Exercise, Motivation, and Mood Disorders
by Imei Hsu, RN, LMHC
Most people who struggle with depression, anxiety, or a mixture of both want to know how to better manage their symptoms. Typically, I spend some time educating each client about the “Big Five” treatment plan. This plan includes the five elements of evidence-based treatment straight from the text books: 1. Talk therapy, 2. Nutrition, 3. Rest, 4. Exercise, and 5. Medication. Of all of these treatment options, which do you think the majority of people struggle with the most when it comes to consistent implementation?
OK, that was a trick question! It’s a trick question because of my clients verbally surveyed, few of them report consistent and simultaneous implementation all five elements. Why? If it were as easy as applying even four of the five arms of treatment, we’d have a bunch of us walking around the city as if we’d been given a giant group hug. It just doesn’t work that way, does it? It’s like asking you to come to my office when you have a balanced life in place.
Let’s face it together. City life can be challenging. You may work in a corporate environment, you try to nourish a loving relationship with your main squeeze, you may have kids to raise, a mortgage to pay, and a honey-do list that never seems to end. After feeling restless and/or blue for months on end, you finally drag yourself into my office, and in my most compassionate voice, I tell you that you need to eat healthy meals on a regular basis, cut back your alcohol intake, get eight hours of sleep a night, move your body around for an hour a day, and possibly take medication if your symptoms don’t improve.
And then, with your permission, I book your appointments out for another month. We talk. You still don’t feel better. I ask you which of the five arms of treatment you are implementing. The answer comes back as the one we’re doing now: talk therapy. Ok, that’s a start! If more time goes on and there is no change, one or both of us starts talking about getting you on a medication. You admit you feel like a failure.
Then, and perhaps only then, do you wonder if it’s time for you to hit the road, not just for a vacation, but to treat the symptoms of your mood disorder.
TAKE A STEP. THEN TAKE ANOTHER.
The most predictable part of this entire description, above, if there is anything that appears to repeat itself from one person to another and from one month to another, is actually the least surprising of all. Most people report “feeling better” — that is, an improved mood with less depression symptoms, higher function, and less anxiety — when they exercise regularly and eat healthy food, combined with the elimination or dramatic reduction of mood altering substances (including candy and sugary treats, MJ, and alcohol).
When I mention exercise, I tend to get some push back. “How much?” “I don’t have time.” “That’s really hard.” “I know I should, but I just don’t have the energy.” “I don’t have money to join a gym.” But unless there is a physical limitation, illness or injury, or disability involved, exercise is often exactly what the doctor orders when it comes to reducing the worst of your depression and anxiety symptoms. We can tell you what you need, but ultimately you must be the one to do it. If I could, I’d prescribe to you a pair of running shoes and a bicycle, but you’d still have to walk or run, and you’d still need to pedal that bike yourself.
Medical researchers don’t really understand WHY exercise works so well regarding mood. What we do know is that we have substantial research that backs up the argument that moderate to vigorous exercise, even in the form of brisk walking, for 40 to 60 minutes a day, can reduce stress, elevate mood, help launch endorphins (our “feel good” brain chemicals), encourage relaxation, and pave the way for better sleep. On top of that list, exercise often causes people to feel more confident, productive, and energetic.
Exercise also has a dramatic effect on the immune system, protecting it from inflammation. You may have seen this effect in friends who exercise daily and do not smoke cigarettes. They often tend to resist illnesses and bounce back from illness quickly when they do succumb. When people who exercise combine their activity with highly nutritious fuel, they tend to report fewer days of poor mood regulation.
When I say that you need to exercise to help decrease your worst depression and anxiety symptoms, I am not saying you need to go out and run a marathon! Working up slowly to being able to run for 30 minutes at a time without stopping can happen over a period of 90 days, starting with one step, and then another. It can also look like walking for 15 minutes, and slowly working up to walking briskly for 60 minutes. What research is showing us is that a short walk per day is often not enough to get heart healthy benefits or to remove excess weight. We’re talking about a brisk walking pace or light jog for more than 30 minutes at a time, more days of the week than not.
