MU001199
MSc in Applied Sport & Exercise Science
MSc Physical Activity & Public Health
Module: Physical Activity & Mental Health
Assignment 1 Title: Physical Activity & Mental Health: Sources of
Evidence
Academic Year: 2007-2008
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Student Name: [COLIN MACGREGOR]
Student Username: [MU001199]
Module Leader: [John Erskine]
Word Count: [1249]
Date Assessment Electronically
Submitted dd/mm/yy: [01/11/07]
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INTRODUCTION
It is the purpose of this essay to look at the link between physical activity and a selected mental
health problem, namely anxiety disorders. Anxiety disorders are amongst the most common mental health
problems found in the United Kingdom (Kirkwood, Rampes, Tuffrey, Richardson & Pilkington 2005).
Specific phobias, social phobias, and post traumatic disorder (PTSD) constitute the most prevalent
anxiety disorders. Recent estimates by Hoge et al. (2004) indicate that at least 17% of Iraq veterans will
develop PTSD, generalized anxiety disorder, or depression.
Regardless of the number of studies carried out, Brown et al. (2007) found the effects of exercise
remain relatively unexplored among anxiety disorders in general. This paper attempts to highlight some
of the relevant literature and critique where necessary in an attempt to highlight the association of anxiety
and physical exercise.
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There have been several studies carried out across differing anxiety conditions but not all have had
a control group or taken into account problems with their research methods. A randomised controlled
study was carried out by Broocks at al. (1998) on the comparison of aerobic exercise, clomipramine and
placebo in the treatment of panic disorder. The researchers found that exercise alone seems to be
associated with clinical improvements in patients suffering from panic disorder. This paper was well
written with clear tables and graphs. They acknowledged potential criticisms, one of which was the short
duration of their study - 10 weeks. Follow up would have been ideal to see if the effects of exercise
continued after the cessation of the study, as this has long term implications with regard to a treatment
strategy and future research design.
A large scale randomised multi centre clinical trial comparing the effectiveness of cognitive
behaviourial therapy and exercise in gulf war veterans illness was carried out by Donta et al. (2003). The
researchers gave a thorough explanation of the method they chose for the study with clear descriptions of
how activity was measured and the breakdown of the 4 interventions along with follow up at monthly
intervals. This is always beneficial to see if the effects of interventions will continue after the trial has
ceased and will give more weight to the initial experiment. The results showed there was a difference
with exercise over the control group which undertook usual care. With regard to the researchers initial
question, which was to look at physical functioning, there were modest improvements. What was
important was the difference in mood and mental health functioning compared to usual care with
exercise. This would appear to open the door for a future study looking primarily at the anxiety levels of
this clinical group and the association of aerobic exercise.
Some of the problems with this study were the lack of compliance with the therapies with an
attendance on average of about 50%. This study was not clear on the intensity related to maximal heart
rate that the participants were exercising at and again it was dependent on self reporting as to how
frequently the participants exercised.
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In regard to the previously discussed papers there have been numerous psychological and
physiological mechanisms suggested to explain the beneficial effects of exercise on mental health.
Paluska and Schwenk (2000) noted that few have been supported by randomized controlled trials. There
appears to be three main areas that are examined; biochemical, physiological and psychological. In the
review by Dunn, Trivedi and O’Neal (2001) it was noted that depression and anxiety have been linked to
multiple aetiologies. These included psychological trauma and chronic stress, faulty neurotransmitter
systems such as norepinephrine and serotonin (5-HT) and phypothalmic-pituitary-adrenocortical (HPA)
dysfunction. Several cognitive based theories have gained prominence as possible explanations of the
positive effects of exercise on psychological well-being such as the distraction hypothesis with further
theories developed to explain their occurrence. One such theory is the transient hypofrontality theory.
Dietrich (2006, p.82) proposed that:
exercise exerts some of its anxiolytic and antidepressant effects by involving large scale bodily
motion that requires massive neural activity and thus places a strain on the brains finite neural
resources, making it impossible to sustain excessive neural activity in structures such as the
prefrontal cortex and the amygdale, that are not needed at this time. It was noted however, that
this type of activity returns to normal after only a few minutes after exercise finishes and that
studies using a delay should not be used to interpret cognition during exercise.
This of course has a bearing on the results of questionnaires that are administered during and after
exercise. Consequently as discussed by Dishman et al. (2006) it is important to distinguish acute
responses to a single episode of physical activity from chronic effects adaptation of repetitive physical
activity. It is likely that there may be an interaction of many of the effects of exercise both chemical and
psychological that played a part in the alleviation of the anxiety problems.
