Exercise and mental health. Health UMB November 26, Egil W. Martinsen Department Mental Health and Addiction Oslo University Hospital
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1 Exercise and mental health. Health UMB November 26, 2007 Egil W. Martinsen Department Mental Health and Addiction Oslo University Hospital
2 My oldest sport poem Better to hunt in the fields For health unbought. Than pay the doctor For nauseous draught. For cure the wise On exercise depend. John Dryden, 16th century
3 Exercise is useful for Hypertension Overweight Diabetes Coronary heart disease Cancer, some forms Osteoporosis Muscular sceletal complaints
4 General psykological effects associated with exercise Wellbeing Energy Improved sleep Reduced need of minor tranquillizers and hypnotics Creative thinking Self esteem Relation to body Experience of mastery
5 Can exercise prevent mental disorders? Epidemiological studies Cross- sectional designs Longitudinal designs Physically active have reduced tendency to develop Depression Alzheimer s disease (dementia)
6 Generalized Anxiety Disorder * Substance abuse/dependence * Eating Disorders, normal- og overweight patients** Schizophrenia * Conversion disorder* Senile dementia** Exercise as treatment for mental disorders: State of the art. Depression *** Anxiety Disorders Panic Disorder**
7 Exercise as treatment of other disorders Chronic fatigue syndrome** Fibromyalgia** Chronic pain* Burn-out Cancer survivors*
8 Negative effects of exessive exercise Increased risk of eating disorders Maintenance of eating disorders Anorexia for males: Muscle dysmorphia? Exercise dependence Compulsive exercise Vasalopp-syndrome Staleness due to overtraining
9 Anxiety during exercise intervention First session Time
10 Anxiety during exercise intervention Later sessions Time
11 Patients ranking of most important therapeutic elements (Martinsen et al, 1989) Psychotherapy Milieu therapy Other patients Exercise
12 How much exercise is enough? 30 minutes exercise most days of the week at an intensity of a brisk walk Various forms of exercise seem to have similar mental effects
13 Motivation About 50% drop out of training programs Same problems with various programs for life style changes Those who need it most are least able to manage Knowledge, beliefs and attitudes are not necessarily accompanied by behavioural change
14 Improtant factors for adherence If possible an exercise milieu Not too ambitious Same time every week Participation more than achievement Choose an activity you like Exercise dependence? Purposeful physical activity
15 Hypotheses about mechanisms Nevrobiological hypotheses Cell growth in hippocampus Generation of new networks among neurons Effect on transmittor substances Increase in blood flow to the brain Increase in body temperature
16 Hypotheses about mechanisms Antrophology (man as hunter or gatherer) Phenomenology
17 Hypotheses about mechanisms Cognitive theories Our emotions are influenced by our thoughts and behaviour Distraction vs. rumination (Nolen-Hoeksema) Mastery (self-efficacy: Bandura) Flow-hypothesis (Csikszentmihalyi) Resilience Attention restoration
18 Cognitive behavioural therapy Mental disorders affect the whole human being: Thoughts Emotions Bodily symptoms Behaviour
19 Cognitive behavioural therapy Bodily symptoms. Cannot be influenced directly Emotions: Cannot be influenced directly Thoughts: We can learn to be awreof them, and then we can question their validity and functionality Behaviour can be changed
20 Exercise in the management of various mental disorders Depression: Behavioural activation Anxiety disorders: Exposure Cognitive restructuring Substance abuse and dependence Regulation of emotions Behavioural activation Exposure Alternative content of life
21 Exercise in the management of various mental disorders, cont. Eating disorders (bulimia and binge eating disorder) Emotional regulation Schizophrenia: Behavioural activation for n negative symptoms and depression, distraction for positive symptoms Chronic pain: Exposure and behavioural activation
22 After all Year after year you sit over the books. You have gathered more knowledge than you need for nine lives. After all so little is needed And that tiny bit The heart has always known. In ancient Egypt The god of wisdom had the head of a monkey. Olav H. Hauge
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