Ebook: The Exercise Effect on Mental Health: Neurobiological Mechanisms

The Exercise Effect on Mental Health contains the most recent and thorough overview of the links between exercise and mental health, and the underlying mechanisms of the brain. The text will enhance interested clinicians’ and researchers’ understanding of the neurobiological effect of exercise on mental health. Editors Budde and Wegner have compiled a comprehensive review of the ways in which physical activity impacts the neurobiological mechanisms of the most common psychological and psychiatric disorders, including depression, anxiety, bipolar disorder, and schizophrenia. This text presents a rigorously evidence-based case for exercise as an inexpensive, time-saving, and highly effective treatment for those suffering from mental illness and distress.

---------------- The body– mind connection has recaptured scientific interest in recent years with more than a dozen academic books, several special issues in journals (e.g. Neural Plasticity, CNS and Neurological Disorders – Drug Targets) and even one international impact- factored journal (Mental Health and Physical Activity, first issue 2008) entirely dedicated to this topic. The number of manuscripts published on the topic in peer- reviewed journals has increased from 10 in 1990, to about 60 in 2000, to over 700 in 2017, based on a raw search on PubMed using the words “exercise” and “mental health”. This reflects the growth in interest available through just this one search engine. It is agreed that mental health is not just the absence of mental disorders. Mental health means mental functioning and has a physiological base. It is interconnected with physical and social functioning as well as with health outcomes (World Health Organization 2001). This definition of mental health also includes concepts like subjective well- being, self- efficacy, autonomy, competence, intergenerational dependence, and being able to utilize one’s intellectual (e.g. cognitive functioning) and emotional potential (e.g. absence of depression and anxiety), and ensures social functioning (World Health Organization, 2001, 2004) and life satisfaction (Gauvin & Spence 1996). This book focuses on several aspects included in mental health. Physical activity refers to body movement that leads to energy expenditure and is initiated by skeletal muscles (Caspersen, Powell, & Christenson 1985; Budde et al. 2016). Exercise has been previously defined as a disturbance of homeostasis through muscle activity resulting in movement and increased energy expenditure (Scheuer & Tipton 1977). The critical difference between both terms refers to the planned and structured nature of exercise (Caspersen et al. 1985). The pandemic nature of mental health problems like anxiety and depression (see Chapter 1 by Kohn in this book) in combination with the costs and time associated with cognitive psychotherapy, as well as the potential side effects of various drugs used in the treatment of such diseases, stipulate the search for a potent cure. Provided with positive attributes, exercise or PA could be the treatment of choice if it could be found to be effective and applicable in treating as well as preventing mental diseases. Previous research has strongly suggested that exercise or PA benefit different areas of mental health (Taylor, Sallis, & Needle 1985; Hughes 1984) including depression, anxiety, cognitive functioning, and psychological well- being in adults as well as in the elderly (Gauvin & Spence 1996; Hillman, Erickson, & Kramer 2008; Wegner, Helmich, Machado Arias- Carrión, and Budde 2014) and in children and adolescents (Lagerberg, 2005; Donaldson and Ronan 2006; Biddle and Asare 2011; Sibley and Etnier 2003). However, the effectiveness of exercise or PA as a mental health intervention is not universally acknowledged nor perfectly understood. Still little is known about the exercise– mental health relationship regarding physiological mechanisms. Future studies are strongly needed that more closely investigate the underlying neurobiological mechanisms. However, for various reasons, researchers and practitioners in medicine, psychology, and public health remain either uninformed or unconvinced about the potential of this intervention to promote mental health (Ekkekakis 2013). Some of these reasons may be due to concerns about the methodological accuracy of the studies. Distinguishing between good and poor methodology paired with suggestions for future studies is a topic that runs like a continuous thread through the book. Additionally, mostly due to inexperience, practitioners find it hard to “subscribe” exercise (e.g. in an in- patient setting for majorly depressive individuals) as an effective treatment. To this end, the present book is an attempt to give a state- of- the- art overview of the topic and the editors hope that it will encourage more collaboration between researchers and practitioners to further utilize exercise and PA as effective means to support mental health. Along with Biddle, Fox, Boutcher, and Faulkner (2000) there are five reasons why physical activity may be a very effective strategy to promote mental health. One is that physical activity is potentially