A call to action: exercise as treatment for patients with mental illness
Robert Stanton A F , Simon Rosenbaum B C , Megan Kalucy C D , Peter Reaburn E and Brenda Happell AA Centre for Mental Health Nursing Innovation, Institute for Health and Social Science Research, School of Nursing and Midwifery, Central Queensland University, Bruce Highway, North Rockhampton, Qld 4702, Australia.
B The George Institute for Global Health and School of Public Health, University of Sydney, 321 Kent Street, Sydney, NSW 2000, Australia.
C School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia.
D South Eastern Sydney and Illawarra Health Service, Bondi Junction Community Health Centre, 26 Llandaff Street, Bondi Junction, NSW 2022, Australia.
E School of Medical and Applied Sciences, Central Queensland University, Bruce Highway, North Rockhampton, Qld 4702, Australia.
F Corresponding author. Email: r.stanton@cqu.edu.au
Australian Journal of Primary Health 21(2) 120-125 https://doi.org/10.1071/PY14054
Submitted: 21 March 2014 Accepted: 1 July 2014 Published: 18 July 2014
Abstract
Mental illness affects the lives of a significant number of Australians. In addition to pharmacological and psychological interventions, exercise has demonstrated benefits for people with mental illness including symptom reduction, improved cardiovascular risk profile and improved physical capacity. Unfortunately, evidence shows that clinician-delivered exercise advice is not routinely offered. This is despite patient acceptability for exercise. This article summarises the recent evidence supporting the prescription of exercise for people with mental illness and offers a model incorporating basic exercise prescription, and referral pathways for specialised advice. Current exercise prescription patterns for people with mental illness may not meet patient expectations; therefore, clinicians should consider exercise referral schemes to increase the accessibility of interventions for people with a mental illness.
References
Abramson S, Stein J, Schaufele M, Frates E, Rogan S (2000) Personal exercise habits and counseling practices of primary care physicians: a national survey. Clinical Journal of Sport Medicine 10, 40–48.| Personal exercise habits and counseling practices of primary care physicians: a national survey.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7lvVeqtA%3D%3D&md5=0e87d842c3bf2f5b9d2d4f5b32b26106CAS | 10695849PubMed |
Abrantes AM, Strong DR, Cohn A, Cameron AY, Greenberg BD, Mancebo MC, Brown RA (2009) Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder. Journal of Anxiety Disorders 23, 923–927.
| Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder.Crossref | GoogleScholarGoogle Scholar | 19616916PubMed |
AIHW (2013) ‘Mental health services—in brief 2013.’ (Australian Institute of Health and Welfare: Canberra)
Asmundson GJ, Fetzner MG, Deboer LB, Powers MB, Otto MW, Smits JA (2013) Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depression and Anxiety 30, 362–373.
| Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders.Crossref | GoogleScholarGoogle Scholar | 23300122PubMed |
Berk M, Sarris J, Coulson CE, Jacka FN (2013) Lifestyle management of unipolar depression. Acta Psychiatrica Scandinavica 127, 38–54.
| Lifestyle management of unipolar depression.Crossref | GoogleScholarGoogle Scholar |
Britt H, Miller C, Henderson J, Charles J, Valenti L, Harrison C, Bayram C, Zhang C, Pollack AJ, O’Halloran J, Pan Y (2012) ‘General practice activity in Australia 2011–12. General practice series number 31.’ (Sydney University Press: Sydney)
Brown RA, Abrantes AM, Strong DR, Mancebo MC, Menard J, Rasmussen SA, Greenberg BD (2007) A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder. The Journal of Nervous and Mental Disease 195, 514–520.
| A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder.Crossref | GoogleScholarGoogle Scholar | 17568300PubMed |
Caemmerer J, Correll CU, Maayan L (2012) Acute and maintenance effects of non-pharmacologic interventions for antipsychotic associated weight gain and metabolic abnormalities: a meta-analytic comparison of randomized controlled trials. Schizophrenia Research 140, 159–168.
| Acute and maintenance effects of non-pharmacologic interventions for antipsychotic associated weight gain and metabolic abnormalities: a meta-analytic comparison of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 22763424PubMed |
Carpiniello B, Primavera D, Pilu A, Vaccargiu N, Pinna F (2013) Physical activity and mental disorders: a case–control study on attitudes, preferences and perceived barriers in Italy. Journal of Mental Health 22, 492–500.
| Physical activity and mental disorders: a case–control study on attitudes, preferences and perceived barriers in Italy.Crossref | GoogleScholarGoogle Scholar | 24206453PubMed |
Coombes JS, Law J, Lancashire B, Fassett RG (2013) ‘Exercise is medicine’: curbing the burden of chronic disease and physical inactivity. Asia-Pacific Journal of Public Health
| ‘Exercise is medicine’: curbing the burden of chronic disease and physical inactivity.Crossref | GoogleScholarGoogle Scholar | 23572372PubMed |
Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE (2013) Exercise for depression. Cochrane Database of Systematic Reviews 9, CD004366
Crews DJ, Landers DM (1987) A meta-analytic review of aerobic fitness and reactivity to psychosocial stressors. Medicine and Science in Sports and Exercise 19, S114–S120.
