Exercise is Medicine for Depression

Depression can be a short-term state or a long-term clinical disorder.  Depression as a transient mood state is characterized by feeling sad, discouraged, or unhappy. These feelings generally resolve over the course of a few days or less.  Depression as a clinical condition is a psychiatric disorder where certain diagnostic criteria must be met.  The diagnosis of major depressive disorder requires psychiatric evaluation by a qualified professional. The diagnosis typically includes at least several of the following: weight loss, sleep disturbance, agitation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished concentration, and possibly recurrent thoughts of death.  Major depressive disorder is distinguished from transient feelings of depression by both the severity and duration of symptoms.

It is estimated that one in five adults will suffer from major depressive disorder at some point in their life.  The incidence is higher in women.  One in four adolescents suffers from depression and this increases the risk of depression later in life.   Depression has also been linked to obesity, diabetes, and heart disease.  All of these disorders, including depression, are on the rise in the United States.   These disorders are also commonplace in outpatient physical therapy clinics where individuals are recovering from injuries.  Perhaps, the knowledge and positive habits learned in physical therapy can assist those with symptoms of depression and chronic disease.  Follow-through with a long-term exercise program can produce meaningful changes in mood, physical health, and quality of life.   All of these benefits can be achieved without the adverse effects associated with other forms of treatment.

Conventional Treatments for Depression

Antidepressant medication is the staple treatment for symptoms of depression.  Approximately half of individuals with depression will respond favorably to prescription medications without side effects.  The other half will either not respond to treatment or suffer side effects from the medications such as constipation, sleep loss, blurred vision, weight gain, fatigue, nausea, and sexual dysfunction.

Treatment may involve individual or group counseling lasting several months. Psychotherapy has been shown to be an effective long-term treatment for depression.  This form of treatment is often used in conjunction with antidepressant medication for individuals with more severe depression.   Cognitive behavioral therapy is one form of psychotherapy which aims to identify and change negative thoughts in those with depression.

Exercise as a Treatment for Depression

As a stand-alone treatment, exercise has been shown to result in moderate to large improvements in depressive symptoms.  Research has also shown no difference in outcomes when comparing exercise to cognitive behavioral therapy.  When combining the results from four studies, no differences were found between the effects of exercise and antidepressant medication.  This is not to suggest that medication and psychotherapy are ineffective.  Instead, exercise may enhance the effects of these conventional treatments for depression.  And perhaps, exercise may even be able to replace them over time.

Type and Dose of Exercise to Manage Depression

Most studies showing positive effects with exercise have included some form of aerobic exercise.  Walking, jogging, and cycling are the most commonly utilized forms of aerobic exercise.  The optimal frequency of exercise has not been determined but most studies have included exercising 3-5 times per week.  Programs with higher energy expenditures have been shown to produce greater results but positive effects can be achieved with lower intensity programs. A good starting point is to perform short walks 3 days per week.   As aerobic capacity and confidence improve, exercise should be progressed based on the American College of Sports Medicine recommendations of moderate intensity exercise performed for at least 30 minutes 5 days per week.  As aerobic capacity improves, exercise intensity and duration should be progressed in order to continue to make gains.

Tips to Increase Chances of Success

The first challenge with any exercise program is simply taking the first step.  Starting small and gradually building up the intensity, duration, and frequency is a wise approach.  Expect minor setbacks along the way and do not be discouraged when they occur.  The antidepressant effects of exercise takes time.  Be patient.   Once you begin to notice small progress in your exercise capacity and overall well-being, momentum will start to build.  The key to long-term adherence is to stay disciplined and develop habits for a lifetime.  Below are a few tips to help you on your journey.

  • Pick a form of exercise you enjoy and stick with it
  • Invest in a good pair of sneakers to exercise in
  • Pick a time of day to exercise which works best for you and make this part of your daily routine
  • Set your own goals and track your progress
  • Anticipate barriers (fatigue, work duties, bad weather, etc) and develop solutions ahead of time
  • Team up with a partner or partners and you will be more likely to stick with it
  • Do not be discouraged if you miss one session. If you fall off, get right back on the next day.
  • Take a minute and appreciate how you feel at the end of each exercise session

Let us know if you need help getting started and best of luck!

References

  1. Blumenthal JA, Smith PJ, Hoffman BM. Is exercise a viable treatment for depression? ACSMs Heal Fit J. 2012;16(4):14-21. doi:10.1249/01.FIT.0000416000.09526.eb.Is.
  2. Cooney G, Dwan K, Greig C, et al. Exercise for depression (Review). Cochrane Database Syst Rev. 2013;9:1-125. doi:10.1002/14651858.CD004366.pub6.www.cochranelibrary.com.

