Sports and Mental Health

Mental health has been described as the emotional and spiritual resilience that enables people to enjoy life and to survive pain, disappointment, and sadness.  It  is  fundamental  to  health  and  well-being and is more than the absence of symptoms of mental  illness.  Mental  illnesses  are  health  conditions that  are  characterized  by  alterations  in  thinking, mood, or behavior associated with distress and/or impaired  functioning.  Mental  health  and  mental illness should be considered distinct. An individual may  have  a  diagnosis  of  a  mental  illness,  such as  schizophrenia,  yet  still  attain  positive  mental  health.  Mental  health  problems,  such  as  subclinical levels of depression, can affect individuals without  necessarily  becoming  a  diagnosed  mental  illness.  Consequently,  mental  health  concerns everyone, and strategies to promote mental health should  be  implemented  for  the  benefit  of  all.  No single factor causes poor mental health or mental illness. Rather, these are influenced by a range and combination of factors such as genetic inheritance, biochemical and psychological factors, life events, and socioeconomic circumstances. Similarly, when mental health improves, it is likely that a combination of factors is at work.

The  physical  health  benefits  of  exercise  and physical activity (PA) are well established. PA, as a general term, refers to any movement of the body that  results  in  energy  expenditure  above  that  of resting  level.  Exercise  refers  to  a  subset  of  PA  in which  the  activity  is  structured  and  often  supervised and undertaken with the aim of maintaining or  improving  physical  fitness  or  health.  Research is rapidly increasing concerning the impact of both on  mental  health.  A  focus  on  this  relationship  is very relevant as mental health outcomes may motivate  people  to  stay  physically  active  while  also having  a  potentially  positive  impact  on  mental health. Without regular participation, both mental and physical benefits will not accrue.

sports-and-mental-health-sports-psychologyThis entry describes four main functions of PA in impacting mental health. First, PA may prevent mental health problems. Second, exercise has been examined  as  a  treatment  or  therapy  for  existing mental  illness.  Third,  exercise  may  improve  the quality  of  life  (QOL)  for  people  with  mental  illness.  Fourth,  exercise  and  PA  can  improve  the mental  health  of  the  general  public  in  a  broad number of ways.

Prevention

There  is  some  evidence  that  participation  in  PA prevents  mental  health  problems  from  occurring at  a  later  time.  Given  our  aging  society,  senile dementia  and  Alzheimer’s  disease  represent  significant  public  health  burdens.  Some  evidence suggests  a  reduced  risk  of  dementia  for  individuals who are physically active. More extensive evidence  is  available  regarding  depression.  In  2010, the  World  Health  Organization  predicted  that depression  would  be  second  only  to  ischemic heart  disease  in  global  overall  disease  burden  by the  year  2020.  This  prediction  is  alarming  when considering depression’s detriment to physical and mental health. Depression is commonly associated with high morbidity and mortality rates; increased risk  of  suicide;  major  suffering;  and  a  decrease in  physical,  cognitive,  and  social  functioning. To  look  at  the  role  PA  has  on  the  prevention  of depression,  epidemiological,  prospective  longitudinal  studies  are  required  to  identify  a  temporal relationship.  Such  studies  involve  large  numbers of  people  and  measure  levels  of  PA  and  depression at two or more time periods. For example, a study conducted by William Strawbridge and colleagues in California collected measures of PA and depression from 1,947 community-dwelling adults ages 50 to 94 years at baseline in 1994 and after 5  years  of  follow-up.  After  excluding  individuals with  depression  in  1994,  an  increase  in  PA  was associated  with  a  significant  (20%)  reduction  in the likelihood of being depressed in 1999. Perhaps this  finding  could  be  explained  by  bias  in  some way—for  example,  individuals  with  a  physical disability  may  have  both  a  higher  risk  of  depression and lower levels of PA. Most studies like this one, however, continue to demonstrate a relationship  between  PA  and  a  decreased  risk  of  depression while accounting for a wide range of possible confounding  factors,  such  as  disability,  smoking, alcohol, and social status, in the statistical modeling. Overall, these types of studies suggest PA has a protective effect against developing depression.

