Fitness and Mental Health


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NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at

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Fitness and Mental Health

  1. 1. Fitness and Mental Health: Exploring the Mind-Body Connection
  2. 2. Objectives <ul><li>The student will learn about: </li></ul><ul><ul><ul><li>The benefits of sunlight, oxygen, movement and endorphins on mood </li></ul></ul></ul><ul><ul><ul><li>How exercise can help mitigate depression, anxiety, bipolar disorder, postpartum depression, hyperactivity, bulimia/binge eating and addiction </li></ul></ul></ul><ul><ul><ul><li>Common mental health issues in the “average” population and their frequency </li></ul></ul></ul><ul><ul><ul><li>Common psychotropic medications and their side effects which may affect balance, coordination, reaction time and stamina </li></ul></ul></ul>
  3. 3. Objectives Cont... <ul><ul><ul><li>Dehydration and the effectiveness of certain medications </li></ul></ul></ul><ul><ul><ul><li>Special concerns when working with clients/students with eating disorders </li></ul></ul></ul><ul><ul><ul><li>The benefits of exercise in the elderly with regard to depression and suicide </li></ul></ul></ul><ul><ul><ul><li>The benefits of teaching children to love exercise including prevention of many physical and mental health problems in later life </li></ul></ul></ul><ul><ul><ul><li>The interaction between hormone shifts, sleep deprivation and postpartum depression </li></ul></ul></ul>
  4. 4. S.O.M.E. <ul><ul><li>Gotta getcha S.O.M.E. </li></ul></ul><ul><li>Sunlight </li></ul><ul><li>Oxygen </li></ul><ul><li>Movement </li></ul><ul><li>Endorphins </li></ul>
  5. 5. Sunlight <ul><li>Benefits </li></ul><ul><ul><li>Vitamin D </li></ul></ul><ul><ul><li>Stonger Bones </li></ul></ul><ul><ul><li>Improved Rest </li></ul></ul><ul><ul><li>Improved Mood </li></ul></ul><ul><li>Ways to incorporate </li></ul><ul><ul><li>Go outside </li></ul></ul><ul><ul><li>Sunlight spectrum bulbs </li></ul></ul><ul><li>How much? </li></ul><ul><ul><li>20 minutes per day </li></ul></ul>
  6. 6. Oxygen <ul><li>Signs of too little in a healthy person </li></ul><ul><ul><li>Yawning </li></ul></ul><ul><ul><li>Feeling tired </li></ul></ul><ul><li>Benefits </li></ul><ul><ul><li>Energy </li></ul></ul><ul><ul><li>Increased blood flow </li></ul></ul><ul><ul><li>Relaxation </li></ul></ul>
  7. 7. Movement <ul><li>Signs of too little (or too much) </li></ul><ul><ul><li>Tiredness </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Aches/Stiffness </li></ul></ul><ul><ul><li>Weight problems </li></ul></ul><ul><ul><li>Muscular atrophy </li></ul></ul><ul><ul><li>Sleep problems </li></ul></ul>
  8. 8. Movement cont… <ul><li>Benefits </li></ul><ul><ul><li>Increase bloodflow </li></ul></ul><ul><ul><li>Strengthen muscles and bones </li></ul></ul><ul><ul><li>Improve sleep </li></ul></ul><ul><ul><li>Reduce aches and pains </li></ul></ul><ul><ul><li>Improve weight </li></ul></ul><ul><ul><li>Improve self-esteem </li></ul></ul><ul><ul><li>Eliminate toxins </li></ul></ul><ul><ul><li>Relieve constipation </li></ul></ul>
  9. 9. Movement cont… <ul><li>Types </li></ul><ul><ul><li>Fitness classes---provide levels of workout </li></ul></ul><ul><ul><li>Encourage movement bewteen classes—walking, house cleaning, gardening, tennis... </li></ul></ul>
  10. 10. Endorphins <ul><li>Happy chemicals </li></ul><ul><li>Finding the happy medium </li></ul>
  11. 11. Stress <ul><li>What is it: Fear? Anger? Both? </li></ul><ul><li>How common is it (15 per day) </li></ul><ul><li>6 Basic Stressors </li></ul><ul><ul><li>Fear of Death </li></ul></ul><ul><ul><li>Loss of Control </li></ul></ul><ul><ul><li>The Unknown </li></ul></ul><ul><ul><li>Rejection </li></ul></ul><ul><ul><li>Failure </li></ul></ul><ul><ul><li>Isolation </li></ul></ul>
  12. 12. * Discussion Forum * <ul><li>How prevalent is stress in your life? In your work? What would you identify are the primary sources of your stress? How does stress affect you physically? What activities reduce your stress? We would love for you to share your responses in the discussion forum. Thank you. </li></ul>
