Skip to main content
Submitted by Mangala R on 15 May 2017

Exercise and yoga can improve quality of life for people with mental illness and reduce risks of strokes, diabetes, auditory hallucinations and other health problems, informs Dr R Padmavati, Additional Director, Schizophrenia Research Foundation.

World Health Organisation defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity is not just "exercise". Exercise, is a subcategory of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. Physical activity includes exercise as well as other activities which involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities.

Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million (6 %) deaths globally. Physical inactivity is also an independent risk factor for non-communicable diseases. It is estimated to be the main cause for approximately

  • 21–25% of breast and colon cancers
  • 27% of diabetes
  • 30% of ischaemic heart disease burden

Therefore, non-communicable diseases associated with physical inactivity are a significant public health problem in most countries around the world.

Severe mental disorders (SMD) include conditions such as Schizophrenia, Bipolar disorders and Depression. Persons with SMD are more at a risk of developing chronic physical diseases like diabetes, hypertension, heart attacks, stroke, cancers and other conditions that may lead to mortality. SMD and chronic disease risk factors are related in complex ways. Lifestyle (smoking, obesity, lack of physical activity) and treatment with psychiatric medications account for the increased risk for most of these physical diseases in persons with SMD. Mental illness itself may be risk factor for chronic diseases; its presence increases the chance that an individual will also suffer from one or more chronic illnesses. In addition, individuals with mental health conditions are less likely to seek help for physical illnesses.

Physical inactivity amongst persons with severe mental disorders may be due to several reasons.

  • Symptoms of the illness such as depression, anxiety, hallucinations and delusions may result in the person not wanting or able to do any activity.
  • A sedentary lifestyle results in increase in weight and consequent difficulties in mobility. For many patients, the only reason that they go out of home is to buy cigarettes or beedis. Household chores are not done as expected by the family – slowness, “not satisfactory” etc. A critical feedback from the family creates a vicious cycle.
  • Also, medications may cause slowing.
  • Young students with psychosis report problems in attention, concentration and memory as a difficulty.

Patients with mental illness thus find it even more difficult to engage in structured, repetitive activities like exercise, yoga.

What are the benefits of physical activity?

Improves Physical Health

Getting more physical activity can help to combat the problem of weight gain. Exercise and yoga can help to reduce physical health problems like heart disease and diabetes in itself. Studies have shown that where people engage in exercise programmes their risk of developing conditions like stroke and diabetes are reduced despite not having lost much weight. In addition, exercise can help with problems like osteoporosis (a long term weakening of the bones) that is a problem for some people taking antipsychotics. It also helps keep blood pressure down and improves general levels of physical fitness.

Improves Social Interaction

Exercise can help to improve the negative symptoms of schizophrenia such as apathy, lethargy and social withdrawal, although research evidence for this is limited. However, most studies have found an improvement in social interest, behaviour and self-esteem in people with schizophrenia when they engage in an exercise programme. The benefits vary from person to person with some people being more motivated by, for instance, improvements in their physical appearance and others being motivated by the improved opportunity for social interaction.

Reduces Auditory Hallucinations

There has also been some research which has found that exercise can, in some people, help to reduce auditory hallucinations (hearing voices). However, it has to be stressed that the evidence for this is extremely limited and it may be that the distraction provided by the activity is the key factor in helping the person to cope with their voices.

Psychological Wellbeing

There is much stronger evidence linking exercise with general psychological wellbeing. Getting more exercise helps to reduce stress, improve relaxation and sleep patterns, mood, motivation and self-esteem. How this works is not clear. Researchers have suggested that the benefit comes from changes in the brain’s chemistry brought about by increased exercise, whilst others have proposed that the change is caused as much by psychological and social factors, for instance better social contact involved with say joining a fitness class. It is thought that all types of exercise such as running, swimming and gym work have a similar effect and the more exercise you get the greater the benefit. However, over-exercising has been found to have a negative effect as it may increase anxiety levels.

Improves Sleep

Exercise improves sleep. The mechanisms for this may be that exercise reduces anxiety or depression or that the changes in brain chemistry or body temperature may help improve sleep. There is evidence for psychological benefits of general activities such as household chores, although the evidence for this is decidedly mixed.

What Types of Exercise Can You Do?

There are a number of different types of exercise including running, walking, swimming, weight training etc. The internet abounds with a lot of information on the benefits of various kinds of exercise. However, there are things that one should consider before starting an exercise regimen:

  • Would you prefer to exercise on your own or in a group with others?
  • Do you have any underlying physical problems that may limit the type of exercise you can do?
  • What sort of fitness needs to be achieved e.g. if bone strength is important then a gym may be better for you?
  • Will you enjoy it? It is important to enjoy what you are doing. If it feels like it is always a struggle then it may be best to try something else.
  • What facilities are available locally?

One type of exercise that is often undervalued is general activity such as household chores and looking after the garden. Similarly, there are lots of other little ways that you can encourage yourself to get more exercise, for instance by using the stairs instead of the lift in a building or by getting off the bus one stop earlier and walking the remainder of the journey.

How much and what is the best time to exercise?

The World Health Organisation recommends about 150 minutes or two and a half hours of moderately intense exercise per week for adults. In theory, people taking antipsychotics should aim for more than this as they have to offset this additional risk factor. While any exercise is better than none, setting some realistic goals is a good idea.

As to when is best to exercise: whenever is best for you is the answer. However it is best to avoid intense physical activity in the evening as that may make it more difficult to settle down to a good night’s sleep.

Various psychological hypotheses have been proposed to explain the beneficial effects of physical activity on mental health, the main being

  1. Distraction
  2. Self-efficacy
  3. Social interaction

Distraction: The distraction hypothesis suggests that diversion from unfavourable stimuli leads to an improved mood during and after exercise.

Self-efficacy: The self-efficacy hypothesis proposes that, since physical exercise can be seen as a challenging activity, the ability to get involved in it in a regular manner might lead to improved mood and self-confidence.

Social Interaction: With respect to the social interaction hypothesis, the social relationships commonly inherent in physical activity, as well as the mutual support that occurs among individuals involved in exercise, play an important role in the effects of exercise on mental health.

YOGA

The science of yoga is an ancient one. It is a rich heritage of our culture.

Yoga as a therapy has proven to be effective as a sole or additional intervention in psychiatric disorders such as depression and anxiety. Research reports have demonstrated the feasibility and efficacy of yoga as an add-on therapy in schizophrenia, particularly in improving apathy, socialisation and motivation, etc.. However, the biological mechanisms of this effect remain unclear.

Yoga practice may specifically help persons with mental illness in at least five ways.

  1. Calming effect
  2. Increasing awareness
  3. Increasing the attention span
  4. Acceptance and adaptability
  5. A sense of security

The prescribed yoga asanas, breathing and relaxation techniques are largely individualised and depend upon the body structure and specific needs of the individual.

Thus, the value of physical activity, exercise or yoga cannot be undermined for persons with mental illnesses. Mental health professionals, caregivers and the patients themselves need to be aware of the value of physical activity in the overall quality of life of the individual.

Reference

  1. WHO and Physical Activity  -http://www.who.int/dietphysicalactivity/pa/en/
  2. Yoga and Mental Health:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768208/