All blog posts from Dr. Allott are provided for educational and informational purposes only. As Dr. Allott is also a licensed medical practitioner, we must make it clear that nothing on the blog is intended to constitute medical advice, consultation, recommendation, diagnosis, or treatment. If you are concerned about your health, please seek appropriate care in your area.


Minimal Metrics for Exercise

In 2018, my blog focused primarily on anxiety. This year I am thinking more about movement and mental health. A good starting place is identifying the minimal metrics for movement and how achieving these metrics can support mental health.

So, I spent some time reviewing the most recent studies for exercise.

What is definitive?

Exercise reduces dementia and reduces all causes of death. For mental health in general, cognitive functioning exercises in studies don’t always show that it is helpful. They have not shown that they decline cognitive functioning. Ok. Exercise dose not always helps to be smarter. But for depression, the research is clear: exercise is an excellent therapy on its own and in conjunction with other therapies. Exercise increases neuroplasticity, improves how the autonomic and endocrine systems respond to stress, improves sleep, improves self-esteem, …the list goes on. So, we can definitely say now that exercise is good for both the brain and body.

How much movement do the studies say is needed?

When people exercise three times a week for 12 to 24 weeks, there is a dramatic reduction of depression, and if the exercise continues, there is a reduction in recurrence. That sounds great! And… those people were selected and paid to be in the studies.

Beyond the studies and in my office

When people can feel that movement improves how they feel, then it becomes a useful tool for treating energy and mental clarity in the moment. I believe that part of treating depression, mental health, pain, and other diseased states, is to provide people with tools that move them towards resilience moment to moment. If a person has a tool that can help them feel better now, today, or later today, we can build experiences that move us away from depression, fatigue, low self-esteem, anxiety, pain, or whatever their points of suffering are. Why does this work? When people can experience change that they are in control of, and learn the value of the process, they have a model of change that can then apply to other things in their life.

But how do you actually get someone who is depressed moving?

At my last PESI training in Richmond, VA, I posed this question to the group of around 90. I like to start with the smallest possible metric, in large part because it is doable. And since I am all about being able to feel what’s going on in the body, I first asked everyone to do an experiment. You, the reader, can do the same experiment now.

The Minimal Movement Experiment

1. Check-in and rate your energy level at this moment, using the scale below.

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Now stand up. Choose one of the three possible movements that you will do four times. Here is a video of me squatting, marching and flapping my hands, in case you want to see what I am talking about.

  • Chair squats – have a chair behind you and sit down as though you are going to take a seat. Just as the chair touches you, stand back up;

  • March in place – with your knees coming up as high as it is comfortable; or

  • Overhead hand clap – raise both arms in the air and bring your hands together comfortably over your head. Clap your hands together if that sounds like fun.

Remember one of these, just four times.

3.  Sit back down and re-rate your energy level.

The majority of people in my training reported feeling at least 10% better. So, if you were initially at 6 (out of 10), you might now be at 7… in less than 30 seconds! What could you do with 10% more energy? Do you get up to snack or drink coffee at work when you might just need to move your body a little bit to get some energy and mental clarity?

Where can the experiment be done?

Certainly, YOU can do this experiment anywhere: at the office, in the bathroom, when you get off the couch from watching TV. Additionally, you can try this experiment with clients who present with fatigue or who are kinesics learners. I offer it as a mindfulness exercise for people with childhood history of trauma, as a way got them to learn to listen to their bodies. It is a small enough dose that it is unlikely to make fatigue worse. Maybe nothing is noticed, but they tried something new. I also like to give it to my clients as homework (“Since the exercise was helpful in my office, I would like you to try it when you have been sitting for more than three hours.”)

Throughout the year, I will write more about how to use movement as a way to improve energy and mental clarity.

References:

Medina JL, Jacquart J, Smits JAJ. Optimizing the Exercise Prescription for Depression: The Search for Biomarkers of Response. Curr Opin Psychol. 2015;4:43-47. doi:10.1016/j.copsyc.2015.02.003. Link to study.

Belvederi Murri M, Ekkekakis P, Magagnoli M, et al. Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes. Front psychiatry. 2018;9:762. doi:10.3389/fpsyt.2018.00762. Link to Study.

New Study: Nutrition is a Cost Effective Tool for Major Depression

Since Felice Jacka’s landmark study in 2010, accumulating evidence shows that poor nutrition contributes to depression and anxiety. For years studies have shown the importance of B vitamins, omega 3 fats in the form of EPA and DHA, and individual amino acids for correcting depression. Dr. Felice Jacka pioneered research demonstrating that whole food nutrition counts for adults and adolescents in treating depression and anxiety.