Donaghy M, Taylor AH (2010) Should practitioners promote physical activity as a treatment for depression? Journal of the Royal College of Physicians of Edinburgh 40, 132–135.
| Should practitioners promote physical activity as a treatment for depression?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M%2Fhs12hug%3D%3D&md5=a34ccbfa7ae644b08a5a85813c03d3caCAS | 21125058PubMed |
Ellis P (2004) Australian and New Zealand clinical practice guidelines for the treatment of depression. The Australian and New Zealand Journal of Psychiatry 38, 389–407.
| Australian and New Zealand clinical practice guidelines for the treatment of depression.Crossref | GoogleScholarGoogle Scholar | 15209830PubMed |
Elmslie JL, Mann JI, Silverstone JT, Williams SM, Romans SE (2001) Determinants of overweight and obesity in patients with bipolar disorder. The Journal of Clinical Psychiatry 62, 486–491.
| Determinants of overweight and obesity in patients with bipolar disorder.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mvhs1Gjsg%3D%3D&md5=d95131e8258371550ac2f56a9176a1d3CAS | 11465534PubMed |
Forsyth A, Deane FP, Williams P (2009) Dietitians and exercise physiologists in primary care: lifestyle interventions for patients with depression and/or anxiety. Journal of Allied Health 38, e63–e68.
Frank E, Rothenberg R, Lewis C, Belodoff BF (2000) Correlates of physicians’ prevention-related practices. Findings from the Women Physicians’ Health Study. Archives of Family Medicine 9, 359–367.
| Correlates of physicians’ prevention-related practices. Findings from the Women Physicians’ Health Study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3jvVKltw%3D%3D&md5=09e44b76c689e5d9634b3b30a23f5c7bCAS | 10776365PubMed |
Galletly CA, Foley DL, Waterreus A, Watts GF, Castle DJ, McGrath JJ, Mackinnon A, Morgan VA (2012) Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. The Australian and New Zealand Journal of Psychiatry 46, 753–761.
| Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis.Crossref | GoogleScholarGoogle Scholar | 22761397PubMed |
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, Nieman DC, Swain DP (2011) Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and Science in Sports and Exercise 43, 1334–1359.
Glover CM, Ferron JC, Whitley R (2013) Barriers to exercise among people with severe mental illnesses. Psychiatric Rehabilitation Journal 36, 45–47.
| Barriers to exercise among people with severe mental illnesses.Crossref | GoogleScholarGoogle Scholar | 23477650PubMed |
Gorczynski P, Faulkner G (2010) Exercise therapy for schizophrenia. Cochrane Database of Systematic Reviews CD004412
| Exercise therapy for schizophrenia.Crossref | GoogleScholarGoogle Scholar | 20464730PubMed |
Happell B, Platania-Phung C, Scott D, Nankivell J (2014) Communication with colleagues: frequency of collaboration regarding physical health of consumers with mental illness. Perspectives in Psychiatric Care 50, 33–43.
| Communication with colleagues: frequency of collaboration regarding physical health of consumers with mental illness.Crossref | GoogleScholarGoogle Scholar | 24387613PubMed |
Hébert ET, Caughy MO, Shuval K (2012) Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. British Journal of Sports Medicine 46, 625–631.
| Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22711796PubMed |
Helmich I, Latini A, Sigwalt A, Carta MG, Machado S, Velasques B, Ribeiro P, Budde H (2010) Neurobiological alterations induced by exercise and their impact on depressive disorders. Clinical Practice and Epidemiology in Mental Health 6, 115–125.
| Neurobiological alterations induced by exercise and their impact on depressive disorders.Crossref | GoogleScholarGoogle Scholar | 21283646PubMed |
Hilton MF, Scuffham PA, Vecchio N, Whiteford HA (2010) Using the interaction of mental health symptoms and treatment status to estimate lost employee productivity. The Australian and New Zealand Journal of Psychiatry 44, 151–161.
| Using the interaction of mental health symptoms and treatment status to estimate lost employee productivity.Crossref | GoogleScholarGoogle Scholar | 20113304PubMed |
Jayakody K, Gunadasa S, Hosker C (2014) Exercise for anxiety disorders: systematic review. British Journal of Sports Medicine 48, 187–196.
