mental health through exercise: how to incorporate physical activity into psychotherapeutic...

8/17/2019 Mental Health Through Exercise: How to Incorporate Physical Activity into Psychotherapeutic Treatment

1/14The Neuropsychotherapist Vol 4 Issue 5,May 201624

Mental Health Through Exercise

How to Incorporate Physical Activity

into Psychotherapeutic Treatment

Christina G. Hibbert


2/14www.neuropsychotherapist.com 25The Neuropsychotherapist

Exercise is one of the best things we can do for ourphysical wellbeing; this has long been known.It has only been more recently, however, thatresearch has demonstrated exercise is just as

much, if not more, benecial for our mental health. Astherapists and clinicians, we hopefully already knowabout this link, but do we fully comprehend the remark-

able ways exercise can change our body and mind? Dowe recognize the value of exercise and include it in ourclients’ treatment plans? Do we take it one step furtherand actually teach clients how to start and keep exercis-ing for their mental health?

For most of us, I venture to guess, the answer is “No”.Yet exercise is quite literally one of the best things wecan do for our body, mind, and spirit, and the research toback this up is prolic. While we may understand someof the benets of exercise, we likely do not grasp its fullpotential. We may even recommend exercise to clients

but forego the extra step to show them how to make

exercise work for them. As we learn more about the linkbetween exercise and mental health, and the tools tostart and stick with it long-term, this can—and hopefullywill—change.

The Physical Health Benets of Exercise

If we want to help clients incorporate exercise intotheir health and wellness plan, it is important for us torst understand the immense benets exercise oers.When it comes to physical health, exercise has longbeen associated with weight loss and control. This is animportant part of exercise, of course, since a healthyweight leads to a multitude of other health benets, in-cluding the prevention and cure of other diseases (Blair1995; Pate et al., 1995). But exercise is about so muchmore than weight loss, and it is important to help clientsunderstand this. As we shift our focus from exercising

for weight loss to exercising for mental health, we ndmany more reasons to keep exercising—mainly because



we recognize how incredibly good exercise makes usfeel. This also helps us to shift the focus from exercisingto punish our body (because we don’t like our body) toexercising because we love our body, mind, and spirit—allowing us to create a habit of lifelong health and well-ness.

In addition to weight loss and management, exerciseis also correlated with the following desirable physical

health gains:

• Lower risk of heart attack and stroke, type 2 dia-betes, metabolic syndrome, osteoporosis, andhigh cholesterol: exercise also increases HDL,or “good” cholesterol—the kind that is foundin plants, nuts, or sh such as salmon or tuna—which helps rid the body of bad cholesterol andkeeps blood owing smoothly, making our heartsstronger (Blair, 1995; Pate et al., 1995).

• Lower overall cancer rates, especially colon andbreast cancer: exercising at least four hours perweek has been shown to lower the risk of breastcancer by 37% (Thune, Brenn, Lund, & Gaard,1997).

• Improved immune system for overall betterhealth: better immune functioning means less ill-ness, which benets us physically and mentally(Northrup, 2006).

• Improved quality of sleep and greater energy:exercise delivers oxygen to the brain, body, and

heart. This increases stamina to help us feel lessfatigued during the day and sleep better at night,creating even greater energy (Driver & Taylor,2000; Grin & Trinder, 1978).

• Increased muscle strength and mass, enhanced

exibility and movement, and stronger bones:exercise keeps our bones sturdy and our jointsand muscles strong and limber (Hunter, McCa-rthy, & Bamman, 2004; Williams et al., 2007; Nel-son et al., 2007).

• Alleviated symptoms of premenstrual syndrome(PMS): exercise can reduce cramping, bloating,and even the mental and emotional symptoms of

PMS in women (Prior, Vigna, Sciarretta, Alojado,& Schulzer, 1987).

In fact, regular exercise can increase life expec-tancy by an average of seven years (Belloc & Breslow,1972). One study in the New England Journal of Medicineshowed that women who were not t had twice the riskof death than those who were (Gulati et al., 2005). So,the bottom line: exercise is critical to a long, healthy life.

The Mental Health Benets of Exercise

Exercise is also critical to a long and happy life.We canexperience signicant gains in all aspects of our mentalhealth through exercise, including our emotional, intel-lectual, social, and even spiritual wellbeing.

The potential impact of regular exercise on our men-tal health is varied and profound. According to the re-



search, exercise

• increases levels of serotonin, dopamine, and nor-epinephrine in the brain (Biddle & Fox, 1989; Ch-oulo, 1994, 1997; Meeusen & de Meirleir, 1995);

• increases endorphins, which are associated withimproved mood and energy (Durden-Smith,1978; Riggs, 1981);

• enhances mood: going for a walk when we’re feel-ing fatigued and irritable, or lifting weights whenfeeling anxious, can reduce tension and increaseenergy to help us feel happier (Thayer, 2001);

• reduces and helps us manage stress, and leads todeeper relaxation: exercise helps us calm down,rest, and relax more eectively, increasing ourability to withstand daily hassles and enabling usto manage stress more eectively (Mayo Clinic,2012);