cost effective – it is relatively inexpensive to deliver as an intervention and to participate in. Second and third, in contrast to pharmacological interventions, physical activity is associated with minimal adverse side- effects but it has the potential to simultaneously improve physical health and well- being. Fourth, physical activity can be indefinitely sustained by the individual unlike pharmacological and psychotherapeutic treatments, which often have a specified end- point. Finally, many other non- drug treatments (such as cognitive behavioral therapy) are expensive and therefore often in short supply. The idea behind this book is to foster the understanding of the link between mental health and exercise or physical activity in a potentially broad field from neuroscience across many different dimensions of mental health and psychological well- being. In this book we have drawn together researchers from different disciplines, e.g. brain science, cognitive psychology, neuroscience, exercise science as well as psychophysiology to present a state- of- the- art summary of what is known about exercise/ PA and mental health. However, the explaining mechanisms underlying the effects of regular physical activity and exercise on the different facets of mental health are not completely understood up to now. In Section 1, the authors discuss the mechanisms behind the benefits of exercise as a theoretical introduction. Robert Kohn starts this section by giving a detailed epidemiological overview of the occurrence of common mental disorders including, for example, the prevalence and incidence of mental disorders, sociodemographic risk factors, the comorbidity and the financial burden for the society. Following, Terry McMorris and Jo Corbett present existing evidence for neurobiological mechanisms behind the benefits of exercise for mental health. The purpose of their chapter is to outline the neurobiological changes induced by acute and chronic exercise, which are thought to influence depression, anxiety, and psychological well- being. In their chapter entitled “Causality in the associations between exercise, personality, and mental health,” Marleen De Moor and Eco de Geus show that part of the same set of genetic factors that influence whether people participate in regular exercise also affect mental health outcomes. Based on a review of published evidence they further conclude that, in the population at large, the association between exercise participation and higher levels of life satisfaction and happiness and lower levels of anxiety and depression is not causal. The authors include evidence that immunomodulation is a biological mechanism responsible for the anti- inflammatory effects of regular exercise. Aderbal Silva Aguiar, Jr. and Alexandra Latini are taking a very close look at an immune perspective when talking about treating depression with exercise. The focus of Section 2 are age- related effects of exercise on mental health which will start out with a chapter on the younger age group by Mirko Wegner and Henning Budde. This chapter aims to illustrate how physical activity and exercise benefit different areas of mental health in children and adolescents including their general well- being, reductions in depression and anxiety, and benefits to cognitive functioning. Exercise may positively affect well- being through different neurobiological mechanisms which are highlighted for this age group of children and adolescents. The second chapter of this section is a contribution by Inna Bragina, Claudia Niemann, and Claudia Voelcker- Rehage and focuses on the exercise effect on mental health in older adults. The authors provide insights on how PA and exercise interact with cognitive functioning and psychological well- being in older adults. They include research on healthy aging of cognitive functions and the brain, on cognitive and neuronal plasticity, dementia and mild cognitive impairment, on how physical activity can prevent or postpone mild cognitive impairment (MCI) and dementia, and support psychological well- being, self- efficacy, and selfesteem. They further show how diseases like dementia, depression, and anxiety interact and explain the underlying neurobiological mechanisms. Section 3 of this book is dedicated to the exercise effects on cognition and motor learning. It starts with David Moreau, who stresses a possible impact of physical exercise on cognitive enhancement with a summary of recent work in this field. He presents new experimental evidence for integrated activities combining physical and cognitive demands with applications in the classroom. Nico Lehmann and Marco Taubert then talk about exercise- induced improvement in motor learning. They review physical (endurance) exercise as a new approach to enhance motor skill learning through facilitation of the underlying neurobiological processes. Megan Herting finishes this third section with a review of research on exercise and learning. In her chapter she reviews some basic concepts of the ways in which we learn (and remember) information before she dives into the established associations between exercise and these cognitive abilities as well as the underlying neurobiology. The effects of