Proof of causality between exercise and good mental health is elusive but still apparent. The association can also be shown in other latent ways. For example, the benefits of exercise on physical health are clear. In turn, improved physical health is known to result in improved physical health. The specifics of how this happens are still being parsed out but the association is still strong. Of course, the chain also works in the opposite direction. The lack of physical activity is associated with a decline in physical health.
A decline in physical health is then associated with a decline in mental health. As a clinical treatment for disorders such as depression and anxiety exercise is still not widely used. There is evidence, however, that prescribed exercise can be an effective part of a treatment regimen. Past research on the effects of exercise has focused mostly on mentally healthy individuals, but there has been a recent increase in research focused on individuals with diagnosed psychiatric disorders.
In general, the research has shown that exercise had a lesser effect on high level psychiatric disorders like schizophrenia than for the more common conditions of depression and anxiety (Tkachuk and Martin, 1999). Exercise is clearly one of the most cost-effective potential treatments for low to mid-level mental illness. There are, nonetheless, a few potential drawbacks. The underlying mental illness could sabotage the effectiveness of an exercise program. A patient with addictive tendencies could become addicted to exercise.
Without supervision a patient could exercise in unhealthy ways. In extreme cases the patient could develop an eating disorder or body image problems. Compliance issues can also be a problem. There is a lack of study about prescriptive exercise compliance in patients with mental difficulties. With some patients gaining exercise compliance may be more difficult than gaining compliance with a counseling and medication regimen. According to Pollack “compliance with an exercise recommendation is dramatically less than that for antidepressant medication.
Further, the number of psychotherapists using exercise as an integrated and explicit part of their therapeutic approach appears negligible” (Pollack, 2001). In other words, follow up and counseling may be needed on a continual basis to ensure compliance for some patients. As long as exercise is a well thought out part of a comprehensive mental health treatment program these problems should be rare. Counseling provides the opportunity for a therapist to evaluate the progress of a patient and make adjustments as necessary. Consultation between the therapist and the patient’s personal trainer can also help add perspective.
The more serious the mental disorder is, the more important it is to have oversight and consultative links among the patients treatment team. Different types of exercise can have different physical and mental effects. This is why patient input in the process of developing a regimen is important. For example, a patient might dread a 30 minute ride on an exercise bike at the gym, but be much more amenable to a ride of the same length on a bike trail. As a result both attitude and compliance are likely to improve in the latter case.