A Fit Prescription: Exercise Programs and Mental Health

The Total Health and Wellness Strategy released in 2017 by the Department of National Defence remains the most ambitious and important program to date aimed at improving the health of Canadian Armed Forces (CAF) members.

Creation of the strategy was vital.

Many soldiers returning from conflicts experience considerable mental suffering, affecting their life as a whole. Repeated studies have found that CAF members deployed to combat zones experience chronic conditions such as anxiety, depression and Post-traumatic Stress Disorder (PTSD) after returning home, at elevated levels relative to the general population.

Mental health researchers and professionals, myself included, are still in the early stages of understanding causal links between trauma and mental health outcomes such as PTSD and addiction, but our knowledge is surely deepening. There remain many challenges ahead, but one hopeful area is in the mounting evidence showing a connection between exercise and improvements in some mental health and anxiety disorders.

It was only about 20 years ago that the U.S. National Institute of Mental Health recognized a link between physical activity and emotional well-being. Studies have recommended that adults get approximately 2.5 hours of moderate-to-vigorous physical activity per week to achieve significant health benefits. Yet, relatively few Canadians exercise to this degree. According to one study, only about 15% and 30% of Canadian and American adults, respectively, exercise to this extent.

The evidence strongly indicates that exercise is an effective treatment for a broad range of mental health conditions (such as depression, anxiety, addiction and posttraumatic stress). Moreover, exercise is affordable and accessible for most of the population.

The Research

While studies are rarely “conclusive,” the following indicate some of the promising results from regular exercise. Research findings have included:

• The positive effects of an eight-week program consisting of 30 minutes of both aerobic and nonaerobic exercise, three times per week. Substantial improvements were observed among patients with panic disorder with agoraphobia, social anxiety disorder (SAD) and generalized anxiety disorder (GAD).
• Regular physical activity is associated with a lower prevalence of select anxiety disorders. This was from an examination of data from a large, nationally-representative sample of American adults.
• Exercise and mindfulness-based stress reduction (MBSR) led to significant improvements in mental health compared to those who had no treatment. This research was tested on 77 adults with SAD for the effectiveness of no treatment versus exercise and MBSR.
• An eight-week study involved 40 minutes of aerobic exercise three times a week for adolescent females with PTSD. Participants experienced lower levels of depression, anxiety and PTSD.

It is interesting that longer exercise programs appear to have a larger therapeutic effect. The evidence suggests that exercise programs should be at least 10 weeks in duration in order to produce meaningful reductions in trait anxiety.

Why Exercise Works

Why might exercise bring benefit? Not a lot of research has been done on this, but research indicates the following:

• Short bursts of aerobic exercise help lessen the fear that anxiety will lead to catastrophic consequences. This “anxiety sensitivity” is a common trait among individuals diagnosed with anxiety disorders.
• Exercise may provide natural exposure to bodily sensations related to fear and anxiety. Exercise may help patients understand that these associated physical sensations are non-threatening.
• Exercise may help raise the individual’s resilience to stressful mood states. A variety of neurochemicals released during exercise are thought to be possible mechanisms for regulating negative psychological states.
• Sleep disturbances, daytime sleepiness, nightmares and poor sleep quality are prevalent among individuals with anxiety disorders. There is a strong relationship between exercise and sleep improvement.
• Research indicates that individuals who successfully complete an exercise regimen, especially at higher intensities, may experience a sense of mastery and confidence that they have the power to change conditions around them and achieve desired outcomes.

CAF Services

The CAF offers extensive services and programs focused on the prevention and treatment of mental health issues. CAF primary care physicians are all trained in suicide assessment, management and prevention. Any member that is identified as being at risk of suicide is seen immediately by a medical doctor.

Base clinics offer access to psychosocial services and mental health clinicians, all of whom have training and expertise in assessing, managing, treating and preventing suicide. Members can call 1-800-268-7708 to access bilingual telephone or in-person counselling services. Individuals are encouraged to dial 911 or go to their local hospital in the event of an emergency. The CAF offers a range of other programs and services as listed here.

Conclusion

While research points to the positive therapeutic effects of exercise, we continue to face challenges surrounding motivation for exercise programs. Not all patients follow the recommended regimes in terms of frequency, duration or intensity. The challenge now is to better understand why this is the case and how we can get more serving members and veterans into the rhythm of regular and sustained activity.