sport and exercise on emotions and psychological diseases is the topic in Section 4. The first chapter by Adrian Taylor and Tom Thompson focuses on exercise in the prevention, treatment, and management of addictive substance use. The chapter begins with identifying the prevalence of addictions, and the implications for health and society. They then briefly identify the scope and extent of evidence for the effectiveness of current treatment options. Following, they turn to summarizing the evidence (and quality/ risk of bias) of the chronic and acute effects of physical activity on different addictive behaviors. Finally, they consider the possible mechanisms for how PA has an impact on addictions and they further identify future research questions and discuss the practical implications. Attila Szabo, Zsolt Demetrovics and Mark D. Griffiths in their chapter more closely examine morbid exercise behavior and discuss exaggerated exercise behavior from the perspective of behavioral addictions. The chapter is followed by a chapter by Davy Vancampfort, Simon Rosenbaum, Michel Probst and Brendon Stubbs who provide new insights to the benefits of aerobic exercise for people with schizophrenia. Their chapter has two aims, the first is to provide a systematic overview of intervention characteristics, exercise outcomes and motivational skills used in recent (i.e. last decade) randomized controlled trials investigating the effect of aerobic exercise in schizophrenia. The second aim is to provide evidence- based clinical and research recommendations regarding the prescription of exercise in schizophrenia. Jennifer Mumm, Sophie Bischoff, and Andreas Ströhle review the links between exercise on anxiety disorders. They focus on the effect of different kinds of exercise or PA typically investigated in research on various forms of anxiety. They also discuss psychological and biological mechanisms of exercise on anxiety. The chapter by Lorna McWilliams is entitled “Exercise and ADHD: Implications for treatment.” The author outlines the research surrounding the promising use of physical activity as a treatment for the disorder, particularly in the aid of development of executive functions. Nanette Mutrie, Katie Richards, Stephen Lawrie, and Gillian Mead’s topic is: Can physical activity prevent or treat clinical depression? In this chapter the authors explore the role of physical activity for the prevention and treatment of depression. They discuss in depth the possible neurobiological mechanisms by which exercise might benefit depression. Finally, they point out various guidelines about the role of physical activity that mental health professionals might find useful. The final section of the book binds chapters dealing with research implications for the health sector and for schools. Brandon L. Alderman and Ryan L. Olson begin the section by summarizing the available evidence on mode and dose- response relationships of exercise on anxiety, depression, and cognitive functioning. Steven J. Petruzzello, Dan Greene, Annmarie Chizewski, Kathryn Rougeau, and Tina Greenlee provide an overview of acute and chronic effects of exercise on important mental health outcomes. In addition, they provide important implications for health care practitioners. Viviane Grassmann, George Mammen, and Guy Faulkner raise the question: Can physical activity prevent mental illness? The focus of their section is to explore whether physical activity may also serve a role in preventing mental disorders – in particular dementia and depression. The inter- disciplinary research on the link between exercise and mental health represented in this edition is an exciting and vibrant field of research in which scholars from different areas meet and produce findings that have strong effects on different domains of society. Our hope is that the interested reader finds the most recent and in- depth overviews on different aspects of the exercise- mental health links including references to underlying neurobiological mechanisms. We are looking forward to seeing more researchers and practitioners working cooperatively to utilize exercise and physical activity in the applied setting. Finally, we hope that the contributions to this edition encourages researchers to further explore the field and contribute health and well- being for future generations. Henning Budde and Mirko Wegner Am Wriezener Bahnhof Berlin, January 2018

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The Exercise Effect on Mental Health contains the most recent and thorough overview of the links between exercise and mental health, and the underlying mechanisms of the brain. The text will enhance interested clinicians’ and researchers’ understanding of the neurobiological effect of exercise on mental health. Editors Budde and Wegner have compiled a comprehensive review of the ways in which physical activity impacts the neurobiological mechanisms of the most common psychological and psychiatric disorders, including depression, anxiety, bipolar disorder, and schizophrenia. This text presents a rigorously evidence-based case for exercise as an inexpensive, time-saving, and highly effective treatment for those suffering from mental illness and distress.

