PRINCIPLES OF THE
INTERVENTION ON PHYSICAL
AND MENTAL HEALTH
Ferran Suay. Departament de Psicobiologia. UV
Addressing...
Physical activity, physical exercise,
sport, fitness
Impact on mental health
Main hypothesis
Is physical exercise reinforcing?
INTERVENTION ON HEALTH: Promoting active lifestyles Physical activity ≠ physical exercise
≠ sport
Physical activity Any form of exercise or movement.
Physical activity may include planned activity such as walking, running, basketball, or other sports. Physical activity may also include other daily activities such as household chores, yard work, walking the dog, etc. ...
Motor activity aimed to immediate goals
Physical exercise
Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health.
It is performed for various reasons: strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance and for enjoyment. ...
Systematic activity oriented to enhance physical fitness
sport
an organized, competitive, and skillful physical activity requiring commitment and fair play, in which a winner can be defined by objective means. It is governed by a set of rules or customs.
Fitness (physical fitness)
Muscular strength
Muscular endurance
Cardiorespiratory endurance
Flexibility Body
composition
Muscular endurance
the ability of a muscle or group of muscles to sustain repeated contractions against a resistance for an extended period of time.
Muscular strength
Strength refers to a muscle's ability to generate force against physical objects.
In the fitness world, this typically refers to how much weight you can lift for different strength training exercises.
Cardiorespiratory endurance
the ability of the body to perform prolonged, large-muscle, dynamic exercise at moderate-to-high levels of intensity.
Also Known As: cardiorespiratory fitness, aerobic fitness, aerobic power
Flexibility-Elasticity
the distance of motion of a joint, which may be increased by stretching
the ability of tissue to regain its original shape and size after being stretched, squeezed, or otherwise deformed
Body composition % of fat,
bone and muscle in human bodies.
Fat % recommendations: Men 8 t0 17% Women 10 to 21%
Regulating factors: Diet Physical Activity Metabolism Hormones
PhA, overweight and obesity
Obesity Health problem:
Hypertension Diabetis (II) Cardiovascular diseases Osteoartrytis Psychological problems
Echonomic cost
Body Mass Index(BMI; Quételet Index )
< 18 lean
18-25 Normal
25-30 Overweight
30-40 Obesity
>40 Morbid Obesity
Category BMI range – kg/m2 BMI Prime
Weight of a 1.8 metres
person with this BMI
Severely underweight
< 16.0 < 0.66 < 53.5 kg
Underweight 16.0 to 18.5 0.66 to 0.73 53.5 to 59.9 kg
Normal 18.5 to 25 0.74 to 0.99 60 to 80.9 kg
Overweight 25 to 30 1.0 to 1.19 81 to 96.9 kg
Obese Class I 30 to 35 1.2 to 1.39 97 to 112.9 kg
Obese Class II 35 to 40 1.4 to 1.59 113 to 129.9 kg
Obese Class III > 40 > 1.6 > 130 kg
Africa & Asia: BMI 22-23 Kg/m2
USA & Europe: BMI 25-27 Kg/m2
And...what has it to do with mental health?
Background: evolutive resumé
MENS SANA IN CORPORE SANO
Background: ancient roman already knew it
W. James
(1899)
Franz & Hamilton
(1905)
Blumenthal et al.
(1999)
PE efficacy pharmacology
“CNS and muscles need exercise, so that its vital metamorphosis contributes to the normal chemical composition of the blood that irrigates the brain”
“Physical exercise can be effective as an adjunct in the treatment of major depressive disorder”
Background:19th and 20th centuries
KNOWN EFFECTSAcute and chronic exercise
1. Acute exercise and mood states
Effects observed after
10 minutes efforts
Intens effort may: Enhance mood (habitual
exercisers)
Be aversive (non
habituated individuals)
Effects more evident
For aerobic exercise In fit individuals
• In clinical population
• With worsened mood prior
to exercise
2. Acute exercise and anxiety
Related to state-anxiety reduction
Anxiolytic effect independent of
the type of exercise, and time of day
Moderate to high intensities (>60%
VO2max)
Very high intensities anxiogenic
effect(Raglin 1997; O’Connor & Davis 1992; Kerr & Sveback 1994; Hale et al. 2002)
Animal model
ESTRÉS
BEHAVIOR
HORMONES
NEUROTRANSMITER
S
RECEPTORS
•OPEN FIELD
•FORCED SWIMMING
•DEPRIVATION
•SHOCKS
•COMBINATION
Training
Open field ambulation
Defecation (Tharp & Carson 1975)
Independent from fitness enhancements (Dishman et al. 1988)
B S Hale, K R Koch, J S Raglin. State anxiety responses to 60 minutes of cross training. Br J Sports Med 2002;36:105–107
Figure 1. State anxiety responses, measured by the State Trait Anxiety Inventory (STAI-Y1), over time after cross training sessions. *p<0.05 compared with baseline.
