Cover Story

Who hasn't heard that a healthy body leads to a healthy mind? In fact, a 1990 meta-analysis on the effects of physical activity on depression showed that exercise, if practiced regularly, can lift depression. A 2007 study led by Duke University psychologist James A. Blumenthal, PhD, found that regular exercise may be as effective as antidepressant medication. Other studies also suggest that physical activity boosts cognitive ability, creativity and concentration.

Yet despite the evidence, many psychologists do not include exercise among their treatments, says Sam Zizzi, EdD, a sport and exercise psychology professor at West Virginia University.

"Exercise as a treatment intervention is not commonly included in doctoral training," Zizzi says.

Here are some experts' suggestions to help your sedentary clients find their stride.

  1. Look inward. Before you send your clients to the walking trail, go yourself, says psychologist Kate F. Hays, PhD, former Div. 47 (Exercise and Sport) president. You're more likely to understand the benefits and you'll feel more comfortable recommending physical activity to clients if you're physically active yourself, and you'll enhance your own well-being as well.

  2. Learn from the pros. Read up on the benefits of exercise on mental health, Zizzi says (see box). In addition, build a collaborative relationship with an expert in your area--a local exercise physiologist or wellness center director, for example. They can answer your clients' questions, and your own. "That way you don't need to be both the personal trainer and the therapist," Zizzi says.

  3. Conduct an exercise assessment. At your initial session, gather information about a client's exercise habits, physical fitness history and comfort level with physical activity in the same way you'd compile information about their medical history, says Hays. If you plan to recommend anything more strenuous than walking, request that they get medical clearance from their physician, Zizzi advises.

  4. Start small. It's challenging to transition from a sedentary lifestyle to exercising five times a week for 30 minutes or more--the Centers for Disease Control and Prevention's recommendation for adults.

    " The prototypical problem is that people will go out too fast and too hard and find exercise uncomfortable and drop out," Hays says.

    To avoid this, help clients set small, measurable goals, almost to the point where they can't fail, says Zizzi. That may mean simply going out and buying a pair of athletic shoes or workout clothes, or encouraging them to walk for five minutes the first week, 10 minutes the next, he says.

  5. Assign homework. Therapists are in a great position to help clients find exercise that they can look forward to, says Patti L. Barrows, PhD, an independent practitioner in Tampa, Fla., and a faculty member at Walden University. Encourage clients to come up with a list of options--perhaps by picking up a class schedule from their local fitness center, she says. Talk through the options and ask them to try one before your next meeting. Then discuss the experience and repeat until the client finds an exercise he or she enjoys, Barrows says.

  6. Get it in writing. Practitioners might also ask clients to write in a journal to keep track of how they feel--physically and mentally--before and after exercise. Helping people monitor their behaviors often makes them more aware of them, and allows clients to gain a clear sense of activities' benefits, says Hays.

  7. Problem solve. Helping clients identify barriers to change can go a long way toward preventing exercise dropout, says Zizzi. Work with clients to establish specific schedules for when they will exercise, and develop contingency plans for bad weather or other unexpected derailments.

  8. Plan rewards. As clients achieve their goals, sustain momentum through a reinforcement program, says Barrows. New exercisers can reward themselves by getting a massage or buying a new pair of workout shorts after they've successfully exercised three days a week for a month, for instance. It's important to work with the client to figure out the individualized incentive or reinforcement that's going to work for that person and his or her lifestyle and financial situation, she notes. With one struggling client, for example, Barrows flipped it so that if the client didn't exercise three days a week, she had to donate $10 to a charity of her choice.

    "It was unfortunate for the charity, but after that she never missed a week," Barrows recalls. "She really didn't want to part with her $10."

  9. Take therapy outside. If a patient is really struggling to get going, practitioners might consider conducting the therapy session while going for a walk, says Barrows. While this requires a discussion with the client upfront about issues of patient confidentiality and liability, it can be a great way to model positive behavior, Hays and Barrows add.

  10. Schedule regular check-ins. Take time to discuss a client's exercise routine periodically, to determine how effective the treatment has been and whether modifications are needed, says Hays. This helps them understand that nurturing the mind by taking care of the body is a marathon, not a sprint, Barrows says.

"We're not trying to get it all figured out immediately," she says. "We're trying to integrate this into a  healthy lifestyle plan that they can maintain for a long period of time."

Further Reading

For clinicians:

  • Blumenthal, J.A., Babyak, M.A., Doraiswamy, P.M., et al. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine, 69 (7) 587-596.

  • Gill, D. & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd ed). Champaign, Ill.: Human Kinetics.

  • Hays, K. (1999). Working it out: Using exercise in psychotherapy. Washington, D.C.: APA.

  • North, T.C., McCullagh, P. and Tran, Z.V. (1990). Effect of exercise on depression. Exercise and sport sciences reviews, 18 (1) 379-415.

For clients:

  • Hays, K. (2002). Move your body: tone your mood. Oakland: New Harbinger Publications.

  • Johnsgard, K. (2004). Conquering depression and anxiety through exercise. Amherst, N.Y.: Prometheus Books.

  • Leith, L.M. (1998). Exercising your way to mental health. Morgantown, W.Va.: Fitness Information Technology.

  • Ratey, J.J. & Hagerman, E. (2008). Spark: The revolutionary new science of exercise and the brain. New York: Little, Brown and Company.