**2.6 Conclusion on causal hypotheses of exercise effects**

At this point it is unclear as to whether biochemical or psychological factors mediate the positive effects of exercise on mood states such as depression. Depression and anxiety are significant factors in PTSD and the alleviation of the emotional distress that they cause would be a productive step in treating PTSD. It may very well be that we are making an error in seeking out unitary causes for the beneficial effects of exercise and that a combination of biochemistry, psychology, and perhaps even socialization, and in some instances, spiritual issues come into play, and maybe these vary in importance depending on at what point in one's cycle of emotional distress one chooses to intervene. What we can derive from the available literature is that exercise alleviates emotional distress.

Why this is so is, as of this writing, unclear. However, from a practical point of view, it does seem that exercise produces biochemical alterations in the nervous system, even if the specific nature of these biochemical events is unclear, and it is these biochemical changes that improve negative emotional states. Perhaps a biochemical and self-efficacy interpretation in combination is the most useful model of the beneficial effects of exercise.

#### **2.7 From research to clinical perspectives**

Those clinicians who have treated individuals suffering from PTSD, anxiety, and depression know that it is a real challenge to get them to engage in exercise, despite its beneficial effects. The American College of Sports Medicine recommends that those between the ages of 18–65 should engage in moderate intensity exercise for 30 minutes 5 days a week. Moderate exercise intensity is defined as 60–80% of maximum heart rate. In general maximum heart rate has been calculated as 220 minus age multiplied by .6 to .8 So, for an individual who is 50 the calculation would be 220 − 50 = 170; 170(.6) = 102; 170(.8) = 136. Therefore the 50 year old should exercise in such a way that they maintain a heart rate of 102–136 for half an hour, 5 days a week. Is this reasonable?

The numbers presented above, exercising 5 days a week for a half hour at moderate intensity are, for all intents and purposes, unrealistic, to say the least, for many and especially for those who are depressed. Getting a depressed patient to do anything, other than that which is absolutely necessary to get on with their lives, is often a real challenge. So what is realistic? In many instances just getting them to go for a walk for 10 minutes or so maybe twice a week might be a major

accomplishment. The idea is to start at a non-challenging level as most emotionally troubled patients are not physically fit, unmotivated, and resistant to physical activity. Start slow, be encouraging and move up the exercise level slowly. Baby steps are the guiding principle here. Start emotionally distressed patients with something they might see as enjoyable. A 10 minute stroll in the park might be a suitable starting point. Certainly, a moderate to vigorous intensity level three to five times per week is likely to have a psychologically beneficial effect, but if the exercise demands become overwhelming to a patient, which they easily can, not only will the patient become discouraged, but they may also begin to believe that their therapist does not understand them and is out of touch. The patient's inability to accomplish exercise goals may likely be seen as a failure and this failure further validates a negative, depressive self-view. As in treating PTSD, the mantra here is to move slowly, and at a pace the patient can tolerate.

## **2.8 Childhood negative affectivity and PTSD reduction through exercise**

With the exception of the few studies noted above involving older children and early adolescents, there are few studies that examine the impact of exercise, anxiety, depression, and PTSD in children and yet anxiety and depression are key components of PTSD. It has been noted [12] that only about 36% of children and adolescents participate in physical education and this is unfortunate given the beneficial effects that exercise appears to have in relation to emotional disorders. The few exercise interventions that have been implemented with children do, in fact show that there is an exercise—anxiety reduction relationship. In a study involving children [13] 9–12 year olds engaged in physical activity, resistance training, and stretching for 12 weeks. Exercise resulted in reductions in anxiety, negative mood, and improvements in physical self-concept, and overall self-concept. There have been additional studies that correlated exercise among children with improvements in grades, standardized test scores, and feelings of well-being.

There are literally hundreds of empirical studies showing that exercise significantly reduces depression in adult samples and often to a degree equal to or greater than traditional cognitive therapies and psychotropic medication. As a result, there can be little doubt about the utility of exercise as an adjunct to traditional therapies or a stand-alone intervention for reducing depression. The problem with prescribing exercise, as clinicians are all too aware, is that the more depressed a person is the less likely they are to engage in exercise. They simply lack the energy or motivation to go to a gym or go outside and engage in brisk walking, jogging, or perhaps swimming. The research on childhood and adolescent depression is far less abundant than that of adults.

