MENTAL HEALTH

“It is is estimated that 25% of the population seek medical help annually for mental health problems and suicide rates for men aged 15-24 rose by 85% between 1980 and 1990.”

sent compelling evidence of the positive relationship between exercise and mental health. In line with an earlier review (3) in this area the consensus statement con- cludes, for example, that there is evidence for a causal link between exercise and decreased depression. Indeed Biddle states that the magnitude of the positive effect of exercise on mental health is ‘moderate to large’ and the consensus statements (in press) suggest that the effect can be of the same magnitude as other psychotherapeu- tic interventions.

New guidelines due The Health Education Authority is just about to publish guidelines for practice on physical activity and mental health. In rec- ommending exercise for people with a diagnosed mental illness the practitioner needs to know what they are trying to achieve. Three possible outcomes have been suggested (5):

1. Providing an opportunity for recre- ation. Patients with long-term mental ill- ness have a right to play sport and have access to leisure opportunities. By enabling people with mental health problems to access leisure centres and use the facilities available, health professionals can have a significant effect on the quality of life of the patient. This type of intervention often calls for leisure and health professionals to work together to arrange appropriate super- vision and pricing structures. 2. Helping to control ‘secondary health problems’. People with mental illness sometimes have physical problems that may be helped through exercise. For exam- ple a patient may be obese and needs to lose weight through moderate physical activity or have mechanical lower back pain that could be helped by active reha- bilitation. Interventions for this outcome may be guided by the FIT-M principle (fre- quency, intensity, duration and mode) and may need the exercise practitioner to work with a health professional such as a phys- iotherapist. 3. The use of exercise to actually improve the mental health of the patient as an adjunct to other forms of treat- ment. In recommending exercise interven- tions as ‘treatment’ the practitioner needs

POSSIBLE MECHANISMS

While people normally associate exercise with improvements in physical health the link with mental health has been under investigation for some time. A study in 1998 (4) suggested four mechanisms which may explain how exercise works to improve mental health.

1 3

The Monoamine Hypothesis

This postulates that exercise affects brain biochemistry in relation to dopamine, serotonin or noradrenaline.

The Endorphin Hypothesis

This explanation has been used to try and explain the so-called ‘runners high’. It suggests that during exercise endorphins (natural morphine like chemicals) are released which help in pain control and provide a sense of wellbeing.

2 4

The Thermogenic Hypothesis

This suggests that the warming effect of exercise on the body may mediate changes in mood state.

The Distraction Hypothesis

This hypothesis simply states that exer- cise gives people with mental health problems ‘time-out’ from their worries and anxieties and enables them to focus on the physical activity.

While scientific work continues to try and explain some of the brain biochemistry surrounding exercise and mood some researchers also highlight the importance of social-psychological mechanisms. For example, the positive effects that exercising in a social environment brings by helping in the establishment of inter-personal relationships and friendships. Equally as important may be the sense of achieve- ment and enhanced self-esteem that comes from engaging in the exercise process. This improved sense of self-worth can be added to if the person can see that their physical work capacity (fitness level) is improving and that ‘they can do it’.

to take into account the mental state and level of motivation of the person and the possible interaction between any drug therapy and the exercise. This calls for a detailed needs analysis and normally for the exercise practitioner to be working as part of the multi-disciplinary team caring for the patient.

Given the nature of mental illness and the need to work with patients as individuals through a needs analysis, it is not possible to present a ‘recommended programme for a patient with manic depression’ in the same way as it may be possible to present a ‘recommended programme for a patient with mechanical lower back pain’. However, when recommending an exercise pro- gramme for mental health improvement the following issues should be considered:

● Is the patient more likely to adhere to and enjoy a structured and supervised exer-

cise programme (eg. a gym) or a physical activity intervention designed to help them ‘be more active, more often’ in the commu- nity (eg. working on an allotment)? The best way to answer this question is to ask them after they have had the chance to try both for a short trial period ● Based on the scientific evidence and academic consensus the Health Education Authority recommends that people should aim to build up to doing 30 minutes of moderate intensity physical activity on five days of the week or more. Whilst ‘moderate’ is a relative term for many people it will mean activities such as brisk walking and gardening. This is an important message to communicate to our client groups to re- assure them it does ‘not have to be hell to be healthy’ and that even if they ‘are not the sporty type’ there are many types of physical activity they can do ● Remember that the exercise programme should lead to a sense of achievement and

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