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My very first #ExerciseIsMedicine #Tweetorial is here: Breaking “it makes me feel good” into pieces
#Thread 
#TwitterPoll at the END
#Thread #TwitterPoll at the END
1/ Are you exercisingto boost your mental well-being during the pandemic
? People exercise because it makes them feel good
, but what exactly happens in our body? Keep reading to satisfy your curiosity & learn about the #mechanisms behind aerobic exercise & #mentalhealth 
to boost your mental well-being during the pandemic? People exercise because it makes them feel good, but what exactly happens in our body? Keep reading to satisfy your curiosity & learn about the #mechanisms behind aerobic exercise & #mentalhealth
2/ Anxiety and depression are common mental health conditions. The prevalence in cardiac patients is ~20-30% & 2x higher in 
vs 
. Social roles (e.g. caregiver role), cultural norms (e.g. societal sexism) and more pronounced hormonal shifts in influence this sex-difference
vs . Social roles (e.g. caregiver role), cultural norms (e.g. societal sexism) and more pronounced hormonal shifts in influence this sex-difference
3/ Pharmacotherapy
and psychotherapy (e.g. CBT) levels of anxiety and depression, yet many patients discontinue (e.g. side effects) or do not respond to treatment
Exercise
comes to the rescue as a low-risk, cost-effective, and easily accessible therapeutic option
and psychotherapy (e.g. CBT) levels of anxiety and depression, yet many patients discontinue (e.g. side effects) or do not respond to treatment Exercisecomes to the rescue as a low-risk, cost-effective, and easily accessible therapeutic option
4/ 
PA is associated with improved #anxiety #depression & #mood in population studies
MA showin anxiety & depression with
in healthy (-0.38 & -0.50) & cardiac populations (-2.59 & -0.61) Figure: http://b.link/Chekroud2018 ; http://b.link/Rebar2015 ; http://b.link/Zheng2019
PA is associated with improved #anxiety #depression & #mood in population studiesMA show
in anxiety & depression within healthy (-0.38 & -0.50) & cardiac populations (-2.59 & -0.61) Figure: http://b.link/Chekroud2018 ; http://b.link/Rebar2015 ; http://b.link/Zheng2019
5/ Anxiety and depression modify the body’s healthy neurobiological state through continuedlevels of catecholamines, cortisol, inflammatory markers & serotonin; leading to overactivity of the SNS & the HPA axis. It is hard to establish the true direction of this relationship
levels of catecholamines, cortisol, inflammatory markers & serotonin; leading to overactivity of the SNS & the HPA axis. It is hard to establish the true direction of this relationship
6/ A key difference between “good” (e.g. aerobic exercise
) and “bad” stressors (e.g. persistent anxiety
) is the prolonged state of hypercortisolemia in the latter, which is associated with inflammation, hypertension, hyperglycemia and dyslipidemia
) and “bad” stressors (e.g. persistent anxiety) is the prolonged state of hypercortisolemia in the latter, which is associated with inflammation, hypertension, hyperglycemia and dyslipidemia
7/ may reverse the altered neurobiological state & thusanxiety & depression
Let’s get into the nitty-gritty: #physiological & #psychological mechanisms responsible for the #mentalhealth benefits of
(1) Aerobic exerciserelease & function of neurotransmitters/neurotrophins:
may reverse the altered neurobiological state & thusanxiety & depressionLet’s get into the nitty-gritty: #physiological & #psychological mechanisms responsible for the #mentalhealth
benefits of(1) Aerobic exercise
release & function of neurotransmitters/neurotrophins:
8/ β-endorphins regulate emotions. in the levels of β-endorphins during & following exercise are linked with anxiety and better mood (ever felt the runner’s high?
). Aerobic exercise can the levels of β-endorphins up to 7-fold
in the levels of β-endorphins during & following exercise are linked with anxiety and better mood (ever felt the runner’s high?). Aerobic exercise can the levels of β-endorphins up to 7-fold
9/ Adults with poor mental health haveBDNF. Acute exerciseBDNF (SMD 0.46) and this acute effect isafter an exercise program (ES 0.59). Chronicin BDNF with exercise have also been reported (ES 0.27). Studies with more show smaller effect sizes 
http://b.link/Szuhany2015
BDNF. Acute exerciseBDNF (SMD 0.46) and this acute effect isafter an exercise program (ES 0.59). Chronicin BDNF with exercise have also been reported (ES 0.27). Studies with more show smaller effect sizes http://b.link/Szuhany2015
10/ Thein BDNF with exercise
has been linked withlevels of depression. Higher-intensity exercise may lead to greaterin BDNF than lower-intensity exercise
http://b.link/Gourgouvelis2018; http://b.link/Hotting2016
in BDNF with exercisehas been linked withlevels of depression. Higher-intensity exercise may lead to greaterin BDNF than lower-intensity exercisehttp://b.link/Gourgouvelis2018; http://b.link/Hotting2016
11/ Persistent anxiety blocks the cortisol feedback loop responsible for down-regulating the HPA axis. Atrial natriuretic peptides (ANP) facilitates the inhibition of the HPA axis to limit overactivity. During exercise, thein atrial stretch
fromvenous return:ANP levels
in atrial stretch fromvenous return:ANP levels
12/ In healthy adults, 30 min of aerobic exercise significantly ANP levels & anxiety in response to a stressor. Enhanced ANP contributes to the anxiolytic effects of #exercise (r=0.69, p=0.03) http://b.link/Strohle2006
significantly ANP levels & anxiety in response to a stressor. Enhanced ANP contributes to the anxiolytic effects of #exercise (r=0.69, p=0.03) http://b.link/Strohle2006
13/ Monoamines dysfunction is involved in the pathogenesis of #anxiety and #depression. Exercise serotonin synthesis (byfree form of tryptophan) and downregulates serotonin receptors
serotonin availability &release of norepinephrine & dopamine
serotonin synthesis (byfree form of tryptophan) and downregulates serotonin receptors serotonin availability &release of norepinephrine & dopamine
14/ (2) Cross-stressor adaptation: duringour bodily systems transiently adapt to meet themetabolic demand. Repeated physiological challenges with chronic exercise lead toimproved physiological control in future exercise bouts which can translate to other daily stressors
our bodily systems transiently adapt to meet themetabolic demand. Repeated physiological challenges with chronic exercise lead toimproved physiological control in future exercise bouts which can translate to other daily stressors
15/ As a result,cardiovascular reactivity. E.g. Acute:
#bloodpressure response to a stressor isif preceded by an exercise bout (ES -0.40). State anxietyfor 2-24h after exercising
This is why you shouldbefore your exam!
