August/September 2022 Issue

Focus on Fitness: Exercise and Mental Health
By Kelly Jones, MS, RD, CSSD, LDN
Today’s Dietitian
Vol. 24, No. 6, P. 54

As RDs, we’re well versed in the benefits of exercise for physical health. Regular moderate physical activity complements a well-balanced diet to aid in chronic disease prevention, supporting heart health, blood sugar management, cancer risk, bone health, and more.1 However, more than 75% of Americans are still not engaging in adequate activity.2 Could promoting the mental health benefits of exercise help shift habits? This article explores how exercise benefits mental health and how RDs can help patients and clients use it to their advantage.

How Exercise Improves Mental Health
Exercise offers everything from an immediate endorphin release to longer-term increases in confidence. While beneficial for those struggling with mental illness, these advantages extend to anyone subject to normal stress.

Endorphins, natural chemicals produced by the nervous system, often are referred to as “feel-good” compounds. With acute activity, there’s a natural release of chemicals called endogenous opioids and endocannabinoids, which are credited for improvements in mood and emotional state.3 While immediate responses are helpful in stress reduction, evidence also shows an association between activity and lower rates of depression and anxiety, and increased quality of life.4 Research has even shown exercise to reduce depressive symptoms among patients with chronic illnesses.5

On top of the acute endorphin release, numerous studies on various demographic groups show long-term benefits of activity include improved self-esteem and confidence. A study on adults showed both direct and indirect associations between physical activity level and positive self-esteem and body image, regardless of BMI.6 Another study on middle-aged women with a two-year walking intervention showed improvements in self-efficacy.7 When it comes to children and adolescents whose mental health has been worsened by the coronavirus pandemic,8 a meta-analysis concluded that physical activity is associated with increased self-concept and self-worth in these groups.9

Mental Health Benefits
While exercise has benefits in both the short and long term, adhering to a program is a challenge for many. However, engaging in activities that are actually enjoyable makes a difference. An individual who enjoys both the form and intensity of physical activity may have greater exercise intention and adherence.10 Exercising outdoors in natural environments may induce additional pleasure, as green space has been known to positively affect mental health. A review article highlighted how activity in natural outdoor space is associated with lower perceived exertion, stress reduction, and improved mood and self-esteem, ultimately showing increased enjoyment and adherence.11

For those with depression, loneliness, or social isolation, exercise may offer the benefit of community and belonging that some individuals may need for their mood and to help make exercise a habit. Becca Blumberg, MS, RDN, CPT, of Ripple Nutrition in Fort Collins, Colorado, notes, “Studies of nursing and medical students as well as older adults found that social support was one of the strongest predictors of the amount of exercise individuals routinely participate in.”12,13 She also mentions how group and partner exercise has increased accountability and motivation with her own clients. Virginia Beach–based dietitian and personal trainer Sara Cully, RD, CPT, agrees, highlighting that buddy- and partner-style exercise can be encouraging for older adults.14 One study suggested the antidepressant effect of exercise may be related in part to socializing while moving.15

A lesser-known benefit of regular moderate physical activity is its potential to impact the diversity of the gut microbiome. Greater gut diversity is associated with a better-functioning microbiome, and higher levels of activity and cardiorespiratory fitness are positively associated with bacterial diversity and short-chain fatty acid production.16 How does this impact mental health? The gut-brain axis, a bi-directional system linking our enteric and central nervous systems, allows the gut to influence mood, cognition, and mental health,17 with specific benefits seen in those with depression and anxiety.18

Physical Activity Guidelines and Potential Barriers
It’s recommended that all healthy adults aged 18 to 65 participate in 30 minutes of moderate-intensity aerobic activity, or 20 minutes of vigorous-intensity aerobic activity, five days per week, and that every adult should perform activities to maintain muscular strength and endurance at least twice per week. Children and adolescents are recommended to engage in 60 minutes of moderate to vigorous activity daily, with this time including aerobic activity as well as muscle- and bone-strengthening movements.19

While these guidelines may seem attainable for some, they may be intimidating for others, particularly those dealing with depression, anxiety, obsessive-compulsive disorder, or chronic stress, or those who have never engaged in regular physical activity at previous stages of life.