| Exercise for anxiety disorders: systematic review.Crossref | GoogleScholarGoogle Scholar | 23299048PubMed |
Lipsky RH, Marini AM (2007) Brain-derived neurotrophic factor in neuronal survival and behavior-related plasticity. Annals of the New York Academy of Sciences 1122, 130–143.
| Brain-derived neurotrophic factor in neuronal survival and behavior-related plasticity.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXhtVOksLs%3D&md5=bb8c48ea6b79fe3bce209e2435f000e5CAS | 18077569PubMed |
Livaudais JC, Kaplan CP, Haas JS, Perez-Stable EJ, Stewart S, Jarlais GD (2005) Lifestyle behavior counseling for women patients among a sample of California physicians. Journal of Women’s Health 14, 485–495.
| Lifestyle behavior counseling for women patients among a sample of California physicians.Crossref | GoogleScholarGoogle Scholar | 16115002PubMed |
Malchow B, Reich-Erkelenz D, Oertel-Knochel V, Keller K, Hasan A, Schmitt A, Scheewe TW, Cahn W, Kahn RS, Falkai P (2013) The effects of physical exercise in schizophrenia and affective disorders. European Archives of Psychiatry and Clinical Neuroscience 263, 451–467.
| The effects of physical exercise in schizophrenia and affective disorders.Crossref | GoogleScholarGoogle Scholar | 23873090PubMed |
Mammen G, Faulkner G (2013) Physical activity and the prevention of depression: a systematic review of prospective studies. American Journal of Preventive Medicine 45, 649–657.
| Physical activity and the prevention of depression: a systematic review of prospective studies.Crossref | GoogleScholarGoogle Scholar | 24139780PubMed |
McDevitt J, Snyder M, Miller A, Wilbur J (2006) Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation. Journal of Nursing Scholarship 38, 50–55.
| Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation.Crossref | GoogleScholarGoogle Scholar | 16579324PubMed |
McGarry H, Hegarty K, Gunn J (2005) How do Victorian GPs manage patients with depression? Australian Family Physician 34, 603–606.
McGorry P, Killackey E, Lambert T, Lambert M, Jackson H, Codyre D (2005) Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. The Australian and New Zealand Journal of Psychiatry 39, 1–30.
Mental Health Foundation (2009) ‘Moving on up.’(Mental Health Foundation: London)
Morgan AJ, Parker AG, Alvarez-Jimenez M, Jorm AF (2013a) Exercise and mental health: an exercise and sports science Australia commissioned review. Journal of Exercise Physiology Online 16, 64–73.
Morgan AJ, Jorm AF, Reavley NJ (2013b) Beliefs of Australian health professionals about the helpfulness of interventions for mental disorders: differences between professions and change over time. The Australian and New Zealand Journal of Psychiatry 47, 840–848.
| Beliefs of Australian health professionals about the helpfulness of interventions for mental disorders: differences between professions and change over time.Crossref | GoogleScholarGoogle Scholar | 23677848PubMed |
National Institute for Health and Care Excellence (2009) Depression: the treatment and management of depression in adults (update). NICE clinical guideline 90. Available at www.nice.org.uk/CG90 [Verified 2 November 2012]
Ravindran AV, Lam RW, Filteau MJ, Lespérance F, Kennedy SH, Parikh SV, Patten SB (2009) Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. V. Complementary and alternative medicine treatments. Journal of Affective Disorders 117, S54–S64.
| Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. V. Complementary and alternative medicine treatments.Crossref | GoogleScholarGoogle Scholar | 19666194PubMed |
Rimer J, Dwan K, Lawler DA, Greig CA, McMurdo M, Morley W, Mead GE (2012) Exercise for depression. Cochrane Database of Systematic Reviews 7, CD004366
Robertson R, Jepson R, Shepherd A, McInnes R (2011) Recommendations by Queensland GPs to be more physically active: which patients were recommended which activities and what action they took. Australian and New Zealand Journal of Public Health 35, 537–542.
| Recommendations by Queensland GPs to be more physically active: which patients were recommended which activities and what action they took.Crossref | GoogleScholarGoogle Scholar | 22151160PubMed |
Rogers LQ, Gutin B, Humphries MC, Lemmon CR, Waller JL, Baranowski T, Saunders R (2006) Evaluation of internal medicine residents as exercise role models and associations with self-reported counseling behavior, confidence, and perceived success. Teaching and Learning in Medicine 18, 215–221.
