The Gold Standard: Getting Physical for Mental Health
Network, Spring/Summer 2006
Individuals with emotional distress or mental illness report poorer physical health and have greater rates of chronic conditions such as arthritis, diabetes, high blood pressure, heart disease and stroke than the general population. This is why it is said there can be no health without mental health. For persons with serious mental illness, poor physical health is attributed in part to unhealthy weight, resulting from medication, poor nutrition and lack of exercise.
Exercise is an essential strategy for achieving a healthy weight. Given the mind/body connection, exercise enhances not only physical health but also mental health. Physical activity is as beneficial to persons with mental illness as for the general population. In one study, physical activity was associated with better quality of life among persons with anxiety or affective disorders (depression, mania or bipolar), even after adjusting for differences in income. This is an important qualifier, as income is a well-known determinant of health. Typically, the greater one’s income, the better one’s self-reported health. However, in this study, they found that persons with anxiety or affective disorders and low income who were physically active reported better health-related quality of life than persons with the same condition who had higher income but did not exercise.
There are a number of explanations offered as to why exercise benefits mental health. Psychological explanations include that exercise generates a sense of control over one’s health and improves self-esteem. It increases opportunities for social contact and therefore reduces social isolation. It can provide distractions from unpleasant thoughts or feelings, thereby creating a greater sense of well-being. Physiologically, exercise can reduce muscle tension, as well as generate the release of chemicals in the brain that elevate mood.
Formal exercise programs can promote a healthy weight. However, the drop-out rate for exercise programs can be greater than 50 percent after six months, and the cost is often prohibitive for persons with serious mental illness. Canada’s Physical Activity Guide to Healthy Active Living recommends that Canadians take 20 to 30 minutes a day of vigorous physical exercise. Alternatively, they can engage in 30 to 60 minutes a day of moderate physical activity or 60 minutes per day of light effort physical activity. The thinking is that some physical activity is better than none at all.
Mental health service providers are beginning to experiment with offering physical activity programs to persons with serious mental illness. They are a natural fit with a recovery-based approach. In the Michigan Walk Your Talk Program, participants from a hospital outpatient program, a community mental health centre and a clubhouse (social-recreation) program participated in both a walking group and educational sessions on nutrition and the benefits of physical activity. While the drop-out rate was still high, those individuals who completed the program lost weight and were encouraged enough to continue to organize themselves for a weekly walk even after the formal program ended.
In a more intensive exercise program for persons with serious mental illness, three vigorous exercise sessions were provided each week, along with an individualized fitness assessment and personal wellness plan. Adherence to the program was better than average. Participants showed significant improvements in cardiovascular fitness and enhanced self-esteem, quality of life and mood. The program was so successful it sparked the creation of the Recovery Center within the Center for Psychiatric Rehabilitation at Boston University. The Recovery Center uses an adult education model to offer a range of courses to promote health for persons with mental illness.
Integrating exercise into mental health services is being recommended as an important strategy to promote better health. Physical activity programs offered through mental health services have the potential to lift the financial burden that restricts the participation of persons with low income. Motivation to adhere to exercise can be enhanced when barriers to participation are addressed in a non-judgmental and supportive setting specifically designed to meet the needs of persons with mental illness.
Of course, a focus on the individual to participate in exercise programs is only one strategy. Through the pursuit of healthy public policy, communities have an important role to play in promoting the physical and mental health of all. Recreation fees geared to income can ensure that persons of limited means can participate in activities as full members of the community. And municipal policies that ensure, for example, pedestrian walking paths, attractive scenery, and adequate lighting can create safe and friendly environments that are conducive to the pursuit of health.
Michelle Gold, MSW, MSc, is senior director of policy and programs at CMHA Ontario.