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Effects of Physical Inactivity on Health: Part 1 - Anxiety and Depression

anxiety depression physical activity physical inactivity Aug 09, 2022

 Our Current State of Health

Our society is the most unhealthy it has ever been, with the CDC stating 70% of the U.S. population is overweight or obese.1 That is tantamount to 2 out of 3 people in the United States. The World Health Organization (WHO) outlined that 86% of U.S. adults do not meet the weekly physical activity requirements (figure 1), which is greater than 280 million people.2 As these numbers are spiraling out of control, we have non-communicable diseases on the rise, including mental health. These lists consist of conditions like heart disease, hypertension, anxiety, depression and obesity; the list goes on and on. In most health conditions we’re either told or assume these health problems are irreversible in the majority of cases. What is disheartening is we as a society continue to push for simple solutions and never confront the root problem. These quick fixes are usually in the form of either a supplementation or some form of medication, which at best suppress symptoms, often with an array of other side effects. It has been stated that at least 35 unhealthy conditions, including the majority of the top 10 leading causes of death in the U.S. are contributed by physical inactivity.3 On the other hand, physical activity has been recognized as a “protective” mechanism towards conditions that are caused by physical inactivity.3 First, I’m going to outline the disease or condition and the role physical inactivity plays in its manifestation. Next, I’m going to lay out research on the prevention and treatment using physical activity on those conditions. Finally, I’m going to discuss our clinic's role in this epidemic and what exactly our mission is.

Figure 1: World Health Organization (WHO) Physical Activity Guidelines 

The Lancet just published an article outlining cases of anxiety and depression that occurred during the COVID-19 pandemic. Before 2020, depression was the leading cause of global health related burden. In 2020, before the pandemic, it was estimated that there would be an estimated 193 million cases of depression globally, however, there were a staggering 247 million cases reported globally. This is about a 28% increase of what was estimated without the pandemic. The same is true for anxiety, there were an estimated 298 million cases of anxiety anticipated for 2020, with 374 million cases reported. This is a 25% increase of what was estimated without the pandemic.5 Now, I know the pandemic could obviously account for some depression and anxiety, but I don’t believe that’s the entire explanation. As a result of the pandemic, people either weren’t working or they were working from home, gyms, restaurants, and bars were closed, as well as, sports and sports events canceled. What this meant on a physical level is that people didn’t leave their house. Period. Relating to physical inactivity, a study of five healthy males underwent 20 days of bed rest. Before they went on bed rest, these males’ aerobic fitness levels were analyzed and tested again after the 20 days of bed rest. The results showed that there was a 27% decrease in VO2max (aerobic fitness), 11% decrease in heart size, 26% decrease in maximal cardiac output, and 29% decrease in maximal stroke volume.6 I say that most of us didn’t just stay in bed all day, but are physically activity was greatly diminished, as a result of this.

Physically Active vs Physically Inactive

The Old Order Amish in Canada, on average, take ~18,000 steps for men and ~14,000 steps for women. Not only are they walking a lot, but the community is engaged in 10 and 3 hour/week of vigorous activity, 43 and 40 hour/week of moderate physical activity, and 12 and 6 hours/week of walking for men and women.7 Yet, depression and anxiety do not plague these isolated communities. It has been estimated that modern societies obtain only 1/3rd of the steps per day compared to this community. The modern American adult gets 5,117 steps per day and as a result has skewed the levels of activity within our society. “Very active'' is now 6,805 steps/day, “somewhat active” is 5,306 steps/day, “somewhat inactive” is  4,140 steps/day, and “very inactive” is 3,093 steps/day.8 It’s interesting how we’re still trying to draw conclusions as to why mental health issues are on the rise. Physical inactivity is the gatekeeper for a myriad of health conditions and it is no coincidence that as mental health conditions are on the rise, so is physical inactivity. 

You might be asking at this point… What does physical activity have to do with the prevalence of depression and anxiety? Well, a 2008 publication of physical activity guidelines demonstrated that those who were physically inactive were ~45% more likely to exhibit depressive symptoms compared to those who are active.9 Another article stated that after adjusting for other risk factors of depression (sex, age, income, alcohol use, chronic health conditions, education, race, and smoking) 22% of depression was likely directly caused by physical inactivity.10 After sifting through over 120,000 Americans through cross-sectional studies, the National Physical Activity Guidelines Report concluded that physical inactivity increases the risk for developing anxiety.9 The National Comorbidity Survey, after adjusting for sociodemographics and illness, stated that there was an increase of 1.38-1.75 fold for acquiring anxiety for those who were physically inactive.11

Physical Activity as a Treatment

A 1978 study indicated running as a viable and cost effective treatment for depression. Running reduced depression symptoms similarly to time-limited/unlimited psychotherapy.12 After walking 12 miles/week for 12 weeks, they found depressive symptoms were lowered by 47%.13 These benefits can be experienced in 10 days of adhering to a 30 minutes/day walking routine.14 Likewise for anxiety, the National Physical Activity Guidelines Report found that moderate physical activity for 25 minutes or more per day reduced anxiety symptoms.9 Not to mention that exercise prescription was actually found to be more adhered to over prescription drugs. 66% of exercise prescribed patients adhered to the program as opposed to 40% of patient prescribed medication.13 This means that a reduction in symptoms from depression and anxiety can be obtained through something as easy as walking. 

