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Jackson, Allen W. , James R. Morrow , David W. Hill , and Rod K. Dishman. "Mental Health."
Physical Activity for Health and Fitness. Champaign, IL: Human Kinetics, 2004. 271–298.
Human Kinetics Library Platform. Web. 27 Apr. 2021.
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Copyright © Allen W. Jackson. James R. Morrow. David W. Hill. Rod K. Dishman. All rights
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from the publishers.

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Mental Health
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DOI: 10.5040/[Link]-011
Page Range: 271–298
I’ve been really down lately. I don’t know why I feel like this. I had fun in college last
year. I look around me now and it seems like everyone else is having fun. I have no
energy, I don’t care about my classes, and I feel like crying most of the time. I do
remember last year when I played tennis and took aerobics I’d feel pretty energized
afterward, and feel pretty good about myself. Now I can’t stand myself and don’t even
want to go outside of my room. I just want to sleep all day. I wonder if getting back
into exercise can help me feel better?
—Maria, 19-year-old sophomore

What do you think?

Maria is certainly describing a depressed state, though it’s hard to diagnose from her
brief statement whether or not she’s clinically depressed. However, if she is, she’s not
as alone as she thinks: about one in seven women in the United States between the
ages of 15 and 54 has experienced an episode of depression within the past year.
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Maria’s thoughts on exercise and depression are intriguing. Can physical activity
alleviate the effects of depression? How might being physically active affect
depression? Is depression just a “state of mind”—or does it have a physiological or
neurological basis?

In this chapter we’ll explore how physical activity affects depression, anxiety, and stress.
We’ll look at the symptoms of depression and anxiety and study their causes and
treatments. We’ll also explore differences in the ways stress affects people and examine
the impact of physical activity on stress. Finally, we’ll consider specific ways that physical
activity improves mental health: by improving self-esteem and sleep and by causing
biological adaptations that decrease depression and anxiety. The lab at the end of the
chapter will give you ways to estimate your own levels of tension, perceived stress, and
depression.
When most people think of physical activity’s effects on a person, they think of the
physiological benefits to physical health. In this chapter we’ll learn how certain
physiological adaptations can benefit mental health as well.

Depression
About one in five people will experience an episode of depression—feelings of despair or
hopelessness accompanied by a loss of pleasure—at some point in their lives; two of
every three people who experience depression are women. Among different races,
Hispanics tend to experience more depression than Caucasians, who in turn experience
more depression than African-Americans. The annual rate of depression among teenagers
and young adults is nearly twice that of adults 25 to 44 years old, and about four times
the rate among people over age 65. Depression is more prevalent than coronary heart
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disease or heart attacks, and the occurrence of major depression in the United States has
increased steadily during the past 50 years. (See figure 11.1 for the past year prevalence
of depression among young adults in the U.S.) Next to accidental deaths, suicide is the
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leading cause of death among college students—and depression is a major contributing

factor to suicide. According to Greenberg et al. (1993), the annual direct and indirect
costs of depression in 1990 were about $40 billion, nearly one-third of the United States’
total mental health bill of $148 billion. In this section we’ll look at the symptoms of major
depression, its causes and treatments, and the ways in which physical activity affects it.
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Figure 11.1 Past year prevalence of major depression in young adults. DATA FROM KESSLER AND
WALTERS 1998.

Depression is more prevalent than coronary heart disease or heart

attacks, and the occurrence of major depression in the United States has increased
steadily during the past 50 years.

Healthcheck

Q: Why do women experience depression more often than men?

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A: Although it’s not well understood, four hypotheses have been posed. First, men and
women tend to think differently; women think more about their troubles while men
often avoid thinking about them. Second, women may be in better tune with losses
and feelings that can result in depression. They may be more likely to seek help for
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depression, thus skewing the numbers of those who are diagnosed as depressed.
Third, women in many cultures have less control over their lives than men do,
contributing to feelings of helplessness and despair. Fourth, fluctuations in estrogen
and progesterone result in higher risk of depression for women during
menstruation, during menopause, after childbirth, and while taking bir th control
pills. Women do benefit as much as men, or even more, from the protective effects
of physical activity against depression.

Symptoms of Major Depression

The most common form of clinically diagnosed depression is a major depressive episode.
According to the American Psychiatric Association, people are going through a major
depressive episode when they have experienced at least five of the following eight
symptoms during the same two-week period and these symptoms represent a change
from previous functioning. In addition, one of the symptoms must be depressed mood or
marked loss of interest or pleasure (i.e., one of the first two symptoms from the following
list).
Depressed mood most of the day, nearly every day
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Marked loss of interest or pleasure in almost all activities most of the day, nearly every
day

Significant weight loss or weight gain when not dieting (e.g., more than 5% of body
weight in a month); decrease or increase in appetite nearly every day
Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation nearly every day, observable by others

Fatigue or loss of energy nearly every day

Feelings of worthlessness or of excessive and inappropriate guilt nearly every day

Recurrent thoughts of death (not just fear of dying); recurrent ideas of suicide with or
without a specific plan; or a suicide attempt

When a person is experiencing a major depressive episode, these symptoms cause

significant distress and impairment in social and occupational settings as well as in other
areas of the person’s life. Note that it’s not considered a major depressive episode if the
depression is caused by drug abuse or medication or a medical condition such as
hyperthyroidism. Note also that many people have these symptoms within the first two
months after a loved one has died, but it’s not considered major depression unless the
symptoms are associated with marked functional impairment, a preoccupation with
worthlessness, ideas of suicide, psychotic symptoms, or psychomotor retardation.

Causes and Treatments

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Depression can be caused by diseases that have biological consequences for the brain—
for instance, thyroid disease, diabetes, multiple sclerosis, hepatitis, and rheumatoid
arthritis. It can result from psychological, catastrophic events such as the loss of a loved
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one through death or separation. Depression can stem from loss of self-esteem (for
instance, students might feel unworthy when they don’t meet academic goals). It can also
be caused by overstimulation of the sympathetic nervous system and the hypothalamic-
pituitary-adrenal cortical system resulting from persistent anxiety or other forms of
emotional stress. (Later in the chapter we’ll discuss how disruptions of these two systems
contribute to depression.) And depression can occur for no apparent reason.

Regardless of the cause, depression is associated with imbalances in neurotransmitters,

which are chemicals that influence the activity of the brain cells that regulate mood,
pleasure, and rational thought. Research hasn’t confirmed a direct genetic abnormality
leading to depression, but some people are more vulnerable to depression when they are
exposed to stress. Repeated exposure to uncontrolled stress appears to overtax the
body’s natural biological response to threatening circumstances. Two major
neurotransmitters in the brain, noradrenaline and serotonin, modulate the nerve activity
of other cells that stimulate behavioral (e.g., motivation) and physiological (e.g., heart
rate, blood pressure, hormones) responses needed to cope with stress. After persistent
stress, the nerves that manufacture and release noradrenaline and serotonin lose their
ability to do so fast enough to keep pace with needs. As we’ll discuss, drugs can help
most people regain normal function of those cells within a few weeks. Importantly,
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growing evidence suggests that regular physical activity can both protect against loss of
function and restore lost function in ways not too different from the actions of drugs.

