Active bodies and healthy minds: Physical activity promotes recovery from mental illness: CrossCurrents Spring 2004
CrossCurrents
by Cindy McGlynn
For Steve McNall and others in his hockey group, Tuesday is the best night of the week. It's when some 18 players - mostly
men - meet at their rink in Owen Sound, Ontario, for a pick-up hockey game. They get some exercise, work on their skills and
maybe go for dinner afterwards. After nine years of playing, McNall's own skills have advanced so much that he also plays
with an all-men's league and even has a job supervising the Tuesday night games and other recreational activities.
These hockey matches are like thousands across Canada - with one difference: each player has a serious mental illness.
McNall himself was an accomplished high school athlete not long before being diagnosed with schizophrenia. Since then, a 20-year
battle with the illness has included bouts of homelessness and substance use problems. Today, McNall is doing well on his
medication. He is married and works part-time as a recreation co-ordinator.
He says he owes a large part of his recovery to his background as an athlete and his weekly hockey games. "I don't have as
many symptoms now, and I attribute my well-being to the workouts and the teamwork," says McNall. "Group hockey has been so
good, it helped me recover to the point that I was even eligible for my job."
Stories like McNall's are inspiring, but all-too rare. Exercise is healthy for anyone, but for people with severe mental illness,
research suggests that physical activity may be very important to recovery. In addition to cardiovascular benefits, which
are desperately needed by a population plagued with poor health and a high morbidity rate, exercise increases self-esteem,
helps build social skills and reduces isolation. And when done properly, it has no negative side-effects.
A 1999 study published in the Psychiatric Rehabilitation Journal found lowered feelings of depression and improved self-esteem, body consciousness and activities of daily living among participants
with bipolar disorder, depression, schizophrenia and borderline personality disorder who exercised three days a week over
a period of 15 to 20 weeks.
Exercise may even reduce psychotic symptoms such as auditory hallucinations. A 1999 study published in the Journal of Sport and Exercise Psychology found that clients with schizophrenia reported hearing fewer voices on the days they participated in a voluntary exercise
program. Participants also reported sleeping better and feeling better about themselves and their bodies. The benefits seemed
to last up to three hours after each exercise session.
Despite these positive findings, little has been done to promote physical activity among people with mental health issues.
"There are enormous benefits to exercise programs like these," says Owen Sound social worker and case manager, Mike Schwan.
He should know: he's been facilitating the weekly recreational hockey league for Steve McNall and his teammates for most of
the 14 years it has been running. Everyone is welcome at these games, no matter what their skill level.
"Players always say how energized they feel after a game," says Schwan. "The fitness benefits help them cope with symptoms
of illness like lack of motivation or lack of energy. The other thing is the teamwork - passing to other players or setting
up a goal or scoring gives teammates a feeling of involvement in something greater than themselves. Players also feel a sense
of normalcy. Hockey is Canada's national sport and people feel like they are participating in something that's valuable in
Canada."
Facilitating the games started as a voluntary pursuit for Schwan, who went after the workday was over. His employer now recognizes
the value of the games, and Tuesday night games are now part of Schwan's job description.
But this sort of recognition of the value of physical activity is not the case in many places. Dr. Guy Faulkner, an assistant
professor in the University of Toronto's Faculty of Physical Education, says there are still many barriers to implementing
exercise as routine therapy. Systemic and attitudinal barriers persist in the medical community, where the focus remains treating
illness rather than promoting wellness. The fact that it is unclear how much to prescribe and even how exercise works to ease
psychiatric symptoms and improve well-being make physicians wary of considering it as a viable treatment.
"Those are very important questions, and the research still needs to be done," says Dr. Dori Hutchinson, director of the Center
for Psychiatric Rehabilitation at Boston University in Massachusetts. "But in some ways, it's no different than the general
population. We are approaching exercise for people with mental illness like it's different. People without mental illness
reap physiological and mental benefits from exercise and so do people with mental illness."
The answer to the question of how much physical activity to prescribe is individual evaluation, says Paul Martin-Demers, a
recreation therapist who works with up to 200 clients a week at the Centre for Addiction and Mental Health in Toronto. "The
first thing that needs to be understood is the needs of the client," says Martin-Demers. "If someone who is severely mentally
ill comes to me and says, 'I just want to participate in basketball,' I need to remember they may not have played in 20 years.
They're on medication, which perhaps has promoted weight gain."
Martin-Demers' clients go through a series of evaluations before beginning a program. Their medications are researched to
ensure there are no contraindications, and they have an ECG to check cardiac health.
Boston University's Center for Psychiatric Rehabilitation takes the same approach. "We've learned to provide a wide range
of wellness options because people are at different points of readiness to change their lifestyle," says Hutchinson. "It might
be something as simple as taking a healthy lifestyles class where they learn what a healthy lifestyle looks like. We also
offer courses in tai chi and yoga. It's important to remember that not everyone can hop on the treadmill for 20 minutes."
Some practitioners are daunted by how to motivate clients who have low self-esteem, significant weight gain and low energy
as a side-effect of medication or the illness itself. But it may not be much different than motivating anyone to exercise.
"Like everyone, clients feel strapped for time, or feel overwhelmed by unattainable goals like losing significant amounts
of weight," says Martin-Demers.
His approach to motivation is three-fold: goal setting, progressive exercise and, perhaps most importantly, one-on-one support.
For example, he would encourage a goal of walking several times per week instead of losing 30 pounds. The sessions would advance
progressively, starting off gently and building intensity as the individual gains strength and endurance. Martin-Demers is
with the client every step of the way, literally. "I give them the activity and participate in the activity. Each time they
run, I'm there."
Hutchinson agrees that personal support is crucial. "When you provide individual support, the results are much better," she
says. "That can be anything from calling people up and encouraging them to come to exercise class, to exercising with people,
to charting their progress over time so they can visually see that they are making progress."
The results Martin-Demers sees are remarkable. One woman went from having never run, to completing a 10-kilometre race four
months later. "We worked progressively, starting with a walking program for 30 minutes, then a run/walk program and then a
running program. Before we knew it, she ran a 10k."
For people with mental illness, the body often becomes the enemy. It is something to be controlled, medicated and fought against.
One of the biggest benefits of physical fitness may be reconnecting with their bodies as a source of strength, rather than
a source of illness and pain. "We tell our clients that they have a body that has value that we hold in high esteem," says
Hutchinson. "We help people begin to make changes for themselves. And we spend a lot of time telling people they have a right
to a healthy body, just like anyone else."
For more information about the Owen Sound hockey group, contact Mike Schwan at Community Connections, at 519 371-2390.
Centre for Addiction