The problem of varied frequency or duration along with controlled total energy expenditure was
highlighted in the review by Netz, Wu, Becker and Tenebaum (2005). Their meta-analyses looked at the
link between physical activity and well being in older adults. They showed a small but significant effect
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of exercise on the well being of older adults without clinical disorders. They highlighted the fact that the
literature did not allow them to estimate effects pertaining to the minimum time, intensity and mode of
exercise needed to achieve a meaningful psychological effect for exercise in older adults.
The results of a recent meta-analysis by Stathpoulou, Powers, Berry, Smits and Otto (2006)
indicated that exercise can be a powerful intervention for clinical depression. Hirschfeld (2001)
concluded that between 10 and 20 percent of adults in any given twelve month period will visit their
primary care physician during an anxiety or depressive episode. Out of that number more than 50 percent
of these patients suffer from a comorbid second depressive or anxiety disorder. With the apparent
interrelation of anxiety and depression the meta-analysis findings may have great importance for the use
of exercise therapy in a clinical setting.
The analysis study did show a significant effect size but it is important to note that the researchers
deleted any studies that did not target clinical levels of depression, were not published in peer-reviewed
journals, or did not provide a control group. This is one of the problems with meta-analysis as the
resultant effect size can be altered by eliminating studies which are of sound construction that may alter
the result one way or the other whilst trying to establish a measurable number. The problem with
mathematical models as highlighted by Aoun, Pennebaker and Wood (2004) is that when you try to
account for every variable you lose some of that significance and by controlling for confounding factors,
important interactions are thus ignored.
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CONCLUSION
Exercise appears to be related with a relief in the symptoms of anxiety but more research is
needed to determine if this overall relationship is causal. There is also a need to examine further some of
the variables that are believed to moderate the overall relationship. To that end Scully, Kremer, Meade,
Graham and Dudgeon (1998) suggested there is a need for large scale multidimensional experimental
programmes, associated with multivariate analyses of covariance, in order to clarify the complexities of
the relations between physical exercise and psychological health. It is necessary to examine both the
direct effects of exercise with regard to clinical primary research and to look at the causality effect with
regard to large epidemiological studies.
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Aoun, S., Pennebaker, D. & Wood, C. (2004). Assessing population need for mental health care: A
review of approaches and predictors. Mental Health Services Research, 6, 33-45.
Broocks, A., Bandelow, B., Pekrun, G., George, A., Meyer, T., Bartmann, U. et al. (1998).
Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. American
Journal of Psychiatry, 155, 603-609.
Brown, R. A., Abrantes, A. M., Strong, D. R., Mancebo, M. C., Menard, J., Rasmussen, S. A. Et al.
(2007). A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder. The
Journal of Nervous and Mental Disease, 195, 514-520.
Dietrich, A. (2006). Transient hypofrontality as a mechanism for the psychological effects of
exercise. Psychiatry Research, 145, 79-83.
Dishman, R. K., Berthoud, H. R., Booth, F. W., Cotman, C. W., Edgerton, V. R., Flashner, M. R., et
al. (2006). Neurobiology of exercise. Obesity, 14, 345-356.
Donta, S. T., Clauw, D. J., Engel, C. C., Guarino, P., Peduzzi, P., Williams, D. A. et al. (2003).
Cognitive behavioural therapy and aerobic exercise for gulf war veterans’ illness. The Journal of the
American Medical Association, 289, 1396-1404.
Dunn, A. L., Trivedi, M. H. & O’Neal, H. A. (2001). Physical activity dose-response effects on
outcomes of depression and anxiety. Medicine and Science in Sports and Exercise, 33, s587-s597.
Hirschfeld, R. M. A. (2001). The comorbidity of major depression and anxiety disorders:
Recognition and management in primary care. Primary Care Companion Journal of Clinical Psychiatry,
3, 244-254.
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I. & Koffman, R. L. (2004).
Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England
Journal of Medicine, 351, 13-22.
Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J. & Pilkington, K. (2005). Yoga for anxiety:
A systematic review of the research evidence. British Journal of Sports Medicine, 39, 884-891.
Netz, Y., Wu, M. J., Becker, B. J. & Tenenbaum, G. (2005). Physical activity and psychological
well-deing in advanced age: A meta-analysis of intervention studies. Psychology and Aging, 20, 272-284.
Paluska, S. A. & Schwenk T. L. (2000). Physical activity and mental health: Current concepts.
Sports Medicine, 29, 167-180.
Scully, D., Kremer, J., Meade, M. M., Graham, G. & Dudgeon, K. (1998). Physical exercise and
psychological well being: A critical review. British Journal of Sports Medicine, 32, 111-120.
Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. S. J. & Otto, M. W. (2006). Exercise
interventions for mental health: A quantitative and qualitative review. Clinical Psychology: Science and
Practice, 13, 179-193.
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