The important role of exercise and nutrition in maintaining mental and physical health and treatment of mental and physical conditions

1. Exercise, Nutrition and Mental health
Dr Nischol Raval
Consultant Psychiatrist, Pune

2. ‘Mens sana in corpore sano’ (A healthy mind
in a healthy body)
- Juvenal

4. ‘Gray Rhino’ in Mental Health
• Growing concerns about the
physical health of persons with
mental health issues [ Osborn 2001,
Alison 2009]
• People with mental health issues
less likely to exercise and be
physically active
• Metabolic syndrome, Obesity, HT,
CVA, etc.
• Lower life expectancy in persons
suffering from CMI [Thornicroft 2011]

5. Metabolic syndrome and Mental Illness
• Metabolic syndrome 2 – 3 times
more prevalent in persons with
mental illness [Holt 2004, Urszula
2014]
• Lifestyle of persons suffering from
mental health issues ,may
contribute to development of
Metabolic syndrome [McCreadie
2003,Kumar 2004]
• Metabolic syndrome contributes to
the reduced life expectancy in
persons with mental illness
[Marder 2004]

6. • Mental health professionals have key responsibility in helping
individuals identify and make necessary lifestyle changes.
[Osborn 2007]
• Little or no mention of exercise as a treatment option in standard
mental health books inspite of many studies advocating positive
effects of exercise on mental health [Callaghan 2004]

8. Definition
• Physical activity
• Involves any bodily
movements produced by
skeletal muscles which
expends energy
• Exercise
• Planned
• Structured
• Repetitive and
• Purposive
• For improvement or
maintenance of one or
more components of
physical fitness
• Training of body to
improve fitness and
enhance its functions

9. Exercise and Depression
• Beneficial effects more pronounced in people
with anxiety and depression [Wegner 2014]
• Regular exercise can be helpful in prevention
and treatment of depression [Lawlor and
Hopker 2001, Stathopoulou 2006, Rethorst
2009, Krogh 2011]
• Exercise less effective than antidepressant
medication, but when combined, had better
treatment outcomes [Jaya Kody 2014]
• Specially designed exercise programme is
more effective than regular exercise
[Callaghan 2011]

10. Exercise and Depression
• Only moderate or high intensity exercise significantly reduces
depression [Dunn 2005]
• Exercise brings about improvement in mood state and self esteem,
lower stress and anxiety levels [Anderson 2013, Chang 2017]
• Recommended for people with mild and moderate depression who
are willing, motivated and physically healthy enough to engage in
such a programme [Josefsson 2013]

11. Exercise and Anxiety disorders
• Regular exercise can reduce anxiety levels
[Wegner 2014]
• Decreased state and trait anxiety in clinical
and non-clinical samples [Wipfli 2008]
• Patients with PTSD, showed significant
improvement in symptoms [Fetzner 2015]
• As effective as CBT [Wipfli 2008]
• CBT plus exercise had better treatment
outcome than CBT alone in treatment of
anxiety disorders [Merom 2008]

12. Exercise and Schizophrenia
• Reduced anxiety, psychological stress, improved subjective
well-being in patients of schizophrenia with exercise
[Vancampfort 2011, Firth 2015 ]
• Induces decrease in positive and negative symptoms [Pajonk
2010]
• Associated with increase in hippocampal volume after 3
months of aerobic exercise
• Helps in prevention and treatment of metabolic syndrome

13. Exercise and Dementia
• High physical activity seems to
delay onset of dementia [Hamer
2009, zschucki 2013]
• Slows the cognitive decline
[zschucki 2013]
• Improves quality of life and
cognitive function along with brain
plasticity in patients with MCI,
dementia and neurodegenerative
illnesses [Geirsdottir 2012, Heyn
2004, Kramer 2007, Rolland 2007]

14. Beneficial effects in other disorders
• Significant reduction in levels of insomnia in postmenopausal
women [Abedi 2015]
• Aerobic exercise associated with significant improvement in
quality of sleep and mood states associated with chronic primary
insomnia [Passos 2011]

15. Beneficial effects in other disorders
• Reduction in anxiety and depression scores in children [Larun
2006]
• Positive impact on functional outcome in ADHD, especially in
motor skills and executive function.
• Longer intervention yielding better results [Ruta Vysniauske
2016]

16. Beneficial effects in other disorders
• Exercise reduces craving and
severity of withdrawal in
substance use disorders
[Wang 2014, Giesen 2014]
• Associated with increased
abstinence rate [Wang 2014]

17. Aerobic Vs Nonaerobic
• Aerobic exercise better in reducing
anxiety and anger
• Advantage of aerobic over anaerobic
in long term beneficial effects.
[Stathopoulou 2006]
• As per recommendations by, ACSM
an effective fitness programme
must include all components of
exercise – aerobic, non-aerobic,
balance and flexibility.