3. Chronic exercise and anxiety Participation in Physical
Exercise programs can reduce trait-anxiety (Petruzzello et al. 1991)
Clearest benefits for anxious people Effect greater than placebo and
independent from previous expectations
Efficacy comparable to stress inoculation
First hypothesis concerning anxiety reduction
How is it done?
HPT
SOMATIC RESPONSES
(vasodilation,...)
Physical Exercise
Tª
TERMOGENIC MODEL
Von Euler & Soderberg (1957)
MYOTATIC REFLEX
WEL-BEING FEELING
EEG (8-12 Hz)
Motor Cortex estimulation
motoneuronal activity
THAL
How would you prove this hypothesis as false?
Complementary mechanism?Tª changes
Cells
Enzims
Reactions
•Catecholamines (Galbo et al. 1979)
•Cortisol (Galbo et al. 1979)
•5-HT (Barchas & Freedman 1962)
-Endorphin (Kelso et al. 19784)
NEHPT Tª
(Gisolfi et al. 1980)
4. Exercise and depression
Morgan (1969): Less fit psychiatric inmates were the most depressed ones.
Consistent relationship between physical activity and mental health (Salmon 2001)
Regular exercise reduces stress levels (physiologically as well as psychologically measured).
The effects can not be exclusively attributed to an improved physical condition (Dishman et al. 1988; Salmon 2000)
Background
HARMFUL EFFECTS
HARMFUL EFFECTS
BENEFICIAL EFFECTS
PHYSICAL E XE R C I SE
Sedentary lifestyle
Overtraining
Main hypothesis concerning antidepressive effects of physical exercise
How is it done?
5HT hypothesis
Monoamines: Indolamines
Complex effects on behavior: regulation of Body temperature Sleep Mood Appetite Pain
(Carlson 2002)
TRYPTOPHAN
TRP
5-HIDROXITRYPTOPHAN
5-HTP
SEROTONIN
5-HT
TRP HIDROXILASE 5-HTTP DESCARBOXILASE
Serotonin biosynthesis
Physical Exercise
5HT synthesis & metabolism
minutes
5HT releasing
TRP supply in 1-2 hours
The enhanced tryptophan supply is not the cause for the increased 5HT releasing
RECEPTORS?
studied in relation to physical exercise
Pre: 5-HT1A Post: 5-HT2
Animal experiments: rats
Stress-induced Depression (animal model)
Corticosteroids No-Responses to acute
stress Psychomotor
retardation Anhedonia
4 weeks of Physical exercise (swimming 30 min/day) synthesis & metabolism 5-HT in various brain
regions Prevention of animal model-induced depression
(Katz 1981)
160 rats housed in
group
Control animals in water (no swimming) = conditions
N=25: swimming 30 min/day; 6 d/week; 4 weeks
Open field: pre & + 48 h.
4 groups•agonists of 5HT1A-5HT2 receptors administration
= controls
Dey, S. Physical exercise as a novel antidepressant agent: Possible role of serotonin receptor subtypes . Physiology & Behavior, 55 (2), 1994, 323-329
resultsTrained rats
• Less emotional reactivity
• More exploratory activity
• Responsivity 5HT2 (post-)
• Sensitivity 5HT1A (auto-)
Training 5HT2 + 5HT1A 5HT
neurotransmission
results tricyclic medication (A-D) & ECT in enhancing 5HT2 receptors’ sensitivity
Conclusion: 4 weeks of physical exercise prevent stress-induced depression in 100% of rats
Summary: PhEx5HT
Acute PhEx
5-HT activity
Fatigue, PE
training
5-HT1A sensitivity
5-HT2A sensitivity
Fatigue, PE
A-D effect
Summary: Chronic PhEx5HT
Acute PhEx training overtraining
Regulation of 5-HT
neurotransmission
Malfunction
5-HT system 5-HT activity
Complementary hypothesis about antidepressive actions
(Barden et al. 1994)
A-D would stimulate expression of corticoesteroid receptors responsivity to inhibitory al feedback from
glucocorticoids HPA activity ( CRH-neurones expression )
HYPOTHALAMUS
ANTERIOR PITUITARY
ADRENAL CORTEX
CRH
ACTH
POMC-END
NSQ
CIRCADIAN RHYTHMS
NPV
STRESS
Glucocorticoids(GC)
FEEDBACK
HPA: variability sources
EstradiolT
LH, FSH
GnRH
Tissues
Cortisol
ACTH
CRH
EXCITATON
-endorphin
s
INHIBITION
PhEx ACUTE RESPONSE: HPA & HPG-AXIS
Adaptive mechanismProtecting muscles (and other tissues) from high GC concentrations receptor downregulation (Duclos et al. 2001)
Glucocorticoids(GC)
CRH
ACTH
Physical
exercise
EMG
?Tª
HPA/HPG
5-HT
Brain-Derived Neurotrophic Factor (BDNF)
More abundant neurotrophin in brain Stimulates neurogenesis and neuronal
resilience “… voluntary exercise can increase
levels of BDNF and other growth factors, stimulate neurogenesis, increase resistance to brain insult and improve learning and mental performance”
(Cotman & Berchtold 2002)
(modified from Stahl 2002)
Monoamine related hypothesis about genic expression
ATROPHY
APOPTOSISDEPRESSION
HYPOCAMPUS
BDN
FBDN
F BDN
FBDN
F
BDN
F BDN
F
BDNF gene
Neurones’ viability
STRESS
Monoamine transduction
deficit
Physical activity–antidepressant treatment combination: impact on BDNF and behavior in an animal model (Russo-Neustadt et al. 2001)
Tranilcipromine treatment during 1 week
Tranilcipromine treatment
Voluntary PhEx
Voluntary PhEx (running on an wheel) for 1 week
No treatment + forced swimming
Control group:• Sedentary• No treatment• No forced-swimming
no escape forced swim
1rst day: 15 min.
2ond day: 5 min.
Behaviour assessment:
Swimming vs.
immobility
in situ BDNF mRNA
hybridization: mRNA
levels in various
hippocampal areas
BDNF as an action mechanism for antidepressant drugs
A-D drugs upregulation of BDNF mRNA demonstrated in Hippocampus and Cortex (Nibuya et al.
1995)
BDNF infusion recovery of behaviour deficits
induced by animal models of depression (Siuciak et al.
1997)
Fig. 1. BDNF is a natural candidate to mediate the benefits of exercise on brain health. (a) BDNF is transported retrogradely and anterogradely to synapses, where it potentiates synaptic transmission, participates in gene transcription, modifies synaptic morphology, and enhances neuronal resilience. BDNF mRNA and protein levels increase in an activity-dependent manner. (b) Released BDNF binds to its receptor (TrkB) presynaptically to modify transmitter release and postsynaptically to modify postsynaptic sensitivity, for example, via interaction with NMDA receptors
The two-day forced swim procedure led to decreased BDNF mRNA levels (diminished grain density) (B), which was restored to baseline after prior physical activity (C). The combination of tranylcypromine and physical activity prior to forced swim stress led to BDNF mRNA significantly higher than baseline levels (D).
Fig. 1. Representative autoradiograms from in situ BDNF mRNA hybridization in the rat hippocampus (coronal plane).
A: Control B: Untreated animal after 2 day forced swim
C: 1 week of physical activity prior to forced swimming
D: combination of running and tranylcypromine
Fig. 2. Effects of exercise on hippocampal BDNF mRNA and protein levels. (a) In situ hybridization shows that expression of BDNF mRNA in the rat dentate gyrus (DG), hilus, CA1–CA3 regions and cortex is greater following exercise (seven days of voluntary wheel-running) than in sedentary animals (b). (c) ELISA quantification of hippocampal BDNF protein levels in the hippocampus in sedentary (SED) and exercising (EX) animals, after five days of wheel-running (*P <0.05). (d) Rats and mice acclimate rapidly to the running wheel and progressively increase their extent of daily running, in some cases up to a startling 20 kilometers per night. BDNF protein levels correlate with running distance (average over 14 days running; R2 = 0.771).]
The combination of activity and tranylcypromine treatment led to BDNF mRNA levels significantly elevated above controls in all hippocampal areas measured.
PhExBDNF
PhEx
BDNF
BDNF mRNA
upregulation induced by A-D drugs
(Russo-Neustadt et al.
1999)
In HPPC (Neeper et al. 1995;
1996)
Antidepressantdrugs
Phisical exercise
BDNF
Depression related behaviour
results after forced swim
No-treatment: BDNF mRNA in HPPC
Differences among groups: PhEx & A-D: BDNF mRNA CONTROL [PhEx + A-D]:
mRNA levels > base line (+250%)
More active (immobility time decrease of 89%)
Swimming time +& mRNA levels
neurogenesis and neuronal resilience, neuronal
connectivity and activity-dependent plasticity
Effects on depression?
Physical
exercise
EMG
BDNF
?Tª
HPA/HPG
5-HT
PHYSICAL EXERCISE
TRAINING GENETIC
FACTORS
PSYCHOLOGICAL EFFECTS
Antidepressive
Anxiolytic
NEUROENDOCRINE REPONSES
Metabolic homeostases
IS PHYSICAL EXERCISE REINFORCING?
Everybody knows that PhEx is healthy
only around 30% of Western populations engage in significant amounts of exercise weekly
once initiated, attrition is high (around 50% of participants being lost within 3–6 months)
(Brawley & Rodgers, 1993)
Is exercise enjoyable?
Animals voluntarily run in activity wheels (up to 20 km/day!)
Mood measured before and
after In regular exercisers undertaking strenuous
exercise at a level with which
they are familiar
Competitive efforts High intensity or
strenouss exercise Non habitual
exercisers
YES NO
People don’t do it!!
YES Runners’ high Compulsory
exercisers Endorphin
hypothesis “Most forms of exercise also increase blood -Endorphin level, especially when exercise intensity involves reaching the anaerobic threshold and is associated with the elevation of serum lactate level”.
Hamer M, Karageorghis CI. Psychobiological mechanisms of exercise dependence.
Sports Med. 2007;37(6):477-84.
Interesting issues Positive or negative reinforcer? On which characteristics does the
reinforcing effect rely? Aerobic / Anaerobic Duration Intensity Individual / Social Interactive Others
If PhEx is a reinforcer... Every body should be able to enjoy
it. Adherence should be easy to
promote. Exercise prescription should be one
key-point.
How could it be studied?
Experimental design: ... ... ... ... ...
Guidelines for healthy adults under age 65
Basic recommendations from ACSM and AHA Do moderately intense cardio 30 minutes a day, 5 days a weekOrDo vigorously intense cardio 20 minutes a day, 3 days a weekAndDo eight to 10 strength-training exercises, eight to 12 repetitions of each exercise twice a week.
Moderate-intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation.
It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of physical activity may be necessary.
The 30-minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease.
http://www.acsm.org/
Tips for meeting the guidelines Do it in short bouts. Moderate-intensity
physical activity can be accumulated throughout the day in 10-minute bouts, which can be just as effective as exercising for 30 minutes straight. This can be useful when trying to fit physical activity into a busy schedule.
Mix it up. Combinations of moderate- and vigorous-intensity physical activity can be used to meet the guidelines. For example, you can walk briskly for 30 minutes twice per week and jog at a higher intensity on two other days.
Set your schedule. Maybe it’s easier for you to walk during your lunch hour, or perhaps hitting the pavement right after dinner is best for you. The key is to set aside specific days and times for exercise, making it just as much a regular part of your schedule as everything else.
The gym isn’t a necessity. It doesn’t take an expensive gym membership to get the daily recommended amount of physical activity. A pair of athletic shoes and a little motivation are all you need to live a more active, healthier life.
Make it a family affair. Take your spouse, your children, or a friend with you during exercise to add some fun to your routine. This is also a good way to encourage your kids to be physically active and get them committed early to a lifetime of health.
© Williams & Wilkins 1996. All Rights Reserved. Publicado por Lippincott Williams & Wilkins, Inc. 2
Figure 1Perception of pain following aerobic exercise.KOLTYN, KELLI; GARVIN, ANN; GARDINER, R; NELSON, TOBEN
Medicine & Science in Sports & Exercise. 28(11):1418-1421, November 1996.
Figure 1 -Means and standard errors for pain threshold responses in the exercise and control conditions.
© Williams & Wilkins 1996. All Rights Reserved. Publicado por Lippincott Williams & Wilkins, Inc. 3
Figure 2Perception of pain following aerobic exercise.KOLTYN, KELLI; GARVIN, ANN; GARDINER, R; NELSON, TOBEN
Medicine & Science in Sports & Exercise. 28(11):1418-1421, November 1996.
Figure 2 -Means and standard errors for pain ratings in the exercise and control conditions.
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