Depression is associated with imbalances in neurotransmitters, which are

chemicals that influence the activity of the brain cells that regulate mood, pleasure, and
rational thought.

Most depression is unipolar, characterized by depressed mood. A small percentage of

people have bipolar depression, which is also known as manic-depressive disorder. People
who have bipolar depression experience wild swings of emotions and feelings, ranging
from depressed moods to elevated, expansive, or irritated moods; this type of depression
can cause exaggerated self-confidence, risky or asocial behavior, and paranoia. People
who have bipolar depression are often treated with a drug called lithium carbonate—a
salt that influences how ions pass through brain cells and regulates nerve impulses that in
turn regulate mood, pleasure, and rational thought.

Thankfully, about 9 of 10 people who seek treatment for depression can be effectively
treated as outpatients through antidepressant medications, psychotherapy, or a
combination of the two. People who don’t respond to these treatments may be helped by
electroconvulsive therapy, in which small amounts of electric current are passed through
the brain.

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Unfortunately, in studies among people who report having experienced symptoms or

signs of depression, only about 3 in 10 actually seek the help of a mental health
professional. About half the people who have an episode of clinical depression go
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undiagnosed or misdiagnosed. Of the people who are correctly diagnosed with

depression and who would be helped by antidepressant drugs, half have never taken the
drugs and less than one-third are prescribed the appropriate dose. Many antidepressants
have negative side effects for many people; some side effects are serious (see table 11.1).
These facts point to the importance of self-help behaviors that enhance mental hygiene.
Many studies have shown that regular physical activity can prevent or reduce symptoms of
depression.

Physical Activity and Depression

Most studies that have evaluated exercise as treatment for depression were conducted
with young to middle-aged adults; reductions in depression after exercise were similar for
men and women. Fewer studies have been done with children or people over age 65,
though the mental health outcomes for these groups after exercise are nearly the same as
for people of middle age. There’s some evidence that the benefits of exercise for
reducing depression may diminish slightly as people age; however, older people have a
lower prevalence of depression than young and middle-aged adults. In contrast, the
benefits of physical activity for helping prevent depression usually occur regardless of
people’s age, gender, race, or socioeconomic status (Dunn, Trivedi, and O’Neal, 2001).
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Table 11.1. Common Antidepressant Drugs

Antidepressant drugs

Tricyclics
Anafranil (clomipramine)[*]
Asendin (amoxapine)
Aventyl (nortriptyline)
Elavil (amitriptyline)
Norpramin (desipramine)
Sinequan (doxepin)
Tofranil (imipramine)
Trimipramine (surmontil)
Vivactil (protriptyline)

Selective serotonin reuptake inhibitors

Celexa (citalopram)
Desyrel (trazodone)
Ludiomil (maprotiline)
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)

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Selective serotonin and noradrenaline reuptake inhibitor

Effexor (venlafaxine)
Serzone (nefazodone)
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[*]
The generic name of each drug appears in parentheses. Side effects: low blood pre
ssure; blurred vision; dizziness; irregular heart beat; weight gain; stomach and gastroin
testinal upsets; dry mouth; sexual dysfunction; toxicity after extended use, especially
with lithium

The benefits of physical activity for helping prevent depression usually

occur regardless of people’s age, gender, race, or socioeconomic status.

Preventing Depression
Over 30 studies conducted around the world have shown that physical activity can play a
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role in preventing depression: (Dunn et al. 2001).

The National Health and Nutrition Examination Survey I (NHANES I), a 1975 survey of
nearly 7,000 Americans aged 25 to 74, found that people who said they got little or
no exercise in their leisure time also reported more symptoms of depression
(Stephens 1988).
The Canada Fitness Survey of 22,000 Canadians aged 10 years and older yielded
similar findings (Stephens 1988). In this 1981 survey, inactive people reported more
symptoms related to negative moods in comparison to people who said they were
moderately or very active in their leisure time.
A study conducted in Germany between 1975 and 1984, of 1,500 people aged 15
and older, noted the prevalence of several types of depressive disorders for those
who stated that they currently did not exercise for sports, as compared with those
who stated that they did regularly exercise for sports (Weyerer 1992).
In all three studies, higher rates of depression occurred among inactive people regardless
of physical illness, gender, age, and social class. It’s important to note that the studies
reported cross-sectional comparisons of active and inactive people. This means that the
studies merely took a “snapshot” of physical activity and health measured at the same
time. The studies didn’t determine whether it was inactivity or depression that occurred
first. It’s possible that people became less active after becoming depressed, rather than
becoming depressed due to inactivity.
However, about 1,500 of the people originally interviewed in NHANES I were interviewed
again eight years later (Farmer et al. 1988). That follow-up survey first measured physical
activity and then looked for the later occurrence of the symptoms of depression. Among
the findings of the NHANES I follow-up were these:
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The rate of depression among sedentary Caucasian women who were not depressed
in 1975 and who remained inactive was twice that of women who said they
participated in a moderate amount of physical activity and who remained active over
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the eight years.

Caucasian men who were depressed and inactive in 1975 and remained inactive were
12 times more likely to be depressed after eight years than those who were initially
depressed but who had become physically active.

Again, these findings were observed regardless of age, education level, and
socioeconomic status.
Finally, in a study of about 10,000 Harvard male alumni from the mid-1960s through 1977,
physical activity was shown to reduce the likelihood of developing depression
(Paffenbarger, Lee, and Leung 1994). Those who spent 3 or more hours per week playing
sports during their leisure time reduced their risk of developing depression by 17% as
compared with their less active peers.
Treating Depression
About 2,500 years ago, Hippocrates prescribed exercise for his patients experiencing
depression, which he called melancholia—a term still used today for deep depression.
Modern studies show that Hippocrates knew quite well what he was doing. Physical
activity can have a positive effect on depression, and the benefits of exercise have been
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found in patients whether or not they were medicated with antidepressant drugs.
In 1984, the U.S. National Institute of Mental Health concluded that regular exercise and
physical fitness are associated with reduced depression; in 1992, a group of experts who
convened at the Second International Consensus Symposium on Physical Activity, Fitness,
and Health reached similar conclusions. These findings were corroborated in 1996 by the
U.S. Surgeon General’s report, Physical Activity and Health.
Most of the research showing that exercise improves self-ratings of mood has been done
with people having normal mental health, but some experiments involving people
diagnosed with mild unipolar depression have shown improvements in mood after several
weeks of moderately intense exercise. Both aerobic and resistance exercise have been as
effective as traditional psychotherapy and drug therapy for treating mild depression
(Lawlor & Hopker 2000). Medication yields the fastest initial response, but the positive
effects of exercise become similar to drugs after a few months (Blumenthal et al. 1999).
Also, exercisers are more likely to fully recover and less likely to relapse into depression
six months after treatment than patients treated by drugs (Babyak et al. 2000). Although
current evidence on the benefits of physical activity isn’t strong enough to let us conclude
that exercise is a substitute for drug treatment and psychotherapy, exercise is an
important aid in reducing the likelihood of developing depression or anxiety.
How Much Physical Activity Is Enough?
As we’ve seen, population studies indicate that being sedentary increases the odds that a
person will become depressed. It’s not clear how big the increased risk is, but it seems to
be about twofold. This means the risk of depression among physically inactive people is
nearly as great as their risk for developing coronary heart disease. However, unlike the
investigations on exercise and heart disease, the population studies provided no clear