  13. 13. Stress Chemicals <ul><li>Adrenaline </li></ul><ul><ul><li>Function </li></ul></ul><ul><ul><li>Mental Health Side Effects </li></ul></ul><ul><ul><li>Physical Side Effects </li></ul></ul><ul><ul><li>And Exercise </li></ul></ul><ul><li>Cortisol </li></ul><ul><ul><li>Function </li></ul></ul><ul><ul><li>Mental Health Side Effects </li></ul></ul><ul><ul><li>Physical Side Effects </li></ul></ul><ul><ul><li>And Exercise </li></ul></ul><ul><ul><ul><li> </li></ul></ul></ul>
  14. 14. Prevalence of Mental Health Disorders <ul><li>Anxiety: 18% </li></ul><ul><li>Depression: 8-9% (not including situational or postpartum) </li></ul><ul><li>Bipolar Disorder: 3% </li></ul><ul><li>Eating Disorders: 8% </li></ul><ul><li>Alcohol and Drug Addiction: 7% </li></ul><ul><ul><li>According to the National Institute of Mental Health “The Numbers Count: Mental Disorders in America” </li></ul></ul>
  15. 15. Psychotropic Medications
  16. 16. Antidepressants <ul><li>MAOIs </li></ul><ul><ul><li>Side effects: Drowsiness, Dizziness, Weakness, Shakiness, Fatigue, Weight Gain </li></ul></ul><ul><li>SSRIs </li></ul><ul><ul><li>Side effects: Weakness, Dizziness, Shakes </li></ul></ul><ul><ul><ul><li>Usually remit within one to two weeks </li></ul></ul></ul><ul><ul><ul><li>Often recur if client misses a dose </li></ul></ul></ul>
  17. 17. Antianxiety / Sedatives / Anticonvulsants <ul><li>Benzodiazepines, Barbiturates, Anticonvulsants </li></ul><ul><ul><li>Examples: Xanax, Valium, Restoril, Librium, Ativan, Phenobarbital, Pentobarbital, GHB </li></ul></ul><ul><ul><li>Side effects: Drowsiness, Coordination Loss, Dizziness, Occaisional Hypotension, Reduced Reaction time </li></ul></ul>
  18. 18. Mood Stabilizers and Side Effects <ul><li>Lithium </li></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Weight Gain </li></ul></ul><ul><li>Tegretol/Carbamazepine </li></ul><ul><ul><li>Sleep Problems </li></ul></ul><ul><li>Depakote/Valproate </li></ul><ul><ul><li>Weight Gain </li></ul></ul><ul><ul><li>Drowsiness </li></ul></ul><ul><li>Seroquel/Quetiapine </li></ul><ul><ul><li>Drowsiness </li></ul></ul><ul><ul><li>Antianxiety properties </li></ul></ul>
  19. 19. Mood Stabilizers Cont... <ul><li>Geodon/Ziprasidone </li></ul><ul><li>Risperdal/Risperidone </li></ul><ul><ul><li>Drowsiness </li></ul></ul><ul><li>Clozapine </li></ul><ul><ul><li>Major weight gain </li></ul></ul><ul><li>Zyprexa/Olanzapine </li></ul><ul><ul><li>Weight Gain </li></ul></ul><ul><ul><ul><li>Medications in italics have evidence of both anitdepressant and anti-manic properties </li></ul></ul></ul><ul><ul><ul><li>Medications in yellow are classified as Atypical Antipsychotics </li></ul></ul></ul><ul><ul><ul><li> </li></ul></ul></ul>
  20. 20. * Discussion Forum * <ul><li>There are many new treatment medications available today compared to 20 or even 10 years ago. What differences have you noted regarding treatment effectiveness with the newer medications? Which area of psychopharmacology would you like to see researched and developed more? We would love for you to share your responses in the discussion forum. Thank you. </li></ul>
  21. 21. Common Types of Mental Health Issues that Benefit from Exercise as an Adjunct Therapy
  22. 22. Anger <ul><li>Benefits of exercise </li></ul><ul><ul><li>Channels energy to positive activity </li></ul></ul><ul><ul><li>Burns up stress chemicals and free-floating fatty acids </li></ul></ul><ul><ul><li>Can be cathartic </li></ul></ul><ul><li>Medication </li></ul><ul><ul><li>Generally not medicated unless patient is a danger </li></ul></ul><ul><ul><li>Possibly barbiturates </li></ul></ul><ul><ul><li>Tendancy towards alcohol or marijuana abuse </li></ul></ul>
  23. 23. Anxiety <ul><li>Cluster of disorders (GAD, PTSD, Phobias)‏ </li></ul><ul><li>Generally referred to as fear, stress, worry or tension </li></ul><ul><li>Affects 18 percent of the population </li></ul><ul><li>Benefits of Exercise </li></ul><ul><ul><li>Helps clients clear their mind/focus on something other than their fear </li></ul></ul><ul><ul><li>Burns up stress chemicals helping to relieve the fight or flight response </li></ul></ul><ul><ul><li>Provides clients with venue for social support/interaction </li></ul></ul>