• lowers rates and symptoms of depression: regu-

lar exercise has antidepressant eects that are aseective as psychotropic medications or psycho-therapy for mild to moderate depression, makingit a worthwhile adjunct, or alternative, to tradi-tional depression treatments; exercise can even

prevent major depression (Blumenthal et al.,Leith, 2009; 2007; Smith et al., 2010);

• reduces anxiety and worries: studies show exer-cise reduces, treats, and may even prevent anxi-ety and panic attacks (Otto & Smits, 2011; Smitset al., 2008; Thayer, 2001);

• improves mental clarity, eciency, and cognitivefunctioning: we think more clearly when we exer-cise; this leads to increased learning, judgment,insight, and memory; some studies have evenshown that exercise is correlated with higher IQscores (Gutin, 1966; Young, 1979);

• enhances intuition, creativity, assertiveness,and enthusiasm for life: exercise increases alphawaves associated with stronger intuition, whichcan lead to greater creativity (Northrup, 2006);

exercise also builds condence and happiness,which in turn improves assertiveness and life sat-

isfaction (Lannem, Sørensen, Frøslie, & Hjeltnes,2009; Valliant & Asu, 1985);

• improves quality of sexual intimacy: a healthy sexlife is associated with better physical and mentalhealth (Mayo Clinic, 2014), and exercise is associ-ated with a healthier sex life;

• improves social health and relationships: group orpartner exercise increases social activity and con-

nection while decreasing feelings of lonelinessand isolation (Kulas 2015); exercising together asa couple or a family can improve and strengthenfamily relationships (Ransdell et al., 2003);

• improves self-esteem and body image: exercisemakes us feel good about ourselves—not justabout how we look but, even more so, about whowe really are (Leith 2009); and

• increases spiritual connection: walking, running,yoga, tai chi, and many other types of exercise are

linked with increased spiritual awareness, energy,and connection (Musick, Traphagan, Koeing, &Larsen, 2000); in fact, many people incorporateexercise into their spiritual practice (includingme).

Overall, exercise is one of the best ways to improvemood and increase happiness and life satisfaction. Itdoesn’t just make you healthier—it is key to living thelife you desire. And, as we will see next, the benets ofexercise can reach even deeper: exercise can literallyprevent, treat, and cure mental illness.

Exercise to Prevent and Treat Mental Illness

In addition to the many benets mentioned above,exercise has also been proven to prevent and treat manymental illnesses, including the following.

Major depression. Research shows that exercise isequivalent or superior to antidepressants in the treat-ment of both clinical (Blumenthal et al., 2007) and non-clinical depression. Exercise has also been shown to

work as well as psychotherapy in treating mild to mod-erate depression. Regular exercise has been shown to

Overall, exercise is one of the best ways to improvemood and increase happiness and life satisfaction.

It doesn’t just make you healthier— it is key to living the life you desire.

http://www.drchristinahibbert.com/beyond-happiness-10-ways-to-increase-joy/http://www.drchristinahibbert.com/beyond-happiness-10-ways-to-increase-joy/http://www.drchristinahibbert.com/beyond-happiness-10-ways-to-increase-joy/http://www.drchristinahibbert.com/beyond-happiness-10-ways-to-increase-joy/



cut depression prevalence in half—from 1 in 6 adults to 1in 12 (Goodwin, 2003).

Generalized anxiety disorder . Exercise has beenshown to decrease overall anxiety levels by reducingmuscle tension, lowering blood pressure and heart rate,and producing a tranquilizing eect through increasingalpha waves in the brain (Leith, 2009).

Panic disorder . A comprehensive review of the re-search on anxiety disorders and exercise found thatmost studies focused on panic disorder. They found that,though some patients with panic disorder phobicallyavoid exercise, many do not, and that acute and long-term exercise is not only safe for those suering frompanic disorder, but it also signicantly reduces anxietysymptoms (O’Connor, Raglin, & Martinsen, 2000).

Obsessive–compulsive disorder . In a study of those

diagnosed with OCD, participants reported less nega-tive mood and anxiety symptoms following exercise;and, over time, those who stuck with their exercise rou-tine reported less frequent episodes of obsessions andcompulsions (Abrantes et al., 2009).

Posttraumatic stress disorder . Research has shownthat those suering from PTSD tend to be more seden-tary and experience greater physical health concerns.Exercise has been proven to decrease sedentary behav-ior, improve body composition, improve quality of sleep,and treat the spectrum of symptoms, including depres-sion, that accompany PTSD (Rosenbaum et al., 2011).

Social anxiety disorder . For those struggling with so-cial anxiety disorder, aerobic exercise has been shownto reduce clinical anxiety symptoms while simultane-ously increasing a sense of wellbeing. These benets donot only appear during the intervention phase but lastup to three months later (Jazaieri, Goldin, Werner, Ziv,& Gross, 2012).

Bipolar disorders. Considering the pervasive, in-tense nature of bipolar disorder and its treatment, onewould think exercise would be more commonly rec-

ommended. Research shows that structured exercisecan improve emotional, thought-related, and physicalsymptoms in patients with bipolar disorder. It can helpcalm the mind during manic or hypomanic phases, im-proving thought clarity, judgment, and insight. Also,the mood-enhancing and anti-inammatory eects of



exercise seem particularly helpful in alleviating depres-sive symptoms in those suering from bipolar disorder(Alsuwaidan, Kucyi, Law, & McIntyre, 2009).

