Exercise is the Wonder Drug

by New Speakwell Speaker, Anthony Ocana, M.D.

The road ahead is slick with fresh rain. Fog hangs above the towering conifers that line the road as it curves out of sight. A streak of magenta, where the road meets the horizon, is turning reluctantly into another Vancouver sunrise.

As she approaches the crest of the hill, Emily’s breath grows heavy. Push, pull, push, pull… she thinks, trying to filter out the searing pain coming from her thighs and calves. Slowly the heaviness begins to lift like the fog and she feels the wind on her face again, as she cycles the last stretch home.

Peeling off the warm layers and jumping into the shower, she slows momentarily as she catches a glimpse of her ever-so-slightly more muscular body in the mirror crossing the bathroom floor. "That’s good", she thinks. "I can do this". The warm water feels good as she basks in the glow of another well-deserved fitness high.

Long known to be a source of fitness and health, physical activity is now being recognized for its ability to improve mental health.

The runner’s high, a euphoric state associated with endurance activities, is based on the release of morphine- like chemicals into the brain. These neuro-chemicals, called endorphins are thought to be the body’s natural pain-killers. Interestingly, as more research becomes available, it is becoming clear that the mental health benefits of exercise extend beyond the runner’s high.

According to Dr. Jack Raglin, of Indiana University, an authority on exercise and depression. Exactly how exercise works remains a mystery. "We do know that the benefits of exercise are not dependent upon endorphin release, because we find mood improvements and psychological benefits occurring in exercise doses that are too mild to result in much endorphin production. This is helpful because not everyone has the motivation or skill to train for a triathlon. In fact we now know that as little as 30 minutes of brisk walking a day has very profound effects on health and mood and these effects can be felt in the short term, even immediately in some cases", says Raglin.

Emily is not cycling, running and swimming because she wants to lose weight or get in shape. She has been prescribed this regimen, by her physician, to help her battle anxiety, insomnia and burnout.

Evolutionarily speaking, we are wired for physical activity. Survival depended on being able to withstand long stretches of heavy work such as hunting, gathering, defending or attacking. Physical activity is therefore evolutionarily linked to health, pleasure and longevity.

We know that mental health is more than good mood. It includes energy, motivation, drive, focus, pleasure and self control. Neuro-chemically speaking we can assign the different attributes of mental health to three main neuro-chemicals called catecholamines:

1. Serotonin, the chemical of joy, soothing and digestion
2. Noradrenaline, the neurochemical of energy, motivation and drive
3. Dopamine, the neurochemical of focus, control and reward

The hypothesis is that physical activity affects mood in many ways. Given its central role in health, and the multiplicity of mood improvements associated with activity, it is reasonable to hypothesize that it probably raises all neurotransmitters.

Why is this still a mystery? Well, probably because we have no easy way to measure neurotransmitters in humans. As such, we are left to observe the mood changes associated with activity and extrapolate from there to the likely state of brain chemistry.

Support for this can be seen in a recent 10-month study conducted at Duke University Medical Centre, Durham, North Carolina. The researchers assessed 156 adult patients who suffer from major depressive disorder (MDD). Participants were randomly assigned to an antidepressant medication, aerobic exercise, or a combination of the two. Assessments were carried out at the beginning of the study, at 4 months, and 6 months after the study ended. Researchers found that not only was exercise as effective as the medication, but also that the people who exercised were significantly less likely than the group who took medication to relapse into depression.

When Emily gets out of the shower and pats her hair dry, she looks at her self with a new fondness. She feels a sense of accomplishment that she hasn’t felt for a long time. "Not bad" she thinks. "I like getting up in the morning, digging deep, pushing myself and having a good sweat".

Struggling to fight off the winter blues, Emily has joined a running club. She likes the social connections she’s making. They aren’t friends yet, but they could be.

She bought herself a heart rate monitor and a speedometer for her bike. She likes to see her average speed climb slowly week after week. She feel a sense of accomplishment watching herself progress, knocking off the workouts like so many toy soldiers on a battle-field.

She’s not on a diet, but she feels more committed to eating consciously because she feels invested in her health in a way that she didn’t before. All these changes are the result of the commitment to activity she made when her psychiatrist diagnosed her with anxiety and insomnia after her breakdown last spring.

Besides the anxiety and insomnia, her psychiatrist also recognized a pattern similar to attention deficit disorder in the way she was always easily distracted and having difficulty finishing projects. Never one to sit still, Emily kept turning up the pressure on herself, taking on more responsibility, more travel and bigger and harder assignments. Not pushing herself seemed so boring.

But driving herself so hard, she became less and less able to enjoy life’s little pressures. She had become so overworked she could not sleep. She became short-tempered, ineffective, stressed out and overwhelmed. She was drinking so much coffee that she often found herself feeling angry, sad and anxious all at the same time. Eventually she burned herself out and had to take time off work. That’s when, with the help of her employer and family doctor, she went to seek professional help.

She had coped well enough before and was reluctant to take medication, but she knew that the status quo was not an option. Her psychiatrist told her that she needed to exercise to raise her neuro-transmitter levels, especially dopamine, as that would improve her focus, decrease irritability and boredom and help reduce her cravings for more and more stimulation.

Her psychiatrist was basing his advice on a recent study that suggests that the antidepressant effects of exercise may be due to a chemical called phenylethylamine, the precursor of the catecholamines: serotonin, noradrenaline and dopamine. British Journal of Sports Medicine 2001; 35: 342-3)

Of note is the fact that dopamine releasing neurons project to many different parts of the brain regulating attention, pleasure, organization, planning, stress management, self control and sexual function. Mol Psychiatry 2000 Jan;5(1):14-21.

One of the traits Emily has always struggled with was a predisposition to become easily bored. Despite having a good relationship, healthy family and a good job, Emily was always looking for something new.

Novelty seeking is a trait that is hypothesized to have survived in early humans because it conferred an advantage in mating and reproduction. In fact, more than half of the people with attention deficit disorder have this defect in the dopamine receptor, according to Dr. Robert K. Moyzis of the University of California, Irvine. Proceedings of the National Academy of Sciences 2002;99:309-314.

Emily told the psychiatrist of the history of alcoholism, rage and workaholism that ran in her family. Numerous different kinds of studies including twin studies, tell us that about 80% of low dopamine syndromes are genetic. Several population studies have shown attention deficit disorder prevalence rates range from 3% to 10%. Int J Neuropsychopharmacol. 2000;3(suppl 1):S60. Abstract S.38.2.

Maybe that’s why Emily has always felt she was swimming against the current. Now that she has found exercise she feels a sense of peace and grounding that she never knew before.

Dr. Anthony Ocana is a family doctor, dietitian and physician psychotherapist.
He can be reached at 604-222-2256 for a medical consultation.