---------------- The body– mind connection has recaptured scientific interest in recent years with more than a dozen academic books, several special issues in journals (e.g. Neural Plasticity, CNS and Neurological Disorders – Drug Targets) and even one international impact- factored journal (Mental Health and Physical Activity, first issue 2008) entirely dedicated to this topic. The number of manuscripts published on the topic in peer- reviewed journals has increased from 10 in 1990, to about 60 in 2000, to over 700 in 2017, based on a raw search on PubMed using the words “exercise” and “mental health”. This reflects the growth in interest available through just this one search engine. It is agreed that mental health is not just the absence of mental disorders. Mental health means mental functioning and has a physiological base. It is interconnected with physical and social functioning as well as with health outcomes (World Health Organization 2001). This definition of mental health also includes concepts like subjective well- being, self- efficacy, autonomy, competence, intergenerational dependence, and being able to utilize one’s intellectual (e.g. cognitive functioning) and emotional potential (e.g. absence of depression and anxiety), and ensures social functioning (World Health Organization, 2001, 2004) and life satisfaction (Gauvin & Spence 1996). This book focuses on several aspects included in mental health. Physical activity refers to body movement that leads to energy expenditure and is initiated by skeletal muscles (Caspersen, Powell, & Christenson 1985; Budde et al. 2016). Exercise has been previously defined as a disturbance of homeostasis through muscle activity resulting in movement and increased energy expenditure (Scheuer & Tipton 1977). The critical difference between both terms refers to the planned and structured nature of exercise (Caspersen et al. 1985). The pandemic nature of mental health problems like anxiety and depression (see Chapter 1 by Kohn in this book) in combination with the costs and time associated with cognitive psychotherapy, as well as the potential side effects of various drugs used in the treatment of such diseases, stipulate the search for a potent cure. Provided with positive attributes, exercise or PA could be the treatment of choice if it could be found to be effective and applicable in treating as well as preventing mental diseases. Previous research has strongly suggested that exercise or PA benefit different areas of mental health (Taylor, Sallis, & Needle 1985; Hughes 1984) including depression, anxiety, cognitive functioning, and psychological well- being in adults as well as in the elderly (Gauvin & Spence 1996; Hillman, Erickson, & Kramer 2008; Wegner, Helmich, Machado Arias- Carrión, and Budde 2014) and in children and adolescents (Lagerberg, 2005; Donaldson and Ronan 2006; Biddle and Asare 2011; Sibley and Etnier 2003). However, the effectiveness of exercise or PA as a mental health intervention is not universally acknowledged nor perfectly understood. Still little is known about the exercise– mental health relationship regarding physiological mechanisms. Future studies are strongly needed that more closely investigate the underlying neurobiological mechanisms. However, for various reasons, researchers and practitioners in medicine, psychology, and public health remain either uninformed or unconvinced about the potential of this intervention to promote mental health (Ekkekakis 2013). Some of these reasons may be due to concerns about the methodological accuracy of the studies. Distinguishing between good and poor methodology paired with suggestions for future studies is a topic that runs like a continuous thread through the book. Additionally, mostly due to inexperience, practitioners find it hard to “subscribe” exercise (e.g. in an in- patient setting for majorly depressive individuals) as an effective treatment. To this end, the present book is an attempt to give a state- of- the- art overview of the topic and the editors hope that it will encourage more collaboration between researchers and practitioners to further utilize exercise and PA as effective means to support mental health. Along with Biddle, Fox, Boutcher, and Faulkner (2000) there are five reasons why physical activity may be a very effective strategy to promote mental health. One is that physical activity is potentially cost effective – it is relatively inexpensive to deliver as an intervention and to participate in. Second and third, in contrast to pharmacological interventions, physical activity is associated with minimal adverse side- effects but it has the potential to simultaneously improve physical health and well- being. Fourth, physical activity can be indefinitely sustained by the individual unlike pharmacological and psychotherapeutic treatments, which often have a specified end- point. Finally, many other non- drug treatments (such as