Counselling, Exercise and Nutrition: A Complete Strategy for Improving Mental Health Outcomes

A balanced, nutritious diet and regular exercise can do wonders for our physical health, but did you know that these things can have a positive impact on our mental health too? 

When most people think of treatments for mental illnesses, drugs and therapy are some of the first things that come to mind. There is good reason for this, seeing as these treatments have been proven effective for most patients. But, are simpler and more sustainable options being overlooked?

Science is clearly starting to show that what we eat and how much (or how little) we exercise can have a huge impact on our mental health. If used properly, these findings could have huge implications when it comes to the high rates of mental illness in society today. 

Effective dissemination of this information to the public and cooperation from both mental health and fitness industry professionals could lead to better outcomes for patients suffering from mental illness. Ideally, future generations could use this knowledge to greatly increase prevention of problems like anxiety and depression, rather than taking a reactive approach as we tend to do currently. 

As more people become aware of the benefits of nutrition and exercise on mental health, professionals in the fitness industry, including IDEA members, can play an important role in encouraging healthier overall living. While you might not be mental health professionals yourselves, chances are you or someone you know has turned to exercise and nutrition to help with issues like stress, anxiety, and depression. 

By learning more about this, you can be prepared to help others who might cross paths with you during a difficult time in their lives. 

Isn’t This a Job for Healthcare Professionals? 

In a perfect world, people suffering from mental illnesses could present themselves to hospitals or their primary care physicians with their symptoms, receiving diagnosis and effective treatment easily and without delay. Unfortunately, things rarely work out that way. 

According to the World Health Organization, “One in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.” They go on to say that almost 2/3 of people suffering from mental illness never seek help.

There are several reasons why people don’t seek help for known mental illnesses. This may include stigmatization and lack of adequate resources for dealing with mental illness. The sad part is that many mental illnesses can be prevented or effectively treated, but many patients who could benefit from available treatments can’t or aren’t taking advantage of them. 

 

Mental Health and Exercise

It is common knowledge that regular exercise can have a positive impact on mental health, even in small bursts. This has been noted anecdotally through the testaments of many who have experienced the effects of exercise on mental wellbeing for themselves. It has also been supported through scientific research that has shown physical activity to influence the brain and physiological reactions to stress.  

Exercise and the Brain 

How does exercise help improve symptoms of mental illness? For one, it increases the levels of dopamine, norepinephrine, and serotonin in the brain

Dopamine is related to the reward and pleasure centers in the brain, making us feel good and helping us regulate emotions. People who have low levels of dopamine can suffer from symptoms ranging from depression, increased stress, fatigue, mood swings, and lack of sleep, to name a few. 

Similarly, norepinephrine levels are also closely linked to mental wellness. High levels of norepinephrine caused by high levels of stress can lead to issues like insomnia, anxiety, depression, and mood problems, while prolonged stress can lead to low levels of this neurotransmitter. Low norepinephrine can cause things like fatigue and apathy. 

Finally, serotonin and mental health are connected because serotonin helps maintain balance in the brain. Low levels of serotonin can lead to problems like depression, irritability, and lack of sleep. 

As you can see, while balanced levels of dopamine, norepinephrine, and serotonin can help support healthy brain functioning, low levels of one or all of these can be detrimental to brain health. Exercise can help patients regulate these brain chemicals and neurotransmitters to improve their mood, energy, and overall functioning.  

Studies on Exercise and Mental Health

The relationship between mental health and exercise has been studied for years, although results and recommendations from these studies haven’t always been clear. An early study by C.B. Taylor, J.F. Sallis, and R. Needle (1985) found that: 

“The strongest evidence suggests that physical activity and exercise probably alleviate some symptoms associated with mild to moderate depression. The evidence also suggests that physical activity and exercise might provide a beneficial adjunct for alcoholism and substance abuse programs; improve self-image, social skills, and cognitive functioning; reduce the symptoms of anxiety; and alter aspects of coronary-prone (Type A) behavior and physiological response to stressors.” At that time, this information was promising, but studies lacked rigor and practical applications for treating mental illness with exercise. 

Recent studies have had similar findings and limitations. Even though exercise has been used to promote health and well-being worldwide, it appears exercise is a viable treatment option that is often overlooked by healthcare professionals. According to a literature review by P. Callaghan (2004)

“There is evidence that exercise is beneficial for mental health; it reduces anxiety, depression, and negative mood, and improves self-esteem and cognitive functioning. Exercise is also associated with improvements in the quality of life or those living with Schizophrenia.” 

So why isn’t exercise prescribed to individuals with mental illness as a treatment option? 

There are several reasons why exercise might not be the first option for physicians who are diagnosing and prescribing treatments for mental illness. It could be that patients don’t believe that exercise will help, that it is hard to track patient’s progress or see if they are following through with the treatment, or that there simply isn’t enough information on what types of exercise work best. 