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evidence concerning how much physical activity will help prevent or treat depression.
People who were very active did not report fewer symptoms of depression than people
who were only moderately active; thus it appears that while being sedentary increases the
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risk for depression, high levels of physical activity may not be any more protective than
moderate amounts of physical activity.

Being sedentary increases the risk for depression, but high levels of

physical activity may not be any more protective than moderate amounts of physical
activity.

In the Canada Fitness Survey, people were seemingly protected from symptoms of
depression if their daily leisure energy expenditure was at least 1 kilocalorie per kilogram
of body weight per day, which is a low level of activity (e.g., about 20 minutes of walking).
Risk of depression was not further reduced when the energy expenditure was raised to 2
to 5 kilocalories per kilogram of body weight per day. For example, the reduced rate of
depression was similar for people who weighed 60 kilograms (132 pounds) whether they
expended 120 calories (about 1.5 miles of walking) or 300 calories (about 3 miles of
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jogging).

Data from the Harvard alumni study did suggest a dose-dependent reduction in
depression with increased exercise; this occurred after 2,500 kilocalories of expenditure
per week. However, the significance of those findings is limited, because fewer than 1 in
10 adults in America expend this much energy in leisure-time physical activity.
Most people reported changes in self-ratings of depression after exercise whether or not
their cardiorespiratory fitness had increased. Most of the studies used jogging as the
mode of activity; a few used cycling or weight lifting. Training usually was prescribed
based on the guidelines of the American College of Sports Medicine for the types and
amounts of exercise recommended for cardiorespiratory fitness in otherwise healthy
people (see table 2.1 on page 23). Because no adverse effects were reported in these
studies, the following exercise guidelines should be appropriate for people with
depression who are otherwise healthy:
Three to five days a week
20 to 60 minutes each session
55% to 90% of maximal heart rate

Though beginners should always increase the intensity and length of their workouts
gradually, gradual progress is especially important for someone who is depressed.
Gradual progress helps to maximize feelings of success and control and minimize
potential feelings of failure if the person can’t stick with an exercise program because the
program called for too quick a progression.

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Healthcheck
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Q: What type of exercise is best for improving mood?

A: Aerobic and resistance exercise each can reduce depression and mild anxiety; most
studies have used running, swimming, and weight training. Some people may notice
immediate benefits, but for most people the biggest changes occur after about four
months of regular exercise.

Anxiety
Anxiety disorders—characterized by apprehension or worry accompanied by restlessness,
tension, and elevated heart rate and breathing—are the most common mental illnesses in
the United States, affecting about 23 million people (4% of women and 2% of men) each
year. Anxiety disorders in the United States accounted for $46.6 billion in direct and
indirect costs in 1990 (DuPont et al. 1996). While anxiety often occurs with depression,
and chronic anxiety can contribute to the risk of depression, people most often
experience anxiety apart from depression.
You’ve probably had feelings of anxiety before a big exam or a job interview. Anxiety
disorders, however, are illnesses that cause people to feel frightened, distressed, and
uneasy for extended periods of time for no apparent reason. Left untreated, these
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disorders can reduce productivity and diminish the quality of life. There are several types
of anxiety disorders. The major ones include the following:
• Phobias—Intense fear of an object, place, or situation. People with a specific phobia
experience extreme fear of something that poses little or no actual danger; the fear
causes people to avoid these objects or situations and most likely limit their lives
unnecessarily. People with social phobia have an overwhelming fear of scrutiny and
embarrassment in social situations, which causes them to avoid many potentially
enjoyable activities.
• Panic disorder—Repeated episodes of intense fear that strike without warning and
without an obvious source. Physical symptoms include chest pain, heart palpitations,
shortness of breath, dizziness, abdominal distress, and fear of dying.
• Obsessive-compulsive disorder—Repeated, unwanted thoughts or compulsive
behaviors that seem impossible to stop, typified by repetitive acts or rituals to relieve
anxiety.
• Generalized anxiety disorder—Recurrent or persistent excessive worry about everyday,
routine life events and activities, lasting at least six months. This most prevalent type of
anxiety disorder is accompanied by fatigue, trembling, muscle tension, headaches, or
nausea. State anxiety can be used to describe this condition if the feelings of anxiety are
temporary and fluctuate from moment to moment (“How do I feel right now?”); the term
trait anxiety is used if these feelings and symptoms are constant and persistent (“How
have I been feeling generally?”).

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As we’ve already mentioned, the signs and symptoms of anxiety disorders vary in number
and severity. They include agitation, excessive alertness, confusion, muscle tension,
tremors, high heart rates, palpitations, flushing, sweating, dry mouth, and urinary and
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gastrointestinal problems.
As with depression, young people tend to have more anxiety than do older people.
People in the age group of 15 to 24 experience episodes of anxiety about 40% more
often than people aged 25 to 54 years old. This is true regardless of race.

Causes and Treatments

Just as people can have a depressive temperament, people can also, through genetics
and early experiences, have an anxious temperament. And fluctuations in anxiety are a
major part of most people’s emotional lives even for those who don’t have an anxiety
disorder. Anxiety, like depression and anger, is a stress emotion. Uncertainties about
important events can lead to worry and apprehension, especially when a person feels a
lack of control over how the event is going to turn out. Life events such as romance,
divorce, paying bills, making good grades, making a good impression on others, and
getting a good job contribute to anxieties that affect the quality of life. Smaller hassles of
daily living, such as catching the bus on time, making it to class on time, and dealing with
a noisy neighbor or a nagging friend or relative, can also add to stress emotions, including
anxiety.
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Healthcheck

Q: A day or two before every big test, I start having problems sleeping, I'm very
irritable, and I often have a headache. Am I suffering from anxiety?
A: You probably are experiencing state anxiety if your symptoms only last for a few
days and go away after you take the test. If you start to feel nervous before an
exam, take a walk, try the relaxation response on page 280, and don’t forget to
allow yourself extra time to study!