Finished Your Physical Therapy: What’s Next?

The day has come.  You’ve dedicated your time and put in the work now you and your physical therapist have decided you’re ready for discharge.  So what happens after you have completed physical therapy?

Some patients leave physical therapy feeling 100% and return to their regular active lifestyle and prior fitness routine.  In many cases, though the patients we see are ones that do not live an active lifestyle and have no prior fitness routine. Some patients may only feel 80% better and insurance benefits or financial limitations will not allow continued care. These patients, in particular, are the ones who may leave therapy feeling uneasy or unsure.  They may have many questions they are asking themselves:

  • What if I never feel 100%?
  • When will I find time to continue the home exercises on my own?
  • How long will I have to continue these exercises for?
  • What if the exercises feel like they aren’t helping me anymore?
  • Will I be disciplined enough to do them?
  • What if the pain starts to come back?
  • What if I stop doing the exercises?

Exercise After Physical Therapy

Chances are if you are asking yourself any of these questions, you may be someone who requires or would benefit from more guidance moving forward.  Ideally, you would benefit from a long-term fitness routine or group exercise program.  If you are someone who did not exercise regularly prior to staring physical therapy there is a good chance that you will not continue to do the exercise once you are done.  The intentions may be good but many people do fall short.  Some people are disciplined self-motivators but many are not.  Also, it is easy enough to say “I can’t find the time” or “life just got in the way”.   Anyone at anytime can find the excuse as to why they haven’t been able to continue with a routine.

Building Healthy Habits

Most of the time patients attend physical therapy for 2 or 3 visits a week for a few weeks, most commonly between 4 and 8 weeks.  Research says it can take 2 months or more (66 days on average) to form a new habit.  It takes repetition for the new behavior pattern to become imprinted in your neural pathways. In fact, research by Kaushal and Rhodes suggests it takes at least 4 gym sessions per week for 6 weeks to establish an exercise habit. That doesn’t mean you can’t develop an exercise habit by going less frequently; it just means it will probably take longer for it to become automatic.

If you have already been attending physical therapy 2-3 times per week DO NOT stop dedicating that time to yourself when you are done. DO NOT take a week off and decide to figure out the next step later. DO NOT lose your momentum! If you know that you are someone who needs that continued guidance and motivation ask your physical therapist to help you find the right exercise program to start with.  Depending on your fitness level, behavior characteristics and health goals there will be options that are better for some than others.  Fitness is a booming business right now and there are plenty of options out there.  Some people don’t know where to start.  Your physical therapist will have a general knowledge of what types of exercises are done at different fitness facilities, however, depending on where you live these places vary.

Local Recommendations

The physical therapists at BSR Physical Therapy have been doing the research locally here in the Manahawkin, NJ area.  We are helping to build a library of long-term fitness options for our patients.  We want you to succeed in your health goals.

Most recently Dr. Amanda Higgins, Morgan Gamble and I attended a barre class at Black Sheep Studios on LBI.  The fitness studio had a welcoming earthy vibe.  We met with one of the owners Devon who was as personable as they come and full of energy.  It only took one class to know that this is a place where you won’t get lost in the numbers as the class sizes are small and intimate and everyone called everyone else by name.  The instructors paid close attention to form and corrective technique which is a must to get the recommendation from a physical therapist.  Their instructor Wendy provides individualized programs for people with the use of pilates transformers which is a hard find in this area.  They also provide a menu of other unique exercise classes that may be the perfect fit for some of you.

This place is one of many that can help you stay on track.  We want to see you succeed with your health and fitness long term.  Let us help you transition from physical therapy to fitness.

-Dr. Amy McMahon

 

3 Proven Strategies to Achieve Your Goals in the New Year

Every New Year starts with well-intentioned resolutions to change behaviors and achieve personal goals.  However, it is estimated that only 8% of people actually follow-through with their New Year’s resolutions.  Setting and achieving goals, whether part of a New Year’s resolution or not, is a skill which can be learned with practice and a little resilience.  In order to have any realistic chance of achieving any personal goal, you have to clearly identify what it is that you want, make a plan to achieve it and then work on that plan every single day.

