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Walking Throughout Your Day Keeps Depression (and a Host of Other Health Problems) Away

  • Edward R. Laskowski
    Correspondence
    Correspondence: Address to Edward R. Laskowski, MD, Co-Director, Mayo Clinic Sports Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine, Mayo Clinic, Rochester, MN
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      In this issue of Mayo Clinic Proceedings, Edwards and Loprinzi
      • Edwards M.K.
      • Loprinzi P.D.
      Effects of a sedentary behavior–inducing randomized controlled intervention on depression and mood profile in active young adults.
      report on a prospective, randomized trial that examined the effects of a forced period of sedentary behavior on depression and mood status in young adults. Although the duration of the induced sedentary behavior in the experimental group was only 1 week, significant deleterious effects were found on both depression and mood, and these effects were reversed with the reinstitution of physical activity. This study indicates that even a short period of sedentary activity can have negative psychological effects.
      The physical health benefits of exercise are well known and well documented, but the psychosocial benefits of activity may not be as apparent. Holistic wellness includes both physical and psychological factors, and exercise has been found to provide many psychosocial benefits as well as physical benefits. Aerobic exercise reduces anxiety and improves mood and fatigue.
      • Raglin J.S.
      Exercise and mental health: beneficial and detrimental effects.
      • Herring M.P.
      • O'Connor P.J.
      • Dishman R.K.
      The effect of exercise training on anxiety symptoms among patients: a systematic review.
      One randomized controlled study discovered that exercise over a period of 10 days was nearly as effective as antidepressants for treatment of depression.
      • Knubben K.
      • Reischies F.M.
      • Adli M.
      • Schlattmann P.
      • Bauer M.
      • Dimeo F.
      A randomised, controlled study on the effects of a short-term endurance training programme in patients with major depression.
      Exercise has also been reported to elevate productivity and decrease work and school absences.
      • Long B.C.
      • Flood K.R.
      Coping with work stress: psychological benefits of exercise.
      Additional research has determined that exercise has a positive effect as a treatment for anxiety and depression,
      • Salmon P.
      Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory.
      and exercise can help to improve social relationships.
      • Fox K.R.
      The influence of physical activity on mental well-being.
      Exercise also influences cognitive functioning, and a population-based study discovered that physical activity and computer use were associated with a decreased risk of mild cognitive impairment.
      • Geda Y.E.
      • Silber T.C.
      • Roberts R.O.
      • et al.
      Computer activities, physical exercise, aging, and mild cognitive impairment: a population-based study.
      A meta-analysis determined that physical activity may slow cognitive decline, mainly through modification of cerebrovascular risk, and also determined that exercise provides a neuroprotective effect in reducing the risk of dementia in later life.
      • Ahlskog J.E.
      • Geda Y.E.
      • Graff-Radford N.R.
      • Petersen R.C.
      Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging.
      In a 2-part meta-analysis involving data from 23,345 and 10,615 patients, respectively, that also appears in this issue of the Proceedings, Santos-Lozano et al
      • Santos-Lozano A.
      • Pareja-Galeano H.
      • Sanchis-Gomar F.
      • et al.
      Physical activity and Alzheimer disease: a protective association.
      report that regular physical activity performed by elderly people correlates with apparent protection against incident Alzheimer disease.
      Multiple studies have confirmed that regular physical activity and exercise can reduce the incidence of heart disease and high blood pressure and lower the risk of type 2 diabetes mellitus and stroke.
      • Myers J.
      Exercise and cardiovascular health.
      Physical activity also aids in weight loss and weight maintenance,
      • Wing R.R.
      • Venditti E.
      • Jakicic J.M.
      • Polley B.A.
      • Lang W.
      Lifestyle intervention in overweight individuals with a family history of diabetes.
      and a recent large-scale study determined that leisure time physical activity was associated with a lowered risk of 13 cancers, including breast and colon cancers.
      • Moore S.C.
      • Lee I.
      • Weiderpass E.
      • et al.
      Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults.
      Physically active people use less medication, have shorter hospital stays, and require fewer physician visits.
      Despite the impressive data regarding the benefits of physical activity and the importance of limiting sedentary behavior, the United States as a nation and the world as a whole continue to be mired in the midst of an epidemic of obesity and sedentary lifestyle. One study estimated that by 2030, the obesity rate in the United States will increase to approximately 50% for men and 52% for women, with the total number of obese individuals increasing from 99 million in 2008 to 164 million by 2020.
      • Wang Y.C.
      • McPherson K.
      • Marsh T.
      • Gortmaker S.L.
      • Brown M.
      Health and economic burden of the projected obesity trends in the USA and the UK.
      The National Health and Nutrition Examination Surveys document continued increases in the incidence and prevalence of obesity throughout the United States. Approximately two-thirds of Americans are overweight or obese, and more than 70% of Americans do not meet the Centers for Disease Control and Prevention 2008 physical activity guidelines for the amount of physical activity recommended to obtain a health benefit (150 minutes of moderate activity per week or 75 minutes of vigorous activity per week).

