Wellness Industry vs Pubmed, Vol 6: I Work Out for My Brain. Here's Why.
Wellness Industry vs Psychiatrist, Vol. 6: A brief overview of how I think about exercise as a psychiatrist + lifestyle content creator (no overly rigid views edition)
Over the last two years, I’ve written and made content a helluva lot about exercise, and how I view it. I verifiably pissed off the pilates and barre girls on TikTok with this post about the history of exercise for women and the science of building muscle. Moving more is one of the three habits of my 75 grow series. As an individual offline, I find the science and practice of all types of play and movement endlessly fascinating.
Yet, it is one of the hardest things as a clinician to bring up in a helpful way with my patients who are struggling with their mental health.
To be clear, exercise is in no way the 1st or 2nd or even 3rd thing I bring up when working with my patients on treating their symptoms or helping them get back to functioning the way they value. However, when it comes to being an ingredient in the recipe for robust mental health, the research literature seems clear that it is highly associated with better day to day life. However, invalidation and stigma around mental health and who gets to talk openly about psychiatric illness continues, and this in combination with the justifiable concern of dismissal of patients by clinicians with sweeping recommendations about weight or health behaviors, it’s hard to give this recommendation well. While I try to get better at that, the least I can do is give you some ways I think about having exercise in my life as something that is good for my mind, body, and spirit, and give you some of the science behind why.
Exercising for your brain from the biopsychosocial model
First, let’s get a brief overview of how we think about any type of intervention or treatment for mental health. In healthcare in general and psychiatry in particular, the prevailing model for the last two decades has been the biopsychosocial model of illness and health. This approach requires us to ask about three separate realms of how the environment and genetic predisposition broadly impact someone.
The biologic realm in my specialty looks like considering how heritable different mental illnesses are (ie from looking at studies of how an illness like schizophrenia is or is not present in children of someone with schizophrenia). The biologic realm also looks beyond genetics towards the neurophysiology of present behavior and interactions, such as someone with PTSD who may have a neurobiological firing circuit that differs from someone else. Finally, medication and substance can impact the biology of a mental health diagnosis.
The psycho- in biopsychosocial is for cognitive processes, emotion regulation, and narratives from meaning of a feeling or interaction in a moment to broader stories of existential purpose. This is what we often address in therapy, explicitly, but psychotherapy is not the only place where stories change, people learn to think differently, or one’s view and connection to the world change. I don’t need to tell you I don’t agree with the sentiment, “The gym is my therapy,” as a stand in for robust, clinically indicated therapy, but I will say there are ways people learn about the world through sport and fitness that can positively impact how they process the world.
Finally, socially is the category that encompasses community, relationship, and connection. In psychiatry, we think about primary relationships and how these can be protective or harmful to someone’s mental health, as well as a sense of belonging and delight. It can also include cultural considerations, stigma, experiencing discrimination, and beliefs that pervade a culture.
There are many, many benefits from having an active lifestyle.
Here are my five favorites to think about for my own life and in my role as a psychiatrist.
Exercise is associated with reduced risk for anxiety and depression, as well as associated with helping with mild to moderate symptoms of depression and anxiety. 1
Exercise creates routine and structure in day-to-day life, and with this it can make the rest of the day feel less chaotic due to a sense of having anchor points. including hunger and feeding cues and with sleep.
Exercise gives us something to grow and learn in, and that sense of autonomy and mastery is exciting.
Exercise can connect us to new people, places, ways of thinking, and communities.
Exercise helps us sleep better, reduces physical pain, and increases connection with hunger and appetite cues.
Resources for Exploration
If you’d like to deep dive even more into this, here are three excellent longform explorations via podcast (including one my own, How to Be Patient, and others I listen to regularly), and two books I enjoy on the subject.
How To Be Patient Pod:
Psychiatry and Psychotherapy Podcast:
Exercise vs medications for depression and prescribing exercise
Exercise and the Brain Overview
Books (or audiobooks):
Spark: The Revolutionary New Science of Exercise and The Brain
The Joy of Movement, by Kelly McGonigal
*Disclaimer: Though I am a trainee psychiatrist, this is not to be interpreted as medical advice, general or individual. This is an exploration of a topic, and should be read as materials towards public education access only. For questions about exercise, health, and your mental health, please speak to your care team and local professionals.
Rebar AL, Stanton R, Geard D, Short C, Duncan MJ, Vandelanotte C. A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev. 2015;9(3):366-78. doi: 10.1080/17437199.2015.1022901. Epub 2015 Jul 3. PMID: 25739893.