The role of physical activity in mental health and well-being: a review (2023)

methodology

This review article presents a current understanding of the underlying physiological and psychological processes during exercise or physical activity that are involved in improving mental health. Exercise OR physical activity AND mental health, exercise OR physical activity AND depression, exercise OR physical activity AND stress, exercise OR physical activity AND anxiety, exercise OR physical activity AND psychosis, exercise OR physical activity AND addiction were used as search terms in PubMed , Google Scholar and Medline. The vast majority of references are to works published in the last decade.

Effects of physical health on mental health

There is increasing evidence documenting the positive effects of physical activity on mental health, with studies examining the effects of both short bouts of exercise and longer bouts of activity. Systematic evaluations show better results for mental illness with physical activity. Numerous psychological effects such as self-esteem, cognitive function, mood, depression, and quality of life have been studied.[8]. According to the general findings, exercise improves mood and self-esteem, while reducing the propensity for stress, a factor known to exacerbate mental and physical illness.[9]. Studies show that people who exercise regularly have better mental health. However, it must be emphasized that a consistent association between elevated mood and exercise in healthy subjects has not been demonstrated.

Also, people produce more than two neurochemicals when they are physically active. The human body produces opioids and endocannabinoids associated with pleasure, anxiolytic effects, drowsiness, and reduced sensitivity to pain.[10]. Exercise has been shown to improve attention, focus, memory, cognition, fluency, and decision making for up to two hours[11]. Researchers state that regular physical activity improves the function of the hypothalamic-pituitary-adrenal (HPA) axis, decreases cortisol secretion, and restores the balance of leptin and ghrelin (Figure1)[12].

Regular exercise has immunomodulatory effects, such as optimizing catecholamines, lowering cortisol levels, and reducing systemic inflammation. Physical activity has been shown to increase brain-derived neurotrophic factor (BDNF), which reduces beta-amyloid toxicity associated with the progression of Alzheimer's disease.[13].

Although a causal relationship has not been proven, methodologically sound research has found associated improvement in populations with mental and physical illnesses. These results are based on surveys and studies conducted around the world, primarily in the Western Hemisphere. To address a widespread health problem in India, it is useful to conduct a literature review based on research conducted in various contexts. Furthermore, the prevalence of these mental illnesses and the benefits of exercise as a complementary therapy can be highlighted through a meta-analysis of research conducted in India.[14].

This review also reviewed the literature published in India to understand the impact of physical activity on mental health and the implications for disease management and treatment in the Indian context. The results of the Indian studies were consistent with those found in the global meta-analyses. The Indian government has published data on interventions such as the impact of different physical activities. Exercise and yoga have been shown to be effective complementary therapies for a variety of mental illnesses.[12]. Although yoga does not require much effort, other aspects of the program, such as breathing or relaxation exercises, can simultaneously affect the practitioner's mental health. Yoga would be an appropriate activity for this evaluation due to its cultural importance as a common physical practice among Indians and its low to moderate activity level.[quince].

Yoga as an accompaniment treatment

Although yoga is a secular Hindu practice, its possible therapeutic effects have only recently been explored in the West. Mind-body approaches have been the subject of many studies and some of the results suggest that they may help with mental health problems on the neurosis spectrum. As defined by the Center for Complementary and Alternative Medicine at the National Institutes of Health, "mind-body interventions" aim to increase the mind's potential to alter bodily functions.[sixteen]. Due to its beneficial effects on the mind-body connection, yoga is used as a treatment for a variety of medical conditions. Potential therapeutic benefits of yoga include activation of antagonistic neuromuscular systems, stimulation of the limbic system, and reduction of sympathetic tone.

People suffering from anxiety and depression may find benefits in practicing yoga. Yoga is generally safe for most people and rarely causes any unintended negative consequences. Adding yoga to the traditional treatment of mental health problems can be beneficial. Much of the research on yoga has included meditation as an integral part of its methodology. Meditation and other forms of focused mental exercise can trigger a physiological response known as the relaxation response. Functional imaging has been used to implicate specific brain regions that show activity during meditation. A large body of anatomical and neurochemical evidence suggests that meditation has far-reaching physiological effects, including changes in attention and modulation of the autonomic nervous system.[17]. Left frontal brain activity, which is associated with happiness, increased significantly during meditation. There is also evidence that meditation can worsen psychosis by increasing dopamine levels.[18-20]. We still don't know enough about the potential harms of meditation for people with mental illness, as this research lacks randomized controlled trials.

