# Exercise as it relates to Disease/An exercise intervention for improving mental health

Article: An effective exercise-based intervention for improving mental health and quality of life measures: a randomised controlled trial.
Atlantis, E. et al. (2004). An effective exercise-based intervention for improving mental health and quality of life measures: a randomised controlled trial. Preventive Medicine, 39, 424-434.

## What is the background to this research?

This paper written by Atlantis, et al, investigates the effectiveness of aerobic and weight training exercises on mental health and overall quality of life. Using a 24-week program to gain data about mental health and quality of life outcomes. This paper supports prior research, concurring with many other studies surrounding the positive effects of exercise for mental health. Although this topic has been well researched, mental health issues affect 43.7% of Australian’s aged 16-85 so further support to this data is required to reduce this prevalence in Australia. Improving mental health and quality of life in Australia using an easily accessible resource like exercise could drastically reduce the current suicide rate of over 3,000 deaths per year.

## Where is the research from?

This research was conducted in Sydney, Australia, through the University of Sydney. The sample involved 44 employees from a single work site at the Star City Casino. These employees were randomised into treatment or control groups. The research did not affiliate with organisations that would conflict with the findings. Although gaining support from UTS Union Gym with offerings of free access to the facilities, this support would not add bias to the findings.

## What kind of research was this?

This study is a randomised control trial involving Star City Casino employees, aged between 20-54 years. Splitting the 44 participants at random into either the treatment or control group. This type of research design minimises bias and creates a straightforward cause and effect relationship. Randomised control trials have been investigated for their effectiveness as supported by research, d claimed the ‘gold standard’ for clinical trials. The level of evidence created from this study is reliable and compatible to other studies of its kind.

## What did the research involve?

Approximately 3,800 participants were invited to participate in the study through advertising around the workplace. Through 2 orientation phases, 44 participants were randomised into 2 groups. The treatment group exercised a minimum of 3 times per week for a duration of 60 minutes, completing a strength and aerobic program. Quality of life data was collected from both groups at baseline and at completion of 24 weeks trial using the DASS and SF-36 Health Status Survey.
The methodology of this research was a good approach given the investigations preformed. Mental health is difficult to diagnose, with self-administered tests and surveys being a common technique used by a doctor or psychiatrist to diagnose a patient with a mental health illness. Although a self-administered survey like the SP-36 Health Status Survey can be difficult for individuals to identify their thoughts and feelings into specific categories to answer a question where it is considered the standard when assessing mental health. This is a limitation to the data as there is no way of knowing if the data collected is true and what the participants were feeling. Having the participants answer in a survey puts boundaries on the results as there was only 3 options being yes, limited a lot, yes limited a little, and no not limited at all to answer each question. Most people would over or under exaggerate their feelings and experiences to fit within these classes to answer the question. The methodology for recruitment was a fair process with an open invite to a large number of participants, and 2 phases of orientation and assessment where participants could drop out.

## What were the basic results?

After multiple stages of screening, 44 participants were eligible to participate with 24 females and 20 males. There were no significant differences between both the control and trial group base line results for age, gender, waist circumference, body mass index and predicted V0$_2$ max. This study found that depression, anxiety, and stress all exceeded the baseline values when compared to Australian norms. It was reported that mental health improved by 15.9% and vitality by 44.5% for the treatment group. The results of the paper were presented using 2 tables clearly displaying the differences in quality of life and mental health as well as all health statistics recorded. These tables were separated with table 1 showing health statistics comparing treatment and control groups and table 2 compares the primary outcomes of SF 36 and DASS questionaries. The paper thoroughly discusses the results although it doesn’t over emphasise the implications of their findings. The results show clear improvement to mental health and quality of life of treatment group meaning claims such as “multimodal exercise is as effective at improving stress symptoms and QOL outcomes” aren’t over emphasised as there is grounding evidence supporting this as seen in the results.

## What conclusions can we take from this research?

The study promotes any form of exercise for mental health benefits which concurs with previous data showing the major improvements to mental wellbeing. The results target health professionals to show what types of exercises specifically can be prescribed in training programs to improve symptoms of mental health the greatest. In conclusion the research adds to the library of resources surrounding mental health and its direct positive relationship with mental health. This provides a clear insight into how medically society can treat mental health patients with the use of aerobic and weight training exercises.

## Practical Advice

The paper suggests splitting upper body and lower body training sessions which can be followed out in a practical session. Targeting weight sessions at major muscle groups and following 3-15 repetitions and 3-10 sets depending on training volume and load. As the paper suggests aerobic exercises such as swimming, cycling, walking, and running for 20 minutes around 3 times per week. Implementing this knowledge into a mental health unit setting, working with mentally ill patients, motivation can be challenging. Approaching exercise in small dosages rather than long sessions, slowly working up to completing a full session would be most practical. The health and safety of each participant is extremely important and before commencement of exercise and participants should complete an ESSA Pre Exercise Screening to ensure they are fit for exercise to avoid health complications and injuries. This paper ensured all participants produced a doctor’s clearance to exercise.

## Further information/resources

For further information on the effectiveness of exercise for mental health, the supplied links below provide insightful article and further data supporting the claims made in the paper researched. These links can also provide support for those struggling with mental health, offering someone to talk to and get help.
* Sharma, A. et al. (2006). Exercise for Mental Health. The Primary Care Companion Journal of Clinical Psychiatry, 8(2), 106.
* Raglin, J. (2012). Exercise and Mental Health. Sports Medicine, 9, 323—329.
* Beyond Blue
* Head Space
* Life Line

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Atlantis, E. et al. (2004). An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial. Preventive Medicine, 39: 424-434.
* 1 2 Sharma, A. et al. (2006). Exercise for Mental Health. The Primary Care Companion Journal of Clinical Psychiatry, 8(2), 106.
* ↑ Australian Bureau of Statistics. (2022). Mental Health Statistics. https://www.abs.gov.au/statistics/health/mental-health
* ↑ Australian Institute of Health and Welfare. (2022). Suicide and Self-harm Monitoring Data. https://www.aihw.gov.au/suicide-self-harm-monitoring/data
* 1 2 Hariton, E. Locascio, J. (2018). Randomised Controlled Trial, The Gold Standard for Effective Research. Journal of Obstetrics and Gynaecology, 125(13): 1716.
* ↑ Mayo Clinic. (2021). Mental Illness Diagnosis. https://www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-treatment/drc-20374974
* ↑ RAND Health Care. (2022). SF-36 Health Survey. https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html