Methodological Limits of Exercise Trials

Is there evidence that even light exercise can improve mental health and help treat severe mental illness? How easy is it to prove the effects? Are our ever more sedentary lifestyles putting us at risk? How easy is it to apply in the current mental health treatment system?

In this episode we have the revealing research on the use of exercise and movement to treat mental health to get up to date on. This is the third episode out of three in this series on the theme of life-style medicine, the other two being on Sleep for mental health (Episode #72 with Roxanne Prichard) and on diet for mental health (Episode #70 with Felice Jacka), so please check those out as all 3 interrelate in term of mental health outcomes. In this episode though we get into the reasons why even a little movement has a radical effect on our mental health; that movement can be used in association with talky and drug therapies to effectively treat even serious mental health disturbances like schizophrenia; we also get into the huge host of improvements across the board when exercise is applied; the impressive bulk of clinical trials that have proved this in the last 15 years; and we hear about the faster than usual uptake of this data by international policy makers, and the difficulties of practically integrating these protocols into the mental health care system.

Now fortunately for us, our guest today is one of the world’s leading researchers in this field, mental health physiotherapist and Kings College London researcher, Brendon Stubbs. He is the co-author of over 800 highly cited scientific papers, and the book “Exercise-Based Interventions for Mental Illness: Physical Activity as Part of Clinical Treatment”. 

What we discuss:

00:00 Intro

06:40 Early attempts on the mental illness ward as a physio.

09:28 The rise of life-style research into mental health in the early 2000s.

12:00 Sedentary lifestyle issues.

13:24 The benefits of being both therapist & researcher.

15:50 Resistance to the word ‘exercise’.

19:00 Rise in sedentary lifestyle correlates with rise in mental health issues and stress.

23:45 Higher inflammation in sedentary populations.

26:30 Endorphins are not the only reason it feels good.

30:15 15% drop in depression risk.

33:10 Muscle, heart and lung strength is a marker for lower depression risk.

35:30 Even genetic predispositions to depression can be 25% less at risk.

36:30 Equally successful to CBT therapy.

38:30 Hippocampus size variations with just 10 mins of light movement.

41:45 Sleep, diet & movement increase hippocampus size & reduce inflammation.

42:30 Schizophrenia & Psychosis studies.

46:00 Difficulty with continuity of exercise when patients return to society.

49:15 The body likes routine & reduced friction.

50:00 Limitations of randomised control trials on life style interventions.

54:15 The faster than usual integration of this into the consensus. 

56:30 Policy creation at national and world health level.

58:00 Pharmaceutical funded researchers pushing back against these results. 

59:00 Difficulty applying this for family doctors and mental health professionals.

01:01:15 Socio-economic mental health risk and difficulty of access.

01:03:00 The national health money saving motivation is hard to prove.

01:05:00 Main tips for movement for mental health. 

References:

‘Physical Activity and Incident Depression: A Meta-Analysis’ paper, Felipe Shuch et al. 

‘Strength training has antidepressant effects’ paper, Fabricio Rossi et al.

‘Physical activity offsets genetic risk for incident depression’ paper, Karmel Choi et al.

‘Exercise and internet-based cognitive–behavioural therapy for depression’ paper, Mats Hallgren et al.

‘Light-exercise-induced dopaminergic and noradrenergic stimulation in the dorsal hippocampus’ paper, T. Hiragana et al.

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness