SIG Spotlight: COVID-19, Mental Health and Physical Activity – Grace McKeon, Christopher T. Webster, Simon Rosenbaum and James W. Whitworth

The COVID-19 pandemic has drastically altered people’s lives, exacerbated existing health inequalities and increased the risk for mental health problems, including posttraumatic stress disorder (PTSD) (1). One important determinant of mental and physical health that has been impacted by the COVID-19 pandemic is physical activity. While necessary to reduce the spread of COVID-19, social distancing regulations and quarantine measures, such as curfews, and the closure of public parks and gyms have meaningfully reduced opportunities for physical activity and increased sedentary behaviour (2). Inadequate physical activity is a well-known risk factor for numerous negative health outcomes, including PTSD and depression (3, 4). Moreover, experimental research shows that as few as seven days of forced sedentary behaviour is enough to cause depression symptoms in healthy adults (5). Coupled with the numerous other pandemic-related stressors (e.g., financial insecurity and fear of contracting COVID-19), it is no surprise that mental health issues are on the rise (6). However, physical activity is modifiable, and may therefore be a potential target for intervention to protect and promote mental health during this time and as we move forward.

Recent public health messaging as seen in the World Health Organization’s (WHO) #HealthyAtHome campaign recommends and emphasises the importance of engaging in healthy lifestyle behaviours, such as physical activity, in the management of mental health and health more broadly during the COVID-19 pandemic. Regarding its impact on mental health, current evidence indicates physical activity has a protective effect against several common mental disorders including depression and anxiety (7). Physical activity also has utility as an intervention. Meta-analytic research has repeatedly demonstrated that increasing physical activity produces meaningful anti-depressant and anxiolytic effects among individuals with depression and anxiety disorders (8, 9). There is even growing experimental support for the use of physical activity in the treatment of PTSD. Several recent randomized controlled trials report clinically meaningful reductions in PTSD symptoms following physical activity interventions (10, 11). Importantly, no published study to date has reported an iatrogenic effect of physical activity on PTSD.

Clinical implications of physical activity in mental health care during the COVID-19 pandemic. Research suggests that physical activity has potential as a transdiagnostic mental health treatment strategy (12). Physical activity is destigmatising and well accepted among people with anxiety and stressor-related disorders (13). Physical activity also has well-known general health benefits and can reduce the risk for numerous physical comorbidities including obesity, cardiovascular disease and metabolic syndrome (14). These conditions often occur at higher rates among individuals with psychiatric disorders than in the general public (15). Moreover, the COVID-19 pandemic has created a perfect storm of uncertainty, stress and anxiety while also reducing opportunities for many traditional forms of physical activity.

The current situation presents an opportunity. Mental health professionals should consider physical activity as another tool to assist their patients cope with the stressors of the pandemic. In addition to their usual care, patients may benefit from assistance in identifying barriers to physical activity, and support in reengaging with physical activity (e.g., goal setting and determining new ways to be active at home). However, this may be challenging for some mental health professionals, as they may not be familiar the recommended levels of physical activity. Not to worry! There are numerous new resources designed to support physical activity during the pandemic (several are provided below). Professional support can also be gained by reaching out to an exercise physiologist, physical therapist or a certified fitness trainer.

Physical Activity Resources for Mental Health Professionals

Guidelines for Physical Activity for Adults (14)

• Adults should aim to complete at least 150 minutes of moderate effort physical activity a week (e.g., brisk walking, dancing or casual cycling) or 75-150 minutes of vigorous effort physical activity per week (e.g., running, jumping rope or hiking uphill).
• Adults should also aim to do two to three days of muscle strengthening exercises (e.g., weightlifting or calisthenics).

WHO Physical Activity Fact Sheet

WHO #HealthAtHome Campaign

The American College of Sports Medicine (ACSM) Tips for Staying Active at Home

About the LIFTS SIG

What is LIFTS (Lifestyle Interventions for Traumatic Stress)?
LIFTS was founded in November 2019. We are an inclusive, multidisciplinary Special Interest Group comprised of individuals who are motivated to advance and promote lifestyle intervention research within the traumatic stress field.

What are lifestyle interventions?
Lifestyle interventions focus on improving health outcomes through modifying lifestyle factors, such as physical activity (e.g., sport and exercise), dietary intake and quality, mind-body practices (e.g., yoga, tai chi or mindful breathing) and/or smoking cessation.

Why do they matter for people living with PTSD?
In addition to the psychological distress caused by PTSD, cardiovascular and metabolic diseases occur more frequently among individuals with PTSD than in the general population. Making positive lifestyle changes (e.g., exercising more or quitting smoking) can meaningfully reduce the risk for cardiovascular disease, metabolic disorder and premature mortality. Many lifestyle interventions also improve mental health by reducing stress, improving mood, and can even alleviate depression and PTSD symptoms.

Silos hold us all back.
The most effective treatment paradigms consider the whole individual rather than focusing on a singular facet of health (e.g., mental or physical health). PTSD is a systemic disorder that impairs multiple components of mental, physical and social functioning. We strongly believe the best treatments for PTSD should consider the whole individual. As such, it is the intention of LIFTS to draw traumatic stress experts to ISTSS from diverse professional backgrounds (e.g., psychology, exercise science, nutrition, and behavioral medicine) and assist them in disseminating research and applying their expertise for the general advancement of the traumatic stress field.

Learn more about the LIFTS SIG.

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About the Authors

Grace McKeon, B.ExPhys (Student Co-Chair), is an exercise physiologist and PhD candidate within the school of psychiatry at the University of New South Wales in Sydney. Her work focuses on the role of physical activity to improve the mental health of vulnerable groups including emergency service workers and their families. She is interested in investigating how we can use digital technologies (e-health) to deliver novel lifestyle interventions.

Christopher T. Webster, MA (Student Co-Chair), is a graduate student in the Clinical Science Program at Michigan State University. He received his BA in psychology at Rutgers, The State University of New Jersey and his MA in clinical psychology at Teachers College, Columbia University. Chris’s primary research interest is in developing an integrated therapy that combines resistance training exercise and psychotherapy for individuals with PTSD. Chris is also interested in using physiological tools (EEG) to measure the effectiveness of emotion regulation techniques. He is particularly interested in identifying specific emotion regulation techniques that are most effective in reducing PTSD symptoms in individuals who are at risk of experiencing high levels of potentially traumatic events.

Simon Rosenbuam, PhD (Co-Chair), is a Scientia Fellow in the School of Psychiatry, UNSW Sydney and the BlackDog Institute. As an exercise physiologist, Simon’s research focuses on physical activity, mental illness, sustainable development and global mental health. Simon has worked with a variety of groups including youth, veterans, emergency service workers and refugees. Simon has published more than 170 peer-reviewed publications including a textbook. Simon serves as an elected national director of Exercise and Sports Science Australia and is the vice president of the Australasian Society for Traumatic Stress Studies. Simon has led a number of international research and capacity-building projects including a role with the United Nations working in the Rohingya refugee crisis.

James W. Whitworth, PhD (Co-Chair), is an OIF/OEF veteran and former warfighter. Currently, he is a Health Science Specialist at the Behavioral Science Division of the National Center for PTSD at VA Boston Healthcare System and assistant professor at Boston University School of Medicine. James’ program of study focuses on examining the effects of exercise on posttraumatic stress disorder and comorbid conditions. He is committed to conducting research that addresses the physical and mental health needs of veterans with posttraumatic stress disorder.

References

1. The Lancet Infectious D. The intersection of COVID-19 and mental health. The Lancet Infectious Diseases. 2020;20(11):1217.
2. Stockwell S, Trott M, Tully M, Shin J, Barnett Y, Butler L, et al. Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review. BMJ Open Sport & Exercise Medicine. 2021;7(1):e000960.
3. Chwastiak L, Rosenheck R, Kazis L. Association of psychiatric illness and obesity, physical inactivity, and smoking among a national sample of veterans. Psychosomatics. 2011;52(3):230-6.
4. Zhai L, Zhang Y, Zhang D. Sedentary behaviour and the risk of depression: a meta-analysis. British Journal of Sports Medicine. 2015;49(11):705-9.
5. Edwards MK, Loprinzi PD, editors. Effects of a sedentary behavior–inducing randomized controlled intervention on depression and mood profile in active young adults. Mayo Clin Proc; 2016: Elsevier.
6. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Network Open. 2020;3(9):e2019686-e.
7. Schuch FB, Stubbs B, Meyer J, Heissel A, Zech P, Vancampfort D, et al. Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies. Depress Anxiety. 2019;36(9):846-58.
8. Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of efficacy of resistance exercise training with depressive symptoms: Meta-analysis and meta-regression analysis of randomized clinical trials. JAMA psychiatry. 2018;75(6):566-76.
9. Gordon BR, McDowell CP, Lyons M, Herring MP. The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials. Sports medicine (Auckland, NZ). 2017;47(12):2521-32.
10. Rosenbaum S, Sherrington C, Tiedemann A. Exercise augmentation compared with usual care for post-traumatic stress disorder: A randomized controlled trial. Acta psychiatrica Scandinavica. 2015;131(5):350-9.
11. Whitworth JW, Nosrat S, SantaBarbara NJ, Ciccolo JT. Feasibility of Resistance Exercise for Posttraumatic Stress and Anxiety Symptoms: A Randomized Controlled Pilot Study. Journal of traumatic stress. 2019.
12. Ashdown-Franks G, Firth J, Carney R, Carvalho AF, Hallgren M, Koyanagi A, et al. Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes. Sports Med. 2019.
13. Vancampfort D, Sánchez CPR, Hallgren M, Schuch F, Firth J, Rosenbaum S, et al. Dropout from exercise randomized controlled trials among people with anxiety and stress-related disorders: A meta-analysis and meta-regression. J Affect Disord. 2021;282:996-1004.
14. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, et al. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Medicine & Science in Sports & Exercise. 2011;43(7):1334-59 10.249/MSS.0b013e318213fefb.
15. De Hert M, Detraux J, Vancampfort D. The intriguing relationship between coronary heart disease and mental disorders. Dialogues Clin Neurosci. 2018;20(1):31-40.