Chapter 1: The Role of Exercise in Mental Health

While pharmaceuticals have their merits, exercise offers a natural approach to healing.

Photo by Luke Baum on Unsplash

Personally, I have no objections to medication, though my journey has been uniquely mine. For much of my adult life, I have grappled with depression and anxiety, and during those challenging times, medication has provided invaluable support. It has restored a sense of normalcy and empowered me to pursue recovery. I still occasionally rely on medication—primarily for sleep issues related to anxiety—but I've reduced my daily intake due to side effects. Thus, while medication is necessary in some cases, it shouldn't be the sole option prescribed.

Throughout my life, I have explored various medications, therapies, and strategies to enhance both my physical and mental well-being. However, nothing has proven as beneficial as exercise, particularly running.

My experiences are supported by substantial research indicating that exercise can be as effective, if not more so, than medication for numerous health challenges. While it is acknowledged that some individuals may face physical limitations preventing them from exercising, many can engage in some form of physical activity to enhance their quality of life.

Taking a pill is undoubtedly simpler than exercising. Establishing a workout routine demands time and commitment, which can be difficult to sustain, even for those in peak physical condition. With over 20,000 prescription medications available in the U.S., there seems to be a solution for every ailment.

Nevertheless, one significant downside of medication is the potential for adverse effects. The number of prescriptions dispensed in the United States surged from 2.4 billion in 1997 to 4.5 billion in 2016, representing an 85% increase. This uptick exposes more individuals to negative side effects. Common reactions include nausea, drowsiness, fatigue, and skin issues. For those taking antidepressants and benzodiazepines, the consequences can be even more severe, encompassing insomnia, heightened agitation, sexual dysfunction, dizziness, headaches, and risk of addiction. In some instances, side effects from medication can even lead to fatal outcomes.

A 2014 article from Harvard Ethics estimated that roughly 128,000 deaths occur annually in the U.S. due to adverse drug reactions, with the European Commission reporting an even higher figure of 200,000. In either scenario, these numbers contribute to one of the leading causes of mortality.

Additional concerns surrounding medication include high costs, dependence, and long-term ramifications. While some conditions necessitate pharmacological intervention, many could benefit from exercise, which comes with fewer side effects.

In an insightful article titled "Lack of Exercise Is a Major Cause of Chronic Diseases," the authors highlight physical activity as a preventive measure against 35 chronic illnesses. Their research emphasizes the critical role of exercise in averting prevalent and preventable health conditions such as obesity, coronary heart disease, type II diabetes, hypertension, and stroke.

They conclude that “Conclusive and overwhelming scientific evidence, largely ignored and deprioritized, exists for physical inactivity as a primary and actual cause of most chronic diseases.” Additionally, they assert that “The comprehensive evidence herein clearly establishes that lack of physical activity affects almost every cell, organ, and system in the body, leading to sedentary dysfunction and accelerated mortality. Just as food and reproduction are vital for human survival, physical activity is equally essential to optimize health span and longevity.”

This understanding is not novel; we have long recognized that a sedentary lifestyle correlates with adverse health outcomes. The challenge lies not in awareness but in motivating individuals to take action.

This is where the concept of healthcare providers prescribing exercise becomes significant. Integrating physical activity into treatment plans could mirror the way medication is prescribed. While popping a pill is often more convenient than engaging in physical exercise, merely issuing a prescription can encourage patients to adopt healthier lifestyles.

The American College of Sports Medicine (ACSM) is actively promoting the value of exercise through its initiative, Exercise is Medicine. Their research suggests that even a written prescription can significantly motivate patients to increase their physical activity, sometimes by as much as an additional hour per week.

Support from further studies indicates that “Patients receiving a physical activity prescription were more likely to acknowledge its importance for their health and report increased participation levels.”

To facilitate this shift, the ACSM has developed resources for healthcare providers, including an exercise prescription pad, methods for assessing patients' activity levels, and billing and coding guidance. Their mission is to standardize physical activity assessment and promotion in clinical care, linking healthcare with evidence-based resources accessible to everyone.

However, just as doctors cannot compel patients to take their medications, they also cannot enforce exercise. Nonetheless, encouragement or the act of writing an exercise prescription may provide the motivation necessary for individuals to embark on their fitness journey.

In the context of mental health, addressing the underlying causes through therapy is crucial. Failure to do so may result in merely treating symptoms without resolving the root issues.

In many situations, a combination of therapy, medication, and exercise appears to be the most effective approach to enhancing individuals' quality of life. Once a routine of physical activity is established, it may even become feasible for some to reduce or eliminate their reliance on medication.

I recognize that prescribing exercise is not as straightforward as issuing a medication prescription, but perhaps it should be considered more seriously. While I understand that not everyone can engage in exercise and that access to healthcare remains a challenge for many, for those who can, embracing physical activity represents an economical and straightforward solution that could save countless lives and potentially billions in healthcare expenses. According to the ACSM, “Globally, physical inactivity costs health care systems 54 billion dollars, with productivity losses of 14 billion, and 13.4 million disability-adjusted life years.”

The journey ahead may be daunting, but it is undeniably worthwhile. The costs of inaction are becoming increasingly unsustainable.

Chapter 2: The Evidence Supporting Exercise as Medicine

In the video titled "Should doctors prescribe exercise to cure mental health? | ABC News," experts discuss the benefits of exercise in addressing mental health challenges and the potential for healthcare systems to integrate physical activity into treatment.

The second video, "Exercise is Medicine®: The Importance of Connecting Fitness with Healthcare," emphasizes the vital role of exercise in healthcare and the need for a more integrated approach to health and fitness.

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