Begin with a Written List

Don't skip this step
Write down your goals

First, imagine that you have all the time, money, skills, education, and experi­ence that you need to accomplish any goal you can set for yourself.  Dream big!  Write down whatever goals come to mind in 30 seconds.  Your goals must be in writing. They must be clear, specific, detailed, measurable, and written in the past tense as if they have already been achieved.  Only 3% of adults have written goals and we call these people “successful”.  Those who do not put their list in writing do not have goals, they have wishes.  The simple act of writing down your goals cements them in your subconscious mind.  Without conscious awareness, you then begin taking small incremental steps towards achieving your goals.  Next, review your list and identify the one goal which if achieved would have the biggest impact on all your other goals.  This one goal is where you start.

The strategy of putting your goals to paper is a must do within any context including those related to health and fitness goals.  For example, I have a goal related to improving my back squat performance.   My goal is as follows, “I have improved my 1-repetition maximum back squat to twice my bodyweight by the end of 2018.”  This goal is written on paper and visible on my mobile phone every time I access it.   The goal is clearly visible in my mind and not a day goes by where I will not be reminded of it.  Life’s challenges can never derail me from working on this goal.  What is your most important health or fitness goal for the New Year?  Write it down.

Develop Your Plan

Plan your success
Don’t make wishes. Set goals.

Planning starts with writing down a list of every single step that you can think of that you will have to follow to ultimately achieve your goal.  When you write out a list of all the things you will need to do to achieve your goal, you begin to see that your goal is far more attainable than you originally thought.  Next, organize your list by arranging the steps that you have identified by priority.  Identify the most important steps and begin working on them first.  The 80/20 Rule says that 80% of your results will come from 20% of your activities.  What are your 20% of activities which will make the biggest impact on achieving your goal?

Returning to my goal of improving the back squat, there are endless steps I could pursue to achieve this goal.  However, through several hours of deliberation and re-writing of my goals and priorities, I have arrived at the 3 biggest activities which will lead to goal achievement.  I will prioritize squat technique practice, gluteus maximus strength, and thoracic spine mobility.  Now, I have a clear goal, list of steps needed to achieve my goal, and clear priorities to focus on.  What is your plan to achieve your biggest goal for the New Year?

Work on Your Plan Every Day

Put first things first
Work on your plan every day

Your plan to achieving your goal and working on your priorities needs to be broken down into actionable steps.   Start by planning each day, week, and month in advance.  Plan each month at the beginning of the month.  Plan each week the weekend before.  And most importantly, plan each day the evening before.  Write down these actionable steps and then tackle the most important ones at the start of each day.  Don’t put off the most important steps to the end of the day, week, or month.  Procrastination only leads to frustration anda sense of  loss of control over your goal.

Every morning I ask myself, “If I could only do one thing all day long, which one activity would contribute the most value to my goals?”  Returning to the squat, this might include performing a series of thoracic mobility exercise first thing in the morning before the rest of the world is coming at me full speed.  Your ability to select your most important task and then to work on it with purpose, without distraction, at the start of your day will build momentum towards achieving your ultimate goal.  What is the most important action you can take at the start of your day to get you closer towards your goal?

Final Thoughts on Goals

Decide exactly what you want, write it down, make a plan, and work on it every single day.  If you commit to these strategies and develop positive habits, you will accomplish more in the next few weeks than many people accomplish in a year.  Join the 8% of people who actually turn dreams into goals and goals into reality.  Get started today and don’t look back.

Change is Hard: Build Healthy Habits for Life

Old habits die hard.   New habits are even more difficult to start.  When it comes to rehabilitating from an injury, long-term success often depends on developing new positive habits which promote a healthy and active lifestyle.   After completing a course of physical therapy or following the achievement of any fitness goal, it is easy to relax and resort back to old habits.  These old habits could be spending too much time relaxing in front of the television or losing track of several hours while parked in front of a computer.  In order to maintain or maximize positive change from an exercise program, new habits must take the place of the old habits.  Out with the old and in with the new.

 

 

Old Habits Die Hard

 

Intentional behavior change can be broken down into five stages.  Research has found that people move through these stages when modifying or changing behavior. The time a person stays in each stage is variable, but the steps required to move through the process is not.  These five stages are very applicable to optimizing outcomes in physical therapy.

 

Transtheoretical Model of Change

Stage 1: Precontemplation

The first stage is typically characterized by a resistance to change.  During precontemplation individuals do not consider change as an option or they do not see the benefit in changing.  Many who begin their rehabilitation are unsure about how exercise and behavior change can help their condition.  Perhaps, they are confused about why the doctor has not ordered an MRI?  At this point, it is imperative that the physical therapist does not attempt to coerce or force the patient into change.  Only through open communication, trust, and a positive working relationship can an individual progress beyond this stage.