This kind of prescription for movement and heart-healthy exercise doesn’t mean you have to enter races and feel like you’re going to die before you make it to the next water station! Yet it does mean that you’ll probably need a decent pair of running shoes that will put you back about $70. If that sounds like a lot of money, compare that against the number of days you spent last year either missing work because you were too depressed to get out of bed, or the number of hours you were unproductive because you were unable to sleep at night as your thoughts whirled endlessly like a merry-go-round. The same $70 might be reasonably affordable compared to the emotional cost of dealing with the number of times you carelessly projected your stress out on your spouse or partner. A high-intensity jog will help you drop your petty thoughts about winning the argument, because the real argument happening during a jog is whether you will finish your run or your run will finish you.
Walking, jogging, and running are likely the cheapest forms of exercise available. If money isn’t stopping you, select a form of exercise that you can lather, rinse, and repeat with a certain amount of frequency, such as cycling (indoors and outdoors), swimming, working with a trainer, dancing, or whatever suits your fancy and makes you sweat. The point is, if you exercise regularly, you will reap the aforementioned benefits.
The steps to managing your mood include this physical step in whatever form you decide is best for you. The most important elements are that your activity involve:
1. Regularity – so it needs to be convenient and something you can repeat
2. Consistency – you don’t get as much benefit if you only exercise here and there
3. Sustainability (without too much soreness, low risk for injury, and affordable)
4. Elevating your heart rate for cardio-vascular benefit (so talk to your doctor if you have some limitations)
5. Optional: a social aspect (gets you out of the house or away from thinking about work)
ANECDOTES FROM A FITNESS-ORIENTED THERAPIST
Obviously, I cannot make everyone run around the block 6-10 times a day, but I’ve been tempted to want to see what would happen if even 50% of my clients engaged in a moderate walking program for 12 weeks. Based on anecdotal observations from the reports of past clients, I’m convinced that moderate exercise plays a statistically significant role in the improvement of mood for those who have struggled with depression and anxiety.
Submitted to Google Glass for the “I am a ________” video log.
I can tell you to continue to repeat my exercise prescription ad nauseam, but clients must decide for themselves whether to fill that prescription. I believe it has been more effective for me to practice what I believe, and then allow others to ask questions. For example, if you were to ask me, “Imei, how many days have you taken off from your office hours because you were stressed out and anxious?” the answer is, “None.” Or, how about, “Imei, what do you do when you feel down?” I can honestly answer, “I make sure I get rest, meditate, eat well, and put in a good workout on a daily basis. I also rely heavily on my friends and family for support. Now, what about you?”
You see, it’s the same formula, folks. Some of you are only going to need about 30-40 minutes of exercise a day to feel a little better. I need about 60-90 or more to feel at the top of my game, and the odds are in my favor that as I continue to age, I’ll need more, not less. Yet the cost of more time on the trails has not seen a commensurate cost in my work; if anything, as I’ve increased the time spent caring for my body by being a triathlete and dancer, I’ve seen an increase in the success in office with people and in my most important side projects.
I am so convinced that a regular exercise program can improve the lives of my clients that I’m willing to put my money where my mouth is. Here’s the deal: for the months of April – September 2014, if your insurance program has a high deductible or you are paying out of pocket for services, I will give you a one-time discount of $20 if you walk through my office doors with a pair of running or cycling shoes on (and the price tags removed!). The $20 represents the average co-pay cost, and it’s my option to not collect.
And in June 2014, I am researching the possibility of starting a lunchtime meetup for people who want to run in the Pioneer Square to Waterfront area of Seattle from June to September 2014. First, I’m looking into any issues of liability. This seasonal running group will not be limited to clients of SDC — it will be open to the public and limited in number. We will post a public start time and route, and runners can select their pace and buddy up for 45 minutes, allowing time for warm up and cool down.
As I turn the corner into my final weeks of preparation for my first marathon, I have this message for you: it’s never too late to take your first steps to managing your mood disorder, and every run starts with a step. If I can help you make your first step count, drop an email or phone call to our office, and let’s get started!