18. ACSM guidelines
• Frequency – min. 3 sessions per week
• Intensity – between 65 -85% of HRmax
• Time – min. 20 minutes, ideal is 30-40
min.
• Type – Aerobic – walking, running,
swimming
Anaerobic – weight lifting,
weight training
Flexibility – Stretching, Yoga

19. Duration of treatment
• At least 9 weeks duration [Stanton 2014]
• Acute phase – 8 – 12 weeks
• Continuation phase : 4-12 months
• Maintenance phase : beyond 12 months

20. Overlap of several
Neurological, biological,
physiological and
psychosocial factors are
responsible for the effect
[La Forge 1995, Biddle
and Mutrie 2008]
TLR (Toll-like receptors)
MTOR (mammalian target of rapamycin)
HPA axis (hypothalamic pituitary-adrenal
axis).
[Mikkelsen 2017]

21. Negative effects of exercise on Mental Health
• Excessive training can lead to induction of anti-inflammatory
state – often seen in elite athletes [Gleeson 2011] – repeated
infections due to reduced immunity
• Distressing outcomes when associated with eating disorders
• Exercise induced injury in dependent and exercise obsessive
people
• Exercise addiction and withdrawal symptoms [Li 2015]
• Negative self and body image associated with compulsive
exercise

22. “Let food be thy medicine and medicine be
thy food.”
- Hippocrates

23. • Severe macronutrient deficiencies during crucial
developmental periods have long been implicated in the
pathogenesis of both depressive and psychotic
disorders.(Brown 1995, Susser 1992)
• Relation between unhealthy dietary patterns and poorer
mental health in children and adolescents.(O’Neil 2014)

24. • Many epidemiological studies, including prospective studies,
have shown associations between healthy dietary patterns
and a reduced prevalence and risk of stroke, depression,
cognitive impairment, and Parkinson disease.(Psaltopoulou
2013, Lai 2014)
• Reduced risk for depression for individuals randomly assigned
to a Mediterranean diet with nuts and this protective effect
was particularly evident in those with type 2 diabetes
(Sánchez-Villegas 2013)
• Select nutrient-based supplements (in isolation, or in
combination), might provide many neurochemical modulatory
activities that are beneficial in the management of mental
disorders (Rucklidge 2013)

25. Nutrient based
supplements
Omega
3 Fatty
acids
N-Acetyl
Cysteine
S-Adnosyl
Methionine
Zinc
Vit B
Vit D

26. Omega-3 fatty acids Depression,
PTSD and may
help in
prevention of
Psychosis
Neuromodulation,
anti-apoptetic,
Neurogenesis and
upregulation of BDNF
Mischoulon 2013,
Sarris 2012
SAMe Depression Methylation of
Neurotransmitters
Sarris 2014,
Papakostas 2010
NAC Bipolar depression,
schizophrenia, OCD
spectrum disorders
Glutamate
modulatory, Anti-
inflammatory,
antioxidant, and
neuroprotective
activity
Berk 2013

27. Zinc Depression Cytokine modulation,
hippocampal
neurogenesis,
upregulation of BDNF, and
Modifies NMDA and
glutamate activity
Lai 2012
B Vitamins Deficiency associated
with Depression and in
poor responders to
antidepressants.
Known cause of
reversible Dementia
Essential for normal
neuronal activity
Fava 2009
Vitamin D Depression
Low maternal conc.
Implicated in risk of
schizophrenia
Neurosteroid Eyles 2013

28. Conclusion
• Significant role of exercise and nutrition in prevention and as
treatment modalities in psychiatry.
• Efficient and low cost
• Need to be considered and offered as adjuvant treatment
options
• Time to include them in our prescription

30. Thank You