Anxiety can also be more subconscious, leading to tension, digestion problems,

headaches, high blood pressure, and sleep problems, even when people don’t report
they are worried. Though feelings of helplessness can be common to the experience of
both anxiety and depression, depression is distinguished by feelings of hopelessness and
despair. A common view of scientists is that chronic anxiety can lead to depression for
some people. Anxiety and depression share a common link in that the brain cells that help
organize emotional and behavioral responses during real and imagined threat are either
overactive (such as in anxiety) or become overtaxed during chronic stress (such as in
depression). These cells lose their ability to maintain chemical balance in the brain and
physiological balance of the cardiovascular, endocrine, and immune systems.
The two most effective forms of psychotherapy used to treat anxiety disorders are
behavioral and cognitive-behavioral therapy. Behavioral therapy helps patients change
their actions through breathing techniques or through gradual exposure to what is

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frightening them. Cognitive-behavioral therapy, in addition to these techniques, teaches

patients to understand their thinking patterns so they can react differently to the
situations that cause them anxiety.
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The most effective short-term treatment of anxiety uses drugs called benzodiazepines
(see table 11.2). Receptors in the parts of the brain that are important for emotions,
particularly in the hypothalamus and the limbic system, bind benzodiazepine molecules to
brain cells; this activates a bigger molecule that contains a receptor for gamma-
aminobutyric acid, or GABA. The result is an inhibition of brain cells involved with anxiety.
Cells that manufacture GABA are located throughout the brain, but are especially
important in the hypothalamus, the limbic system, and the brain cortex. Some research
suggests that exercise helps reduce anxiety by elevating GABA levels in the brain and
altering the number of GABA receptors.

Table 11.2. Common Antianxiety Drugs and Side Effects

Antianxiety drug

Benzodiazepines
Ativan (lorazepam)[*]
Centrax (prazepam)
Paxipam (halazepam)
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Serax (oxazepam)
Valium (diazepam)
Xanax (alprazolam)

Barbiturates
Librium (chlordiazepoxide)
Tranxene (clorazepate)

Serotonin antagonist
Buspar (buspirone)

Selective serotonin reuptake inhibitors

Celexa (citalopram)
Luvox (fluvoxetine)
Paxil (paroxetine)
Zoloft (sertaline)

[*]
The generic name of each drug appears in parentheses. Side effects: Sedation; low
muscle tone; anticonvulsant effects; tolerance or dependence and withdrawal may de
velop.

Excessive responses by nerves that manufacture and release noradrenaline contribute to

signs and symptoms of anxiety, especially panic. Drugs that block receptors for
noradrenaline, called beta-blockers, help reduce feelings of panic—especially those
related to rapid heartbeat and palpitations. Inadequate responses by nerves that

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manufacture and release serotonin in the brain also contribute to anxiety, especially
obsessive-compulsive disorder. Some drugs lengthen the time that serotonin stays in the
synapse (the area between nerve cells that permits transmission of nerve signals) after it is
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released by serotonin nerves; these help manage anxiety.

Physical Activity and Anxiety

There is no compelling evidence that increased physical activity or fitness changes a
person’s temperament from an anxious one to a calm, relaxed one. However, studies do
show that a single session of physical activity can reduce state anxiety and that regular
exercise can reduce trait anxiety. Because there is no evidence that physical activity
causes the underlying sources of anxiety to disappear or causes people to perceive events
as less threatening, how can these reductions in anxiety be explained?

A number of possible explanations have been put forth. One is that exercise distracts
people from thoughts that cause anxiety or from symptoms of anxiety. This could explain
reduced state anxiety. Another view is that physical activity, by improving body image and
physical skills, increases self-esteem, which in turn reduces worry because it helps people
feel more in control of the events that cause anxiety. Yet another view is that by becoming
accustomed to the sensations of physical exertion, people are less threatened by the
physical arousal that accompanies anxiety—a key element in panic attacks. Another
explanation relates to the chance for social interaction that often occurs while people
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exercise. Because in any given year 9% of women and 6% of men have social phobias
(e.g., fear of groups), the potential benefits of the social environments of physical activity
are not trivial. Case studies show that mild physical activity can help patients with panic
disorders associated with a fear of being in public.

Learning to Relax: The Benson Relaxation Response

Regular physical activity helps many people manage tension and anxiety. However,
some meditational practices, or even just resting or taking “time-out,” can offer equally
effective alternatives for anxiety reduction. Approaches such as these can be especially
useful when an injury or illness prevents exercise, or if you find yourself overstressed or
“stale” in your exercise routine.
Benson’s Relaxation Response (Benson 1975) is based on the following ingredients:

A quiet environment

A mental symbol (mantra), such as a word or phrase, repeated in rhythmical

cadence
A passive attitude with no attention to any single thought

A comfortable, stationary position

Find a quiet, isolated area and follow these instructions:

1. Sit quietly in a comfortable position.

2. Close your eyes.

3. Thoroughly relax all your muscles. Begin at your feet and continue up to your face.
Keep the muscles relaxed throughout the entire session.
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4. Breathe through your nose and become aware of your breathing. As you breathe
out, silently say the word “One” (or substitute another word or phrase). For
example, breathe IN . . . OUT (“One”), IN . . . OUT (“One”). Breathe easily and
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naturally.

5. Continue for 10 to 20 minutes. You may open your eyes to check the time, but do
not use an alarm. When you finish, sit quietly for several minutes, at first with eyes
closed and later with eyes open. Don’t stand up for a few minutes.

6. Don’t worry about whether you are achieving a deep level of relaxation. Maintain a
passive attitude and permit relaxation to occur at its own pace. When distracting
thoughts occur, don’t dwell on them; return to repeating “One.” With practice, the
response should come with little effort. Practice the technique once or twice daily,
but not within 2 hours after any meal; the digestive process interferes with the
relaxation response.

There are still other possible explanations for the effects of physical activity on anxiety
and depression. These involve body warming during exercise; changes in brain blood
flow, endorphins, and brain neurotransmitters; and biological adaptations to physical
activity by the autonomic nervous system and the hypothalamic-pituitaryadrenal system
that operate through mechanisms similar to those of antianxiety drugs. Several of these
mechanisms, which we’ll discuss later in more detail, appear similar to those involved with
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depression, because as we’ve noted earlier, chronic anxiety can lead to depression.

Physical activity may reduce anxiety and depression by temporarily

distracting you from worries or symptoms; it may also produce more lasting changes in
self-esteem, improved sleep, and several biological adaptations that help reduce
anxiety and depression.

