Exercise can improve mental health, writes Aznim Ruhana Md Yusup
THE human body is complex in its functionality. We are made up of skin and bones, of blood and neurons, and of cells and chemicals. We may have a better idea of how things work now compared to 1,000 years ago but there are still many aspects that we need to unravel and discover.
Connected with the tangible side of things are those less so, such as our thoughts, emotions and memories. We are defined by our mental cognisance, and we pride ourselves on being able to control our physical self with our conscious thoughts.
This makes the struggles of mental illnesses such as depression and anxiety doubly unpleasant because it’s a malady that destroys the sense of self while pulling the person into a downward spiral of not recognising that the destruction is happening.
If they do recognise it, they sometimes think: “Is this me or is this my illness? Where do I begin, and at what point do I no longer have control over my thoughts and actions?”
Like a person with autoimmune disease, you wonder why your body is working against you.
To tell a depressed or anxious person to “snap out of it” is an unkindness to their struggles, and shows a lack of respect to the aforementioned complexity of the human body. Of course they want to be able to snap out of it but nothing is as simple as that.
Shankar Thirulchelvam is a counselling psychologist at the Mind Faculty psychiatric clinic in Kuala Lumpur.
His approach is to look at his client’s lifestyle in order to get them on the path to recovery. There’s traditional psychotherapy and medication, but also advice on nutrition and exercise.
He’s especially keen on the latter. Shankar is known to send his clients to personal trainers for workout sessions, although he only picks trainers who have the sensitivity to deal with the issue. But why is exercise important in the recovery of mental illness?
“The first thing is to understand that the body is biological,” he says. “When you exert yourself physically, whether you’re running or lifting weights, it releases certain chemicals in the brain, especially chemicals dealing with dopamine, which is basically the feel-good hormone. Then you have an increase in the release of serotonin, a mood stabiliser.”
“And if you do certain types of exercises, it enhances the brain’s ability to form new neural pathways or brain plasticity.”
Brain plasticity is what gives us the capacity to learn, change and adapt throughout our lives. Commonly speaking, it’s the way in which we can change the wiring in our brain.
People with mental illness are wired differently. To treat it, some rewiring may be required. Traditionally, this is done through talk therapy and medication such as antidepressants. A lot of antidepressants work on increasing serotonin levels but exercise can help as well.
HIT THE GYM
The key aspect of what exercise does in the treatment of mental illness is the release of chemicals and hormones such as dopamine and serotonin.
Shankar explains: “After you finish a workout, you generally feel good and that’s because these chemicals improve mood. If mood is improved, it also improves cognitive functioning, which is how you see the world at large and how you process things.
“People who go through depression and anxiety often have a bleak or negative outlook on life and the world. So if exercise enhances mood and thereby enhances your outlook on life — even by seven to 10 per cent, just to put a measurable figure — it’s still an improvement.”
As the individual begins to exercise consistently, they start making progress. They can run longer and farther. Perhaps they can lift heavier weights or finish their circuit training routine quicker. There’s a sense of accomplishment, and also camaraderie with their fellow runners or gym-goers.
“When the workout becomes a lifestyle, which means it’s something you do a certain number of times a week, you allocate time for it. You’re driven and motivated in the activity and it starts to shift the brain plasticity. The brain has evolved differently,” says Shankar.
He recommends working out four times a week for 45 minutes each session, doing an intense activity that get the heart rate up for 25 to 40 minutes. This includes high intensity interval training (HIIT) and full body floor exercises such as burpees, planks and lunges.
“The rule of thumb is that your workout days should be more than your rest days. If the body has too much rest between workouts, you don’t really improve, proficiency-wise. But I also create workouts for just 12 minutes because that’s what my clients say they can manage. That’s fine too because it still creates that chemical effect.”
NOT A CURE
That said, mental illness can’t be cured simply by exercise, at least not without proper assessment. There is danger in suggesting a physical activity, nutritional advice or spiritual suggestion without trying to understand the person’s struggles and why it has affected their lives in such a wretched way.
“If the person has underlying suicidal tendencies or has a severe chemical imbalance and needs medication to address it, these modalities should be aids to traditional treatment, not the primary movement forward,” says Shankar.
“If it’s someone whose mental health issue is not so severe, perhaps they’re depressed because of issues at work and don’t want to take medication, then therapy and other modalities should be fine. But this should be done only after a thorough assessment with a psychiatrist or a qualified psychologist.”
He adds that issues like depression and anxiety have a somatic component as well, meaning, there is a bodily reaction. The heart rate of someone with social anxiety may spike simply by the act of opening the door. A person who was traumatised may be temporarily immobilised from a scent or song.
“The body feels a lot of things. It has its own set of memories and that’s what imprinting is. The body can feel things and it has got all these sensory modalities that connect with what is outside of our conscious awareness,” says Shankar.
“Exercise helps with the somatics, whether it’s deep breathing techniques or different exercise modalities that calm the body and nervous system down. Yoga is one modality. It uses a lot of breathing techniques which are helpful for patients who suffer from anxiety.”
FOR GREATER GOOD
But there’s an underlying message here that people should be kinder and more sympathetic to one another, rather than resorting to giving a candid solution. This may be challenge though because unlike a broken limb, mental illness is not visible.
A person who is severely depressed will find it a challenge to get out of bed, even if it’s just to the bathroom. Someone with debilitating social anxiety would rather stay hungry than suffer the world outside to get food.
“Just because someone is not diagnosed and is going through this doesn’t make it any less severe. For the person experiencing it, it can be significantly debilitating,” says Shankar.
“We live in a society that doesn’t accommodate or appreciate that a person can have mental health issues. You tend to think this is something normal which you will get out of and eventually get better. It might not,” he warns.
Shankar says he is working on formalising a form of wilderness therapy, where he takes clients to hike in the jungle and, at the same time, address some of their issues like in traditional talk therapy sessions.
“The main idea is to stay mindful of the present environment. It’s also physical so the exercise component is there. Being out in nature is refreshing. These are components that, in some degree, improve a person’s mental health,” he says.