One study conducted by J. Barton and J. Pretty (2010) found that exercising in the presence of nature lead to positive health outcomes in both the short and long-term. Short engagement in exercise that took place in green environments (especially in the presence of water) lead to improved mood and self-esteem in participants with and without mental illness. 

Conversely, several of the studies mentioned noted that in some patients the opposite of the desired effect occurred. Excessive exercise, running addiction, and overtraining syndrome are a few issues that can negatively impact both physical and mental health. These are important issues that should be looked out for, but occur in a small percentage of the general population.

A promising study by A. Sharma, V. Madaan, and F.D. Petty (2006) suggests that 30 minutes of moderate exercise three days a week is enough to see improved mental wellbeing, and that the exercise can even be broken up into smaller intervals and still be effective. They go on to conclude that, 

“Health benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients include the following:

  1. Improved sleep
  2. Increased interest in sex
  3. Better endurance
  4. Stress relief
  5. Improvement in mood
  6. Increased energy and stamina
  7. Reduced tiredness that can increase mental alertness
  8. Weight reduction
  9. Reduced cholesterol and improved cardiovascular fitness

Mental health service providers can provide effective, evidence-based physical activity interventions for individuals suffering from serious mental illness.”

Just because doctors aren’t prescribing exercise as a first line of defense against mental illness, that does not mean that it isn’t effective. In fact, many doctors are beginning to recommend lifestyle changes in exercise and nutrition to complement other treatments that are being used for mental illness, including medication or therapy. 

For patients who are undiagnosed or cannot afford traditional treatments, exercise may be an accessible alternative.  

Mental Health and Nutrition 

Just like exercise, proper diet and nutrition is essential not only for our physical health but also for our mental health. Have you ever noticed that people who eat a lot of sugar-laden and processed foods tend to have less energy and feel down a lot of the time? A healthy diet high in fruits and vegetables can leave us feeling happier, healthier, and more alert, with energy to spend doing the things that we love. 

Studies on Mental Health and Nutrition 

Many studies have been conducted on the role of nutrition on brain development and health. A study by L.M. Bodnar and K.L. Wisner (2005) that aimed to improve the mental health of childbearing-aged women stated that: 

“Adequate nutrition is needed for countless aspects of brain functioning. Poor diet quality, ubiquitous in the United States, may be a modifiable risk factor for depression … Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully. Folate deficiency reduces the response to antidepressants. Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than non-depressed persons.”

This statement is just one example of how nutrition has been found to have a strong relationship with mental illness, something that should not be ignored. While patients may go to their doctors for diagnosis and treatment of some of these deficiencies, clients of fitness professionals may be suffering from these problems and not be aware of it. 

Foods that Can Help Improve Mental Health

While it is not your place to diagnose your clients, or suggest that they take supplements to help with their mental health, fitness professionals can encourage their clients to eat better as an overall strategy for helping them feel better. An improved diet will automatically help balance some potential deficiencies in patients who currently eat a lot of ‘bad’ foods. 

The Mental Health Foundation supports this idea, stating that people who eat fruits and vegetables daily do not report mental health problems compared to those who eat a lot of processed and ‘junk’ foods. While they do not say that diet can cure mental illness on its own, they do state that, “A balanced mood and feelings of wellbeing can be protected by ensuring that our diet provides adequate amounts of complex carbohydrates, essential fats, amino acids, vitamins and minerals and water.” 

In addition to these broad recommendations, fitness professionals can recommend specific foods that clients can eat to help boost their mood and improve their health in a big way. According to Carolyn C. Ross M.D., M.P.H., some of these foods include: 

  • Foods high in omega-3 fatty acids: fish including salmon, herring, and mackerel
  • Whole grains containing complex carbohydrates: oats, barley, beans, and soy
  • Lean protein containing tryptophan: turkey, chicken, and eggs
  • Leafy greens high in folic acid: spinach, romaine, and broccoli
  • Fermented foods and foods with active cultures: yogurt, tempeh, and kimchi

Maintaining a diet that is high in these foods, while following doctor prescribed treatments if necessary, can help patients recover from mental illness and prevent it from recurring in the future by maintaining essential vitamins and minerals that are essential for proper body and brain functioning. 

Counselling/Therapy and Mental Health

As a fitness professional trying to lend a helping hand to clients suffering from mental illness, know that you are not responsible for their health outcomes and you can only do so much. Giving clients support and advice involving proper exercise and nutrition can be a big help, but sometimes people’s problems will be more severe and they may need more help than you can give them. 

Effectiveness of Counselling/Therapy on Mental Health Outcomes

Therapy and counselling have proven to be effective in treating a wide variety of mental illnesses, both on its own and in conjunction with other treatments including medication. Psychotherapy, a broad term that covers a variety of short-term, goal oriented therapies, helps millions of people each year deal with problems from temporary life difficulties to specific mental health concerns. 