| Evaluation of internal medicine residents as exercise role models and associations with self-reported counseling behavior, confidence, and perceived success.Crossref | GoogleScholarGoogle Scholar | 16776608PubMed |
Rosenbaum S, Nguyen D, Lenehan T, Tiedemann A, van der Ploeg H, Sherrington C (2011) Exercise augmentation compared to usual care for post traumatic stress disorder: a randomised controlled trial (the REAP study: randomised exercise augmentation for PTSD). BMC Psychiatry 11, 115
| Exercise augmentation compared to usual care for post traumatic stress disorder: a randomised controlled trial (the REAP study: randomised exercise augmentation for PTSD).Crossref | GoogleScholarGoogle Scholar | 21777477PubMed |
Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB (2014) Physical activity interventions for people with mental illness: a systematic review and meta-analysis. The Journal of Clinical Psychiatry
| Physical activity interventions for people with mental illness: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 24813261PubMed |
Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder (2004) Australian and New Zealand clinical practice guidelines for the treatment of bipolar disorder. The Australian and New Zealand Journal of Psychiatry 38, 280–305.
| Australian and New Zealand clinical practice guidelines for the treatment of bipolar disorder.Crossref | GoogleScholarGoogle Scholar | 15144505PubMed |
Searle A, Calnan M, Lewis G, Campbell J, Taylor A, Turner K (2011) Patients’ views of physical activity as treatment for depression: a qualitative study. The British Journal of General Practice 61, 149–156.
| Patients’ views of physical activity as treatment for depression: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 21439172PubMed |
Stanton R (2013) Accredited exercise physiologists and the treatment of people with mental illnesses. Clinical Practice 2, 5–9.
Stanton R, Happell B (2014) A systematic review of the aerobic exercise program variables for people with schizophrenia. Current Sports Medicine Reports 13,
| A systematic review of the aerobic exercise program variables for people with schizophrenia.Crossref | GoogleScholarGoogle Scholar | 25014392PubMed |
Stanton, R, Reaburn P (2013) Exercise prescription for people with depression. Activate September, 12–16.
Stanton R, Reaburn P (2014) Exercise and the treatment of depression: a review of the exercise program variables. Journal of Science and Medicine in Sport 17, 177–182.
Stanton R, Happell B, Reaburn P (2014a) The development, validation and reliability of a questionnaire to investigate the views of health professionals regarding exercise for the treatment of mental illness. Mental Health and Physical Activity
| The development, validation and reliability of a questionnaire to investigate the views of health professionals regarding exercise for the treatment of mental illness.Crossref | GoogleScholarGoogle Scholar |
Stanton R, Happell B, Reaburn P (2014b) The mental health benefits of regular physical activity, and its role in preventing future depressive episodes. Nursing: Research and Reviews 4, 45–53.
Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto MW (2006) Exercise interventions for mental health: a quantitative and qualitative review. Clinical Psychology: Science and Practice 13, 179–193.
| Exercise interventions for mental health: a quantitative and qualitative review.Crossref | GoogleScholarGoogle Scholar |
Stephenson CP, Karanges E, McGregor IS (2013) Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. The Australian and New Zealand Journal of Psychiatry 47, 74–87.
| Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011.Crossref | GoogleScholarGoogle Scholar | 23144164PubMed |
Sylvia LG, Ametrano RM, Nierenberg AA (2010) Exercise treatment for bipolar disorder: potential mechanisms of action mediated through increased neurogenesis and decreased allostatic load. Psychotherapy and Psychosomatics 79, 87–96.
| Exercise treatment for bipolar disorder: potential mechanisms of action mediated through increased neurogenesis and decreased allostatic load.Crossref | GoogleScholarGoogle Scholar | 20051706PubMed |
Toosi TD, Azizian A, Roushan N, Khasaeipur Z, Soleimanzadeh M (2009) The views of general practitioners in Iran about prevention and health promotion and related obstacles in clinical practice. Acta Medica Indonesiana 41, 115–120.
Tsatsoulis A, Fountoulakis S (2006) The protective role of exercise on stress system dysregulation and comorbidities. Annals of the New York Academy of Sciences 1083, 196–213.
| The protective role of exercise on stress system dysregulation and comorbidities.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXmslKrug%3D%3D&md5=15a617ea50bd42f89b643933fa7bcc02CAS | 17148741PubMed |
Wolff E, Gaudlitz K, Lindenberger B-L, Plag J, Heinz A, Ströhle A (2011) Exercise and physical activity in mental disorders. European Archives of Psychiatry and Clinical Neuroscience 261, 186–191.
| Exercise and physical activity in mental disorders.Crossref | GoogleScholarGoogle Scholar |
Zschucke E, Gaudlitz K, Ströhle A (2013) Exercise and physical activity in mental disorders: clinical and experimental evidence. Journal of Preventive Medicine and Public Health 46, S12–S21.
| Exercise and physical activity in mental disorders: clinical and experimental evidence.Crossref | GoogleScholarGoogle Scholar | 23412549PubMed |