Physical activity and schizophrenia

Schizophrenia is a debilitating mental disorder that often manifests itself in the early years of working life (late second decade). Remission of this disorder occurs only in a small fraction of cases. More than 60% suffer relapses, which can present with or without an apparent deficit. In addition to delusions, hallucinations, and formal thought disorders, many patients have cognitive deficits that appear early in the disease and do not respond adequately to therapy.[21].

The treatment of schizophrenia is challenging. Extrapyramidal side effects are a problem with first-generation antipsychotics. Obesity and dyslipidemia have been linked to second-generation drugs that can cause or worsen these conditions. Most patients do not achieve a complete remission and many do not even experience satisfactory relief of symptoms. While certain antipsychotic medications can alleviate or even worsen negative and cognitive symptoms, these reactions are much less common. This means that patients can benefit from cognitive rehabilitation. They may also have depressive symptoms due to illness or an adverse reaction to medication. This would make his condition even more disabling. Many patients also struggle with medical and emotional complications. Late extrapyramidal disorders, metabolic syndromes, defective states, and suicide attempts fall into this category. Patient adherence to treatment plans is often poor. Nursing staff absorb a lot of stress and are often exhausted as a result.

There is evidence that increased physical activity may help alleviate some psychotic symptoms and treat medical comorbidities associated with psychotic disorders, particularly those subject to the metabolic side effects of antipsychotics. Physically inactive people with mental disorders have higher morbidity and health care costs. Exercise solutions are often recommended to counteract these difficulties and maintain physical and mental well-being.[22].

The failure of current medications to effectively treat schizophrenia and the lack of improvement in cognitive or negative symptoms from medication alone supports the use of yoga as an adjunctive therapy for schizophrenia. Co-occurrence of psychosis and obesity/metabolic syndrome is possible even without concomitant drug treatment. The endocrine and reproductive systems of drug addicts undergo subtle changes. Numerous studies have shown that yoga can improve endocrine function, leading to better weight control, cognitive performance, and menstrual regularity, among other benefits. In this context, the role of yoga in the treatment of schizophrenia was conceptualized. However, only a small number of studies have examined yoga for its potential efficacy as a therapy. There could be several reasons for this. First, many yoga academies are opposed to adapting the practice to any medical method. The second misconception is that people with schizophrenia cannot benefit from the mental and physical aspects of yoga when it is practiced in the recommended way. Third, scientists may be reluctant to recommend yoga to these patients due to a lack of knowledge and adherence to the therapy.

In a randomized controlled trial involving a yoga group (n=21) and an exercise group (n=20), the yoga group showed a statistically significant reduction in negative symptoms[2]. In line with the latest recommendations from the National Institute for Health and Care Excellence (NICE), previous research provides substantial evidence supporting the use of yoga in the treatment of schizophrenia. Based on a meta-analysis of 17 different studies[23]As for frequent physical activity, it significantly reduces the negative symptoms associated with schizophrenia.

Physical activity and alcohol dependence syndrome

Substance abuse, especially alcohol, can have devastating effects on a person's mental and physical health. Tolerance and the inability to control drinking are some of the characteristics of alcoholism. Research shows that physical activity is an effective adjunct in the fight against alcohol use disorders. Physical activity may not only have a central effect on neurotransmitter systems, but may also reduce the harmful health consequences of alcohol consumption. There is evidence that people with alcohol use disorder are not physically active and have low cardiorespiratory fitness. A variety of medical comorbidities, such as diabetes mellitus, hypertension, and other cardiovascular diseases, occur with alcohol use disorders. Physical activity can be very useful to help control these comorbidities[24].

Exercise and yoga can help control cravings for substances when other forms of therapy, such as counseling or medication to control cravings, are not feasible or acceptable. Physical exercise has been shown to have positive effects on mental health, reduce stress and provide a pleasant substitute for the substance. However, the patient must take an active role in movement-based therapies rather than passively accept the process as it is, which is in contrast to the conventional medicine approach. As most substance-using patients lack motivation and commitment to change, it is recommended that exercise-based therapies be supplemented with therapies that focus on motivation to change to maximize therapeutic results.

