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.