cognitive behavioral therapy) are expensive and therefore often in short supply. The idea behind this book is to foster the understanding of the link between mental health and exercise or physical activity in a potentially broad field from neuroscience across many different dimensions of mental health and psychological well- being. In this book we have drawn together researchers from different disciplines, e.g. brain science, cognitive psychology, neuroscience, exercise science as well as psychophysiology to present a state- of- the- art summary of what is known about exercise/ PA and mental health. However, the explaining mechanisms underlying the effects of regular physical activity and exercise on the different facets of mental health are not completely understood up to now. In Section 1, the authors discuss the mechanisms behind the benefits of exercise as a theoretical introduction. Robert Kohn starts this section by giving a detailed epidemiological overview of the occurrence of common mental disorders including, for example, the prevalence and incidence of mental disorders, sociodemographic risk factors, the comorbidity and the financial burden for the society. Following, Terry McMorris and Jo Corbett present existing evidence for neurobiological mechanisms behind the benefits of exercise for mental health. The purpose of their chapter is to outline the neurobiological changes induced by acute and chronic exercise, which are thought to influence depression, anxiety, and psychological well- being. In their chapter entitled “Causality in the associations between exercise, personality, and mental health,” Marleen De Moor and Eco de Geus show that part of the same set of genetic factors that influence whether people participate in regular exercise also affect mental health outcomes. Based on a review of published evidence they further conclude that, in the population at large, the association between exercise participation and higher levels of life satisfaction and happiness and lower levels of anxiety and depression is not causal. The authors include evidence that immunomodulation is a biological mechanism responsible for the anti- inflammatory effects of regular exercise. Aderbal Silva Aguiar, Jr. and Alexandra Latini are taking a very close look at an immune perspective when talking about treating depression with exercise. The focus of Section 2 are age- related effects of exercise on mental health which will start out with a chapter on the younger age group by Mirko Wegner and Henning Budde. This chapter aims to illustrate how physical activity and exercise benefit different areas of mental health in children and adolescents including their general well- being, reductions in depression and anxiety, and benefits to cognitive functioning. Exercise may positively affect well- being through different neurobiological mechanisms which are highlighted for this age group of children and adolescents. The second chapter of this section is a contribution by Inna Bragina, Claudia Niemann, and Claudia Voelcker- Rehage and focuses on the exercise effect on mental health in older adults. The authors provide insights on how PA and exercise interact with cognitive functioning and psychological well- being in older adults. They include research on healthy aging of cognitive functions and the brain, on cognitive and neuronal plasticity, dementia and mild cognitive impairment, on how physical activity can prevent or postpone mild cognitive impairment (MCI) and dementia, and support psychological well- being, self- efficacy, and selfesteem. They further show how diseases like dementia, depression, and anxiety interact and explain the underlying neurobiological mechanisms. Section 3 of this book is dedicated to the exercise effects on cognition and motor learning. It starts with David Moreau, who stresses a possible impact of physical exercise on cognitive enhancement with a summary of recent work in this field. He presents new experimental evidence for integrated activities combining physical and cognitive demands with applications in the classroom. Nico Lehmann and Marco Taubert then talk about exercise- induced improvement in motor learning. They review physical (endurance) exercise as a new approach to enhance motor skill learning through facilitation of the underlying neurobiological processes. Megan Herting finishes this third section with a review of research on exercise and learning. In her chapter she reviews some basic concepts of the ways in which we learn (and remember) information before she dives into the established associations between exercise and these cognitive abilities as well as the underlying neurobiology. The effects of sport and exercise on emotions and psychological diseases is the topic in Section 4. The first chapter by Adrian Taylor and Tom Thompson focuses on exercise in the prevention, treatment, and management of addictive substance use. The chapter begins