Aerobic exercise that lasts for about 30 minutes is associated with the largest reductions
in self-rated symptoms of anxiety (O’Connor, Raglin, and Martinsen 2000). This also is true
for physiological signs of anxiety; exercise reduces resting muscle tension as measured by
electromyography and changes electrical activity of the brain (especially by increasing the
number of alpha waves, which are believed to indicate relaxed wakefulness). Anxiety is
reduced the most about 20 to 30 minutes after exercise. In addition, studies show that
the reduction in trait anxiety after three to four months of regular exercise training is
about half the reduction that occurs after taking the most commonly prescribed
antianxiety drugs (Broocks et al. 1998).

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Aerobic exercise that lasts for about 30 minutes is associated with the
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largest reductions in self-rated symptoms of anxiety, as long as the exercise intensity is

between 55% and 90% of maximal heart rate.

As with depression, people in the Canada Fitness Survey reported fewer symptoms of
anxiety if their daily leisure-time energy expenditure was at least 1 kilocalorie per
kilogram of body weight per day. Risk for developing symptoms of anxiety was not further
reduced by increasing the energy expenditure to 2 to 5 kilocalories per kilogram of body
weight per day. Most people can reduce their risk of anxiety by expending about 50 to 80
extra calories per day—which usually occurs in about a 1-mile walk.
Although the relationship of exercise to anxiety hasn’t been studied as much as that
between exercise and depression, Breus and O’Connor (1998) found that college women
with higher-than-average trait anxiety experienced a greater-than-usual reduction in state
anxiety after 20 minutes of cycling at a mild intensity (40% of aerobic capacity).

Healthcheck
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Q: Should I be concerned about “exercise addiction?”

A: It’s true that some people are so committed to exercise that they abuse it—they let
it take priority over school, job, family, and social responsibilities and work out even
if they are injured or sick. But this addiction is not caused by exercising. It occurs in
people who are vulnerable to abusive behavior—and it’s not very common. Only
10% of Americans are active enough to become fit; surely few of them are
“addicted” in a bad way. When regular exercisers are forced to be inactive, they
usually report a worsened mood after a few days, but they don’t have the
physiological signs of withdrawal, which are the hallmark of addiction. The health
risks—both physical and mental—of being sedentary are clearly a greater concern
for the public than the potential risk of abusive exercise.

Stress
As we’ve seen, depression and anxiety are stress emotions. They differ in their subjective
aspects (e.g., despair or fear), but they have some common roots in how people respond
physiologically during stressful events. Stress occurs when the harmony or balance of
bodily functions (i.e., homeostasis) is disrupted by real or imagined threat. Stress
produces feelings of strain that are often accompanied by abnormal physiological
changes in the skin, digestion, muscle tension, heart rate and rhythm, brain activity, and
hormone levels. Catastrophic events cause stress, but so do daily hassles. Even positive
life events or daily uplifts in spirit can be stressful—but in good ways. It’s when you feel
overwhelmed by responsibilities, have too much to do in too little time, or are uncertain
about important consequences that seem out of your control that you are a candidate for
chronic stress, which strains cells, organs, and body systems. This chronic wear and tear
can contribute to a poor quality of life and to increased risk for diseases such as coronary

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heart disease and hypertension and for suppression of the immune system. Depression,
anxiety, and anger are stress emotions that can threaten homeostasis when they occur too
often or are not controlled.
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The chronic wear and tear of stress can contribute to a poor quality of life

and increased risk for diseases such as coronary heart disease and hypertension and for
suppression of the immune system.

Though it is true that some people simply are exposed to more events that cause stress or
strain (e.g., family conflicts, money problems, relationship problems, loss of a loved one,
too many hard exams), it is also true that personality and coping skills can lessen one’s
vulnerability to stress. About 50% of your temperament—whether it’s usually calm or
usually nervous or fiery—is explained by heredity and early childhood learning.
Nonetheless, you can improve your ability to deal with stress by learning skills to reduce
your exposure to stressful events or to change your outlook on life. People who view
change as a challenge or an opportunity for success, who feel in control, and who have a
strong commitment to a purpose in their lives (e.g., career, other people, spirituality)
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seem to deal better with misfortune than people whose outlook interprets change as a
threat, who feel out of control, and who lack a guiding purpose in their lives. Avoiding
fatalistic, all-or-none thinking (e.g., “I must,” “I can’t”) or catastrophic thinking (i.e.,
making mountains out of molehills) can help control emotions by helping you become
more rational in your thinking. Doing nothing but worrying about the stressful situation
exacerbates stress. Taking positive steps to deal with the situation can alleviate the stress.
In other words, if you’re stressed out about exams coming up, the best solution is to
study!

Good and Bad Stress

If chronic stress can increase your risk of conditions such as heart disease, high blood
pressure, a suppressed immune system, eating disorders, headaches, sleep disorders,
and ulcers, you might be wondering if you should attempt to remove all stress from
your life. The answer is no. A certain amount of stress is needed for optimum health
and performance—life without stress would be very boring! Stress researcher Hans
Selye made a clear distinction between distress (“bad stress”) and eustress (“good
stress”). Some level of stress (eustress) is desirable for optimal performance and well-
being; however, each person can reach a point where stress can become too much
(distress) and it starts to inhibit our mental, emotional, and physiological abilities to
function effectively (see the figure below).
Excessive stress can blunt positive emotions such as love, joy, and surprise and
exaggerate negative emotions such as anger, sadness, and fear. Exercise can
contribute to your levels of good stress when it is enjoyable and isn’t so intense that it

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causes strain or so frequent that you don’t recuperate. Moderate exercise performed
regularly can offset negative stress emotions and possibly enhance positive stress
emotions.
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Nonetheless, exercise is another good way to cope with stress once it occurs. Though
exercise usually won’t eliminate the source of stress, it can provide a temporary
distraction from the problem. An exercise program might increase feelings of control or
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commitment; it can provide a sense of success in doing something important for yourself,
which buffers the impact of stressful events.

How Physical Activity Improves Mental Health

We’ve already stated that, in addition to preventing physical disease and developing
fitness, physical activity can help improve your mental health by preventing or reducing
depression, anxiety, and perceived stress. In the following sections, we’ll discuss in more
detail how physical activity may produce lasting changes in self-esteem, improved sleep,
and several biological adaptations that help reduce anxiety and depression.

Improved Self-Esteem
Self-esteem is the value people place on their conception or view of themselves. It is a
composite of specific personal features—including physical attributes such as appearance,
endurance, strength, and sport skills—and social, academic or professional, emotional,
and spiritual attributes. Self-esteem is the cornerstone of mental health and behavior.
Depression and anxiety are often associated with low self-esteem. Because body image is
related to general self-concept, an improvement in body image or physical skills can
contribute to general self-esteem in people who place high value on physical attributes
relative to the other aspects of self-concept. Positive comments from others about fitness
or physique, or merely expectations of increased fitness, can improve self-esteem even
when actual fitness hasn’t been improved. A sense of achievement is the key.