Schizophrenia. Research shows exercise improvesmental clarity and helps those suering from schizo-phrenia feel less overwhelmed by their symptoms. Ex-ercise can alleviate depression and anxiety symptoms in

those with schizophrenia and also works to calm symp-toms like auditory hallucinations (Faulkner & Biddle,1999; Gorczynski & Faulkner, 2010). Exercise has alsobeen shown to improve physical health and wellbeing inschizophrenic individuals (Bernard & Ninot, 2012).

Drug, alcohol, and process addictions. Exercise is avaluable addition to addiction treatment programs formany reasons (Faulkner & Biddle, 1999). First, it has

been shown to improve sleep and mental clarity, which

leads to better decision-making. Second, as we know,exercise can reduce depression and anxiety, which arecommon underlying factors that lead people to self-medicate with substances/processes. Third, the mood-enhancing eects of exercise may also mimic the eectsof addictive substances in a healthy way, leading to adecreased need for the substance/process and a lowerrisk of relapse (Alcoholrehab.com, n.d; Taylor, Sallis, &Needle, 1985)1.

Eating disorders. Although exercise has been mostly

ignored as a treatment for eating disorders in the past(due to its relationship with the disease itself), recent re-search shows that, while exercise can lead to improve-ments in physical appearance and body image, it is notthe physical benets of exercise that make the dier-ence with eating disordered individuals, rather it is themental health benets (Cook, Hausenblas, Tuccitto, &Giacobbi, 2011). Exercise improves relaxation, lowerstension and worry, and improves mood—all of which

1 Note that exercise addiction—or over-exercising

to feel “good” about oneself or as a self-punishing mecha-

nism—is a serious issue that requires intervention andshould be treated similar to other addictions.

can improve eating disorders. The positive eects ex-ercise can have on self-esteem and depression can alsoreduce the risk of (and help treat) eating disorders (Cooket al., 2011).

Personality disorders. For those who learn to man-age and stick with an exercise routine, exercise is as-sociated with improved insight, judgment, and mental

clarity, all of which alleviate the more intense symptomsof personality disorders. Exercise can also treat under-lying conditions such as anxiety or depression that canworsen personality disorders. Finally, exercise has thepotential to positively impact and even improve per-sonality traits—for example, sociability, internal moti-vation, assertiveness, neuroticism, placidity, emotionalstability, and self-condence (University of MinnesotaDuluth, n.d.).

Cognitive decline, Alzheimer’s, and dementia. Exer-cise earlier in life has been shown to prevent cognitivedecline later in life, improving mental clarity and func-tioning and keeping the body and mind healthier andmore vibrant (Larson et al., 2006). Aerobic exercise hasalso been shown to increase oxygen ow to the brainand thereby decrease brain cell loss in the elderly. Addi-tional benets may be gained from engaging in physicalactivities that also involve focus, planning, or thinking(Alzheimer’s Association, 2016).

Grief . Endorphins help with the depression and sad-ness of grief: getting outside in the sunlight and seeingpeople remind us of the good in the world around us.Exercise also increases self-condence, to help us feelmore in control of life again (“Moving Through Grief,”2012).

The list is seemingly endless: exercise is powerful inthe prevention and treatment of a multitude of mentalillnesses. This is great news for those who do not seemto respond to traditional treatments; it is also great news

for those who do respond since exercise complements,

For those who learn to manage and stick with anexercise routine, exercise is associated with improvedinsight, judgment, and mental clarity,

all of which alleviate the more intense symptoms ofpersonality disorders.



and in many cases improves, the ecacy of these treat-ments (Leith, 2009), making exercise an outstanding al-ternative or addition to traditional treatment methodsin either case.

Exercise also overcomes many of the barriers to tra-ditional mental health treatments, for example:

• the stigma of traditional treatments: exercise hasno negative stigma;

• the side eects of medications: exercise has onlypositive side eects when done correctly, under adoctor’s care; and

• the cost involved in mental illness treatment:other than perhaps a pair of good shoes, exercisecan be completely free.

The Neuroscience: How Exercise Works to

Improve Mental Health

There are several dierent theories on how exer-cise improves mental health, and no single hypothesisseems to explain it all. Understanding a few of the mainideas of how exercise works, however, can help us bet-ter understand how exercise may work to improve ourmental health too.

The endorphin hypothesis. Endorphins or the “feelgood” chemicals released in the brain when we exer-

cise actually mimic the chemical structure of morphineand have the ability to ease pain, regulate emotion, andproduce a sense of euphoria often referred to as “therunner’s high”. It is believed that this sense of euphoriais responsible for improving mental health by reducingdepression, anxiety, and other negative mood states.This is perhaps the most popular theory, though theresearch behind it is not particularly compelling (Leith,

2009).The monoamine hypothesis. This theory posits that

exercise improves mental health through changes inmonoamines (e.g., serotonin, dopamine, norepineph-rine) in the brain. When these neurotransmitters be-come too low, emotional symptoms and mental distressor illness ensues. Many studies have produced evidenceto support the idea that exercise increases levels ofneurotransmitters in the brain, making this hypothesiscompelling (Leith, 2009; Meeusen & de Meirleir, 1995).