One hundred and seventeen people with an alcohol use disorder participated in a single-arm exploratory study that included a 12-minute stationary bicycle fitness test as the intervention. Statistically significantly fewer cravings experienced by 40%[24]. In a meta-analysis and comprehensive review of the effects of such therapies, exercise programs were found to significantly reduce alcohol consumption and binge drinking in people with alcohol use disorder.[25].

Physical activity and sleep.

Despite the widespread consensus that they should prioritize their health by making time for exercise and getting enough sleep, many people don't. Sleep deprivation has negative effects on immune system function, mood, glucose metabolism, and cognitive ability. Sleep is a glycogenic process that replenishes glucose stores in neurons, in contrast to wakefulness, which is organized for the repetitive breakdown of glycogen. In light of these results, it appears that sleep has endocrine effects on the brain that are unrelated to hormonal control of metabolism and waste removal at the cellular level. Several factors have been suggested as possible triggers for this chain reaction: changes in core body temperature, cytokine concentrations, energy expenditure/metabolic rate, central nervous system fatigue, anxiety symptoms and mood, heart rate, and variability. Heart Rate, Growth Hormone, and Brain Changes. Derived neurotrophic factor secretion, fitness level, and body composition[26].

After 12 weeks of physical training, one study showed that both the quantity and quality of sleep in adolescents improved. Studies using polysomnography have shown that regular exercise reduces stage N1 NREM (very light sleep) and increases REM sleep (and REM sleep continuity and performance).[22]. As we age, both short-term and long-term activities have increasingly detrimental effects on sleep. In general, both short- and long-term physical activity has been found to have a beneficial effect on sleep quality; However, the magnitude of this benefit varied significantly between the different sleep components. Acute exercise had no effect on measures of sleep quality, including total sleep time, deep sleep, sleep onset latency, and REM sleep reduction. But both moderate and vigorous exercise have been shown to improve sleep quality.[27]. According to a meta-analysis of randomized controlled trials, exercise showed a statistically significant effect on sleep quality in adults with mental illness.[28]. These findings underscore the importance of exercise in improving outcomes for people with mental illness.

Physical activity in depressive and anxiety disorders

"Depression is the leading cause of disability worldwide and one of the major contributors to the global burden of disease" (World Health Organization, 2020). However, only 10-25% of people with depression seek therapy, possibly due to a lack of money, a lack of trained doctors, or the stigma associated with depression.[29]. For people with less serious mental illnesses, such as depression and anxiety, regular physical activity can be a crucial part of their treatment and management. Exercise and physical activity can improve depressive symptoms comparable to, if not more effective than, traditional antidepressants. However, the research linking exercise to a lower risk of depression has not been thoroughly scrutinized.[30]. Endorphins, like opiates, are opioid polypeptide compounds produced by the hypothalamic-pituitary system of vertebrates in response to extreme physical exertion, emotional arousal, or physical pain. The opioid system may mediate analgesia, social bonding, and depression due to the association between beta-endorphins and depressive symptoms (Fig.2).

The "endorphin hypothesis" states that physical activity causes the brain to produce more endogenous opioid peptides, which reduces pain and improves mood. The latter reduces feelings of worry and hopelessness. A recent study that positively demonstrated that endorphins improve mood during exercise supported these theories, suggesting that more research is needed on the endorphin theory.[31].

Physical activity and exercise have been shown to improve depressive symptoms and general mood in people of all ages. Exercise has also been linked to a reduction in depressive and anxiety symptoms in children and adolescents.[32]. Joint research from around the world has shown that exercise that is more effective than a control group is a viable antidepressant.[33]. Most forms of yoga that begin with a focus on breathing exercises, self-awareness, and relaxation techniques have a positive impact on depression and well-being.[34]. Despite claims that exercise improves mood, the ideal type or amount of exercise needed to achieve this effect remains unclear and appears to depend on several factors.[35].

Exercise as a therapy for unipolar depression was examined in a meta-analysis of 23 randomized controlled trials involving 977 subjects. The effect of exercise on depression was small and not statistically significant at follow up, although initially modest. Compared with no intervention, the effect size of exercise was large and significant, and compared with treatment as usual it was moderate but still notable.[36]. A systematic review of randomized controlled trials evaluating exercise therapies for anxiety disorders showed that exercise seemed useful as an adjunctive treatment for anxiety disorders, but was less effective than antidepressant treatment.[37]