Emotional Well-Being and

Mental Health
KNES 253 – Winter 2024

S. Nicole Culos-Reed
Health and Wellness Lab
Faculty of Kinesiology
 Readings

Textbook Chapter 13 – Physical Activity and Mental Health

Textbook Chapter 5 (read on anxiety only) – Anxiety in

Sport and Exercise

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 Depression
• Depression is a major public health concern
• > 264 million people suffer from depression worldwide
• leading cause of disability and a major contributor to overall burden of disease globally
(morbidity)
• Impacts all facets of health
• Associated with additional co-morbidities:
• Physical health concerns (e.g., heart disease, diabetes mellitus, asthma, arthritis)
• Mental health concerns (e.g., anxiety, stress)
• link to mortality

3 See: https://www.who.int/news-room/fact-sheets/detail/depression for a useful factsheet

 Depression
• Depression exists on… continuum
• From episodes of unhappiness that effect most people from time to time, to persistent low mood
and inability to find enjoyment

clinical or non clinical

• Depression can be either …depending on severity and duration of symptoms
• Not all forms of depression reach clinical levels

4 Biddle & Murtrie, 2001; Parker & Paterson, 2015

 Depression
one or more
• Depression is characterized by … of the following symptoms:
• Sustained feelings of sadness
• Feelings of guilt or worthlessness
• Disturbances in appetite
• Disturbances in sleep patterns
• Fatigue or lack of energy
• Difficulty concentrating
• Loss of interest in all or most activities
• Problems with memory
• Thoughts of self-harm/suicide automatically clinical depression
• SIGECAPS

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 Depression

• Diagnosed with DSM-V

• Clinical Diagnosis:
5+
• …symptoms including depressed mood,
loss of interest/pleasure lasting for at
least … 2 weeks

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 Causes
• Both physiological and psychological factors interact
• Neurotransmitter function interacts with … individual’s stress responses

• Factors such as heredity, coping skills, and social support influence degree to which
depression manifested

• Impact of the… environment

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USDHHS, 1999
 Measurement tools to measure change in depression via intervention,
not diagnosis

• Self-report measures in research

• BDI – Beck Depression Inventory
• CES-D – Centre for Epidemiological Studies-Depression
• Zung Self-Rating Depression Scale
• POMS – Profile of Mood States
• PHQ-9 – Patient Health Questionnaire

most common

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 Treatment

Pharmacological
• E.g., medication • side-effects
• cost
• stigma

Psychotherapy
• E.g., cognitive behavioural therapy
• duration and intensity
• cost
• stigma (seen as only
in someones head)

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 exercose

Evidence for Preventative Effects

inactivity and depression across
• Cross-sectional and prospective studies show association between …
age spectrum
• People who are less active or sedentary at greater risk for depression than people who are
more active
• Physical activity … offers defence against depressive symptoms

• Regular physical activity is useful for mental health problems

preventing

50% reduction of depression based on exercise (regularly vs never)

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 Exercise Versus ‘Traditional’ Treatments
as effective as therapies
• Exercise has been shown to be …such as relaxation, psychotherapy, and in some
instances medication
• Exercise in conjunction with psychotherapy and/or medicine yielded the best results
• combined approach when necessary
cost-effective
• Exercise is both and can improve other aspects of physical health and mental
health
• Aids in prevention of other physical maladies
• … it is WHOLE BODY

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 Exercise Prescription for Depression

• Mode
• Does not matter
• Intervention length
• At least …weeks
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• Frequency
• 3-5 times per week
• Intensity
• Aerobic 50-85% HR max, Resistance 80% of 1RM better than 20% of 1RM
• Duration
45-60 minutes
• Sessions 30-60 mins; greatest benefit at ….

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 Consensus Statements

1. Exercise has protective effects against

symptoms of depression
increase with greater levels
2. Protective effects of exercise seem to ….of
physical activity
3. Exercise associated with decreased level of mild
to moderate depression
adjunct to the professional treatment
4. Exercise may be …. of severe depression
5. Optimal types and/or amounts of physical
activity remain unknown

13 exercise not accepted in the healthcare system

 Mechanisms of Change

• Anthropological hypothesis
we were born to move
can never really test this hypothesis
(don’t know what ancestors felt)
• Endorphin hypothesis

• Monoamine hypothesis

• Mastery hypothesis

• Social interaction hypothesis

14 Mikkelsen et al., 2017

 Endorphin Hypothesis

• During stress (e.g., exercise) body produces endorphins

• Endorphins = body’s natural painkillers

• Hypothesis
• Endorphins released during exercise à ….. exercise feeling good ——> reduced depression

