?
• How intense are your workouts?
• How do you feel about your exercising habits?
• How can we help you with your goals?

3. Work with Your Client’s Physician

Ask the client if you can work with their physician to create a comprehensive exercise plan that keeps the client at the center of the process.

4. Talk About Exercise Habits Regularly

Talk about the client’s exercise habits regularly during psychotherapy sessions by inquiring how they did on their goals that week and asking how you could help them.

5. Use a Journal

Help the client create an exercise journal (either on paper or by using an app) by having the client keep track of their workouts, durations, intensities, and then discussing it together in session.

6. Explore Goals & Motivations

Help the client explore their motivations for exercise and regularly talk about their goals and reasons for continuing to exercise or reasons why they may have stopped or deviated from their goals.

In conclusion, exercise is beneficial for both physical and mental health and it has been found that the same frequency, intensity, and duration factors work for both health benefits. As such it creates a win-win scenario, allowing exercise to serve both means and essentially knocking out two birds with one stone.

Do you recommend exercise to your clients? Leave a comment below to share your thoughts and suggestions with the Time2Track community.

References

[1] Bartley, C. A., Hay, M., & Bloch, M. H. (2013). Meta-analysis: Aerobic exercise for the treatment of anxiety disorders. Progress In Neuro-Psychopharmacology & Biological Psychiatry, 45, 34-39. doi:10.1016/j.pnpbp.2013.04.016[2] Deslandes, A., Moraes, H., Ferreira, C., Veiga, H., Silveira, H., Mouta, R., & … Laks, J. (2009). Exercise and mental health: Many reasons to move. Neuropsychobiology, 59, 191-198. doi:10.1159/000223730[3] Donaghy, M, E. (2007). Exercise can seriously improve your mental heatlh: Fact or fiction? Advances in Physiotherapy, 9, 76-88. doi:10.1080/14038190701395838[4] Dunn, A. L., Trivedi, M. H., Kampert, J. B., Clark, C. G., & Chambliss, H. O. (2005). Exercise treatment for depression: Efficacy and dose response. American Journal Of Preventive Medicine, 28(1), 1-8. doi:10.1016/j.amepre.2004.09.003[5] Josefsson, T., Lindwall, M., & Archer, T. (2014). Physical exercise intervention in depressive disorders: Meta-analysis and systemic review. Scandinavian Journal of Medicine & Science in Sports, 24, 259-272. doi:10.1111/sms.12050[6] Stathopoulos, G., Powers, M. B., Berry, A. C., Smits, J. J., & Otto, M. W. (2006). Exercise interventions for mental health: A quantitative and qualitative Review. Clinical Psychology: Science And Practice, 13, 179-193. doi:10.1111/j.1468-2850.2006.00021.x[7] Radak, Z., Chung, H. Y., Koltai, E., Taylor, A. W., & Goto, S. (2008). Exercise, oxidative stress and hormesis. Ageing Research Reviews, 7(1), 34-42. doi:10.1016/j.arr.2007.04.004[8] Portugal, E. M., Cevada, T., Monteiro-Junior, R. S., Guimarães, T. T., da Cruz Rubini, E., Lattari, E., & … Deslandes, A. C. (2013). Neuroscience of exercise: From neurobiology mechanisms to mental health. Neuropsychobiology, 68(1), 1-14. doi: 10.1159/000350946[9] Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78. doi:10.1037/0003-066X.55.1.68[10] Thøgersen-Ntoumani, C., & Fox, K. R. (2007). Exploring the role of autonomy for exercise and its relationship with mental well-being: A study with non-academic university employees. International Journal Of Sport And Exercise Psychology, 5, 227-239. doi:10.1080/1612197X.2007.9671833[11] Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I., & …

Swain, D. P. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine And Science In Sports And Exercise, 43, 1334-1359. doi:10.1249/MSS.0b013e318213fefb

[12] Burton, N. W., Pakenham, K. I., & Brown, W. J. (2010). Are psychologists willing and able to promote physical activity as part of psychological treatment?. International Journal Of Behavioral Medicine, 17, 287-297. doi:10.1007/s12529-010-9087-8[13] Burks, R. J., & Keeley, S. M. (1989). Exercise and diet therapy: Psychotherapists’ beliefs and practices. Professional Psychology: Research And Practice, 20, 62-64. doi:10.1037/0735-7028.20.1.62[14] Phongsavan, P., Merom, D., Bauman, A., & Wagner, R. (2007). Mental illness and physical activity: Therapists’ beliefs and practices. Australian And New Zealand Journal Of Psychiatry, 41, 458-459. doi:10.1080/00048670701266862[15] Barrow, J. C., English, T., & Pinkerton, R. S. (1987). Physical fitness training: Beneficial for professional psychologists?. Professional Psychology: Research And Practice, 18, 66-70. doi:10.1037/0735-7028.18.1.66[16] McEntee, D. J., & Halgin, R. P. (1996). Therapists’ attitudes about addressing the role of exercise in psychotherapy. Journal Of Clinical Psychology, 52(1), 48-60. doi:10.1002/(SICI)1097-4679(199601)52:1<48::AID-JCLP7>3.0.CO;2-S[17] Weir, K. (2011, December). The exercise effect. Monitor on Psychology, 42(11), 48. Retrieved from http://apa.org/monitor/2011/12/exercise.aspx