Exercise Prescription for Mental Health

As a fitness professional, you undoubtedly know how prevalent mental health issues are, and you may even work with people who have them. However, there’s very little specific information on how to make it better (other than “exercise is good for you”) and any improvements that come are simply a side effect of exercise. But what if there was a direct way to exercise specifically for improvement of mental health issues? That’s exactly what we’ll cover in this article.

If your clients have noticed that they:

• Have lost pleasure in activities that they really used to enjoy
• Aren’t taking care of themselves as much
• Are neglecting certain relationships
• Performing worse at their work than they used to

Then this article is for you.

We’ll discuss the exercise prescription for mental health issues. I use that word, “prescription” very precisely. After all, when a doctor prescribes a medication, there’s a lot of precision behind it. S/he tells you:

• The name of the medication
• The dose
• Whether you should take it with food, or away from food
• Whether you should take it in the morning, or the evening

But, when the doctor recommends exercise, well, the recommendation is vague. You don’t know exactly how to do it. You need the exercise prescription for different conditions:

• The type: cardio, strength training, or stretching
• The frequency: how many days per week. It’s not always a “more is better” type of scenario. With some things there’s a “sweet spot”.
• The duration: how long you exercise for, or how many sets and reps
• The intensity: at what percent of your maximal effort do you exercise?

CARDIO VS. STRENGTH TRAINING

Although the occasional study finds that cardio is more effective, most studies find no difference in effectiveness between cardio and strength training.

In one study, researchers divided participants into two groups:

Group 1 did cardio, three times per week, for one hour, at an intensity of 80% of their maximal heart rate.

Group 2 did strength training, three times per week for one hour. They did 10 exercises, in a circuit format, making sure their heart rate did not rise above 50-60% of their estimated maximum.

Group 3 was the control group. They did not exercise.

Both groups one and two had similar improvements in mental health (as judged by their depression score). After the study, around 80% of the people in groups one and two no longer met the diagnostic criteria for depression. But only 17% of the people in group three no longer met the diagnostic criteria for depression.

In another study, participants with mental health issues, whose average age was 71, participated in high-intensity strength training and, after 10 weeks, those who were in the exercise group had a 54% improvement in their mental health.

FREQUENCY

How many days per week is better – one, three, five? Or is it like medications, where if you don’t take it for one day, the effect completely goes away, in which case, you need to take it every day, seven days per week?

That’s what this study tried to answer. In here, researchers divided participants into five groups:

• Group 1: control group (stretching)
• Group 2: burned 7 kcal/kg/week, across 3 days
• Group 3: burned 7 kcal/kg/week, across 5 days
• Group 4: burned 17.5 kcal/kg/week, across 3 days
• Group 5: burned 17.5 kcal/kg/week, across 5 days

In this case, there was no difference between the two groups that burned 7 kcal/kg/week, and the group that didn’t exercise at all. None of those three groups saw much of an improvement in mental health. However, both groups that exercised at 17.5 kcal/kg/week saw reductions in symptoms of mental illness that were similar to each other. After 12 weeks of following this program, the reduction in mental illness symptoms was about 47%.

From this preliminary evidence, it seems like there’s not much of a difference between three times per week, and five times per week, as long as you cross a certain energy expenditure threshold. Is there a greater effect for even greater calorie expenditures? Maybe. But, as far as I know, that research has not yet been done yet.

INTENSITY

So, now that we know the type (cardio and strength training are about even), the frequency (not much of a difference between three and five times per week), what’s the intensity required to reduce mental health issues? Should you take it easy? Or should you really push?

That’s what this study tried to find out.

Researchers divided participants into three groups:

Group 1 was a control group (they didn’t exercise)

Group 2 did strength training at 80% of their maximum weight, three times per week for eight weeks.

Group 3 did the exact same exercises, repetitions, and frequency as group 2, but they did it with only 20% of their maximum weight.

The results:

• 21% of the people in group 1 had a reduction in their mental health issues after eight weeks. Without exercise. Without medication. Without psychotherapy. It just happened.
• 61% of the people in group 2 had a reduction in their mental health issues after eight weeks.
• 28% of the people in group 3 had a reduction in their mental health issues after eight weeks

What’s our conclusion? High intensity (over 75% of your maximum) is superior to low intensity when it comes to mental health improvement. This study looked at strength training, but other studies saw the same effect for cardio.

DURATION

Is this a case of “more is better”, or is this a case of “just right”? Unfortunately, this variable hasn’t been as well studied as frequency, intensity, and type. However, one preliminary study concluded that duration and intensity are much less important than frequency.

In terms of weeks/months, although small, transient reductions are seen with just a single exercise session. To see large, consistent, long-term reductions, you should exercise for at least 9 weeks, according to this study.

EXERCISE VS. MEDICATIONS

And now, the million-dollar question: how do medications compare to exercise when it comes to mental health improvement?

One meta-analysis (a study of several studies), from the journal Frontiers in Pharmacology looked at this question in very significant detail and found that exercise is equally effective to medications in the treatment of mental health issues. And, when the two are combined, the medications work even better.

HOW EXERCISE WORK ON MENTAL HEALTH?

It’s nice to know what works, but “why” does exercise help relieve mental health issues? What are the mechanisms involved?

Reason #1: Endorphins

When you exercise at a high intensity, it’s physically uncomfortable. You’re out of breath and your muscles are burning. Your body doesn’t like that, so it releases “pain-blocking” chemicals called “endorphins.” It makes sense why the high intensity is required for mental health improvement. It has to be uncomfortable enough to trigger the release of endorphins. Low intensity is too comfortable for endorphin release. It blocks physical pain, but along with that, it helps emotional pain, as is seen in mental illness.

Reason #2: Self Efficacy Hypothesis

Often, a person who suffers from mental health issues has the feeling like their life is out of control. Things are happening to them and they are helpless against circumstances. Exercise gives you a sense of control. You know that if you go for an intense 20-minute workout, you’ll feel better. And who controls when you work out? You do! Who controls how long you work out? You do! Who controls how hard you work out? You do!

Reason #3: Distraction

Sometimes exercise just works because you’re focused on how hard you’re breathing and how much your muscles are burning. You are able to forget whatever is stressing you out.

Reason #4: Sleep Improvement

It’s very well-known that people who exercise usually sleep better. People who sleep better have better moods.

Reason #5: Serotonin

Serotonin is the “happy chemical” and when it’s released you feel content and relaxed. Exercise helps increase serotonin in the brain.