      US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. ODPHP Publication No. U0036. Office of Disease Prevention and Health Promotion website. http://www.health.gov/paguidelines. Published October 2008, updated June 2016. Accessed June 8, 2016.

      Sedentary lifestyle deleteriously affects the cardiovascular system and is recognized as an independent risk factor for all-cause mortality.
      • van der Ploeg H.P.
      • Chey T.
      • Korda R.J.
      • Banks E.
      • Bauman A.
      Sitting time and all-cause mortality risk in 222 497 Australian adults.
      Using direct measures, physical inactivity is reported to be the leading remediable cause of death in the United States.
      • Blair S.N.
      Physical inactivity: the biggest public health problem of the 21st century.
      Research in the area of physical activity has revealed an association between the amounts of sedentary time in a person's life and his or her overall metabolic risk, even if the person attains the recommended amount of physical activity.
      • Owen N.
      • Healy G.N.
      • Matthews C.E.
      • Dunstan D.W.
      Too much sitting: the population health science of sedentary behavior.
      • Matthews C.E.
      • George S.M.
      • Moore S.C.
      • et al.
      Amount of time spent in sedentary behaviors and cause-specific mortality in US adults.
      People who are active, move about, and spend less time sitting have heathier blood lipid profiles and blood glucose levels than those who meet the minimum recommended activity levels but who sit for prolonged periods.
      • Owen N.
      • Healy G.N.
      • Matthews C.E.
      • Dunstan D.W.
      Too much sitting: the population health science of sedentary behavior.
      Increased time spent watching television and sitting increases premature mortality risk.
      • Matthews C.E.
      • George S.M.
      • Moore S.C.
      • et al.
      Amount of time spent in sedentary behaviors and cause-specific mortality in US adults.
      Even among persons who engaged in more than 7 hours per week of moderate to vigorous activity, viewing television for more than 7 hours per day was associated with an increased risk of all-cause cardiovascular mortality when compared with those who watched less than 1 hour of television per day.
      • Matthews C.E.
      • George S.M.
      • Moore S.C.
      • et al.
      Amount of time spent in sedentary behaviors and cause-specific mortality in US adults.
      Physical activity and reduction of sedentary behavior have a synergistic effect on improving both physical and psychosocial health. As exemplified by the Exercise is Medicine campaign by the American College of Sports Medicine,

      American College of Sports Medicine. Exercise is Medicine website. Published 2007, updated June 2016. http://www.exerciseismedicine.org/. Accessed June 8, 2016.

      exercise is truly similar to a medication with respect to the myriad of health benefits associated with its consistent application. If the benefits of exercise could be distilled into one medication and bottled, it likely would be the best selling and most prescribed medication in history. Despite these beneficial effects, however, many physicians do not participate in physical activities themselves and do not counsel their patients on exercise and activity and the need to limit sedentary behavior. One study reported that 40% of primary care physicians in the United States and approximately 40% of US medical students do not meet the Centers for Disease Control and Prevention physical activity guidelines.
      • Lobelo F.
      • Duperly J.
      • Frank E.
      Physical activity habits of doctors and medical students influence their counselling practices.
      In addition, physically inactive doctors are less likely to provide exercise counseling to their patients, and they present themselves as less credible role models. One study found that only 34% of adults in the United States report having received counseling regarding exercise at their last medical visit.
      • Wee C.C.
      • McCarthy E.P.
      • Davis R.B.
      • Phillips R.S.
      Physical counseling about exercise.
      It is crucial that we physicians and other health care professionals prescribe this very basic, yet essential, treatment for our patients and that we make a concerted effort to role model activity and movement in our own lives.
      Barriers to exercise are many and varied but can be overcome with education and counseling. The physician—by providing realistic, practical, and acceptable options—can help patients differentiate between perceived and real barriers. With respect to time efficiency, a considerable amount of research on high-intensity interval training reveals that it is well tolerated, even by those with obesity and cardiovascular disease, and leads to similar improvements in cardiovascular and metabolic measures in less time than long-duration moderately intense activity.
      • Fisher G.
      • Brown A.W.
      • Bohan Brown M.M.
      • et al.
      High intensity interval- vs moderate intensity- training for improving cardiometabolic health in overweight or obese males: a randomized controlled trial.
      The voluminous evidence in support of both the physical and psychosocial benefits of exercise is impressive and overwhelming. The effects of a sedentary lifestyle on psychosocial as well as physical and metabolic outcomes have been well documented. The benefits are clear. It is now up to physicians and other health care professionals to ensure that the next generation (1) sees us as role models regarding physical activity and the reduction of sedentary behavior and (2) receives the information and encouragement from us that they need to make physical activity and movement part of their lifestyle. The costs of withholding this form of treatment from ourselves and from our patients are high indeed.

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