Not only has research shown the positive eects ofexercise on monoamines, but exercise has been called“brain food” for its positive eects on other brain mech-anisms. For example, research has shown that exerciseis associated with an increase in brain-derived neuro-trophic factor (BDNF), the primary protein involved inneurogenesis, which is implicated in the pathophysiol-ogy of psychiatric illnesses (Cotman & Berchtold, 2002).Neurotrophins such as BDNF support brain plasticity,



and clinical studies have demonstrated that exerciseincreases neurotrophin levels—improving cognitionand executive processing, and even enhancing phone-mic skills in school children who struggle with reading(Ploughman, 2008). These benets appear to be mosteective at moderate levels of intensity, since high-in-tensity exercise can increase stress hormones that mayinterfere with the positive side eects of exercise. These

ndings are intriguing and point to the benets of ex-ercise on brain plasticity and enhanced development,especially for children, whose brains are in the forma-tive years, and for people with disabilities (Ploughman,2008). In fact, a combination of exercise and antidepres-sant treatment has been shown to converge at the cel-lular level (Russo-Neustadt, Beard, Huang, & Cotman,2000), having a synergistic-type eect that accounts forthe greater cognitive functioning associated with exer-cise (Szuhany, Bugatti, & Otto, 2015).

The anti-inammatory theory. Anti-inammatories

are associated with greater heart health, lower depres-sion, and improved aging—and exercise is a natural an-ti-inammatory. Simply engaging in active leisure timeactivities has been shown to have anti-inammatoryeects. Those who exercise regularly were reported inone study to have lower inammation markers even 10

years later (Hamer et al., 2012).

Other theories on how exercise improves mentalhealth include: the self-ecacy theory—when we be-lieve we can achieve something and do it, we feel betterabout ourselves, and this improves our mental health;the thermogenic hypothesis—when we increase ourbody temperature through exercise, it results in thedeeper slow wave sleep that makes us feel relaxed and

renewed; and the distraction hypothesis—when we aredistracted from stress, or get “time out” through exer-cise, we feel mentally refreshed and improved (Leith,2009).

Whatever the reasons, the evidence is solid—exer-cise works. But it is up to us to take advantage of it.

Six Ways to Incorporate Exercise Into

Psychotherapeutic Treatment

With research like this in your back pocket, it shouldbe easy to make a case for exercise as part of a client’streatment plan. However, we all know it is one thing torecommend exercise and a whole other thing for clientsto actually do it. How can we help clients create an exer-cise program they can, and will, stick with? The follow-

As we shift our expectations of what exercise is, we nd we can exerciseby gardening, doing housework, playing with our kids, or dancing, and ahost of other ways. Exercise can be redened and reimagined.



ing six suggestions, taken from 8 Keys to Mental HealthThrough Exercise (Hibbert, 2016), can get you started.2

1. Teach the principles of motivation. There are a mul-titude of theories on motivation, but one of the mosthelpful I have found for exercise is expectancy theory.The expectancy theory of motivation is based on theidea that people choose to act in a certain way becauseof what they expect the result of their behavior to be. It

proposes that our motivation to behave is determinedby the desirability of the outcome that we expect thatbehavior to produce (Oliver, 1974). We can help clientsidentify and evaluate their expectations about exercisein order to help them increase motivation. What do theyexpect exercise to be like? What do they expect the re-wards to be? How about the negatives? Identifying ex-pectations allows us to then challenge them, nding thedierence between what we expect and the reality ofthe situation. This, in turn, allows us to alter either ourexpectations or the reality—in other words, make exer-

cise motivation more “do-able”.

One expectation we should all challenge is that ex-ercise just means running, or doing a tness class, orlifting weights for an hour. Rather, exercise for mentalhealth is about being active—about moving. As we shift

2 Before beginning an exercise program, it’s impor-tant to get a healthcare provider’s clearance and guidance.

our expectations of what exercise is, we nd we can ex-ercise by gardening, doing housework, playing with ourkids, or dancing, and a host of other ways. Exercise canbe redened and reimagined. As long as it gets us mov-ing, exercise can be fun, which can boost our motivationand help us persist.

It is also helpful for clients to understand their intrin-sic and extrinsic motivators for exercise. Extrinsic mo-

tivators—or doing something for an external reward,such as being able to eat more, gaining the approvalof friends or a loved one, or exercising in a class to earnhigh marks—are helpful for getting us started. However,intrinsic motivators—exercising because it makes us feelhealthy and strong or because we want to live a long lifeand model mental health and wellness for our children—is linked with longer term dedication. Studies show weare most likely to start and keep exercising when we aremotivated by both intrinsic and extrinsic factors, and wecan aid clients in uncovering and building these motiva-

tors to increase adherence to overall exercise for mentalhealth (Ryan & Deci, 2000).

