Fitness and Mental Health:

Exploring the Mind-Body

Connection
Objectives
 The student will learn about:
 The benefits of sunlight, oxygen, movement and
endorphins on mood
 How exercise can help mitigate depression, anxiety,
bipolar disorder, postpartum depression, hyperactivity,
bulimia/binge eating and addiction
 Common mental health issues in the “average”
population and their frequency
 Common psychotropic medications and their side effects
which may affect balance, coordination, reaction time
and stamina
Objectives Cont...
 Dehydration and the effectiveness of certain medications
 Special concerns when working with clients/students
with eating disorders
 The benefits of exercise in the elderly with regard to
depression and suicide
 The benefits of teaching children to love exercise
including prevention of many physical and mental health
problems in later life
 The interaction between hormone shifts, sleep
deprivation and postpartum depression
S.O.M.E.

 Gotta getcha S.O.M.E.

 Sunlight
 Oxygen
 Movement
 Endorphins

 Activity: Brainstorm ways to increase each

Multidisciplinary Teams
 Personnel and their roles
 Counselor
 Work with team and client to identify activities and factors that
mitigate MH issues
 Case Manager
 Supervise case plan implementation and make needed changes
 Physician
 Monitor for safety
 Trainer:
 Design and tweak program as needed
 Teach staff necessary skills and safety
 Tech
 Lead group activities (i.e. morning walk, evening stretch)
 Monitor moods and prompt activities
 Monitor environment
Sunlight
 Benefits
 Vitamin D
 Stonger Bones
 Improved Rest
 Improved Mood
 Ways to incorporate
 Go outside
 Sunlight spectrum bulbs
 How much?
 20 minutes per day
Oxygen
 Signs of too little in a healthy person
 Yawning
 Feeling tired
 Benefits
 Energy
 Increased blood flow
 Relaxation
 Ways to incorporate
 Deep breathing
 Go outside
 Stretching with deep breathing
 Exercise
 Warning: bluish color in lips esp. with pale coloring can mean
person is not getting enough oxygen and is a medical
emergency (RAD, Asthma, Bronchitis)
Movement

 Signs of too little (or too much)

 Tiredness
 Depression/Irritability
 Aches/Stiffness
 Weight problems
 Muscular atrophy
 Sleep problems
 Benefits
 Increase bloodflow
 Strengthen muscles and bones
 Improve sleep
 Reduce aches and pains
 Improve weight
 Improve self-esteem
 Eliminate toxins
 Relieve constipation
 Improve concentration
 Types
 Fitness classes---provide levels of workout
 Encourage movement bewteen classes—walking,
house cleaning, gardening, tennis, playing with
dogs/kids, shopping...

 Activity
 Other ideas???
 How do you get someone who is sedentary to start
exercising?
 Alternatives for rainy days or heat-sensitive people
Endorphins

 Happy chemicals
 Finding the happy medium
 How to get them?
 Laughter
 Exercise
 Sex
 “Rush” producing activities
Activity
 Go out for a walk
Stress
 What is it: Fear? Anger? Both?
 How common is it (15 per day)
 6 Basic Stressors
 Fear of Death
 Loss of Control
 The Unknown
 Rejection
 Failure
 Isolation
Activity
 What types of stressors do we face each day?
 What fears are they related to?
 What types of stressors do our clients face each
day? What fears are they related to?
 Personal Training
 SED
 Pregnant/Postpartum
 Addicts
 Elderly
Stress Chemicals
 Adrenaline
 Function
 Mental Health Side Effects
 Physical Side Effects
 And Exercise
 Cortisol
 Function
 Mental Health Side Effects
 Physical Side Effects
 And Exercise
 http://www.heartcenter.com/billett.html
Physical Stress
 Trifecta
 Caffeine, Sugar, Nicotine
 Interaction with psychotropics
Prevalence of Diagnosed
Mental Health Disorders
 Anxiety: 18%
 Depression: 8-9% (not including situational or
postpartum)
 Bipolar Disorder: 3%
 Eating Disorders: 8%
 Alcohol and Drug Addiction: 7%
 According to the National Institute of Mental Health “The Numbers
Count: Mental Disorders in America”
 Recognize that many disorders go undiagnosed/untreated by
medical personnel
Psychotropic Medications
http://www.londonprepared.gov.uk/downloads/heatw
aveheathandsocialcare.pdf
MEDICATIONS LIKELY TO PROVOKE OR INCREASE THE SEVERITY OF
HEATSTROKE
Diuretics, especially loop diuretics
Those causing dehydration or electrolyte
Any drug that causes diarrhea or vomiting
imbalance
(colchicine, antibiotics, codeine)
NSAIDS, sulphonamides, indinavir,
Those likely to reduce renal function
cyclosporin
Those with levels affected by Lithium, digoxin, antiepileptics, biguanides,
dehydration statins
Those that interfere with
thermoregulation:
by central action Neuroleptics, serotoninergic agonists

by interfering with sweating – H1 (first generation) antihistamines

– certain antiparkinsonian drugs
– certain antispasmodics
– neuroleptics
– disopyramide
– antimigraine agents
-- Vasoconstrictors
Those reducing cardiac output – beta blockers, diuretics
by modifying basal metabolic rate Thyroxine
Drugs that exacerbate the effects of heat
All antihypertensives, Antianginal drugs
by reducing arterial pressure
Antidepressants

