Fitness and Mental Health: Exploring the Mind-Body Connection

Objectives The student will learn about:

The benefits of sunlight, oxygen, movement and endorphins on mood

How exercise can help mitigate depression, anxiety, bipolar disorder, postpartum depression, hyperactivity, bulimia/binge eating and addiction

Common mental health issues in the “average” population and their frequency

Common psychotropic medications and their side effects which may affect balance, coordination, reaction time and stamina

Objectives Cont...

Dehydration and the effectiveness of certain medications Special concerns when working with clients/students

with eating disorders The benefits of exercise in the elderly with regard to

depression and suicide The benefits of teaching children to love exercise

including prevention of many physical and mental health problems in later life

The interaction between hormone shifts, sleep deprivation and postpartum depression

S.O.M.E.

Gotta getcha S.O.M.E. Sunlight Oxygen Movement Endorphins

Sunlight

Benefits Vitamin D Stonger Bones Improved Rest Improved Mood

Ways to incorporate Go outside Sunlight spectrum bulbs

How much? 20 minutes per day

Oxygen

Signs of too little in a healthy person Yawning Feeling tired

Benefits Energy Increased blood flow Relaxation

Movement

Signs of too little (or too much) Tiredness Depression Aches/Stiffness Weight problems Muscular atrophy Sleep problems

Movement cont…

Benefits Increase bloodflow Strengthen muscles and bones Improve sleep Reduce aches and pains Improve weight Improve self-esteem Eliminate toxins Relieve constipation

Movement cont…

Types Fitness classes---provide levels of workout Encourage movement bewteen classes—walking,

house cleaning, gardening, tennis...

Endorphins

Happy chemicals Finding the happy medium

Stress

What is it: Fear? Anger? Both? How common is it (15 per day) 6 Basic Stressors

Fear of Death Loss of Control The Unknown Rejection Failure Isolation

* Discussion Forum *

How prevalent is stress in your life? In your work? What would you identify are the primary sources of your stress? How does stress affect you physically? What activities reduce your stress? We would love for you to share your responses in the discussion forum. Thank you.

Stress Chemicals Adrenaline

Function Mental Health Side Effects Physical Side Effects And Exercise

Cortisol Function Mental Health Side Effects Physical Side Effects And Exercise

http://www.heartcenter.com/billett.html

Prevalence of Mental Health Disorders

Anxiety: 18% Depression: 8-9% (not including situational or

postpartum) Bipolar Disorder: 3% Eating Disorders: 8% Alcohol and Drug Addiction: 7%

According to the National Institute of Mental Health “The Numbers Count: Mental Disorders in America”

Psychotropic Medications

Antidepressants

MAOIs Side effects: Drowsiness, Dizziness, Weakness,

Shakiness, Fatigue, Weight Gain SSRIs

Side effects: Weakness, Dizziness, Shakes Usually remit within one to two weeks Often recur if client misses a dose

Antianxiety / Sedatives / Anticonvulsants

Benzodiazepines, Barbiturates, Anticonvulsants Examples: Xanax, Valium, Restoril, Librium,

Ativan, Phenobarbital, Pentobarbital, GHB Side effects: Drowsiness, Coordination Loss,

Dizziness, Occaisional Hypotension, Reduced Reaction time

Mood Stabilizers and Side Effects Lithium

Dizziness Weight Gain

Tegretol/Carbamazepine Sleep Problems

Depakote/Valproate Weight Gain Drowsiness

Seroquel/Quetiapine Drowsiness Antianxiety properties

Mood Stabilizers Cont...

Geodon/Ziprasidone Risperdal/Risperidone

Drowsiness Clozapine

Major weight gain Zyprexa/Olanzapine

Weight Gain

Medications in italics have evidence of both anitdepressant and anti-manic properties

Medications in yellow are classified as Atypical Antipsychotics http://www.psycheducation.org/depression/meds/moodstabilizers.htm

* Discussion Forum *

There are many new treatment medications available today compared to 20 or even 10 years ago. What differences have you noted regarding treatment effectiveness with the newer medications? Which area of psychopharmacology would you like to see researched and developed more? We would love for you to share your responses in the discussion forum. Thank you.

Common Types of Mental Health Issues that Benefit from Exercise as an Adjunct Therapy

Anger

Benefits of exercise Channels energy to positive activity Burns up stress chemicals and free-floating fatty

acids Can be cathartic

Medication Generally not medicated unless patient is a

danger Possibly barbiturates Tendancy towards alcohol or marijuana abuse

Anxiety Cluster of disorders (GAD, PTSD, Phobias) Generally referred to as fear, stress, worry or

tension Affects 18 percent of the population Benefits of Exercise

Helps clients clear their mind/focus on something other than their fear

Burns up stress chemicals helping to relieve the fight or flight response

Provides clients with venue for social support/interaction

Anxiety Medications

Benzodiazepines Barbiturates SSRIs/Antidepressants Busiperone

Bipolar Disorder

Formerly called manic depression Occurs in 3 percent of the population Benefits of Exercise

