By: Irina Padua, MD, PGY-2, OhioHealth Grant Family Medicine Residency; and Sarah Vengal, MD, OhioHealth Physician Group
Reprinted from the summer issue of The Ohio Family Physician
The COVID-19 pandemic has changed the lives of all. There has been a decrease in the quality and quantity of social interaction due to quarantines, social distancing, and masking. While these measures are important to help prevent and decrease the spread of COVID-19, they have also directly affected the mental health of the general population and adolescents in particular.
In the United States, there was a 51% increase in teen girls and a 4% increase in teen boys in emergency room visits after suicide attempts in 2021 compared to 2019.1,2 The COVID-19 pandemic has changed school and community experiences for our youth, significantly affecting their mental health.1 With this crisis, it is imperative to address mental health disorders in our patients.
Family physicians are the first line for mental health screening and treatment. Oftentimes, especially during this pandemic, psychiatrists, therapists, and counselors are unavailable or have long waitlists. Some patients may also be hesitant about starting medications like antidepressants due to side effects, social stigma, and/or personal beliefs. Limited availability of psychotherapy options delay treatment for those who wish to avoid pharmacotherapy, leading to worsening of the patient’s mental health.
One way to promote better mental health is an exercise prescription. Exercise positively affects mental health. In fact, one study showed that for patients with major depressive disorder, physical activity and pharmacotherapy resulted in similar four month remission rates.3 Studies have also shown that both aerobic exercise and resistance training decreases anxiety sensitivity, a precursor to panic attacks.4,5 Thus, it is important to encourage exercise as part of the treatment of anxiety and depression.
Exercise includes aerobic activity (e.g. walking, running, biking, and swimming) and resistance training (e.g. lifting weights, using resistance bands, doing body weight exercises, and using weight machines). For anxiety and depression, it is recommended to do at least 150 minutes per week of light to moderate intensity aerobic activity (e.g. brisk walks, water exercises, or light cycling) or 75 minutes per week of higher intensity aerobic activity (e.g. jogging, swimming, hiking, and biking).6 This time can be split up between three to five days per week. An easy way to describe the intensity of activity is through real-life examples, such as during moderate activity, one can carry a conversation, but not sing a song; and during vigorous activity, one cannot carry a conversation. Always remember to start light and work up to more vigorous activity, especially if the patient is new to exercise.
For resistance training, it is recommended to do about 10 to 15 repetitions for each major muscle group (legs, back, chest, core, and arms) for two to four sets.6 Eventually, the patient will increase repetitions of more challenging resistance. The minimum recommendation for resistance training is twice a week.6 Just like with aerobic activity, start light and work up to heavier resistance. Always remember to take a rest day between resistance training days.
As the pandemic continues to cause constant change in schools, workplaces, and communities, it is important to continue screening for and treating mental health disorders. As family physicians, we should regularly encourage exercise as treatment, especially if patients are unable to obtain behavioral health therapy or are hesitant to start medication. Exercise, as shown in the example below, can be done easily at home, at a park, and even with a buddy!
References available on the Ohio Academy of Family Physicians website.