2. Help clients identify unhealthy beliefs about exerciseand change them. This includes family beliefs as well aspersonal beliefs. Some of us may have been raised in afamily that believed exercise was pointless or, on the ip



side, in a family where we were forced to exercise in-tensely. These experiences shape how we view exerciseand activity today, and it is important to identify, chal-lenge, and alter those thoughts and beliefs that stand inour way.

Cognitive behavioral therapy (CBT) is a great tool forteaching clients to hear, challenge, and alter unhealthyand untruthful thoughts. First, help them listen for and

then write down automatic thoughts. Hearing and writ-ing down thoughts, such as: “I can’t do this . . . It’s toohard” or “I feel panicky every time I exercise” can helpidentify what is really going on. Perhaps they need a dif-

ferent form of activity, or maybe a less intense versionof what they are doing, to learn how to make exercisefun or to start with small steps so it does not feel impos-sible. Help clients nd the more truthful, helpful alter-native to the unhealthy thoughts, and then implementthese new beliefs and thoughts into daily practice. Morehelpful, truthful thoughts, such as: “I don’t feel like exer-cising, but I know how great I’ll feel when I’m done” or “I

can just walk to the mailbox and back, and that’s goodenough for today” can help tremendously.

3. Teach SMART goal-setting skills. Once clients haveidentied blocks to motivation and thinking, it is timeto set goals. Most people are never taught how to setrealistic, attainable goals, however—which is where we,as psychotherapists, come in. We can teach clients goal-setting strategies and skills, and this can make a worldof dierence in their ability to implement an exerciseprogram. The commonly known mnemonic SMARTstands for: Specic, Measurable, Attainable, Results-Focused, and Time-Bound. SMART goal setting allowsus to focus on what we really want from the goals weset, make sure they are realistic, and build in monitoringtools to keep us on track. This has the added benet ofenabling us to recognize when a goal is not working, sowe can reevaluate and set new, more achievable, goals.Use SMART goal setting to help clients establish goalsfor exercise and mental health; then, help them moni-tor their progress, tweaking one or more componentsof the goal as needed. As you teach goal-setting strat-egies, you will be giving clients skills that will benetthem not only through exercise, and mental health, but

through all areas of life.

4. Identify and make a plan to overcome roadblocks toexercise. It helps to be mentally strong if we want to be-come physically strong. That is why I have focused onbuilding motivation, learning how to tackle unhelpfulthoughts, and setting goals before actually discussingstarting exercise. This is an important point, and onethat most of us often miss: being mentally prepared to

exercise is just as important as doing the physical workof exercise. In fact, without mental awareness, skillbuilding, and fortitude, our chances of exercise successare slim.

One of the most important ways we can do this is tolook for the obstacles that will come our way as we beginexercising, and make a plan to overcome them. Some ofthe most common roadblocks when it comes to exerciseinclude: “I don’t have time to exercise”, “I’m too busy”, “Idon’t feel motivated”, or “I’m too tired”. Others may bea fear of failing at exercise, or feeling embarrassed to goto the gym, or even something as simple as bad weath-er. Whatever the “reason” we give ourselves for not ex-ercising, the truth is, it is really an excuse—and we canovercome the excuses with a little ingenuity and work.

We need to work with clients to detect potentialroadblocks ahead of time, and as they arise suggest op-tions to overcome their personal roadblocks and helpthem establish a plan. This may include teaching themto: schedule exercise, seek to exercise earlier in the dayso there are less reasons to not exercise, nd an exer-cise buddy or accountability partner, and remember the

healthy beliefs they have discovered and how they feelwhen they are done. The goal is to help clients be pre-pared for the roadblocks (because they will come) andto provide them with the solutions and plans they needto overcome them.

5. Use the FITT principle to create an exercise program.FITT stands for: Frequency (“How often will I exer-cise?”); Intensity (“How hard?”); Type (“What will I do?”);and Time (“How long?”). Helping clients understand thisprinciple allows them to create an exercise program thatwill work for their unique situation and needs. In gen-

eral, it is recommended to exercise three to ve days aweek, at a moderate intensity (though low or high can

We need to work with clients to detect potentialroadblocks ahead of time, and as they arise suggestoptions to overcome their personal roadblocks and

help them establish a plan.



be ne, too, depending on one’s health and personalgoals). Twenty minutes or more is the generally recom-mended time for exercise, but research shows even two10-minute segments of exercise yield similar results.There are three general types of exercise: cardiovascu-lar activity (any activity that gets your heart rate up fora sustained period of time); muscle conditioning (activi-ties that build muscle mass); and exibility (stretching,

yoga, Pilates). The best exercise programs incorporateall three, but the most important point is to nd whatworks for you and do that. We must not compare howoften we exercise, or how long, how hard, or what wedo, with others. When it comes to establishing an exer-cise program, it is an individual process.

6. Help clients create a long-term vision of health andwellness. It is one thing to think, “I will stay dedicated toexercise, long-term” or “I can do anything . . . my futurehas great potential” and quite another to actually see,strive for, and eventually realize that potential. Creating

an exercise for mental health vision is the place to start.