 MAOIs
 Side effects: Drowsiness, Dizziness, Weakness,
Shakiness, Fatigue, Weight Gain
 Levels affected by dehydration
 SSRIs
 Side effects: Weakness, Dizziness, Shakes
 Usually remit within one to two weeks
 Often recur if client misses a dose
Antianxiety/Sedatives/
Anticonvulsants

 Benzodiazepines, Barbiturates,
Anticonvulsants
 Examples: Xanax, Valium, Restoril, Librium,
Ativan, Phenobarbital, Pentobarbital, GHB
 Side effects: Drowsiness, Coordination Loss,
Dizziness, Occaisional Hypotension, Reduced
Reaction time
 Levels affected by dehydration
Buspar (Serotoninergic
agonists)
 Used to treat anxiety and some anger
disorders
 Not addictive like benzos

 Affects thermoregulation
Mood Stabilizers,
Antipsychotics, Neuroleptics
 Lithium
 Dizziness

 Weight Gain
 Tegretol/Carbamazepine
 Sleep Problems
 Depakote/Valproate
 Weight Gain
 Drowsiness
 Seroquel/Quetiapine
 Drowsiness
 Antianxiety properties
Mood Stabilizers Cont...

 Geodon/Ziprasidone
 Risperdal/Risperidone
 Drowsiness
 Clozapine
 Major weight gain
 Zyprexa/Olanzapine
 Weight Gain

 Other antipsychotics: Haldol, Thorazine, Prolixin

 Medications in italics have evidence of both anitdepressant and anti-manic properties
 http://www.psycheducation.org/depression/meds/moodstabilizers.htm
 Levels affected by dehydration
 Can directly affect thermoregulation increasing chances of heat stroke
 http://www.rxlist.com
Activity
 http://www.funnycatvideos.net/

 http://www.jack-russell-terrier-pictures.com/funnyd
Common Types of Mental Health
Issues that Benefit from Exercise
as an Adjunct Therapy
Anger

 Benefits of exercise
 Channels energy to positive activity
 Burns up stress chemicals and free-floating fatty
acids
 Can be cathartic--- Examples???
 Medication
 Generally not medicated unless patient is a
danger
 Possibly barbiturates
 Tendancy towards alcohol or marijuana abuse
Anxiety
 Cluster of disorders (GAD, PTSD, Phobias)
 Generally referred to as fear, stress, worry or
tension
 Affects 18 percent of the population
 Benefits of Exercise
 Helps clients clear their mind/focus on something
other than their fear
 Burns up stress chemicals helping to relieve the
fight or flight response
 Provides clients with venue for social
support/interaction
Anxiety Medications

 Benzodiazepines (Valium, Xanax, Librium, Ativan)

 Most end with “-zolam” or “-azepam”
 Barbiturates (Phenobarbital, Amital, Seconal)
 Most end with “-barbital”
 SSRIs/Antidepressants: Prozac, Zoloft (sertraline),
Paxil, Celexa (citalopram)
 Most end with “-pram” or “-ine”
 Busiperone
Bipolar Disorder

 Formerly called manic depression

 Occurs in 3 percent of the population
 Benefits of Exercise
 Improves mood during depressive phases
 May provide an appropriate outlet during manic
phases
 Clients can be reckless during manic phases so
adequate supervision is essential
Medications for Bipolar

 Mood Stabilizers are the drugs of choice

 Many mood stabilizers
 Cause weight gain
 Increase fatigue
 May demonstrate alterations in effectiveness if
patients become dehydrated (A. Fariborzian, M.D. (2006),
personal communication)
Depression

 Major
 Situational
 Seasonal Affective Disorder (SAD)
 Premenstrual Dysphoric Disorder (PMDD)
 Postpartum
Depression Treatment

 Major
 Antidepressants (SSRIs)
 Start/Stop symptoms
 Antidepressants (MAOIs)
 Ex: Phenylzine (Nardil); Isocarboxazid (Marplan)
 Severe dietary restrictions
 Behavioral—nutrition, exercise, social support, sunlight
 Situational/SAD/PMDD
 Anitdepressants (Short course)
 Behavioral as above
Postpartum Depression
 Crucialto be aware of statements of harm or
obsessions
 Often occurs during major hormone or
schedule shifts
 1-2 weeks after birth
 1-2 weeks after stopping breast feeding
 Periods of sleeplessness
 Can occur up to 1 year after birth
 Might be associated with hypothyroid
 http://www.med.umich.edu/depression/postpartum.htm
PPD Cont...

