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Mood Disorders and Exercise

 Mood disorders: Does exercise matter?

By Kendall Wisehart DPT, ATC

In physical therapy, it’s easy to get caught up in the physicality of it all – muscles, bones, joints, biomechanics, and our favorite, physics. Unfortunately, what doesn’t get this well-deserved attention are the non-physical benefits, the mental and emotional benefits. Specifically, when examining mood disorders such as depression and bipolar disorder studies found that exercise impacts both physical and mental health outcomes. Exercise also positively affects conditions frequently associated with mood disorders such as anxiety, pain, and insomnia or other sleep disturbances.

Several mechanisms have been proposed for the anti-depressive effects of exercise, which can be divided into two categories – psychological and biological. Psychological variables include increased feelings of control (autonomy), physical wellness, quality of life, improved self-esteem / mood. Biological variables include several growth factors, oxidative stress, and genetics and their role in exercise-induced neurogenesis and anti-depressive effects.

“Studies have shown that after several weeks of moderate intensity exercise, oxidative stress and pro-inflammatory markers are decreased.”

Most of the recent work related to the anti-depressive effect of exercise and biological makers has focused on the role of BDNF or Brain Derived Neurotrophic Factor. By definition, BDNF supports neurogenesis or the growth of neurons. In fact, antidepressant medications up-regulate BDNF and patients with mood disorders exhibit lower levels of BDNF compared to their healthy counterparts. Simply put, BDNF may be the primary mechanism of the anti-depressive effects of exercise. While BDNF is important enough to have it’s own dedicated blog post, what’s important to know is that BDNF is essential in nerve survival, growth, and pathological levels of BDNF may contribute to psychological disorders and chronic pain sensitization.

Exercise may also impact oxidative stress. We’ve all heard the term anti-oxidant and generally accepted it as a good thing. Without going into the specifics of cellular (mitochondrial) energy production, it’s important to understand that oxidation is a normal part of the energy production system of the cell. In the absence of anti-oxidant defense, oxidative stress and cellular damage can occur. Fortunately, exercise can impact oxidative stress. This is especially important for those with mood disorders in which there are increases in inflammation and oxidative stress. Studies have shown that after several weeks of moderate intensity exercise, oxidative stress and pro-inflammatory markers are decreased. On the flip side, high intensity exercise increased oxidative stress. The summary here is simple, a balance of exercise intensity is key when achieving both physical and psychological benefits of exercise.

Finally, based on recent research, exercise has been associated with epigenetic changes that are beneficial for those with mood disorders. Epigenetic changes refer to changes in gene expression without an actual change in DNA sequence. For example, BDNF can be upregulated through these types of exercise induced changes. It has also been suggested that exercise promotes epigenetic changes that promote homeostasis, neuroplasticity, circadian rhythms, and endocrine and immune regulations.

Others have suggested that exercise induced epigenetic changes can reduce the aging process and have beneficial effects on the musculoskeletal system across the lifespan.

Exercise may be an acceptable alternative or adjunctive therapy to enhance mood, functioning, and co-morbid conditions for individuals with mood disorders. Overall, there is promising evidence to support the use of exercise in the treatment of mood disorders. Future research will focus on specific frequencies, durations and types of exercise for specific mood disorders.

For now, balance is key and something is always better than nothing – even a short walk can have it’s benefits (see upcoming post).

 

Kendall Wisehart DPT, ATC Bio

 

Pain: Everything works, but nothing is effective

Pain: Everything works, but nothing is effective

By Terri Sullivan, DPT OCS

 

When it comes to the treating a patient in pain, physical therapists often speak highly of their favorite methods and how effective his or her unique techniques are.  On the other hand, naysayers will quickly

refute those methods, presenting research that shows how that treatment is ineffective. There is simply disagreement on the best practices to improve a patient’s pain experience. There are so many different methods that physical therapists have adopted that they state will help with pain reduction, when what should really be emphasized are the principles of how to treat pain.  

While reading this blog post in Evidence in Motion, written by Kory Zimney, PT, DPT, it made me stop and think about how physical therapists treat pain.  It made me really think of how pain needs to be treated differently in the medical community.  What we as physical therapists need to embrace is “psychologically informed practice”.  How this is employed is by using evidence based practice guidelines and helping educate a patient to return to full activity despite the pain.  Obviously, in helping a patient cope with the pain, there must be ways to recognize and also manage psychological obstacles with the combination of activity based interventions.   What are most helpful and essential for a physical therapist are assessment skills, treatment planning, and communication with the patient.  

But the question that was brought up by Patrick Wall, PT, was “if we are so good, why are our patients so bad?”  An Institute of Medicine report from 2011 found that 100 million people are dealing with chronic pain conditions regularly.  How are physical therapists treating and helping these people?  Why when the physical therapists report success that the science does not seem to validate our methods?  When we are teaching a patient how to correct their posture or correct a movement pattern with an exercise, it may not help them fix the problem but it may instead help with self-efficacy.   There also could be reduced learned response to the pain or decreased learned helplessness when patients are more well informed of their movements that are contributing to the pain.  The manual therapy that is used may not be improving motion at the joint or decreasing muscle restriction as much as it’s helping sharpen a patient’s ability to be more familiar with different parts of their body. 

The final thoughts of the blog are what resonated with me the most.   What we as physical therapists should try to do for our patients is be more psychologically aware.  Maybe we can all reach a point in the spectrum of our careers when we can focus less on the methods of treatment and more on the principles of what is behind them.   Understanding the principles of treatment will drive our care to choose methods that work best for the patient, not the methods that work best for the physical therapist. 

So whomever is reading this post, think about the treatment approach that is utilized.  Whether you are a provider or a patient, is the treatment approach addressing all the principles of treating an individual biomechanically, psychologically, and sociologically?  It’s always important to think outside of the box and let the patient’s multidimensional presentation help a physical therapist choose a form of treatment that is a patient-centric model for pain management.