L13 - Exercise & Psych Well-Being Part 3

• PA & Depression - Recap 

  • RCT research suggests exercise can improve depression 
  • Clinical & non-clinical populations 
  • Exercise seems to be as effective as medication 
  • Moderate intensity, aerobic exercise, over 3-5 days per weeks for >10 weeks is required 
  • For best effects 
  • But small bouts can still be beneficial
  • But even short term exercise can have a positive acute effect 
  • Exercise should be considered a valuable tool in the depression treatment “toolbox”
• Challenges

  • What are the challenges of promoting or using PA as a means of treating depression?
  • Additional barriers to participation:
  • 50% not meeting guidelines have additional barriers ro take into account 
  • Low motivation 
  • Social withdrawal &/or anxiety 
  • Learned helplessness 
  • Fear of failure 
  • Lack of self-confidence 
  • Also, PA doesn't address the root cause 
  • Psychological therapy likely need for this (& medication)
• Challenges

  • What are the challenges of promoting or using PA as a means of treating depression?
  • Additional barriers to participation:
  • Learned helplessness 
  • Sense that nothing you do is useful; nothing you do is gonna change (don’t see benefits)
  • Set goals to help overcome - goals are achievable, also helps w/ motivation & confidence (goldilocks goals); also helps notice short term benefits 
• Anxiety 

  • “A state of worry, apprehension or tension that often occurs in the absence of real or obvious danger”
  • Common causes:
  • Public speaking 
  • Nervousness before speaking 
  • Phobias 
  • Not clinical until becomes imbedding to daily life 
  • Sports performance 
  • Nerves
• Signs of Anxiety - Symptoms 

  • Cognitive 
  • Worry, guilt
  • Somatic 
  • Physical feeling, headaches 
  • Difficulty breathing 
  • Behavioural 
  • Grinding teeth
  • Nervous habits, fidgeting 
  • Important to recognise these symptoms to help client (find symptoms in image)

  
• Signs of Anxiety 

  • Non-clincal 
  • Everyday 
  • Acute 
  • Experience on a day to day basis 
  • State anxiety 
  • Clinical 
  • Diagnosed 
  • Chronic 

  
• Signs of Anxiety 

  • Anxiety disorders 
  • GAD (generalised anxiety disorder)
  • Generalised, not associated w/ a particular thing 
  • OCD (obsessive compulsive disorder)
  • Have to be done the right way
  • Agoraphobia 
  • Phobia of social situations & large open spaces
  • Amount & variety makes it so difficult to see if PA is effective treatment for all

  
• Prevalence of Anxiety

  • ‘Up to 33.7% of the population are affected by an anxiety disorder during their lifetime’ 
  • Mental health in Aotearoa 
  • In graph results from the 2018 Mental Health Monitor & the 2018/19 NZ Health Survey 
  • 18-25 yrs olds have highest prevalence of anxiety 
  • During the 2020 lockdown, 15.6% of NZ respondents reported moderate to high anxiety; younger adults fared worse 
  • Older adults - anxiety was lower, more room to be PA & be w/ friends/family

  
• Prevalence of Anxiety

  • Treating or coping w/ anxiety 
  • Treatment speaks to clinical; Coping = for daily living 
  • Medication - self medication (alcohol, drugs) 
  • Psychotherapy - other forms of therapy also (eg talking therapy)
  • Exercise/PA - weather clinical or nonclinical
  • Breathing - link w/ breathing & PA (got to breath well for PA)

  
• Mechanisms of Action - Neurobiological

  • Aerobic exercise →
  • Decreased sympathetic nervous system (SNS) & hypothalamic-pituitary-adrenal (HPA) axis reactivity +
  • Decreased flight or fight response 
  • May have higher levels than general pop
  • Neurogenesis & neuroplasticity (eg BDNF) +
  • Can be structural brain changes 
  • Endorphin production → 
  • = a pain relief 
  • Decreased anxiety 
  • Limited evidence to date… but promising
• Mechanisms of Action - Psychosocial

  • Anxiety sensitivity 
  • Tendency to misinterpret & catastrophize anxiety-related sensations (eg increased HR)
  • Will interpret response as a panic attack 
  • Inverse relationship bw/ anxiety sensitivity & exercise frequency 
  • Higher levels of PA associate w/ lower levels of anxiety sensitivity 
  • Avoidance of somatic sensations that may be interpreted as anxiety & panic?
  • Short term aerobic exercise might reduce anxiety sensitivity 