Treatment

Exercise might be used as a therapeutic strategy to alleviate mental health problems or mental illness. As with the preventive function, the most compelling  evidence  comes  from  studies  in  the  area  of clinical depression. As depression is the most common mental health problem, it has received more attention  by  researchers  than  other  conditions. Meta-analyses  quantify  results  from  a  number  of studies and allow statistical techniques to be used as a means of analysis. The basis of a meta-analysis is  the  effect  size  (ES),  which  transforms  differences between an experimental and control group to  a  common  metric.  As  a  guideline,  ES,  usually determined  through  the  calculation  of  differences between  an  exercise  and  control  group  or  from preto post-exercise intervention, of ≥.2, ≥.5, and ≥.8,  is  generally  described  as  reflecting  a  small,  moderate,  and  large  effect,  respectively.  In  one meta-analysis of 28 studies examining exercise and depression, comparing exercise with no treatment or  a  control  intervention,  the  ES  was  –0.67  indicating  a  moderate  clinical  effect.  However,  when only  the  four  methodologically  strongest  trials were analyzed, the ES was reduced and was small at –0.31. Notably, this ES is comparable to those seen in meta-analyses of the effects of medication on  depression.  These  findings  suggest  exercise might be an additional consideration for treatment for those who are interested in trying it. Researchers have started to examine how exercise might be an adjunctive treatment for other illnesses such as bipolar disorder, anxiety, and drug dependence.

Physical Activity for Quality of Life and Coping With Mental Illness

For   people   with   severe   and   enduring   mental health  problems,  improvement  in  QOL  tends  to enhance  the  individuals’  ability  to  cope  with  and manage their disorder. In this case, exercise might be  useful  in  improving  the  mental  health  of  individuals  with  a  mental  illness.  A  good  example  is schizophrenia—a  serious  mental  illness  that  is characterized  by  psychotic  symptoms  (e.g.,  hallucinations,  delusions),  disorganized  speech  and behavior, negative symptoms (e.g., apathy, blunted or flattened affect), and neurocognitive and social cognitive  deficits.  Epidemiological  surveys  demonstrate  an  excess  of  physical  morbidity  and  premature mortality in individuals with schizophrenia with the largest causes of death being related to cardiovascular disease, obesity, and diabetes. Potential causes  of  this  excess  mortality  and  morbidity  are varied  but  can  be  broadly  categorized  in  terms of  changes  in  treatment  (metabolic  side  effects  of medication);  greater  prevalence  of  engagement  in unhealthy  behaviors  such  as  smoking,  physical inactivity, and poor nutritional habits; and limited access to health care. Consequently, PA promotion is well warranted in this population irrespective of mental  health  gains.  One  meta-analysis  suggests small effects in terms of improvements in some of the  negative  symptoms  of  schizophrenia  such  as depression, low self-esteem, and social withdrawal. There is less evidence that exercise may be a useful coping strategy for dealing with positive symptoms such  as  auditory  hallucinations.  There  are  limitations  to  this  research  literature,  but  the  evidence suggests  exercise  interventions  are  feasible  in  this population and can have healthful effects on both the physical and mental health of individuals with schizophrenia.