  24. 24. Anxiety Medications <ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><li>Barbiturates </li></ul></ul><ul><ul><li>SSRIs/Antidepressants </li></ul></ul><ul><ul><li>Busiperone </li></ul></ul>
  25. 25. Bipolar Disorder <ul><li>Formerly called manic depression </li></ul><ul><li>Occurs in 3 percent of the population </li></ul><ul><li>Benefits of Exercise </li></ul><ul><ul><li>Improves mood during depressive phases </li></ul></ul><ul><ul><li>May provide an appropriate outlet during manic phases </li></ul></ul><ul><ul><ul><li>Clients can be reckless during manic phases so adequate supervision is essential </li></ul></ul></ul>
  26. 26. Medications for Bipolar <ul><li>Mood Stabilizers are the drugs of choice </li></ul><ul><li>Many mood stabilizers </li></ul><ul><ul><li>Cause weight gain </li></ul></ul><ul><ul><li>Increase fatigue </li></ul></ul><ul><ul><li>May demonstrate alterations in effectiveness if patients become dehydrated (A. Fariborzian, M.D. (2006), personal communication) </li></ul></ul>
  27. 27. Depression <ul><li>Major </li></ul><ul><li>Situational </li></ul><ul><li>Seasonal Affective Disorder (SAD) </li></ul><ul><li>Premenstrual Dysphoric Disorder (PMDD) </li></ul><ul><li>Postpartum </li></ul>
  28. 28. Depression Treatment <ul><li>Major </li></ul><ul><ul><li>Antidepressants, MAOIs </li></ul></ul><ul><ul><li>Behavioral—nutrition, exercise, social support, sunlight </li></ul></ul><ul><li>Situational / SAD / PMDD </li></ul><ul><ul><li>Anitdepressants (Short course) </li></ul></ul><ul><ul><li>Behavioral as above </li></ul></ul>
  29. 29. Postpartum Depression (PPD) <ul><li>Crucial to be aware of statements of harm or obsessions </li></ul><ul><li>Often occurs during major hormone or schedule shifts </li></ul><ul><ul><li>1-2 weeks after birth </li></ul></ul><ul><ul><li>1-2 weeks after stopping breast feeding </li></ul></ul><ul><ul><li>Periods of sleeplessness </li></ul></ul><ul><ul><li>Can occur up to 1 year after birth </li></ul></ul><ul><ul><li>Might be associated with hypothyroid </li></ul></ul><ul><ul><ul><li> </li></ul></ul></ul>
  30. 30. PPD Cont... <ul><li>Mothers at higher risk (controversial) </li></ul><ul><ul><li>Mothers with pre-existing eating disorders </li></ul></ul><ul><ul><li>Mothers with pre-existing depression or anxiety disorders </li></ul></ul><ul><ul><li>Mothers with little social/family support </li></ul></ul>
  31. 31. PPD Treatment/Exercise <ul><li>Medications </li></ul><ul><ul><li>Antidepressants </li></ul></ul><ul><ul><li>Antipsychotics </li></ul></ul><ul><ul><li>Antianxiety </li></ul></ul><ul><ul><li>Anticonvulsants </li></ul></ul><ul><li>Sunlight and Exercise </li></ul><ul><ul><li>To improve mood and regulate sleep schedule </li></ul></ul><ul><ul><li>Some evidence indicates exercise can help mitigate the negative interaction between hormones and neurotranmitters </li></ul></ul><ul><ul><li>Can help mom relax and have positive effects on baby </li></ul></ul><ul><ul><ul><li>Exercise & PMS By: Carol Krucoff </li></ul></ul></ul>
  32. 32. Behavioral Issues and Exercise
  33. 33. Addictions <ul><li>Most people with addictions have co-occurring depression and anxiety. </li></ul><ul><li>Addictions are often self-medicating. </li></ul><ul><li>Exercise can help relieve stress, improve self esteem, improve energy and increase positive neurochemicals: norepinepherine, endorphins. </li></ul>
  34. 34. Eating Disorders—Bulimia, Binge Eating <ul><li>Approximately 8% of the population can be diagnosed with anorexia or bulimia. </li></ul><ul><li>5.5%-11% of the population can be diagnosed with binge eating disorder. </li></ul>
  35. 35. What can we do? <ul><li>Providing a healthy exercise environment models positive behaviors for clients with EDs. </li></ul><ul><li>Teach that moderate exercise is a vital component to reducing depression, anxiety and bingeing. </li></ul><ul><li>Be aware that overuse of vomiting, laxatives and diuretics may make this population weak and can lead to heart attack, fainting, stroke. </li></ul>