  
• Mechanisms of Action - Psychosocial

  • Short term aerobic exercise might reduce anxiety sensitivity 
  • How? Or how can we use this knowledge to support people
  • Exposure to exercise (ie rapid heartbeat) in the context of exercise & re-appraisal supported by exercise professionals might increase tolerance &/or aid re-interpretation of physiological symptoms 
  • Also supports self-efficacy for dealing w/ perceived threats = experience lower levels of anxiety (social cognitive theory)
  • Also self-determination theory

  
• Mechanisms of Action - Improving interoception accuracy

  • PA & exercise a route to developing interoception?
  • Another treatment in the toolbox 
  • Importance of breathing here too → increases w/ PA
  • Understanding what's happening within our bodies (HR)
  • Things that you don't necessarily see, but something that you experience 
  • High anxiety = high awareness of signals 
  • Interoception high with people with anxiety but misinterpret & catastrophize 
  • But, mistakes in interpreting them (i.e catastrophizing) 
  • Related to self-regulation/emotional regulation (anxiety)

  
• What Does the Evidence Say? PA/Exercise & Anxiety 

  • Systemic review
  • Synthesis of the evidence on the effects of PA on symptoms of depression, anxiety & psychological distress in adult populations 
  • Both clinical & non-clinical anxiety 
  • Is exercise a genuine treatment for anxiety disorders?

  
• Systemic Review

  • Really important with research along with meta-analysis (gold standard)
  • Brings up quality issues in psychological experiments 
  • Overtime (difference in quality, how measured etc)
  • PA had medium effect size on anxiety (0.42)
  • Even small effects sizes can have a big difference 
  • Is about clinical significance 
  • Both medication (0.39) & Cognitive Behavioural Therapy (0.51) have been found to have similar effects
• Non-Clinical Anxiety 

  • Anxiety & PA relationships under COVID 
  • More moderate to vigorous PA → 15-34% reduced likelihood of anxiety symptoms
  • Looked at WHO-5 
  • Self-regulating anxiety through PA?
  • Mental health continuum → stop that slide to mental illness
  • Reviews w/ non-clinical populations
  • PA has a significant, small reductive effect on anxiety
  • No clear pattern of what combo of exercise mode, duration & intensity was most effective, suggesting a variety may be effective in reducing (state) anxiety
  • Effects aren’t dependent on fitness change
• Non-Clinical Anxiety 

  • Reviews w/ non-clinical populations
  • PA has a significant, small reductive effect on anxiety 
  • Just bc/ small doesn’t mean not significant 
  • No clear pattern of what combo of exercise mode, duration & intensity was most effective, suggesting a variety may be effective in reducing (state) anxiety
  • Consider what they prefer - context in which we exercise 
  • Green-washing: exercise in nature is better for you
  • Also got to do with people's experiences 
  • Speaks to importance of working with individuals 
  • Effects aren’t dependent on fitness change
  • Physiological changes
• Clinical Anxiety 

  • Correlational studies 
  • Regular PA provides a buffer against clinical anxiety symptoms & disorders 
  • Prevalence of panic attacks, social anxiety, agoraphobia is lower in physically active individuals 
  • But those w/ > anxiety symptoms are less likely to be PA 
  • Lack of RCTs w/ clinical anxiety patients mean that it’s premature to recommend exercise as a treatment 
  • Or reviews of RCTs even better 
  • However, signs are looking good 
  • Image:
  • Less evidence…, but signs are looking good 
  • So building up can show in which conditions it is good

  
• Takeaways: When working w/ people who might be experiencing depression &/or anxiety…

  • Recognise the signs/symptoms
  • What does depression or anxiety look like?
  • What are the behaviours that might indicate either condition?
  • The person themselves might not realise that they are experiencing depression of anxiety 
  • Not as easy as looking at a broken bone, is more difficult to see 
  • esp if putting on a good show 
• Takeaways: When working w/ people who might be experiencing depression &/or anxiety…

  • Seek external guidance 
  • Know who to refer clients onto & make those referral 
  • Clinical professionals 
  • Sometimes you might be the 1st port of call for mental health issues 
  • Not trained as mental health professionals 
  • Knowing your limits - into info can provide 
• Takeaways: When working w/ people who might be experiencing depression &/or anxiety…

  • Use your exercise physiology expertise 
  • Teach & reassure clients that their physiological responses are natural, which all improve their interoception accuracy 
  • But, do watch out for genuine physical warning signs of something more serious 
• Takeaways: When working w/ people who might be experiencing depression &/or anxiety…

  • Treat people as individuals 
  • One size doesn’t fit all (at all times)
  • Tailoring programs & how interact w/ individuals 
  • Will have different needs, goals, ways they think etc 
  • Need 2 way conversations, rather than a prescription