Improves mood during depressive phases May provide an appropriate outlet during manic

phases Clients can be reckless during manic phases so

adequate supervision is essential

Medications for Bipolar

Mood Stabilizers are the drugs of choice Many mood stabilizers

Cause weight gain Increase fatigue May demonstrate alterations in effectiveness if

patients become dehydrated (A. Fariborzian, M.D. (2006), personal communication)

Depression

Major Situational Seasonal Affective Disorder (SAD) Premenstrual Dysphoric Disorder (PMDD) Postpartum

Depression Treatment

Major Antidepressants, MAOIs Behavioral—nutrition, exercise, social support,

sunlight Situational / SAD / PMDD

Anitdepressants (Short course) Behavioral as above

Postpartum Depression (PPD)

Crucial to be aware of statements of harm or obsessions

Often occurs during major hormone or schedule shifts 1-2 weeks after birth 1-2 weeks after stopping breast feeding Periods of sleeplessness Can occur up to 1 year after birth Might be associated with hypothyroid

http://www.med.umich.edu/depression/postpartum.htm

PPD Cont...

Mothers at higher risk (controversial) Mothers with pre-existing eating disorders Mothers with pre-existing depression or anxiety

disorders Mothers with little social/family support

PPD Treatment/Exercise

Medications Antidepressants Antipsychotics Antianxiety Anticonvulsants

Sunlight and Exercise To improve mood and regulate sleep schedule Some evidence indicates exercise can help mitigate the negative

interaction between hormones and neurotranmitters Can help mom relax and have positive effects on baby

Exercise & PMS By: Carol Krucoff http://yourtotalhealth.ivillage.com/diet-fitness/exercise-amp-pms.html?pageNum=1

Behavioral Issues and Exercise

Addictions

Most people with addictions have co-occurring depression and anxiety.

Addictions are often self-medicating. Exercise can help relieve stress, improve self

esteem, improve energy and increase positive neurochemicals: norepinepherine, endorphins.

Eating Disorders—Bulimia, Binge Eating

Approximately 8% of the population can be diagnosed with anorexia or bulimia.

5.5%-11% of the population can be diagnosed with binge eating disorder.

What can we do?

Providing a healthy exercise environment models positive behaviors for clients with EDs.

Teach that moderate exercise is a vital component to reducing depression, anxiety and bingeing.

Be aware that overuse of vomiting, laxatives and diuretics may make this population weak and can lead to heart attack, fainting, stroke.

* Discussion Forum *

Do you see a difference in response to treatment for those clients who exercise as suggested versus those who do not exercise? How are their outcomes different? Please share your responses in our discussion forum. Thank you.

Eating Disorders: Anorexia

They are driven by an obsession with perfection and control.

Fitness Instructors: Use extreme caution working with this population. They are often emaciated and in uncertain physical condition.

Hyperactivity

Home grown 7-year old hyperactivity, not AD/HD

Group fitness classes right after school can provide positive outlets for pent up energy

Exercise in the morning for adults who have excess nervous energy

Special Populations

Children Elderly Law Enforcement

Children

Develop self esteem and motor skills through exercise

May reduce oppositionality Provide daily opportunities for success and

challenge Early exercise habits prevent later life obesity

etc. Early exercise habits also improve self-esteem

and self confidence which buffer against later mental health problems.

Kids continued...

Make it FUN! http://kidshealth.org/parent/nutrition_fit/fitness/exercise.html Theodore Ganley, MD, and Carl Sherman, “Exercise and

Children’s Health," The Physician and Sports Medicine Journal, (February, 2000).

Elderly

18 % of elderly persons are depressed (National Alliance on Mental Illness, 2008)

Persons over 65 have the highest rates of suicide of any age group

Social interaction is the number one buffer against elder suicide

Elderly cont...

Exercise provides Social Interaction Reduced depression Improved Sleep

Have classes that target the over 65 group Use music appropriate to their genre For counselors: Many elderly patients have

trouble opening up in a counseling office, but not on the walking track

Many elders will confide in each other, but believe “counseling” is taboo.

Law Enforcement/ER Physicians and Nurses

Constantly experience chronic low-grade stress with bursts of extreme stress

LEO have heart disease now listed as a work related disability due to chronic stress levels

(D. Snipes (2002) Gender differences in the perception of stressors among law enforcement officers”)

Can reduce some of the negative impact through exercise

Shift workers

Have classes/appointments at 2 or 3 in the afternoon for midnight shifters

Keep the room bright 12-hour shifts

Showing up after a long shift, coordination and energy levels may be down, but cortisol may still be high

Encourage mild to moderate exercise

•Summary

Exercise can mitigate many mental health and behavioral problems through S.O.M.E.

Many class participants/clients are probably taking psychotropic medications

Side effects of medications can include reduced reaction time, impaired judgement, dizziness and impaired coordination

Some medications effectiveness is drastically changed based upon the hydration level of the patients (esp. antipsychotics)

Summary cont...

Getting children to love exercise early helps prevent a host of later-life physical and mental health problems

Fitness programs targeting the elderly help reduce depression and possibly suicide