How exercise can treat and prevent common mental health issues like anxiety and depression
During the pandemic, Nikola Sowry made a decision that helped her become happier and healthier.
After feeling challenged and disconnected during recurring lockdowns, the 29-year-old decided to try out a community football team in Melbourne's inner suburbs.
"Finding footy and this club genuinely changed my life," she said.
Before football, Nikola struggled to find exercise that suited her.
Nikola at pre-season training with the South Melbourne Districts Football Club. (ABC News: Kate Ashton)
While she never had a diagnosed mental health condition, she credits the South Melbourne Districts team with transforming her physical and mental health.
"I'm just such a happier, healthy version of myself by being here,"she said.
What Nikola experienced is backed by research.
The link between mental health and physical activity is strong enough that studies are showing exercise can be used on its own as a treatment for mild to moderate depression or anxiety.
Nikola says she always leaves footy training with a better mindset. (ABC News: Kate Ashton)
Physical activity has also been shown to prevent the onset of common mental health conditions in the first place.
With the latest figures pointing to declining mental wellbeing and an alarming rise in mental illness, particularly among younger Australians, experts say increasing the use of exercise for mental health should be part of the solution.
Exercise can change the brain, researchers say
Last year, a group of Australian researchers published a review summarising what we know about the effects of physical activity on symptoms of depression, anxiety and mental distress in adults.
The scope of the study was large, and looked at previous reviews that captured the results of more than 1,000 trials involving 128,000 participants. It was peer-reviewed and published in the British Journal of Sports Medicine.
"What we found was that basically any type of exercise is effective for improving our mental health," said University of South Australia researcher Ben Singh.
Ben Singh says there's strong evidence for using physical activity to improve and treat mental health conditions. (ABC News: Brant Cumming)
The review found that using physical activity to treat mild to moderate depression and anxiety was more effective than conventional treatments like therapy.
"And on average, we found that it was about 1.5 times more effective than medications," Dr Singh said.
Exercise has also been shown to prevent the onset of mental disorders like depression.
"There is a lot of strong evidence to show that people who are regularly active over a long period of time have a lower rate of being diagnosed with a mental health condition," Dr Singh said.
The social element of exercise is believed to help protect against anxiety and depression.
Part of this is due to the sense of community and achievement physical activity can provide, the research suggests.
Exercise has also been shown to trigger structural and biological effects on the brain.
While there's still more to learn, exercise has been proven to help reduce brain inflammation, promote the growth of neurons and trigger the release of mood-boosting chemical messengers like serotonin.
And even a small amount of physical activity can help.
From tai chi to swimming, all exercise can bring benefits
Dr Singh and his co-authors found all kinds of physical activity could help relieve the symptoms of depression and anxiety, or distress.
That included cardio such as walking, cycling, swimming, running or playing a team sport.
Even low-intensity exercise like walking can improve mental wellbeing. (Supplied: parkrun)
Strength and resistance training was found to have the biggest impact on symptoms of depression.
Mind-body exercises like tai chi and yoga were most effective at reducing anxiety and were shown to help with symptoms of depression too, the study found.
Dr Singh said it was important people chose the type of exercise that suited them.
In general, the review found the more vigorous the exercise was, the bigger the improvement in mental wellbeing.
"But what was important is we found that also low-intensity exercise — so just getting outdoors for a leisurely stroll — is still extremely beneficial," he said.
Key advice on how to use exercise for mental health concerns. (ABC News: Magie Khameneh)
The national physical activity guidelines recommend adults aged 18 to 64 should aim to be active on most days, if not every day. The advice is to aim for 2.5 to 5 hours of moderate intensity physical activity and between 1.25 and 2.5 hours of vigorous physical activity a week.
For some people, that might sound like a lot.
But Dr Singh's research found even those doing less than 2.5 hours of physical activity per week experienced mental health benefits.
Nikola had never played Aussie Rules before joining a community footy team. (ABC News: Kate Ashton)
Exercise should be used more often for mental health conditions, researcher says
Jodie Sheehy, a PhD candidate with Melbourne's Victoria University, thinks exercise should be used more often to treat mental health conditions and promote mental wellbeing.
Her current project is investigating how to encourage general practitioners to prescribe exercise specifically for mental health concerns.
"There's actually been a number of studies that look at GPs prescribing physical activity for mental health, and they really don't," she said.
Jodie Sheehy says more Australians could benefit from using exercise to address mental health concerns. (ABC News: Darryl Torpy)
"Some recommend it, but they seldom prescribe it."
She said using physical exercise to treat mental health concerns was not a big part of the GP training curriculum, despite the fact most people saw their doctor more than any other mental health professional.
"What I would like to see happen is for there to be something specific, so that a GP can actually prescribe the exercise — the type, the dose and the frequency," she said.
Challenges for using exercise in mental health treatment
Caroline Johnson is a Melbourne GP who delivers mental health training to doctors wanting to become general practitioners.
The Royal Australian College of General Practitioners said exercise was included in medical school curriculum on mental health. The college also produces resources for GPs on this topic.
Dr Johnson admitted it was a small mention in a "jam-packed" curriculum.
"But most GPs know that exercise is good for depression. It's more about how do you deliver that message to the person in a way that will actually help them engage with it," she said.
Caroline Johnson says a GP can help a patient consider what type of exercise might work for them. (ABC News: Darryl Torpy)
She said the more pressing issue was whether patients had the time, money or ability to actually do it.
"Depression really does affect your sense of self — you lose motivation, you lose interest in doing things and sometimes you even lose a belief that you're worth working on," Dr Johnson said.
She said it was easy to portray exercise as free and easy, but that was certainly not the case for people of different abilities or those who were time-poor.
"If you've got low income, or you're not in an urban environment where walking is easy to do, where there's not parklands, those kinds of things, then that's a much harder thing for you to change,"she said.
That's why it was important to view exercise in the context of other treatments for mental health issues, like therapy and medication, and recognise that it was not necessarily a solution for everyone, she said.
Overcoming barriers to exercise
One strategy for those who may be struggling to exercise is to seek advice from an exercise physiologist, if they can afford it.
Jason Gardner, an exercise physiologist on Victoria's Mornington Peninsula, said there were plenty of people living with mental illness or mental health concerns.
"And certainly not all of those are receiving support around exercise," he said.
Exercise physiologist Jason Gardner with a client at his clinic. (ABC News: Kate Ashton)
He helps people manage injuries and chronic health issues, but some patients see him specifically for mental health concerns.
Subsidised exercise physiology services are not available under existing mental health care plans, which can help people access subsidised psychology. However they can be accessed through a chronic disease plan, also organised through a GP.
Mr Gardner, Dr Johnson and Ms Sheehy all agreed that expanding access to exercise physiology could remove barriers for people who wanted to to use physical activity for mental health concerns, but were struggling to access it.
"We often often paint exercise as something 'extra'," Mr Gardner said.
"But in many cases it's sufficient as a treatment on its own, or in addition to medication and psychological support."