We can help clients visualize what they really want intheir future. Does this vision include physical and mentalhealth, strong relationships, and happiness? If so, thenexercise is key. Once clients have seen the vision theydesire, help them write it down, and then get to work—

taking one action today to lead toward that vision. Oncethey have got that rst action down, help them chooseanother, and so on. Living with vision, seeing what wedesire and then moving toward it, step by step, enablesus to utilize the resources we currently have and buildupon them to eventually realize the vision we once onlydreamed of. Exercise can help us get there, and visioncan help us exercise—for life.

Portions of this article were excerpted from 8 Keysto Mental Health Through Exercise (Hibbert, 2016). Oth-er strategies and additional research can be found at http://www.drchristinahibbert.com/

References

Abrantes, A. M., Strong, D. R., Cohn, A., Cameron, A.Y., Greenberg, B. D., Mancebo, M. C., & Brown, R.A. (2009). Acute changes in obsessions and com-

pulsions following moderate-intensity aerobic ex-ercise among patients with obsessive–compulsivedisorder. Journal of Anxiety Disorders , 23, 923–927.doi:10.1016/j.janxdis.2009.06.008

Alcoholrehab.com. (n.d.). Exercise an efective treatmentin rehab: Physical tness can help in early recovery.Retrieved from http://alcoholrehab.com/alcoholism/

http://www.drchristinahibbert.com/http://www.sciencedirect.com/science/journal/08876185http://www.sciencedirect.com/science/journal/08876185http://www.drchristinahibbert.com/



exercise-for-alcohol-rehab-treatment/

Alsuwaidan, M.T., Kucyi, A., Law, C. W., & McIntyre, R.S. (2009). Exercise and bipolar disorder: A review ofneurobiological mediators. Neuromolecular Medicine,11, 338–336. doi:10.1007/s12017-009-8079-9

Alzheimer’s Association. (2016). Alzheimer’s diseasefacts and gures. Retrieved from http://www.alz.org/mglc/in_my_community_60862.asp

Belloc, N. B., & Breslow, L. (1972). Relationship of physi-cal health status and health practices. PreventiveMedicine, 1, 409–421.

Bernard, P., & Ninot, G. (2012). Benets of exercisefor people with schizophrenia: A systematic re-view. L’Encé phale, 38, 280–287. doi:10.1016/j.en-cep.2011.07.001

Biddle, S. J., & Fox, K. R. (1989). Exercise and health psy-chology: Emerging relationships. The British Journalof Medical Psychology, 62, 205–216.

Blair, S. N. (1995). Exercise prescription for health.Quest, 47 , 338–353.

Blumenthal, J. A., Babyak, M. A., Doraiswamy, P. M.,Watkins, L., Homan, B. M., Barbour, K. A., . . . Sher-wood A. (2007). Exercise and pharmacotherapy in thetreatment of major depressive disorder. Psychoso-matic Medicine, 69, 587–596.

Choulo, F. (1994). Inuence of physical exercise on5-HT1A receptor- and anxiety-related behaviors.Neuroscience Letters, 176, 226–230.

Choulo, F. (1997). The serotonin hypothesis. In W. P.

Morgan (Ed.), Physical Activity and Mental Health(pp. 179–198). Washington, DC: Taylor and Francis.

Cook, B., Hausenblas, H., Tuccitto, D., & Giacobbi, G.R. (2011). Eating disorders and exercise: A structuralequation modeling analysis of a conceptual mod-el. European Eating Disorders Review, 19, 216–225.doi:10.1002/erv.1111

Cotman, C. W., & Berchtold, N. C. (2002). Exercise: Abehavioral intervention to enhance brain health andplasticity. Trends in Neurosciences, 23, 295–301.

Driver, H. S., & Taylor, S. R. (2000). Exercise and sleep.Sleep Medicine Reviews, 4, 387–402.

Durden–Smith, J. (1978). A chemical cure for madness.Quest, 2, 31–36.

Faulkner, B., & Biddle, S. (1999). Exercise as an adjunct treatment for schizophrenia: A review of theliterature. Journal of Mental Health, 3, 441–457.doi:10.1080/09638239917157

Goodwin, R. D. (2003). Association between physical ac-tivity and mental disorders among adults in the Unit-ed States. Preventive Medicine, 36, 689–703.

Gorczynski, P., & Faulkner, G. (2010). Exercise therapyfor schizophrenia. The Cochrane Database of System-

atic Review, 12(5). doi:10.1002/14651858.CD004412.pub2

Grin, S. J., & Trinder, J. (1978). Physical tness, exer-cise, and human sleep. Psychophysiology, 15, 447–450.

Gulati, M., Black, H. R., Shaw, L. J., Arnsdorf, M. F.,Merz, C. N., Lauer, M. S., . . . Thisted, R. A. (2005). Theprognostic value of nomogram of exercise capacity

in women. The New England Journal of Medicine, 353,468–475.

Gutin, B. (1966). Eect of increase in physical tness onmental ability following physical and mental stress.Research Quarterly, 37 , 211–220.

Hamer, M., Sabia, S., Batty, G. D., Shipley, M. J., Tabák,A. G., Singh-Manoux, A., & Kivimaki, M. (2012). Phys-ical activity and inammatory markers over 10 years:Follow-up in men and women from the Whitehall IIcohort study. Circulation, 126, 928–933. doi:10.1161/CIRCULATIONAHA.112.103879

Hibbert, C. (2016). 8 Keys to Mental Health Through Exer-cise. New York, NY: Norton.