 Mothers at higher risk (controversial)

 Mothers with pre-existing eating disorders
 Mothers with pre-existing depression or anxiety
disorders
 Mothers with little social/family support
PPD Treatment/Exercise
 Medications
 Antidepressants
 Antipsychotics
 Antianxiety
 Anticonvulsants
 Sunlight and Exercise
 To improve mood and regulate sleep schedule
 Some evidence indicates exercise can help mitigate the negative
interaction between hormones and neurotranmitters
 Can help mom relax and have positive effects on baby
 Exercise & PMS By: Carol Krucoff http://yourtotalhealth.ivillage.com/diet-
fitness/exercise-amp-pms.html?pageNum=1
Behavioral Issues and Exercise
Addictions

 Most people with addictions have co-occurring

depression and anxiety
 Addictions are often self-medicating
 Exercise can help relieve stress, improve self
esteem, improve energy and increase positive
neurochemicals: norepinepherine, endorphins
Eating Disorders—Bulimia,
Binge Eating

 Approximately 8% of the population can be

diagnosed with anorexia or bulimia
 An additional 5.5%-11% of the population can be
diagnosed with binge eating disorder
 Dietary recommendations are not going to help these
people lose weight

 Activity: Discuss psychological implications of EDs

What can we do?
 Providing a healthy exercise environment models
positive behaviors for clients with EDs
 Activity: Brainstorm ways to do this

 Teach that moderate exercise is a vital component to

reducing depression, anxiety and bingeing
 Activity: Brainstorm ways to do this

 Be aware that overuse of vomiting, laxatives and

diuretics may make this population weak and can
lead to heart attack, fainting, stroke
Eating Disorders: Anorexia

 They are driven by an obsession with

perfection and control
 Fitness Instructors: Use extreme caution
working with this population. They are often
emaciated and in uncertain physical condition.

 Case study “Sally”

Hyperactivity

 Home grown 7-year old hyperactivity, not

AD/HD
 Group fitness classes right after school can
provide positive outlets for pent up energy
 Service learning opportunities
 Exercise in the morning for adults who have
excess nervous energy
Special Populations

 Children
 Elderly
 Law Enforcement
Children
 Develop self esteem and motor skills through
exercise
 May reduce oppositionality
 Provide daily opportunities for success and
challenge
 Early exercise habits prevent later life obesity
etc.
 Early exercise habits also improve self-esteem
and self confidence which buffer against later
mental health problems
Kids continued...

 Make it FUN!
 http://kidshealth.org/parent/nutrition_fit/fitness/exercise.html
 Theodore Ganley, MD, and Carl Sherman, “Exercise and Children’s Health," The
Physician and Sports Medicine Journal, (February, 2000).

 Activity: Options for incorporating exercise into

kids lives
Elderly
 18 % of elderly persons are depressed (National
Alliance on Mental Illness, 2008)
 Persons over 65 have the highest rates of
suicide of any age group
 Social interaction is the number one buffer
against elder suicide
Elderly cont...
 Exercise provides
 Social Interaction
 Reduced depression
 Improved Sleep
 Have classes that target the over 65 group
 Use music appropriate to their genre
 For counselors: Many elderly patients have
trouble opening up in a counseling office, but
not on the walking track
 Many elders will confide in each other, but
believe “counseling” is taboo.
Law Enforcement/ER
Physicians and Nurses

 Constantly experience chronic low-grade

stress with bursts of extreme stress
 LEO have heart disease now listed as a work
related disability due to chronic stress levels (D.
Snipes (2002) Gender differences in the perception of stressors among law
enforcement officers”)
 Can reduce some of the negative impact
through exercise
 Often have an Us vs. Them mentality
Shift workers

 Have classes/appointments at 2 or 3 in the

afternoon for midnight shifters
 Keep the room bright
 12-hour shifts
 Showing up after a long shift, coordination and
energy levels may be down, but cortisol may still
be high.
 Encourage mild to moderate exercise
•Summary
 Exercise can mitigate many mental health and
behavioral problems through S.O.M.E.
 Many class participants/clients are probably taking
psychotropic medications
 Side effects of medications can include reduced
reaction time, impaired judgement, dizziness and
impaired coordination
 Some medications effectiveness is drastically
changed based upon the hydration level of the
patients (esp. antipsychotics)
Summary cont...
 Getting children to love exercise early helps
prevent a host of later-life physical and mental
health problems
 Fitness programs targeting the elderly help
reduce depression and possibly suicide