  36. 36. * Discussion Forum * <ul><li>Do you see a difference in response to treatment for those clients who exercise as suggested versus those who do not exercise? How are their outcomes different? Please share your responses in our discussion forum. Thank you. </li></ul>
  37. 37. Eating Disorders: Anorexia <ul><li>They are driven by an obsession with perfection and control. </li></ul><ul><li>Fitness Instructors: Use extreme caution working with this population. They are often emaciated and in uncertain physical condition. </li></ul>
  38. 38. Hyperactivity <ul><li>Home grown 7-year old hyperactivity, not AD/HD </li></ul><ul><li>Group fitness classes right after school can provide positive outlets for pent up energy </li></ul><ul><li>Exercise in the morning for adults who have excess nervous energy </li></ul>
  39. 39. Special Populations <ul><li>Children </li></ul><ul><li>Elderly </li></ul><ul><li>Law Enforcement </li></ul>
  40. 40. Children <ul><li>Develop self esteem and motor skills through exercise </li></ul><ul><li>May reduce oppositionality </li></ul><ul><li>Provide daily opportunities for success and challenge </li></ul><ul><li>Early exercise habits prevent later life obesity etc. </li></ul><ul><li>Early exercise habits also improve self-esteem and self confidence which buffer against later mental health problems. </li></ul>
  41. 41. Kids continued... <ul><li>Make it FUN! </li></ul><ul><ul><li> </li></ul></ul><ul><ul><li>Theodore Ganley, MD, and Carl Sherman, “Exercise and Children’s Health,&quot; The Physician and Sports Medicine Journal, (February, 2000). </li></ul></ul>
  42. 42. Elderly <ul><li>18 % of elderly persons are depressed </li></ul><ul><ul><ul><li>(National Alliance on Mental Illness, 2008) </li></ul></ul></ul><ul><li>Persons over 65 have the highest rates of suicide of any age group </li></ul><ul><li>Social interaction is the number one buffer against elder suicide </li></ul>
  43. 43. Elderly cont... <ul><li>Exercise provides </li></ul><ul><ul><li>Social Interaction </li></ul></ul><ul><ul><li>Reduced depression </li></ul></ul><ul><ul><li>Improved Sleep </li></ul></ul><ul><li>Have classes that target the over 65 group </li></ul><ul><li>Use music appropriate to their genre </li></ul><ul><li>For counselors: Many elderly patients have trouble opening up in a counseling office, but not on the walking track </li></ul><ul><li>Many elders will confide in each other, but believe “counseling” is taboo. </li></ul>
  44. 44. Law Enforcement/ER Physicians and Nurses <ul><li>Constantly experience chronic low-grade stress with bursts of extreme stress </li></ul><ul><li>LEO have heart disease now listed as a work related disability due to chronic stress levels </li></ul><ul><ul><ul><li>(D. Snipes (2002) Gender differences in the perception of stressors among law enforcement officers ”) </li></ul></ul></ul><ul><li>Can reduce some of the negative impact through exercise </li></ul>
  45. 45. Shift workers <ul><ul><li>Have classes/appointments at 2 or 3 in the afternoon for midnight shifters </li></ul></ul><ul><ul><li>Keep the room bright </li></ul></ul><ul><li>12-hour shifts </li></ul><ul><ul><li>Showing up after a long shift, coordination and energy levels may be down, but cortisol may still be high </li></ul></ul><ul><ul><li>Encourage mild to moderate exercise </li></ul></ul>
  46. 46. <ul><li>Summary </li></ul><ul><li>Exercise can mitigate many mental health and behavioral problems through S.O.M.E. </li></ul><ul><li>Many class participants/clients are probably taking psychotropic medications </li></ul><ul><li>Side effects of medications can include reduced reaction time, impaired judgement, dizziness and impaired coordination </li></ul><ul><li>Some medications effectiveness is drastically changed based upon the hydration level of the patients (esp. antipsychotics) </li></ul>
  47. 47. Summary cont... <ul><li>Getting children to love exercise early helps prevent a host of later-life physical and mental health problems </li></ul><ul><li>Fitness programs targeting the elderly help reduce depression and possibly suicide </li></ul>