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A new study (SMILES) provides evidence that that nutrition is a cost-effective treatment for major depression. The prospective research comes from Australia and New Zealand where they enlisted 67 adults meeting the criteria for a poor-quality diet and major depression. These individuals were randomized in one of two arms of the study: nutrition support (33 people) or social support (34 people). The nutrition arm provided up to seven sessions with a nutritionist, and the social support provided the same amount of time and emotional intensity. The study took into consideration both healthcare costs and time lost at work from major depression. Below is a summary of the significant findings of the study.

Nutritional intervention: 33 people received 7 sessions with a nutritionist for support enacting the Mediterranean diet

Positive Findings

  • Higher remission rates of major depression

  • Lower missed paid and unpaid work days

  • Lower use of health care services

  • Overall health care costs on average was $940 lower

  • Lost productivity costs were $1589 lower

Downside costs

  • Higher cost of session delivery, travel and food costs

Social Support: 34 people received seven sessions of social support. No nutritional changes.

Positive Findings

  • Lover cost of session delivery, travel and food costs

Negative findings

  • Lower recovery rates and lower remission rates of depression

  • More use of allied professionals occupational therapists, such as: physiotherapists, osteopaths dentists, podiatrists, orthodontists

  • More lost productivity due to missed paid and unpaid work days.

  • Higher health care costs and lost productivity costs

Although this is a small study, the accumulating scientific evidence suggests that nutrition provides support for depression as a therapeutic tool. Additionally, major depression increases the risk of diabetes, cardiovascular disease, and obesity. All of these conditions are costly to the person, negatively impact productivity at work, drive health care costs up, and have studies associated with them that show nutrition can slow or reverse the disease. When we are connected to a person suffering from depression helping them take action to address the depression can be life-changing.

The typical therapeutic tools for major depression are psychotherapy, medications, and maybe mindfulness. If nutrition is going to be referred to, we have to create a path that lowers the shame. Most people believe that they should be able to improve their diet on their own and recognize that they don't--causing shame.

I want to review some options for getting traction when examining a person’s diet, used in the context of a therapeutic ally or psychotherapist.

Possible Experiments

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1. First, I am going to refer to our previous blog about Hope Rising by Chan Hellman, Ph.D. When someone is stuck in depression it is possible that they are missing some important tools. Dr. Hellman discusses that for Hope to exist we have to have both Waypower and Willpower to achieve our goals. In other words, we need to have a path with small achievable steps laid out, and we need willpower which is a personal investment in our goal and good nutrition to keep us in our pre-frontal cortex (the "smart brain") and out of our the limbic system (the "lizard brain"). So when I am discussing the causes of depression with someone, I try to identify whether they know what the next couple of steps are toward a goal -- any goal, or if they do not have the will power to move forward. If they don't have the willpower and their diet is low in nutrients, I will start doing 3-day experiments with food or movement/exercise. (See my handout on 3 Days of Protein to increase energy and mental clarity).

2. From a motivational interviewing perspective, giving them a choice on what they are willing to try to address their depression and then set a time to see if the therapy helped. For example, I will go see a nutritionist 7 times over 12 weeks. I will walk every day for 10 minutes for 30 days.. The activities can include medication, nutrition, mindfulness, movement/exercise, or a gratefulness diary, to name a few. Put a timeline on how long you will try that path before trying another path.

3. At the start of a relationship, or when a client reports a particularly bad day, simply ask, “What did you eat yesterday?” The brain needs fuel just like the body and sometimes what and when we eat or don’t eat has an influence on how we feel. One child therapist I know asks the parents when they meet, "What is happening in the home?" She always follows up with questions about what the child has been eating. She barely has to comment on the cereal, pizza and mac and cheese pattern for them to notice the relationship between the food quality and their child's behavior. Our intention of healthy meals easily becomes lost in the busyness of life.

4. If a person is stuck in their depression, ask if they are willing to do an experiment for 3 days to change their nutrition. We have a video and a handout on increasing protein to improve energy and mental clarity. Note that some people may not be able to notice a difference until they go back to their original diet.

5. Find a good referral for nutrition in your area. There are many professionals that can discuss nutrition. Here are some professionals to approach possible referrals: nutritionists, acupuncturists, naturopathic physicians, and health coaches, to name a few. One of the important questions to ask is if the person is comfortable helping someone improve their diet without the goal of losing weight. If the depressed person is overweight, I find that it’s important to focus first on having more energy and mental clarity and feeling better day-to-day before embarking on losing weight. Often the loss of fat can make an individual feel bad because fat contains hormones, heavy metals, and other toxins. The release can overwhelm the liver and cause fatigue and distress. Without the right context, this can be confused with depression even though it is a physiological response to losing fat from their body.

We all know that when we feel better, and have more energy and mental clarity, work and life don’t seem as overwhelming and those small steps towards a goal are more accessible. Better management of anxiety and depression through nutritional interventions is a cost-effective way to improve both quality of life and productivity. What are the first steps that businesses can take support their employees on this path?