A Workout For The Mind

Exercise could be just as effective as medication in treating depression in the short term

November 08, 2007|By Meredith Cohn | Meredith Cohn,Sun Reporter

Deborah Cerasoli always knew walking helped her work through her troubles.

The 54-year-old, who has severe depression, once walked from East to West Baltimore, "until I felt better."

Now there is growing evidence that she's onto something.

Studies going back to the 1970s have suggested that exercise may be beneficial in treating mental illness in the long term. But a recent study has gone further in showing exercise could be as effective as medication in treating depression in the short term.

And while few who treat mental illness are ready to ditch drugs or even say for sure there is an immediate mental-health benefit to exercising, there aren't many who dispute the long-term physical health benefits. Prescribing exercise is becoming more mainstream in many doctors' offices for everything from severe depression and anxiety to mild cases of the blues.

Cerasoli credits walking with helping her to lose weight, get control of her diabetes and keep her in a good mood.

She now lives in her own apartment in Baltimore and catches the bus to Mosaic Community Services Inc., the Timonium-based nonprofit mental-health treatment facility that has made her a co-leader of an exercise group.

"I don't force it," she said of those in her group. "I tell them I'm here when they're ready. I tell them they will feel better. And they do. I haven't lost anyone yet."

Mosaic formed the group after executive director Jeff Richardson read a report this year that said chronic mental illness can cut 25 years off people's lives and most of the causes of death are preventable.

Richardson knew many of Mosaic's 4,000 annual clients smoke, are overweight or have diabetes. But the report startled him. He became convinced exercise and nutritional counseling were needed to reverse the course. And maybe those people who improved wouldn't just live longer, they'd feel better, depend on services and medication less and contribute to society more.

His staff began putting many of Mosaic's clients into wellness programs.

It's too early to know if Richardson's clients will buck the statistics, but he already has positive anecdotal evidence of improved physical and mental health. And a growing collection of research by others seems to be backing up the stories with science.

"It's hard to separate the mind from the body," said Richardson, who took his own advice and recently lost 20 pounds. "Our goal is to help these people live longer lives but also more satisfying lives."

To get clients into the mood to move, Mosaic didn't lecture. The staff formed groups of people with severe depression, schizophrenia and bipolar disorder so they could encourage each other to take care of themselves, exercise and eat right. Their wellness became something within their control and something to take pride in.

Also, with an annual budget of just $18 million - about 85 percent of the nonprofit's clients are Medicare or Medicaid recipients - Mosaic staff found buying a little equipment and hiring a dietitian to be a good value for the returns.

Cerasoli, who has been going to Mosaic for about four years, says the best benefit hasn't been what it's done for her - it's what it helps her do for others. Still, her energy, positive outlook and leadership skills have landed her a position leading another group at the University of Maryland.

The improved sense of self-worth, and the physical benefits, have led many doctors to embrace exercise for their patients with depression and anxiety, even if the science isn't completely proven, said Philip R. Muskin, a Columbia University professor of clinical psychiatry and the former chairman of the American Psychiatric Association's Council on Psychosomatic Medicine.

But, he said, health care providers have to be careful about making promises because patients could be let down. And those with severe mental and physical conditions may need medication and therapy before they can even get out of their pajamas.

He said professionals also have to tailor their advice because some people may not want to run or lift weights and may dismiss the prescription. But they may be willing to take the stairs instead of the elevator or enjoy a bowling league but not a gym.

It's not known how often exercise is prescribed. But Muskin said he believes that not just psychiatrists and therapists are advising that people do something physical, but also primary care doctors who see patients feeling a little down.

"I think it's worked its way into the traditional from the complementary or alternative," Muskin said. "Everybody agrees that exercise appears to help because there really isn't data saying exercise does not help. And even if exercise isn't as good as drugs, maybe patients notice their abs are a little flatter, their arms a little more toned and they aren't fatigued all the time. And that makes them feel better. "

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