• Reality
• more research required

Hoffmann, 1997
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 Monoamine Hypothesis
• Explain effects of exercise on depression via alteration in neurotransmitters
• Neurotransmitters implicated in regulation of emotion
• Exercise can increase rate at ….NTs produced, released and processed
• Exercise leads to increased neurogenesis

• Much of the evidence for these models based on animal research

Chaouloff, 1997; Dishman, 1997

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 Mastery and Social Hypotheses

• Psychology is only one part of it…

• Mastery – build self-efficacy, feel better about oneself, may help to alleviate
depression
• … increase control over one’s environment

• Social Interaction –building social connections provides the support and

relationships needed to alleviate symptoms of depression
• May be an important part, but …. not causal
• Can see benefits of exercise even …. if done alone

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 What is Stress?
face challenges (stressors)
• What we experience when we ….. in our lives
• Psychophysiological tension experienced in face of …. real and/or perceived challenges
• Stressors (challenges) can be:
• External or Internal
eg. exercise, learning
• Distress (negative) or Eustress (positive)
• Sources – biological, psychological, interpersonal
• Primary appraisal
• Assessing stressor as ….important and potentially demanding
• Secondary appraisal
• Assessing ….stressor can lead to revision of primary appraisal
resources to deal with
what determines impact of stress

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 Key Point
People self-report feeling less stress following acute exercise bouts and feeling less stressed in general when physically
• … active
• Seems likely exercise useful in reducing stress response
• Whether in terms of reduced reactivity to stressor or faster recovery from stressor
remains unclear
• Research necessary to examine both aspects of stress response and potential
buffering effects exercise may have
• Exercise can lead to:
• Reduced risk of disease and disability associated with stress
• Exercise is associated with less stress, better coping
- potential mechanism - socializing

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 Defining Anxiety
• Anxiety disrupts thought processes, behavior,
and alters physiological functioning
• When anxiety affects processes to such an
extent that normal behavior is disrupted,
it becomes clinical
“clinical” anxiety distinguished from “normal” anxiety on basis of
• ….number and intensity of symptoms,
degree of suffering, and degree of
dysfunction
• Diagnosed with DSM-V

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 Defining Anxiety

Anxiety is more than increased arousal:

1. Perceptions and concern over threat …. disproportionate to actual threat
2. Cognitive and behavioral actions undertaken to avoid symptoms of anxiety
3. Anxiety usually experienced …. far longer than arousal lasts
4. Anxiety can occur in absence of actual threat; ….can result in anxiety
even perceived threat

21 (USDHHS, 1999)
 Prevalence
16-18%
• … prevalence rate for diagnosable anxiety disorder in US adult population
• Of those individuals diagnosed:
• 22.8% serious
• 33.7% moderate
• 43.5% mild doesn’t mean its not disruptive

22 National Institute of Mental Health

 Symptomology
• Anxiety can be manifested both psychologically and physiologically and is characterized
by one or more of the following:
• Unpleasant feelings (emotions)
• X Bodily symptoms
• x Changes in cognition
• Changes in behavior
• Vigilance
• Treatment: same as depression – meds, therapy…limitations!

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 Measurement
• State Anxiety:
transient emotional state
• ….characterized by feelings of apprehension and heightened autonomic nervous system
activity single bout
• Assess before and after ….of exercise
• Trait Anxiety:
general predisposition
• ….to respond with anxiety across many situations
• Assess before and after …exercise program
chronic

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 Measurement

• Psychological measures
• Self-report inventories (STAI, POMS-T)

• Physiological measures
• Blood Pressure and Heart rate (ECG)
• Muscle tension (EMG) may just be response to exercise - physiological measures of exercise can be seen in anxiety
• Sweaty palms (GSR) as well
• Neurocognitive (EEG, fMRI)
• Neuroendocrine (salivary assays)

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 Treatment
• Physical Activity
• Exercise now examined as potential tool in prevention and treatment of anxiety
• Worldwide survey: (Stubbs et al., 2017)
• 47 countries (n=237,964 adults)
• Adjusted for age and sex, …. anxiety was associated with low PA
• Systematic review: (Mochcovitch et al., 2016)
• 8 studies (n=278 healthy older adults)
• Regular and supervised PA resulted in …. decreased anxiety
• Meta-analysis of 8 RCTs: (Rebar et al., 2015)
• 306 study effects with 10,755 participants
• PA ….in non-clinical populations
reduced anxiety

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low fit high anxious people = more to gain

 Evidence for Exercise as Treatment
• Some evidence suggests …. exercise useful in treatment of anxiety
• Regular exercise habits associated with low symptom scores
• Increase in fitness, not just PA level, associated with anxiety reduction
low-fit and highly anxious people may have most to gain
• ….from exercise training from psychological perspective
• Moderate intensity exercise ….sufficient to decrease anxiety
• Exercise has been shown to be as effective as other …. known anxiety-reducing treatment

some exercise causes increased anxiety - eg. resistance training; muscle tension can mirror muscle tension during
anxiety