Cognitive behavioral therapy, a short-term, goal-oriented psychotherapy that aims to help clients change problem thinking and behavior patterns and provide them with long-term coping mechanisms, is one popular and effective option. A review of met analyses conducted by A.C. Butler, J.E. Chapman, E.M. Forman, and A.T. Beck (2006) stated that: 

“Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders … CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder.”  

Other forms of psychotherapy include family therapy, interpersonal therapy, psychodynamic therapy, and group therapy. 

Online Counselling/Therapy as an Alternative to Traditional Options

For patients who feel stigmatized for their mental illnesses, online counselling can be a great way to get help that is more accessible and anonymous than looking for a therapist in their local area. Services like BetterHelp offer patients convenient and affordable access to counselling and therapy services that can be used from the convenience of their connected devices, including computers, laptops, and cellphones. 

Online therapy may be a good solution to the overburdening of traditional mental health services. A study conducted by J. Proudfoot, C. Ryden, B. Everitt, et al. (2004) found that computerized cognitive behavioral therapy was effective in treating anxiety and depression, even lead to higher satisfaction with treatment compared to non-computerized CBT. 

According to one study by J.R. Alleman (2002), “Conclusions are that therapy can be done online, that it can be done ethically, and that online services might not be a serious threat to face-to-face therapy. Regulatory and professional organizations are strongly advised to cooperate with each other.” 

Services like BetterHelp can have added benefits in comparison to traditional in-person therapy and counselling, including the fact that it is easy to sign up online and patients are matched with a qualified professional who has experience dealing with their particular health issues. If a user does not like their counsellor, it is easy to switch to another that might be a better fit. 

Integration of Exercise, Nutrition, Counselling, and Other Treatment Methods for Improving Mental Health

There is information available to suggest that proper diet and exercise can help people improve their overall well-being and mood, provide them with more energy, and reduce symptoms of mental illnesses like anxiety and depression. 

Still, traditional treatment options like counselling and pharmacotherapy are often turned to as the first line of defense for treating patients who go to their doctor for help with mental illness. Depending on the severity of the patient’s symptoms, sometimes these kinds of treatments are necessary but they are also more expensive and in the case of medication, can come with some pretty undesirable side effects. 

While medication can play an important role in controlling and treating mental illness, some of the potential side effects of these types of medications include: 

  • Nausea and vomiting 
  • Weight gain
  • Dizziness
  • Headache 
  • Drowsiness
  • Blurred vision 
  • Fatigue 

Another issue with using medication to treat mental illness is that patients could need to be on these medications for the rest of their lives. These medications unfortunately do not help people learn to cope with the symptoms of their mental illness, and problems can arise if a patient decides to come off their medication or if they can’t afford to purchase their meds. 

An integrated strategy can help patients by reducing the need for medications with negative side effects and help give them a holistic method for improving their health, both mental and physical. While some sources show that general practitioners are beginning to ask patients about their lifestyle habits and offer lifestyle counselling, more work needs to be done to convince physicians of the usefulness of encouraging lifestyle changes promoting better health in patients.

A literature by A.J. Daley (2002) also looked at whether exercise therapy is a useful intervention for mental illness. This study found that while exercise has proven to have large positive effects in psychiatric patients, it is still rarely adopted as a treatment option. However, the review also cited a study by Martinsen & Medhus (1989) which found that patients ranked physical fitness training as more helpful than other forms of therapy. 

Considering the size of the fitness industry, which brings in a whopping $80 billion USD per year, more research should be conducted into ways that fitness and mental health professionals can come together to offer patients integrated services that rely on exercise and nutrition as a way to prevent and ease the symptoms of mental illness, as well as help relieve the burden on traditional healthcare services being overwhelmed by the need for better options for the large numbers of individuals suffering from mental illness.  

Conclusion 

Since mental illness is becoming such a common feature in today’s society it is important for fitness professionals to be aware of the problem so they can help their clients in the best way possible. Not all fitness industry clients are going to present themselves with mental illness, and most will not share that information with you, but in the case that they do fitness professionals should know that they are equipped with expertise that can help ease people’s symptoms. 

Regular exercise and a nutritious diet can have a positive impact on mental health outcomes, according to many studies conducted over the last 40 or 50 years. Both exercise and diet can be used in the future to help prevent mental illness in the first place, but in cases where illnesses have already presented themselves individuals may need other treatment such as therapy or medication in addition to lifestyle changes to return to optimal health. 

Since primary care physicians and mental health professionals so far seem reluctant to prescribe exercise and diet as ways to curb mental illness, fitness professionals are in a good position to promote the benefits of these lifestyle changes. 

In the future, it would be nice to see partnerships form between key players in the fitness and mental health industries to provide proven programs that focus on improving patient’s overall health. These interventions should aim at providing patients with the knowledge, support, and tools they need to recover from mental illness and help prevent relapse in the long term.

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