Wednesday, September 11, 2019

Getting Patients to Exercise Could Reduce Population Burden of Mental Illness

Could more rigorous efforts on the part of physicians and health systems to encourage people to exercise lower the population-wide burden of mental illness?

In an editorial in JAMA Psychiatry, the author of a study published last year showing that even relatively modest regular exercise has significant beneficial effects on an individual’s mental health said that including exercise in the treatment of mental illness could improve rates of recovery and reduce illness burden.

“[C]linical psychiatry has an ever-increasing need for strategies to reduce the population burden of mental illness,” wrote Adam Chekroud, Ph.D., of Yale University and Alisa Trugerman, Ph.D., of Altru Consulting. “Exercise may be one such strategy, but we are a long way from realizing this potential.”

Chekroud was one of the authors of a study in Lancet Psychiatry last year showing how the specific type, duration, and frequency of physical exercise affects mental health. The study, which received widespread publicity, suggested that an exercise regimen specifically tailored to a person’s needs, capabilities, and lifestyle could have a measurable impact on the individual’s mental health.

In the JAMA Psychiatry editorial, Chekroud and Trugerman wrote that when applied to the entire population, exercise could have a significant effect on reducing the population burden of mental illness. They noted that though the benefits are compelling, the uptake of exercise remains well below federal guidelines: According to the U.S. Centers for Disease Control and Prevention, less than half of the U.S. population reaches the recommended 150 minutes of moderately vigorous physical activity per week, and 30% of the population does no exercise at all.

These are among the areas in which the authors called for action:

  • Educate doctors about how best to prescribe exercise as part of mental health treatment: “We should help train, support, and incentivize clinicians to prescribe exercise actively and in detail,” they wrote. “Professional organizations, health system training programs, and medical school curricula could each be another avenue for increasing professional awareness about how and when to use exercise as an additional therapeutic strategy in mental health treatment.”
  • Reform insurance reimbursement practices: “Although clinicians are paid for providing psychotherapy or medication treatment options, there is little financial imperative or logistical support encouraging them to help their patients to exercise,” Chekroud and Trugerman wrote. “This lack of a reimbursement structure for exercise may contribute to an implicit message that exercise is less worthwhile than medication or therapy. …”
  • Help patients overcome barriers to exercise: “Many symptoms of mental illness serve as barriers to exercising, such as low mood, lack of motivation, and fatigue,” they wrote. “As with many chronic conditions, structured encouragement and adherence monitoring are critical. Aligning the specific type of exercise with the patient’s preference may improve adherence, as could passive wearable or smartphone technologies.”

Chekroud and Trugerman concluded: “The future holds promise. … Along with digital cognitive-behavioral therapy and traditional self-guided educational resources, one could devise a highly scalable and cost-effective active waitlist or lightweight treatment program that requires less time from clinicians. If delivered alongside psychotherapy or medication management protocols, the augmentation of exercise and digital content might also lead to faster patient recovery.”

For related information, see the Psychiatric News article “Minimal Exercise May Help Prevent Future Depression” highlighting the American Journal of Psychiatry article “Exercise and the Prevention of Depression: Results of the HUNT Cohort Study.”

(Image: iStock/Dusanpetkovic)

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