Physical Activity and Mental Health and Well-Being

According to the World Health Organization, 1 in 8 people across the world live with a mental disorder and most of these individuals don’t have access to effective medical care for their conditions. (1) Nationally, 1 in 5 Canadians will experience a mental illness annually, with 1 in 2 experiencing a mental illness by 40 years of age. (2)

Mental and physical health are interconnected. Individuals with chronic physical health conditions are more likely to develop mental illness, while those with mental illness are at a higher risk of developing other comorbidities and long-term medical conditions. (3,4) Despite evidence-based guidelines recommending exercise (i.e., structured physical activity) as an effective treatment option for various mental health conditions with good adherence, multisystem benefits and low adverse events compared to other treatments, current practice guidelines predominantly focus on pharmacotherapy and psychotherapy, which typically address mental health symptoms without comparable multisystem benefits. (5)

Regular physical activity promotes and protects both mental and physical health. Strong evidence shows that meeting recommended levels of physical activity is associated with a reduced risk of all-cause mortality, cardiovascular disease mortality and incidence of coronary heart disease, stroke, hypertension, type 2 diabetes, several cancers (bladder, breast, colon, endometrial, oesophageal, gastric, renal), dementia, depression and anxiety. 6(,7) Physical activity is associated with improved brain health (e.g., cognitive function, academic performance), stronger muscles and bones, and reduced risk of falls. (6,7)

The WHO recently released the first-ever global status report on physical activity – the first dedicated global assessment of the cost to health systems of not taking action to improve physical activity levels. Globally, almost 500 million new cases of preventable non-communicable diseases (NCDs) will occur between 2020 and 2030, incurring treatment costs of just over US$ 300 billion if there is no change in the current prevalence of physical inactivity. Nearly half of these new cases of NCDs (43%) will result from depression and anxiety, which will account for 28% of total direct health care costs. (8)

Recently, an overview of systematic reviews was conducted to examine the effectiveness of physical activity interventions for improving depression, anxiety, and psychological distress. (9) Findings suggest that physical activity is highly beneficial for managing symptoms of depression, anxiety, and distress across a wide range of adult populations, including the general population, people diagnosed with mental health disorders, and people with chronic disease. Reductions in symptoms of depression and anxiety were comparable to or slightly greater than the effects observed for psychotherapy and pharmacotherapy. Importantly, all types of PA were beneficial, including aerobic, resistance, and flexibility, with higher intensity exercise leading to greater improvements. (9)

In addition to the established relationship between negative mental health states (e.g., depression) and physical activity, new research has now shown that there is also a bidirectional relationship between favourable mental health status (i.e., mental well-being) and physical activity. Specifically, higher levels of mental well-being positively predicts adherence to recommended physical activity levels while greater physical activity positively predicts improved mental well-being. (10)

Engaging in outdoor activity and being active in the presence of nature (‘green exercise’) has been shown to promote particularly salient mental health benefits. Recent evidence suggests that exercising in nature produces psychological benefits and improves connectivity of several brain regions responsible for relaxation. (11) It has also been shown that going for a walk in nature can have positive effects on stress-related brain regions (i.e., decrease in amygdala activation), and consequently, it may act as a preventive measure against mental strain and potentially disease. (12) Further, frequent visits to green spaces, such as parks and community gardens, have been linked to lower use of prescription medications for anxiety and depression. (13)

Together, these findings suggest that physical activity should be considered as a foundational pillar in the management and treatment of depression, anxiety, and psychological distress. Leveraging physical activity as an efficacious approach has the unique potential to improve both mental and physical health outcomes, and in turn overall health and well-being.

Reference:

1. Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx (https://vizhub.healthdata.org/gbd-results/, accessed 14 May 2022).

2. Smetanin et al. (2011). The life and economic impact of major mental illnesses in Canada: 2011-2041. Prepared for the Mental Health Commission of Canada. Toronto: RiskAnalytica.

3. Gronholm, P. C., Chowdhary, N., Barbui, C., Das-Munshi, J., Kolappa, K., Thornicroft, G., ... & Dua, (2021). Prevention and management of physical health conditions in adults with severe mental disorders: WHO recommendations. International Journal of Mental Healt Systems, 15(1), 1-10.

4. Scott, K. M., Bruffaerts, R., Tsang, A., Ormel, J., Alonso, J., Angermeyer, M. C., ... & Von Korff, M. (2007). Depression–anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. Journal of affective disorders, 103(1-3), 113-120.

5. Stubbs, B., Vancampfort, D., Hallgren, M., Firth, J., Veronese, N., Solmi, M., ... & Kahl, K. G. (2018). EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). European Psychiatry, 54, 124-144.

6. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, D.C.: U.S. Department of Health and Human Services, 2018.

7. Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., ... & Willumsen, J. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462.

8. Global status report on physical activity 2022. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

9. Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., ... & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine.

10. Román, J. E. I., Ekholm, O., Algren, M. H., Koyanagi, A., Stewart-Brown, S., Hall, E. E., ... & Santini, (2023). Mental wellbeing and physical activity levels: A prospective cohort study. Mental Health and Physical Activity, 24, 100498.

11. Mavrantza, A. M., Bigliassi, M., & Calogiuri, G. (2023). Psychophysiological mechanisms underlying the effects of outdoor green and virtual green exercise during self-paced walking. International Journal of Psychophysiology, 184, 39-50.

12. Sudimac, S., Sale, V. & Kühn, S. (2022). How nature nurtures: Amygdala activity decreases as the result of a one-hour walk in nature. Mol Psychiatry. https://doi.org/10.1038/s41380-022-01720-6

13. Turunen, A. W., Halonen, J., Korpela, K., Ojala, A., Pasanen, T., Siponen, T., ... & Lanki, T. (2023). Cross-sectional associations of different types of nature exposure with psychotropic, antihypertensive and asthma medication. Occupational and Environmental Medicine, 80(2), 111-118.