Hunter, G. R., McCarthy, J. P., & Bamman, M. M. (2004).Eects of resistance training on older adults. Sports Medicine , 34, 329–348.

Jazaieri, H., Goldin, P. R., Werner, K., Ziv, M., & Gross,J. J. (2012). A randomized clinical trial of MBSR ver-sus aerobic exercise for social anxiety disorder. Jour-nal of Clinical Psychology, 68, 715–731. doi:10.1002/ jclp.21863

Kulas, M. (2015, January 28). Social and emotional ben-ets of exercise. Retrieved from http://www.lives-trong.com/article/477451-social-emotional-benets-of regular-exercise/

Lannem, A. M., Sørensen, M., Frøslie, K. F., & Hjeltnes,N. (2009). Incomplete spinal cord injury, exercise andlife satisfaction. Spinal Cord, 47 , 295–300. doi:10.1038/sc.2008.117

Larson, E. B., Wang, L., Bowen, J. D., McCormick, W.C., Teri, L., Crane, P., & Kukull, W. (2006). Exercise isassociated with reduced risk for incident dementia

among persons 65 years of age and older. Annals ofInternal Medicine, 144, 73–81.

Leith, L. M. (2009). Foundations of exercise and mentalhealth (2nd ed.). Morgantown, WV: Fitness Informa-tion Technology.

Mayo Clinic. (2012, July 21). Exercise and stress: Get mov-ing to manage stress. Retrieved from http://www.mayoclinic.org/healthy-living/stress-management/in-depth/exercise-and-stress/art-20044469?pg=1

Mayo Clinic. (2014, February 5). Exercise: 7 benets ofregular physical activity. Retrieved from http://www.

mayoclinic.org/healthy-living/tness/in-depth/exer -

http://www.ncbi.nlm.nih.gov/pubmed/15107011http://www.ncbi.nlm.nih.gov/pubmed/15107011http://www.ncbi.nlm.nih.gov/pubmed/15107011http://www.ncbi.nlm.nih.gov/pubmed/15107011



cise/art-20048389?pg=1

Meeusen, R., & de Meirleir, K. (1995). Exercise and BrainNeurotransmission. Sports Medicine, 20, 160–188.

Moving through grief: Exercise can help. (2012, Octo-ber). Wellness Monthly . Retrieved from http://www.hr.uci.edu/hcf/publications/WM-UBH-1210-ENG-Fe.pdf

Musick, M. A., Traphagan, J. W., Koeing, H. G., & Larsen,

D. B. (2000). Spirituality in physical health and aging. Journal of Adult Development, 7 , 73–86.

Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W,Judge, J. O., King, A. C., . . . American Heart Asso-ciation. (2007). Physical activity and public health inolder adults: Recommendation from the AmericanCollege of Sports Medicine and the American HeartAssociation. Circulation, 116, 1094–1105.

Northrup, C. (2006). The wisdom of menopause: Creating physical and emotional health during the change. NewYork, NY: Bantam Books.

O’Connor, P. J., Raglin, J. S., & Martinsen, E. W. (2000)Physical activity, anxiety and anxiety disorders. Inter-national Journal of Sports Psychology, 31, 136–155.

Oliver, R. (1974). Expectancy theory predictions of sales-men’s performance. Journal of Marketing Research,11, 243–253.

Otto, M. W., & Smits, J. A. (2011). Exercise for mood andanxiety: Proven strategies for overcoming depressionand enhancing well-being. New York, NY: Oxford Uni-versity Press.

Pate, R. R., Pratt, M., Blair, S. N., Haskell, W. L., Macera,C. A., Bouchard, C., . . . Wilmore, J. H. (1995). Physicalactivity and public health. A recommendation fromthe Centers for Disease Control and Prevention and

the American College of Sports Medicine. Journal ofthe American Medical Association, 23, 402–407.

Ploughman, M. (2008). Exercise is brain food: The ef-fects of physical activity on cognitive function.Developmental Neurorehabilitation, 11, 236–240.doi:10.1080/17518420801997007

Prior, J., Vigna, Y., Sciarretta, D., Alojado, N., & Schulzer,M. (1987). Conditioning exercise decreases premen-strual symptoms: A prospective controlled 6-monthtrial. Fertility and Sterility, 47 , 402–408.

Ransdell, L. B., Eastep, E., Taylor, A., Oakland, D.,

Schmidt, J., Moyer–Mileur, L., & Shultz, B. (2003).Daughters and mothers exercising together(DAMET): Eects of home- and university-based in-terventions on physical activity behavior and familyrelations. American Journal of Health Education, 34,19–29. doi:10.1080/19325037.2003.10603521

Riggs, C. E. (1981). Endorphins, neurotransmitters and/

http://www.hr.uci.edu/hcf/publications/WM-UBH-1210-ENG-Fe.pdfhttp://www.hr.uci.edu/hcf/publications/WM-UBH-1210-ENG-Fe.pdfhttp://www.hr.uci.edu/hcf/publications/WM-UBH-1210-ENG-Fe.pdfhttp://www.hr.uci.edu/hcf/publications/WM-UBH-1210-ENG-Fe.pdfhttp://www.hr.uci.edu/hcf/publications/WM-UBH-1210-ENG-Fe.pdfhttp://www.hr.uci.edu/hcf/publications/WM-UBH-1210-ENG-Fe.pdf


14/14

or neuromodulators and exercise. In M. H. Sacks & M.L. Sachs (Eds.), Psychology of Running (pp. 224–230).Champaign, IL: Human Kinetics.