Conclusion

The question is “where do you start?” We’re innately human, so we automatically make things more complicated than the problem should be. Physical activity will be a conscious deliberate effort, but will slowly morph into an unconscious action. Meaning, you will build it into your schedule at the beginning, but eventually you will be building your schedule around it. Start with walking. You can do this in place right now. Walk around your house, up and down the stairs, in the neighborhood. It doesn’t matter, just get your body in motion and it will remain in motion. Do it everyday, as mentioned above, in modern society a very active individual is someone who acquires 6,805 steps; but remember compared to the Amish this is only 1/3rd of the steps they take. Make a goal for 10,000 and increase it from there. Once you’ve mastered walking, implement intervals of 10, 20, or 30 seconds of jogging. Graduate from there to 1, 2, and 5 minute runs. Gradually increase, always challenge yourself each bout of walking or running. If you feel better walking and jogging, join a gym and start a resistance exercise program with a trainer. The point is to exhaust every outlet to ultimately feel better, more confident, competent and the ability to handle stress. I have no evidence to support this, but being physically active is like externalizing the internal conflict and struggle within (cue Metallica) and beating them through exercise. A physical representation of thoughts, feelings, and emotions. No matter who walks through our clinic doors, I will always be a strong advocate for physical activity and the pursuit of long and healthy life; mind and body.

 

References: 

  1. Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over: United States, 1960–1962 through 2011–2014. National Center for Health Statistics Data, Health E-Stats, July 2016. 
  2. Troiano, Richard P., et al. “Physical Activity in the United States Measured by Accelerometer.” Medicine & Science in Sports & Exercise, vol. 40, no. 1, 2008, pp. 181–188., https://doi.org/10.1249/mss.0b013e31815a51b3. 
  3. Booth, Frank W., et al. “Role of Inactivity in Chronic Diseases: Evolutionary Insight and Pathophysiological Mechanisms.” Physiological Reviews, vol. 97, no. 4, 2017, pp. 1351–1402., https://doi.org/10.1152/physrev.00019.2016. 
  4. “Physical Activity.” World Health Organization, World Health Organization, https://www.who.int/westernpacific/health-topics/physical-activity. 
  5. Santomauro, Damian F, et al. “Global Prevalence and Burden of Depressive and Anxiety Disorders in 204 Countries and Territories in 2020 Due to the COVID-19 Pandemic.” The Lancet, vol. 398, no. 10312, 2021, pp. 1700–1712., https://doi.org/10.1016/s0140-6736(21)02143-7. 
  6. “Response to Exercise after Bed Rest and after Training.” Annals of Internal Medicine, vol. 71, no. 2, 1969, p. 444., https://doi.org/10.7326/0003-4819-71-2-444_1. 
  7. Bassett, David R., et al. “Physical Activity in an Old Order Amish Community.” Medicine & Science in Sports & Exercise, vol. 36, no. 1, 2004, pp. 79–85., https://doi.org/10.1249/01.mss.0000106184.71258.32. 
  8. ​​Bassett, David R., et al. “Pedometer-Measured Physical Activity and Health Behaviors in U.S. Adults.” Medicine & Science in Sports & Exercise, vol. 42, no. 10, 2010, pp. 1819–1825., https://doi.org/10.1249/mss.0b013e3181dc2e54. 
  9. United States Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans: Be Active, Healthy, and Happy! Washington, DC: U.S. Dept. of Health and Human Services, 2008, p. Ix.
  10. Rothon, Catherine, et al. “Physical Activity and Depressive Symptoms in Adolescents: A Prospective Study.” BMC Medicine, vol. 8, no. 1, 2010, https://doi.org/10.1186/1741-7015-8-32. 
  11. Goodwin, Renee D. “Association between Physical Activity and Mental Disorders among Adults in the United States.” Preventive Medicine, vol. 36, no. 6, 2003, pp. 698–703., https://doi.org/10.1016/s0091-7435(03)00042-2. 
  12. Greist, John H., et al. “Running as Treatment for Depression.” Comprehensive Psychiatry, vol. 20, no. 1, 1979, pp. 41–54., 
  13. ​​Dunn, Andrea L., et al. “Exercise Treatment for Depression.” American Journal of Preventive Medicine, vol. 28, no. 1, 2005, pp. 1–8., https://doi.org/10.1016/j.amepre.2004.09.003. 
  14. Dimeo, F. “Benefits from Aerobic Exercise in Patients with Major Depression: A Pilot Study.” British Journal of Sports Medicine, vol. 35, no. 2, 2001, pp. 114–117., https://doi.org/10.1136/bjsm.35.2.114.
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