How hard do you need to work out for mental health?

Dr. Natalia Jaworska is one of our Inspiration Award recipients this year. She was honoured alongside other mental health advocates at the 2019 Inspiration Awards on March 1.

While everyone knows that regular physical activity is good for our bodies, more evidence is emerging that points to exercise as an effective way to foster healthy minds. 

Studies show, for instance, that exercise can help with depression, anxiety, and stress, and that regular physical activity can serve as an effective prevention and intervention strategy for mental illness; particularly among youth. 

Given the demonstrable benefits of physical activity, the resolve to “exercise more” is always at the top of people’s lists of goals or resolutions for the New Year. 

But how hard do we actually need to work out to see the mental health benefits?

Is a daily walk enough? Or do we need to really push ourselves to our limit on the treadmill to get the best results?

That is what Dr. Natalia Jaworska is trying to uncover. 

“We all sort of know that exercise is good from an anti-anxiety point of view – i.e. healthy body, healthy mind – but what we don’t really know much about is whether the intensity of the exercise actually matters from an outcomes point of view,” says Dr. Jaworska, Director of the Clinical Electrophysiology Laboratory at The Royal’s Institute of Mental Health Research (IMHR). 

“When someone has heart disease or another chronic physical illness, they might be prescribed a particular exercise program based on their disease profile, which takes many individual factors into consideration – however, we aren’t there yet when it comes to mental health.”

As a step towards better understanding how exercise impacts the brain and mental illness – and whether the actual intensity of the exercise plays a significant role – Dr. Jaworska and her research team have launched a new clinical study that will look at the impact of aerobic exercise in depressed, transitional age youth (ages 16-24).

Using a number of assessment tools, including heart rate/cardiorespiratory fitness, brain scans, brain electrical activity (EEG) and questionnaires, the study will evaluate whether there is a difference in terms of clinical, cognitive, and neural outcomes – along with states of well-being – when participants exercise at medium versus high intensities.

Dr. Jaworska says that research in this area is particularly valuable in informing early intervention strategies for youth. 

“The brains of young people are much more ‘plastic’ than adults – they are continuing to develop, and there is greater opportunity to intervene,” she says. 

“If we can figure out what intensity of exercise has the greatest impact for young people, and what effects this has on their brains, we can more effectively personalize exercise programs and provide youth with evidence-based tools and strategies to help manage their mental health into adulthood.”

"We all sort of know that exercise is good from an anti-anxiety point of view – i.e. healthy body, healthy mind – but what we don’t really know much about is whether the intensity of the exercise actually matters from an outcomes point of view." — Dr. Jaworska, Director of the Clinical Electrophysiology Laboratory, The RoyalThe 12-week program that Dr. Jaworska and her team are running will recruit 40 participants to engage in exercise sessions at The Royal, three times per week.  

Participants will get to choose the type of aerobic exercise they prefer to engage in (i.e. cycling, treadmill, elliptical) – but the intensity of the exercise (i.e. medium or high-intensity) will be randomized. 

Before the program begins, participants will undergo a series of clinical, cognitive and neural assessments, and will also undergo a treadmill test to assess their extent of cardiac output. 

At the end of the study, these assessments will be repeated, to evaluate what changes have actually occurred in the brains of participants, at the different levels of exercise intensity. 

Changes that Dr. Jaworska’s team will be looking for include cognitive, neural, depression/anxiety symptomatology changes, and/or ideas of self-worth. 

Dr. Jaworska believes that if science can understand whether moderate intensity exercise has essentially the same impact on the brain as higher-intensity exercise, this could be a valuable piece of information for clinicians to translate to their patients. 

“It would be hugely beneficial to know whether changes in mental health can be significant, even if we are able to change somebody’s cardiac output just a little bit,” she says. 

“This might make the idea of taking up exercise less daunting for some depressed youth.” 

Having an evidence-based and accessible alternative to drug interventions may also be particularly appealing for youth, says Dr. Jaworska, as there are currently few antidepressants available for young people – and those that are prescribed can have undesirable side effects. 

She added that understanding the effects of intensity levels of exercise on mental health outcomes could also open the door for other important research questions or discoveries, such as whether there might be a sex effect (i.e. is moderate intensity exercise more beneficial for depressed females, and high-intensity exercise more beneficial for depressed males, or vice versa?). 

And while science doesn’t quite know yet whether exercise interventions alone are enough to help some individuals get – or stay – well, Dr. Jaworska says regular physical activity can be an important component of an individual’s mental health “toolbox”.

“My strategy is always the more resources you have – and the more multi-pronged approach you can take to dealing with your mental illness – the better.”

If you are 16-24 and currently experiencing depression, you may be eligible to participate in this aerobic exercise study. Click here for more information.


From research to recreational therapy

Steve Clarke is a recreational therapist at The Royal who leads regular exercise intervention programs for youth with mental health disorders. 

He will be working with Dr. Jaworska and her team during this study, to help safely orient youth to the exercise equipment they will be using during the 12-week program, and to provide additional health teachings, as needed. 

He says that the findings from this study could serve as an important teaching tool, and will be extremely valuable in informing the programs he runs with youth. 

“What we’re doing here at The Royal with exercise intervention programs is health promotion – and if you have best practices that you can quote or show people, that carries much more weight, especially with youth,” says Clarke. 

“Young people are more willing to believe a source if they can pull it up on their phones and see it, versus some middle-aged guy telling them that it is a good thing. The results from this study could go a long way in term of exercise prescription – especially if I’m able to bring the findings back to the youth I work with and say ‘this has been done here’.” 

Clarke says he is hopeful that Dr. Jaworska’s study will not only have a short-term therapeutic impact on young people’s mental health, but will also provide them with the skills and confidence necessary to continue to exercise.  

“One of the things that we run up against with youth is medication compliance – so if we can provide them with an outlet or opportunity to experience some form of treatment to abate their symptoms without medication, that can often be invaluable,” he says. 

“Hopefully though this study, young people will be able to see the difference that exercise makes, and realize that it’s something they can do on their own, in the future.”