Rosenbaum, S., Nguyen, D., Lenehan, T., Tiedemann,A., van der Ploeg, H., & Sherrington, C. (2011). Ex-ercise augmentation compared to usual care forposttraumatic stress disorder: A randomized con-trolled trial (the REAP study: Randomised Exercise

Augmentation for PTSD). BMC Psychiatry, 11, 115.doi:10.1186/1471-244X-11-115.

Russo-Neustadt, A. A., Beard, R. C., Huang, Y. M, & Cot-man, C. W. (2000). Physical activity and antidepres-sant treatment potentiate the expression of specicbrain-derived neurotrophic factor transcripts in therat hippocampus. Neuroscience, 101, 305–312.

Ryan, R. M., & Deci, E. L. (2000). Self-determination the-ory and the facilitation of intrinsic motivation, socialdevelopment, and well-being. American psychologist, 55, 68–78.

Smith, P. J., Blumenthal, J. A., Homan, B. M., Cooper,H., Strauman, T. A., Welsh-Bohmer, K., . . . Sherwood,A. (2010). Aerobic exercise and neurocognitive per-formance: A meta-analytic review of randomizedcontrolled trials. Psychosomatic Medicine, 72, 239–252. doi:10.1097/PSY.0b013e3181d14633

Smits, J. A., Berry, A. C., Roseneld, D., Powers, M. B.,Behar, E., & Otto, M. W. (2008). Reducing anxietysensitivity with exercise. Depression and Anxiety, 25,689–699. doi:10.1002/da.20411

Szuhany, K. L., Bugatti, M., & Otto, M. W. (2015). Ameta-analytic review of the eects of exercise on

brain-derived neurotrophic factor. Journal of Psy-chiatric Research, 60, 56–64. doi:10.1016/j.jpsy-chires.2014.10.003

Taylor, C. B., Sallis, J. F., & Needle, R. (1985). The relationof physical activity and exercise to mental health.Public Health Reports , 100, 195–202.

Thayer, R. E. (2001) Calm energy: How people regulatemood with food and exercise. New York, NY: Oxford

University Press.Thune, I., Brenn, T., Lund, E., & Gaard, M. (1997). Physi-

cal activity and the risk of breast cancer. The NewEngland Journal of Medicine, 336, 1269–1275.

University of Minnesota Duluth. (n.d.). Personal-ity and exercise. Retrieved from http://www.d.umn.edu/~dmillsla/courses/Exercise%20Adherence/docu-ments/PersonalityExercise.pdf

Valliant, P. M., & Asu, M. E. (1985). Exercise and its ef -fects on cognition and physiology in older adults. Per-ceptual and Motor Skills, 61, 1031–1038.

Williams, M. A., Haskell, W. L., Ades, P.A., Amsterdam,E. A., Bittner, V., Franklin, B. A., . . . Stewart, K. J.(2007). Resistance exercise in individuals with andwithout cardiovascular disease: 2007 update: A scien-tic statement from the American Heart AssociationCouncil on Clinical Cardiology and Council on Nutri-tion, Physical Activity, and Metabolism. Circulation ,116, 572–584.

Young, R. J. (1979). Eects of regular exercise on cog-nitive functioning and personality. British Journal of

Sports Medicine, 13, 110–117.

Dr. Christina Hibbert is the bestselling author of 8 Keys to Mental HealthThrough Exercise, Who Am I Without You? , and the Independent Publisher’sBook Award-winning memoir This Is How We Grow . Dr. Hibbert is a clinicalpsychologist specializing in women’s mental health, grief and loss, mother-

hood, parenting, perinatal mental health, self-esteem, and personal growth,and is the host of the weekly radio show Motherhood on WebTalkRadio.net oriTunes.

Dr. Hibbert is a frequent keynote speaker, 30Second Mom contributor,founder of the Arizona Postpartum Wellness Coalition, and producer of theinternationally-sold DVD Postpartum Couples, now available free online.

Mostly, though, “Christi” is a wife and full-time mother of six children, ages19 to 8. When she’s not trying to keep up with her family, Christi enjoys trave -ling, songwriting and singing, naps, reading and learning, doing almost any-thing outside on a beautiful day in a hammock, and dark chocolate.
http://www.ncbi.nlm.nih.gov/pmc/journals/333/http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17638929http://localhost/var/www/apps/conversion/tmp/scratch_3/WebTalkRadio.nethttp://localhost/var/www/apps/conversion/tmp/scratch_3/WebTalkRadio.nethttp://localhost/var/www/apps/conversion/tmp/scratch_3/WebTalkRadio.nethttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17638929http://www.ncbi.nlm.nih.gov/pmc/journals/333/

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