The U.S. Preventive Services Task Force of the U.S. Office of Disease Prevention and
Health Promotion concluded in 1989 that regular exercise can improve self-esteem.
Students tend to improve self-esteem more after fitness training than after participating in
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competitive sports (where success and feelings of accomplishment are less predictable).
The biggest gains in self-esteem usually occur for people who value physical fitness or
appearance and aren’t satisfied with their current status in these areas. Believing you are
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doing something positive for yourself may be enough to improve self-esteem (Fox 2000).
Supporting this idea is a study by Desharnais et al. (1993) in which college students
improved their self-esteem after participating in an exercise program whose stated goal
was to improve psychological well-being. Students in the same study who were not told
of the goal did not report improvements in self-esteem—even though they showed
similar fitness improvements.
People who improve their fitness can gain an increased sense of mastery over physical
tasks. Some evidence suggests that this confidence can extend beyond physical activity
settings to enhance overall self-concept and life adjustment, therefore helping to reduce
anxiety and depression and enhance positive moods.

Improved Sleep
About one-third of all adults will experience insomnia sometime in their lives. Chronic
insomnia increases mortality and psychiatric problems and decreases work productivity.
People experiencing depression or anxiety commonly have disturbed sleep. Most people
who have sleep disturbances don’t seek medical treatment, but of those who do, about
half will receive a prescription drug to aid sleep. This is often a drug from the
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benzodiazepine family (refer back to table 11.2), similar to the drugs used to treat anxiety.
Many who don’t seek treatment from a physician buy over-the-counter sleep aids.
Because drugs often don’t address the source of the sleep problem, are expensive, and
can have negative side effects (see table 11.3), exercise is frequently included as a
component of good sleep hygiene.
The small number of studies of the effects of regular physical activity on normal sleepers
indicate small-to-moderate effects of increased slow-wave (deep) sleep and total sleep
time, with decreases in the time needed to fall asleep, in wakefulness during sleep, and in
REM (rapid eye movement) sleep. How exercise facilitates sleep is unknown; possible but
unconfirmed explanations include body restitution, energy conservation, anxiety
reduction, body warming, and increased production of melatonin and adenosine, body
chemicals that help regulate sleep (Youngstedt 2000).
Table 11.3. Common Sleep-Aiding Drugs and Side Effects

Sleep aid Side effects

Benzodiazepines  

Ativan (lorazepam)[*] Toxicity with barbiturates; dependency may develop

Dalmane (flurazepam)
Dormalin (quazepam)
Halcion (triazolam)
Restoril (temazepam)

Barbiturates  

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Sleep aid Side effects

Amytal (amobarbital) Toxicity; dependency may develop

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Nembutal (pentobarbital)
Seconal (secobarbital)
[*]
The generic name of each drug appears in parentheses.

In 1997, several studies were published that examined whether regular exercise promotes
sleep for people with sleep problems. Stanford University researchers found that elderly
patients with insomnia reported improvements in self-rated sleep after a 16-week exercise
program of moderate intensity consisting of 30 to 40 minutes of aerobic exercise four
times a week (King et al. 1997). Tufts University researchers reported that a 10-week,
three-days-a-week, resistance-training program improved self-ratings of sleep in
depressed adults with sleep problems (Singh, Clements, and Fiatarone 1997).

Biological Adaptations
Physical activity is unique among behavioral treatments for mental health. The increased
metabolism of physical exertion produces several responses during exercise, as well as
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more long-lasting adaptations to an exercise program, which appear to improve mental

health. Possible explanations for reduced depression or anxiety after exercise include
increases in body warming, brain blood flow, and endorphins; regulation of pituitary-
adrenal stress hormones; and changes in the autonomic nervous system, brain
noradrenaline, and brain serotonin.
Body Warming
Increases in body temperature in the range that occurs with moderate to intense exercise
under normal environmental temperatures have been associated with reduced muscle
tension. The speculation that reduced anxiety after exercise is dependent on increased
body temperature is biologically plausible, but the handful of studies testing the idea
have not supported it. Changes in anxiety after acute exercise have not corresponded
with manipulations of body temperature before or during exercise. However, the studies
that simulated natural exercise did a poor job controlling temperature or used inadequate
nonexercise control conditions. A study that effectively controlled temperature during
exercise did so in an unnatural exercise setting: subjects cycled in shoulder-deep water. It
remains plausible that increased temperature during typical exercise contributes to
reduced anxiety, but body warming probably isn’t the sole or direct cause of the reduced
anxiety or improved mood.
Brain Blood Flow
The speculation that increased brain blood flow during an exercise session can cause
changes in mood also is plausible but unverified. Studies using estimates of blood flow in
both humans and animals show that blood flow to the brain is increased during acute
exercise, but researchers haven’t examined whether the increased flow occurs in the areas
of the brain that are important in generating emotional responses and moods.

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Endorphins
Endorphins and enkephalins are proteins with analgesic properties that occur naturally in
the brain, spinal cord, adrenal gland, gut, and sympathetic nerves. They help modulate
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body temperature and the cardiovascular system during stress; they can elevate mood
and reduce pain, with effects similar to those of the powerful drug morphine. The
speculation that endorphins influence mood or anxiety following exercise may be true,
but it has been perpetuated as fact by the popular media without a scientific basis. One
type of endorphin, b-endorphin, has opiate-like effects; but its appearance in the blood
during vigorous exercise comes from the pituitary gland, not the parts of the brain
involved with the experience of emotions or moods. The influence of b-endorphins on
mood is not established. In nearly all studies, drugs that block the binding of endorphins
or opiates within brain cells did not prevent mood changes after exercise. Further, b-
endorphin is naturally blocked from entering the brain from the bloodstream. Though
studies with rats and mice show increased levels of endorphins after acute exercise, the
importance of this for behavior, emotion, and physiology is unknown.

So, while runners (and others exercising aerobically and performing resistance exercises)
may indeed experience positive moods after exercise, it’s not just because of endorphins.
Other explanations range from mental states such as feelings of accomplishment to other
brain chemicals, such as noradrenaline, serotonin, dopamine, and GABA, that affect
mood.
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Healthcheck

Q: Is “runner’s high” fact or fiction?