with identifying the prevalence of addictions, and the implications for health and society. They then briefly identify the scope and extent of evidence for the effectiveness of current treatment options. Following, they turn to summarizing the evidence (and quality/ risk of bias) of the chronic and acute effects of physical activity on different addictive behaviors. Finally, they consider the possible mechanisms for how PA has an impact on addictions and they further identify future research questions and discuss the practical implications. Attila Szabo, Zsolt Demetrovics and Mark D. Griffiths in their chapter more closely examine morbid exercise behavior and discuss exaggerated exercise behavior from the perspective of behavioral addictions. The chapter is followed by a chapter by Davy Vancampfort, Simon Rosenbaum, Michel Probst and Brendon Stubbs who provide new insights to the benefits of aerobic exercise for people with schizophrenia. Their chapter has two aims, the first is to provide a systematic overview of intervention characteristics, exercise outcomes and motivational skills used in recent (i.e. last decade) randomized controlled trials investigating the effect of aerobic exercise in schizophrenia. The second aim is to provide evidence- based clinical and research recommendations regarding the prescription of exercise in schizophrenia. Jennifer Mumm, Sophie Bischoff, and Andreas Ströhle review the links between exercise on anxiety disorders. They focus on the effect of different kinds of exercise or PA typically investigated in research on various forms of anxiety. They also discuss psychological and biological mechanisms of exercise on anxiety. The chapter by Lorna McWilliams is entitled “Exercise and ADHD: Implications for treatment.” The author outlines the research surrounding the promising use of physical activity as a treatment for the disorder, particularly in the aid of development of executive functions. Nanette Mutrie, Katie Richards, Stephen Lawrie, and Gillian Mead’s topic is: Can physical activity prevent or treat clinical depression? In this chapter the authors explore the role of physical activity for the prevention and treatment of depression. They discuss in depth the possible neurobiological mechanisms by which exercise might benefit depression. Finally, they point out various guidelines about the role of physical activity that mental health professionals might find useful. The final section of the book binds chapters dealing with research implications for the health sector and for schools. Brandon L. Alderman and Ryan L. Olson begin the section by summarizing the available evidence on mode and dose- response relationships of exercise on anxiety, depression, and cognitive functioning. Steven J. Petruzzello, Dan Greene, Annmarie Chizewski, Kathryn Rougeau, and Tina Greenlee provide an overview of acute and chronic effects of exercise on important mental health outcomes. In addition, they provide important implications for health care practitioners. Viviane Grassmann, George Mammen, and Guy Faulkner raise the question: Can physical activity prevent mental illness? The focus of their section is to explore whether physical activity may also serve a role in preventing mental disorders – in particular dementia and depression. The inter- disciplinary research on the link between exercise and mental health represented in this edition is an exciting and vibrant field of research in which scholars from different areas meet and produce findings that have strong effects on different domains of society. Our hope is that the interested reader finds the most recent and in- depth overviews on different aspects of the exercise- mental health links including references to underlying neurobiological mechanisms. We are looking forward to seeing more researchers and practitioners working cooperatively to utilize exercise and physical activity in the applied setting. Finally, we hope that the contributions to this edition encourages researchers to further explore the field and contribute health and well- being for future generations. Henning Budde and Mirko Wegner Am Wriezener Bahnhof Berlin, January 2018

---

The Exercise Effect on Mental Health contains the most recent and thorough overview of the links between exercise and mental health, and the underlying mechanisms of the brain. The text will enhance interested clinicians’ and researchers’ understanding of the neurobiological effect of exercise on mental health. Editors Budde and Wegner have compiled a comprehensive review of the ways in which physical activity impacts the neurobiological mechanisms of the most common psychological and psychiatric disorders, including depression, anxiety, bipolar disorder, and schizophrenia. This text presents a rigorously evidence-based case for exercise as an inexpensive, time-saving, and highly effective treatment for those suffering from mental illness and distress.