As a physical therapist, I have written down the words “depression and anxiety” as part of a patient’s past medical history more times than I could even count. In 2020, the American Physical Therapy Association House of Delegates passed position #P06-20-40-10: “It is within the professional scope of physical therapist practice to screen for and address behavioral and mental health conditions in patients, clients, and populations.” Yet, as a physical therapist, what have I truly done to promote positive mental health for my patients? Yes, I have passively supported mental health through exercise and physical activity, but is there more that can be included as part of a proactive, thoughtful approach to my patients’ mental health?
Ways Exercise Helps Patients with Anxiety and Depression: What does the research say?
- Exercise for Anxiety: One of the primary methods of reducing anxiety is by using physical activity to reduce anxiety sensitivity. Many patients suffering from anxiety report the bodily symptoms they experience are the most debilitating and lead to the avoidance of exercise. Any stimuli that create a similar response to an anxiety attack (i.e., increased HR) are interpreted in a catastrophic way and avoided.
TO REDUCE ANXIETY SENSITIVITY, CLINICIANS CAN RELIABLY PRODUCE THESE SIMILAR PHYSIOLOGICAL RESPONSES THROUGH EXERCISE IN CONJUNCTION WITH CAREFUL AND THOROUGH INFORMATION TO ALLEVIATE THE CONCERNS. THE PATIENT WILL BEGIN TO DISSOCIATE THE EXPERIENCE OF THE PHYSICAL SYMPTOMS AND NEGATIVE, ANXIOUS FEELINGS.
Essentially, prescribed personalized exercises can help patients interpret bodily symptoms as normal signs of stress and not as indicators that a physical catastrophe will ensue.
- Exercise for Depression: With respect to depression, exercise decreases and replaces passivity to create a sense of accomplishment and pleasure in patients. Feelings of achievement and mastery through exercise can help to enhance positive self-beliefs and buffer from negative self-perception worries. Furthermore, a patient is able to develop a social connection through physical activity to improve patient affect This is not a one-size-fits-all social connection. For some patients, the connection may be with the clinician, for some it may be with friends or family, and others may connect with fellow patients who can relate to their current experiences.
ALONG WITH EXTERNAL SUPPORT AND A SENSE OF ACHIEVEMENT, EXERCISE-BASED INTERVENTIONS HAVE BEEN CONSISTENTLY DEMONSTRATED AS HAVING AN ANTIDEPRESSANT EFFECT IN PEOPLE WITH CLINICAL DEPRESSION, WITH SOME STUDIES REPORTING A TREATMENT EFFICACY COMPARABLE TO ANTIDEPRESSANT MEDICATIONS OR PSYCHOTHERAPY.
Additional Ways to Support the Mental Health of our Patients:
- Including alternative techniques such as mindfulness and acceptance-based interventions as part of pain management/chronic disease management programs.
- Promoting stress management, coping skills, and trauma-informed care.
- Providing education on lifestyle factors such as nutrition, wellness, and exercise, addressing disparities in health caused by social determinants.
- Provide referrals to outside services when further support is needed.
We can no longer separate our patients’ physical health from their mental health. Rehabilitative professionals should aim to optimize wellbeing and empower the individual by promoting functional movement, movement awareness, physical activity, and exercises, bringing together the physical and mental aspects.
REFERENCES
- Belvederi Murri, M., et al., Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes. Front Psychiatry, 2018. 9: p. 762.
- Blake, H., Physical activity and exercise in the treatment of depression. Front Psychiatry, 2012. 3: p. 106.
- Kandola, A., et al., Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Curr Psychiatry Rep, 2018. 20(8): p. 63.
- Martinsen, E.W., Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry, 2008. 62 Suppl 47: p. 25-9