A: The release by exercise of endorphins—proteins that occur naturally in the brain—is
commonly understood to produce “runner’s high,” a euphoric feeling that results
for some people after moderate to intense exercise. However, there’s no good
research that supports this theory. Though endorphins play a role in feelings of
euphoria and analgesia (i.e., pain reduction), the endorphins that have been
measured in humans after exercise come from the pituitary gland, not the parts of
the brain involved with mood—so it is unlikely that they are important for mood
after exercise. Also, the biochemical basis of mood after exercise is more complex
than can be explained by a single chemical system.

Autonomic Nervous System

Many people experiencing depression or anxiety have an imbalance between the
sympathetic and parasympathetic branches of the autonomic nervous system. The
sympathetic nervous system (SNS) stimulates energy expenditure, while the
parasympathetic nervous system (PNS) helps store and conserve energy. The two systems
work together to maintain a balance of the body’s energy resources both at rest and
during stress. Normally, for example, heart rate and blood pressure are restrained by the
vagus nerve of the PNS. Under mild emotional or exercise stress, the vagal restraint is
withdrawn and heart rate and blood pressure increase. As stress becomes greater, the
sympathetic nerves increase their activity to elevate heart rate and blood pressure even
more. Sympathetic nerves stem from the portions of the spinal cord in the areas of the
trunk and stimulate organs such as the heart, adrenal glands, and arteries (see figure

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11.2). Under physical or emotional stress the sympathetic nerves stimulate the heart to
beat faster and more forcefully, the adrenal glands to secrete adrenaline and
noradrenaline, and the arteries supplying the heart and skeletal muscles to dilate so that
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blood flow increases. During physical or emotional stress, systolic blood pressure rises to
help drive blood to the muscles; the nervous, cardiovascular, and endocrine systems are
preparing for a threatening situation—the “fight-or-flight” response to danger. When
people are constantly under emotional stress but not responding physically by “fighting
or fleeing,” brain, heart, and vessel tissues are damaged. This can contribute to diseases
such as coronary heart disease and to suppression of the body’s immune system.
Noradrenaline is the main nerve chemical of the SNS. It modulates behavior during threat,
as well as hormonal release, cardiovascular function, sleep, and responses to pain. About
half of the cells that manufacture noradrenaline in the brain are located in a small area of
the upper brain stem called the locus coeruleus. These cells send nerve fibers to other
parts of the brain involved with stress and emotion—the limbic system—and to the spinal
cord. Noradrenaline is also manufactured in bundles of nerves, or ganglia, located next to
the spinal cord, and in the center of the adrenal glands located above the kidneys. As
happens during many other types of stress, during exercise noradrenaline is secreted into
the blood from the sympathetic nerves that go to the heart and skeletal muscles. During
heavy exercise the adrenal glands can also secrete noradrenaline and its related hormone,
adrenaline. The increased heart rate during exercise results from stimulation of the heart
muscle by SNS nerves and by the action of blood levels of noradrenaline and adrenaline.
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These responses by the SNS adapt to regular exercise. Vigorous exercise training
increases the capacity of the SNS to respond to maximal exercise but lowers the SNS
response to a constant submaximal exercise. For example, people who through training
improve their best mile time from 8 minutes to 7 minutes have lower levels of
noradrenaline in the blood than they had before training. Exercise training increases the
capacity of the sympathetic nerves to respond to maximal exercise while lessening the
SNS response to submaximal exercise.

Though this is yet another example of how increasing one’s level of fitness decreases the
strain of typical physical activity, the more intriguing question for this chapter is whether
this adaptation to exercise also extends to mental stress. Indeed, studies show that
people with high fitness maintain lower heart rates during mental stress. Levels of
noradrenaline or adrenaline in the blood do not explain the lower heart rate. People with
high fitness have the same levels of these chemicals during mental stress as do people
with low fitness. This is important for health because people with lower heart rates tend
to have lower risk for developing cardiovascular disease.

Rather, heart rate during most types of mental stress depends more on excitement of the
heart by SNS nerves than by adrenal hormones. This is illustrated by responses to stress
by heart-transplant patients who have no SNS nerves to the heart muscle and must rely
on adrenal hormones to increase heart rate during stress. During exercise, heart-
transplant patients can increase heart rate to nearly the same level as people with a
complete nerve supply to the heart by the action of adrenal hormones on the heart.
However, they do not have increased heart rate during most kinds of mental stress, which
elevates heart rate by 10 to 30 beats per minute in people with normal hearts.

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Figure 11.2 From From N.R. Carlson Physiology Of Behavior 5/E. Published by Allyn and
Bacon, Boston, MA. Copyright © 1994 by Pearson Education.

There is no evidence that people with higher levels of fitness perceive stressful events
differently than people with lower levels of fitness. People with high fitness probably have
lower heart rates during stress because they have less sympathetic nerve activity on the
heart or because they have what is known as increased cardiac vagal tone. The vagus
nerve slows the heart’s frequency and force of beating and relaxes or dilates arteries that
supply blood to skeletal muscle. So, a person who has increased vagal tone after exercise
training can better offset the effects of the sympathetic nerves on heart and blood
vessels, and thus have lower heart rate and blood pressure at rest and during stress.
Increased cardiac vagal tone helps reduce some of the prominent features of anxiety and
depression and also decreases the risk for coronary heart disease and sudden death.
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Hypothalamic-Pituitary-Adrenal Cortex System

During stress, the brain stimulates energy production through the hypothalamic-pituitary-
adrenal cortex system (see figure 11.3). The front half of the pituitary gland co-releases b-
endorphin and a hormone called adrenocorticotropin (ACTH), which stimulates the outer
part of the adrenal gland to secrete cortisol. Cortisol repairs tissues and maintains blood
glucose levels during stress.

When the hypothalamic-pituitary-adrenal system is functioning properly, cortisol levels

return to normal as the hypothalamus and part of the limbic system sense that enough
cortisol has been released. In major depression and panic anxiety disorder, this feedback
is abnormal— resulting in abnormally high ACTH and cortisol levels. When cortisol levels
are elevated too frequently or remain high, tissues become damaged and the immune
system is suppressed.
Highly fit people can secrete more ACTH and cortisol during maximal exercise than
people who have low fitness levels, but ACTH and cortisol during submaximal exercise
are lowered by exercise training. Thus, similar to the adaptation by the SNS, fit people
have an increased capacity to respond to severe stress and possibly a dampened
response to mild stress.
Brain Noradrenaline and Serotonin
Noradrenaline and serotonin influence attention and vigilance, hormone release,
cardiovascular function during stress, fatigue, and sleep. They play important roles in
depression and anxiety by modulating the neural activity of other brain cells in the cortex,

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limbic system, and hypothalamus. During an episode of depression, people have reduced
blood flow and neural activity in the left frontal lobe of the brain; people with an anxiety
disorder often have exaggerated brain activity in the right frontal lobe.
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A quick lesson in the structure and function of brain neurons will help you understand the
roles of noradrenaline and serotonin in these responses. People with depression and
anxiety often have impaired function of the nerve cells that manufacture noradrenaline
and serotonin. Cells that manufacture noradrenaline (found in the locus coeruleus) and
serotonin (found in a region of the brain stem called the raphe nuclei) send extensions of
the cell body called axons to other parts of the brain involved in stress and emotion—the
limbic system—and to the spinal cord.
Like all cells, neurons have a body where the cell nucleus is located, containing DNA
(deoxyribonucleic acid). The cell body also contains the machinery to translate the DNA
into the chemicals that allow the nerve to transmit an impulse to another cell through an
axon. The region of near-contact between two neurons is called the synapse. When a
neuron is excited electrically, the axon releases chemicals such as noradrenaline and
serotonin that then bind with special receptors, much like a lock and key. Then, through a
series of other chemical events, the second cell is either excited or inhibited depending
on the type of chemical and the type of receptor.