Barriers and Solutions
Time is often cited as the barrier to incorporating regular exercise. However, a 2019 study showed that regardless of race, gender, or economic status, Americans have hours of free time each day, but choose to spend that time using devices such as their phone, tablet, or TV.20 Still, discussing this with those who struggle with their mental health may not be the best approach, as it can feel like a criticism. Instead, RDs can help clients and patients determine ways to realistically incorporate activity into their daily routine. Liz Shaw, MS, RDN, CPT, an author and owner of Shaw Simple Swaps in San Diego, reminds her audience that movement doesn’t have to be structured gym time or classes. She says “NEAT, or non-exercise activity thermogenesis, are lifestyle embedded activities that promote movement without necessarily having to log miles on a treadmill.” Examples include gardening, walking your dog, walking to the playground with your kids, parking at the last spot in the lot when running errands, taking the stairs, and more. She notes that engaging in any physical activity, not just planned exercise, “has shown to positively impact various aspects of health, including depression (in conjunction with proper medical protocols).”1

“All or nothing” mentalities impact many people. Those who were athletes at a younger age or who used to engage in more regular movement may set high expectations or plan a rigid workout schedule, then feel a sense of failure if they miss a training session. Despite the aforementioned recommendations, Blumberg highlights that “the CDC has removed any requirement of a minimum amount of time an activity must last to ‘count’ in the most recent Physical Activity Guidelines.” This may be a good segue into introducing the concept of NEAT that Shaw advocates.

For those with anxiety, it’s easy for the mind to race with fears and barriers. Clients may feel judged for not “looking the part” or be nervous to try new activities. Blumberg acknowledges, “Sometimes, simply knowing we are not alone in these feelings is the biggest help.” Just getting in the front door of the gym may be all it takes to lower expectations and be welcomed by people of all sizes and backgrounds. To increase confidence, she suggests having a comfortable outfit vs one that is too small and bringing along a trusted family member or friend.

When it comes to depression, Blumberg notes that “incorporating movement when you aren’t feeling like yourself is a real challenge, but mindful movement can be a big help.” She also recommends those dealing with depressive symptoms commit to just five minutes of their favorite activity. Often, that time may increase and the positive feelings may “start to reverse the cycle” of inactivity.

All in all, whether in or out of a gym setting, starting small is sometimes the best way for people to stay motivated to move, recognize they have time for movement, and see the benefits accumulate.

How to Support Clients
Including questions related to mental health on intake forms equips you to better serve your clients who may not realize the importance of disclosing that information to their dietitian. Knowing whether someone is suffering can help dietitians adjust education and recommendations for nutrition and exercise. Screening should include whether the client is seeing or has seen a mental health professional. You may also want to know of professionals to refer clients to.

Help work through barriers and meet clients where they are. Messages that can be perceived as “just exercise and you’ll feel better” may seem insensitive and harm your provider-client relationship. Similarly, sharing the physical activity guidelines with those not exercising at all can do more harm than good. Cully suggests her clients start with picking just one day in the next week that is most realistic for them to move without setting a goal for duration. She also advocates “being flexible with what their body may want to do at that time. It helps them build on movement gradually.”

Focus on what they’re doing right, and give them credit for any progress they’ve made. Explore how they felt when they made time for movement and help them hold on to that feeling as motivation to continue engaging in any amount of physical activity. If no progress was made for sustained exercise sessions, probe and explore whether they made progress with NEAT movement.

— Kelly Jones, MS, RD, CSSD, LDN, is a board-certified specialist in sports dietetics and a media and nutrition communications expert who’s regularly featured in broadcast, print, and digital media. Through her private practice, Student Athlete Nutrition, she works with athletes at every level in individual and group settings with a mission to make accurate performance nutrition information and practical applications accessible to all high school and collegiate athletes.

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