http://b.link/RaglinMorgan1987; http://b.link/Hamer2006
cardiovascular reactivity. E.g. Acute:#bloodpressure response to a stressor is
if preceded by an exercise bout (ES -0.40). State anxietyfor 2-24h after exercisingThis is why you should
before your exam!http://b.link/RaglinMorgan1987; http://b.link/Hamer2006
16/ Chronic: Trained adults show a lower HR and cortisol response to a stress task vs untrained. How?Tranquilizing;vasodilation,catecholamine levels & TPR due to SNS inhibition & improved β-receptors responsiveness
http://b.link/Rimmele2009 ; http://b.link/DeVries1981
Tranquilizing;vasodilation,catecholamine levels & TPR due to SNS inhibition & improved β-receptors responsiveness http://b.link/Rimmele2009 ; http://b.link/DeVries1981
17/ (3) Anxiety sensitivity: tendency to misinterpret anxiety sensations (e.g. rising HR“I’m going to have a
attack”
)
The repeated exposure to a new environment (sweat, heavy breathing) not leading to bad outcomes:anxiety when encountering other unfamiliar situations
“I’m going to have aattack”)The repeated exposure to a new environment (sweat, heavy breathing
) not leading to bad outcomes:anxiety when encountering other unfamiliar situations
18/ (4)
moodHPA axis reactivity while mood reactivity. Mood is improved for>30 min post(ES 0.47). Enjoyment may be key.
High-intensitynegative affect more than low-intensity during but NOT after. This change may coincide withself-efficacy http://b.link/Reed2006
moodHPA axis reactivity while mood reactivity. Mood is improved for>30 min post(ES 0.47). Enjoyment may be key. High-intensity
negative affect more than low-intensity during but NOT after. This change may coincide withself-efficacy http://b.link/Reed2006
19/ (5)self-efficacy (ES 0.21) & self-esteem (ES 0.23) are viable mediators of improved #mentalhealth withE.g. running 5K regularlybody satisfaction & sense of mastery that can be transferred to other situations:confidence to cope with stressors http://b.link/White2009
self-efficacy (ES 0.21) & self-esteem (ES 0.23) are viable mediators of improved #mentalhealth withE.g. running 5K regularlybody satisfaction & sense of mastery that can be transferred to other situations:confidence to cope with stressors http://b.link/White2009
20/ (6) Social #isolation worsens mental health. Anxiety & depression have a greater inverse association with team sports & recreational activities(often group-based) than with domestic chores/work-related PA (often individual)
http://b.link/Harvey2018 ; http://b.link/stephens1988
) than with domestic chores/work-related PA (often individual) http://b.link/Harvey2018 ; http://b.link/stephens1988
21/ In
in particular, group-based
with an emphasis on social interactions may maximizein anxiety & depression. Upon an adverse situation,tend to seek support from others, while
are more likely to escape or cope by taking action
Check: http://b.link/Vidal2020
in particular, group-basedwith an emphasis on social interactions may maximizein anxiety & depression. Upon an adverse situation,tend to seek support from others, whileare more likely to escape or cope by taking action Check: http://b.link/Vidal2020
22/ That was a “brief” summary of major #mechanisms behind the #exercise & #mentalhealth relationship
One thing is clear: if you don’t routinely exercise, the time to start is now! Please feel free to share your thoughts and papers to generate discussion
relationship One thing is clear: if you don’t routinely exercise, the time to start is now! Please feel free to share your thoughts and papers to generate discussion
23/ Last but not least #Poll time
If you provide care to patients, do you routinely recommend exercise
as a primary treatment for your patients with high levels of anxiety or depression? Why? (Please
share comments/successful stories/concerns)
#Poll timeIf you provide care to patients, do you routinely recommend exercise
as a primary treatment for your patients with high levels of anxiety or depression? Why? (Pleaseshare comments/successful stories/concerns)
24/ Despitebeing easily accessible, low-risk and cost-effective with remarkable health benefits, only 5% of physicians surveyed
chose exercise as 1 of their 3 most used treatments for depression, while 92% chose medications with multiple side effects http://b.link/reportuk
being easily accessible, low-risk and cost-effective with remarkable health benefits, only 5% of physicians surveyedchose exercise as 1 of their 3 most used treatments for depression, while 92% chose medications with multiple side effects http://b.link/reportuk
25/ Let’s advocate for exercise! Please help get the message across with a #RT, lack of education is often a barrier to exercise referral and participation.
If you liked the #tweetorialfollow https://twitter.com/sol_vidalalmela for more!
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