Several popular antidepressant drugs such as Prozac block serotonin release or reuptake
by the neuron after release. Other antidepressants and antianxiety drugs block the
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release or reuptake of noradrenaline. Two main effects of the drugs are to keep
noradrenaline or serotonin in the synapse longer and to decrease the number or
sensitivity of their receptors. As a consequence, drug therapy returns to normal the rate
of synthesis and release of brain chemicals. Drugs also help to stabilize the electrical
discharge of the neurons that receive and use noradrenaline and serotonin.

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Figure 11.3 Responses of the hypothalamic-pituitary-adrenal cortex system and the

sympatho-adrenal medullary system during stress. ADAPTED FROM BLACK 1995.

Though studies with humans have shown that exercise can be as effective as drug therapy
in treating mild depression if people stay active for at least five months, researchers
haven’t tested whether noradrenaline or serotonin explains the benefits of exercise. This
is so because a strong case hasn’t yet been made that exercise reduces depression in
ways similar to drugs and psychotherapy. However, studies with rats show that regular
exercise has some effects on noradrenaline and serotonin cells that are similar to those
seen after drug therapy. First, exercise training leads to higher levels of noradrenaline in
the pons, limbic system, and cortex (Dishman et al. 2000). Second, the release of
noradrenaline during stress is reduced by chronic exercise (Soares et al. 1999), possibly by
increased levels of proteins that inhibit the locus coeruleus (O’Neal et al. 2001). Third, the
metabolism of serotonin during stress is lower after chronic physical activity (Yoo et al.
2000). Fourth, the number of b-receptors for noradrenaline in the cortex is reduced by
chronic exercise, just as it is by antidepressant drugs (Yoo et al. 2000). As a mild stress,
exercise stimulates the brain—apparently enhancing its ability to manufacture and
conserve noradrenaline and serotonin during more severe stress. Exercise also increases

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neutrophins (Cotman & Engessar-Cesar 2002) which act like a “fertilizer” for brain cells,
protecting them against injury and possibly depression (Russo-Neustadt et al. 2001; Van
Hoomissen et al. 2003).
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Health Concepts
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As you’ll recall from the beginning of the chapter, Maria wondered if physical activity
could help her recover from her depressed state. She noted that her moods were
elevated when she had been regularly physically active. The good news is that regular
exercise can both help prevent and treat depression. Numerous studies have shown
that those who are more physically active have fewer symptoms of depression than
those who are less active. And this isn’t simply because those who are depressed are
less likely to be active; recall the NHANES I follow-up study of the 1,500 men and
women after eight years. Of the men who had been depressed at the outset of the
study and who had been inactive, those who became active over the years showed a
marked decrease in the symptoms of depression when compared with those who had
remained inactive. So physical activity can have a significant positive effect on mental
health.

Summary
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About one in five people will experience an episode of depression at some point in
their lives; two of every three people who have depression are women. The annual
rate of depression among teenagers and young adults is nearly twice that of adults 25
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to 44 years old, and about four times the rate among people over age 65. Depression
is more prevalent than coronary heart disease or heart attacks, and the occurrence of
major depression in the United States has increased steadily during the past 50 years.

Major symptoms of depression (that can be felt or noted nearly every day) include
depressed mood; marked loss of interest in activities; significant weight loss or gain
when not dieting; fatigue or loss of energy; feelings of worthlessness or inappropriate
guilt; and recurrent thoughts of death or suicide.

Depression can be caused by physical illnesses such as thyroid disease, by

catastrophic events, by loss of self-esteem, and by chronic anxiety and stress.
Depression is associated with imbalances in neurotransmitters, which are chemicals
that influence the activity of the brain cells that regulate mood, pleasure, and rational
thought.
Physically inactive people report more symptoms of depression than physically active
people. Physical activity can be used both to prevent depression and to treat it.
Anxiety disorders are a major mental health problem affecting about 23 million
Americans (4% of women and 2% of men) each year.
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There are several types of anxiety disorders. Symptoms include agitation, excessive
alertness, confusion, muscle tension, tremors, high heart rates, palpitations, flushing,
sweating, dry mouth, and urinary and gastrointestinal problems. As with depression,
young people tend to have more anxiety than do older people.
Most people can reduce their risk of anxiety by expending about 50 to 80 extra
calories per day—which usually occurs in about a 1-mile walk.
Stress results from real or imagined threats to a person’s sense of control and from a
disturbed physiological balance. It produces feelings of strain that are often
accompanied by abnormal physiological changes in the skin, digestion, muscle
tension, heart rate and rhythm, brain activity, and hormone levels. Chronic stress
strains cells, organs, and body systems, and can increase the risk for diseases such as
coronary heart disease and hypertension, as well as for suppression of the immune
system.
Though exercise usually won’t eliminate the source of stress, it can provide a
temporary distraction from the problem. An exercise program might increase feelings
of control or commitment; it can provide a sense of success in doing something
important for yourself—which buffers the impact of stressful events.
Physical activity may reduce anxiety and depression through cognitive mechanisms
such as temporary distraction from worries or symptoms. It may also produce more
lasting changes in self-esteem, improved sleep, and several biological adaptations in
the brain, the autonomic nervous system, and the endocrine system that help reduce
anxiety and depression and improve the ability to cope with stress. The social
interaction often gained through physical activity can also have a positive effect on
mental health.
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As you’ve just learned, physical activity can have a positive effect on mental health. Next
we’re going to switch gears and consider physical activity’s impact on aging. In the next
chapter we’ll look at how physical activity can enhance your quality of life as you age.
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Key Terms
anxiety disorders
adrenocorticotropin (ACTH)
benzodiazepines
cortisol
depression
hypothalamus
limbic system
locus coeruleus
neurotransmitters
noradrenaline
raphe nuclei
self-esteem
serotonin
state anxiety
trait anxiety

Gauging Your Levels of Stress and Depression

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