Mental Health Promotion for All

There are many components of mental health such as  self-esteem,  cognitive  functioning,  stress,  and sleep. Although research has been conducted on all of these topics, its extent and degree of methodological  rigor  vary.  The  majority  of  existing  research examining exercise and mental health is included in this category. Self-esteem has received much attention  because  many  consider  it  a  central  aspect  of mental health, as it reflects the overall evaluation or appraisal  of  one’s  own  worth.  In  a  meta-analysis, there was a small relationship between exercise and self-esteem  (+0.23).  One  well-accepted  approach to  self-esteem  considers  the  construct  to  be  multidimensional  and  hierarchical  in  nature.  That  is, self-esteem can be broken down to many constituent  parts  comprising  an  extensive  number  of  life domains.  For  example,  one’s  self-esteem  could  be based on how well he or she performs at work, in relationships  with  others,  or  how  one  looks  and feels  physically.  Theoretically,  one  might  expect exercise to have a stronger relationship with components of self-esteem related to the physical self. Research  confirms  a  stronger  effect  is  seen  when there are significant changes in physical fitness, for example, and this can extend to more generalized improvements in self-esteem. Overall, there is evidence that exercise can change people’s perceptions of their physical self and identity in a positive way.

How Does Exercise Benefit Mental Health?

Understanding  how  exercise  improves  mental health may lead to the development of exercise prescriptions that more effectively and reliably improve the mental health of individuals. Researchers have investigated  a  range  of  mechanisms  that  can  be broadly described as being biochemical, physiological,  or  psychosocial  in  nature.  A  commonly  suggested  biochemical  mechanism  is  that  endorphins (endogenous  opioid  peptides)  are  responsible  for euphoria or other changes in mood during or after acute exercise. While such a mechanism is plausible, there is still no compelling evidence to support such claims. Changes in fitness, a physiological mechanism, may explain improvements in mental health. However, some studies demonstrate mental health benefits even when there are no changes in fitness. Psychosocial mechanisms have also been explored, including how exercise may enhance perceptions of mastery  or  competence,  or  provide  opportunities for  distraction  and/or  social  interaction.  Current consensus is that there is unlikely to be one central mechanism that explains mental health benefits for all people. Because mental health is influenced by many factors, it is just as likely that many factors positively  influence  mental  health  and  that  exercise  could  be  helpful  through  a  number  of  pathways.  Several  mechanisms  most  likely  operate  in concert, with the precise combination being highly individual-specific  and  varying  through  exercise characteristics  such  as  intensity  and  type,  preferences of the individual, and even when and where the exercise takes place. Current guidelines for PA aimed at adults (e.g., accumulating 150 minutes of moderate-to-vigorous physical activity [MVPA] per week) are supported in terms of their potential for enhancing mental health.

Conclusion

The  field  of  exercise  and  mental  health  is  a  rapidly  growing  focus  for  researchers  and  practitioners. As with most fields of study, more research is required—particularly, rigorously designed experimental studies comparing the effects of exercise to other  therapeutic  approaches.  Furthermore,  there is  also  scope  for  exploring  issues  such  as  dose– response  (e.g.,  how  the  type,  intensity,  frequency, and duration of exercise is related to mental health outcomes),  participant  characteristics  (e.g.,  who responds most positively to a “dose” of exercise), and  the  mechanisms  that  explain  mental  health change.  Because  PA  is  an  effective  method  for improving important aspects of physical health, the promotion of PA for mental health can be seen as a win–win situation—the physical health benefits are indisputable, and evidence suggests that there can be important mental health benefits as well.

References:

  1. Gorczynski, P., & Faulkner, G. (2010). Exercise therapy for schizophrenia. Cochrane Database Systematic Reviews, 5, Mental Health and Physical Activity. Retrieved from http://www.journals.elsevier.com/mental-health-andphysical-activity
  2. Rimer, J., Dwan, K., Lawlor, D. A., Greig, C. A., McMurdo, M., Morley, W., et al. (2012). Exercise for depression. Cochrane Database Systematic Reviews, 7,
  3. Spence, J. C., McGannon, K. R., & Poon, P. (2005). The effect of exercise on global self-esteem: A quantitative review. Journal of Sport & Exercise Psychology, 27(3), 311–334.
  4. Strawbridge, W. J., Deleger, S., Roberts, R. E., & Kaplan, G. A. (2002). Physical activity reduces the risk of subsequent depression for older adults. American Journal of Epidemiology, 156(4), 328–334.

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