Stage 2: Contemplation

During the second stage, the individual begins to see that a change may be beneficial but is unsure how to proceed.  Here a patient may begin weighing the pros and cons of following through with their initial home exercise program.  It is common for individuals to remain stuck in this stage throughout their rehabilitation.  Chronic contemplation or procrastination often leads to unsuccessful courses of treatment or frequent relapses of symptoms.  It is imperative that any patient moves beyond this stage before completing their course of care with their physical therapist.

Stage 3: Preparation

 Now the individual is ready to take the initial steps towards change.  This stage is characterized by the intention to change and taking steps towards change.  Developing a plan for change with your physical therapist is very important at this point.  Without purpose, goals, and a plan change will never be long-lasting.

Stage 4: Action

This stage is characterized by concrete steps that will lead to the desired change.  This may involve beginning a daily walking program or strength training in the gym three days per week.  This is where the foundation for lifelong positive healthy habits is built.  We like to see individuals progress into this stage before their final few visits in physical therapy.

Stage 5: Maintenance

Maintenance may be the most important stage because it involves effort to maintain the changes made during the action stage.  Success will require individuals to make modifications in their lifestyles and work to prevent relapses.  While in the maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes.  This is where positive habits are solidified.  Unfortunately, many do not remain in this stage long enough and ultimately resort to old habits leading to relapse.  We see this when dieters achieve a weight loss goal only to regain it back, plus more, within 2 years.  In rehabilitation, we often see individuals return for the same problem year after year because they were unable to follow-through with this final stage of intentional change.

 

Positive Habits Lead to Excellence

Conclusion

Some argue that it is human nature to resist change.  I disagree.  Some of us choose to remain comfortable with routines based on non-productive habits.  We will ultimately become what we think about most of the time.  If we can’t wait to leave work and relax on the couch, then this is what we will become.  If we are serious about our long-term health and life goals, we will take that 30-minute walk instead.  Any human being with purpose, goals, and a plan to change can accomplish great things.

One or two months of physical therapy are only the start towards behavior change.  Take what you have learned from your physical therapist and consider this one small step towards building healthy habits which will benefit you for a lifetime.   Long-lasting intentional change is hard but we all know waiting around for things to change never gets us closer to our goals.

Resilience: The Final Piece of Recovery from Injury

Resilience is the ability to recover from or adjust to misfortune or change.   Successful recovery from injury requires resilience to overcome physical and psychological challenges.  There will always be times during rehabilitation when things seem to never go as planned.  This could be a set back where pain or swelling increases temporarily for unexplained reasons.  During these situations, it can be easy to look for excuses or a quick fix solution.  However, the true solution often lies within us in the form of resiliency.

Developing Resilience

Physical therapists, trainers, or coaches can assist by instilling a sense of resiliency within their patients or clients.  This begins by developing trust and truly understanding what the end goal is.  Understanding the desired outcome and feeling prepared for when adversity strikes is a crucial step towards building resilience.  Attempting to motivate or push individuals is rarely successful under conditions of adversity.  Parents who continuously push their child in sports often undermine resilience and contribute to burnout.  The same often occurs during rehabilitation when healthcare providers fail to collaborate and problem solve with their patients.

Resilience and Mindset

Patients and athletes recovering from an injury often expect the worst.  This mindset is extremely detrimental to recovery.  In order to handle adversity and the challenges of rehabilitation, it is important to put in good old-fashioned hard work.  This work must be purposeful, intense, and practiced repeatedly in order to build resilience.  Those who commit to putting in the work build resilience and begin to expect success.  Those who fail to put in the work often expect the next set back and feel helpless about it.  Ultimately, we become what we continuously think about.  Expecting a set back with a sense of helplessness will nearly always lead to failure.

Resilience from Michael Jordan

Putting in the Work & Mental Toughness

Following through with a rehabilitation program at 100% is an example of putting in the work.  This contributes to developing resilience through physical means such as building a foundation of strength and optimizing movement patterns.  Putting in the work also develops resilience through mental toughness.  When injury or adversity ensues, some look for passive solutions while others dig deep into their mental toughness and work to make things right.   These are life skills and personal traits which go beyond rehabilitation or sport.

Conclusion

Successful recovery from injury requires resilience.  Resilience requires purpose, goals, hard work, repetition, and mental toughness.  Developing a trusting and collaborative relationship with your physical therapist will better prepare you for when adversity strikes.   When adversity does appear, the solution is often found within.   The resilient individual will adapt and overcome.  When things are not going well during rehabilitation, take back control and get yourself back on track.