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 Defining Emotional Well-Being
• All emotions and moods are under affect positive affect and negative afffect

• Affect:
• A more general “valenced” (like or dislike) response
• Evolutionarily more primitive (i.e., pain)
• …thought processes to precede it
does not require

• Well-being: = satisfaction of life or quality of life

• A greater amount of positive affect than negative affect
• Favorable thoughts such as satisfaction with life

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 Defining Emotional Well-Being
• Moods:
• Subjective states that have a …. cognitive basis
• Can enhance or interfere with behavior
• Come and go with sometimes ….unidentifiable causes
• Emotions:
• … an immediate response to a specific stimulus that requires some level of cognitive input
• Usually short term, more intense and variable than moods
• Causes identifiable

• If exercise reduces negative emotions and increases positive emotions, it should result
in better emotional well-being.

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 Exercise-Specific Measures
• Exercise-specific measures:
• Exercise-induced Feeling Inventory (EFI)
• Subjective Exercise Experiences Scale (SEES)
• Physical Activity Affect Scale (PAAS)
• Feeling Scale (FS)
• Limitations:
• None have shown to be any more sensitive to exercise stimuli or better capture
the exercise context than general well-being measures

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 Temporal Dynamics of Affective Responses
before and after
• Majority of literature has studied affective responses …exercise
• Some more recent investigation into affective responses during exercise
during exercise
• Affect experienced …distinct from affective change before and after exercise
• Partially intensity-based

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 Temporal Dynamics of Affective Responses
• Important implications in exercise prescription
• If person does …. not feel well during exercise, even if he/she feels better afterwards, may be less inclined to
continue the activity
more so when they’re new to exercise
• Post-exercise positive feelings may not “override” negative feelings during exercise

32 Image Source: Google Images

 Dose-Response for Positive Impact

• Some researchers have proposed threshold of intensity and duration must

be reached before significant changes in affect can be realized

• Others suggest affect benefit maximized by exercising regularly for a

specific length of time

• Moderate amounts of exercise …usually energize exerciser

• Positive affect tends to increase pre-post exercise following exercise …intensities that are not
exhaustive

• Recommend exercise for 20-30 minutes duration and intensities in

moderate range (70% aerobic capacity) to achieve positive psychological
changes
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 HIIT Training – Good or Bad?
• Following high intensity exercise, negative
affective states may be increased, and positive
affective states decreased, …particularly in less fit individuals

• In more fit individuals, even high-intensity

exercise may result in improved positive affect
after exercise (Ekkekakis & Petruzzello, 1999)

it has to be high intensity for them, not general athlete’s level of high intensity

34 Image Source: Unsplash time is the element we change the most

 Negative Psychological Effects of Exercise

• … Overtraining
• Training at a level greater than what the individual is accustomed to in terms of frequency,
intensity, and/or duration
• … Staleness Syndrome
• Negative mental health and poor performance
• Think about the 1/3 rule
• Exercise Dependence Syndrome biggest one

“addiction”
“excessive exercise"
“compulsive exerciser"
“obligatory”

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 REMEMBER DSMV for Exercise diagnostics blah blah balh

Signs of Exercise Dependence

• Tolerance increased amount of exercise

• Need for ….to achieve desired effect
same amount
• Diminished effect with …of exercise
• Withdrawal
exercise missed
• Withdrawal symptoms when … –e.g., tension
• Exercise relieves or helps avoid …withdrawal symptoms
• Intention Effects
• Exercise often lasts longer than originally intended
• Loss of Control
• Persistent desire and/or unsuccessful effort to control exercise
• “I am unable to reduce how long I exercise”

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 Take-Home Messages

Evidence links lack of physical activity with increased risk for and prevalence of … depression and anxiety

Evidence supports using exercise to alleviate stress, and may make one more … “resilient”

Physical activity is associated with improved treatment outcomes

• Physical activity should be considered important part of any treatment regimen for depression; some evidence for
anxiety; supportive for stress to enhance overall well-being

Beyond positive effects for depression, physical activity can improve a range of physical and
mental health outcomes
• Improving overall mood, wellness, and quality of life
• further reducing risk of depression

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 EXAM REVIEW

• All content since midterm 1

• Online health coaching modules
• HRQL
• Social Support
• Emotional well-being – Stress, Anxiety, Depression
• Lab – reading

• Same format – 35 multiple choice, 5 fill-in-blanks, 5 short answer

• 50 minutes, in class

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