Children and adolescents who are depressed experience prolonged or temporary sadness, reduced interest in normal activity, negative and self-critical selfevaluation, difficulties in concentration and memory, socialization difficulties, and impairment in everyday functioning. In the United States, up to 2.5% or children and 8.3% of adolescents suffer from depression. The problems of depressed youngsters can extend well past childhood and lead to substance abuse and suicide. Approximately 7% of adolescents who develop major depressive disorder, later commit suicide as young adults. In addition to the treatment options of traditional psychotherapies and medication, physical activity has been researched as an alternative for these youngsters.

A correlational study [14] examined the relationships among self-reported exercise levels, depression, and a number of other interpersonal characteristics including relationship with parents and peers, sports involvement, drug use, and academic performance. A sample of high school seniors completed questionnaires

**77**

*The Role of Exercise in Reducing PTSD and Negative Emotional States*

establishing causality from correlational studies are well known.

reduction in depression was found for the exercise group.

depression in this experimentally based study.

**depression and PTSD**

within the school system.

and, on the basis of their answers, were divided into two groups: low exercise and high exercise. It was found that the high-exercise group reported significantly less depression, lower drug use and better relationships than the low-exercise group. While exercise appeared to produce these positive outcomes, it could be argued that those who were less depressed were more likely to have already been engaging in these positive behaviors, unlike the previously depressed individuals. The problems

In contrast to the above correlational study, typical experimental studies randomly assign participants into groups: those who receive treatment and those who do not. Data are gathered before and after the intervention, and the participants' results are compared to one another. Doing so allows researchers to make inferences about the impact of the treatment, in this case exercise, on depressive symptomology. Another study [15] implemented an after school physical activity program with children 9–12 years of age. After assessing for depressed mood, the youngsters engaged in cardiovascular and resistance exercises three times per week for 12 weeks or did not engage in exercise. Upon completion of the study a significant

A further investigation [16] examined the impact of a physical activity program

While the general thrust of the research shows that physical activity is associated with a significant reduction in depression, there are some who maintain that exercise can be a preventive measure as well. In contrast to other strategies that adolescents often use (substance use, emotional coping, and aggressive behavior), physical activity was found to decrease the likelihood of future depressive episodes. Again, this suggests that physical education programs within the schools can be a

There is abundant and ever increasing evidence that exercise can be of significant benefit in reducing adult affective disorders including PTSD. There are literally hundreds of empirical studies demonstrating the beneficial effects of exercise on adult anxiety and depression and these are major components of PTSD. There are also a growing number of studies showing that exercise can beneficially impact adult PTSD directly. The emerging research shows that it can be of value for adolescents and children. The benefit of physical exercise in reducing negative affect is that exercise fits within the natural ecology if childhood and adolescent activity. In contrast psychotherapy and psychotropic medication are alien to youngsters. Physical education classes often exist within their schools so exercise is seen as an integral part of the educational process and part of what it means to be student

Further work is needed to develop empirically sound methodologies for investigating the role of exercise in dealing with PTSD and other affective disorders. Exercise has long been seen as being of value for the physical wellbeing of children,

real benefit in promoting both physical and mental in youngsters.

**3. Conclusion: implications of using exercise to impact anxiety,** 

on the psychological wellbeing of low-income Hispanic 4th grade children. A sample of children participated in a 6-week program. They were assigned to an aerobic group involving stationary bicycling, track running, and jumping on a trampoline or a control group that participated in shooting basketballs, walking, and playing foursquare. Pre and posttest depression scores were obtained and at the end of the intervention the aerobic group reported significantly less depression than the control group. The effect size of −.97 indicates a large impact of exercise on

*DOI: http://dx.doi.org/10.5772/intechopen.81012*

#### *The Role of Exercise in Reducing PTSD and Negative Emotional States DOI: http://dx.doi.org/10.5772/intechopen.81012*

*Psychology of Health - Biopsychosocial Approach*

a pace the patient can tolerate.

accomplishment. The idea is to start at a non-challenging level as most emotionally troubled patients are not physically fit, unmotivated, and resistant to physical activity. Start slow, be encouraging and move up the exercise level slowly. Baby steps are the guiding principle here. Start emotionally distressed patients with something they might see as enjoyable. A 10 minute stroll in the park might be a suitable starting point. Certainly, a moderate to vigorous intensity level three to five times per week is likely to have a psychologically beneficial effect, but if the exercise demands become overwhelming to a patient, which they easily can, not only will the patient become discouraged, but they may also begin to believe that their therapist does not understand them and is out of touch. The patient's inability to accomplish exercise goals may likely be seen as a failure and this failure further validates a negative, depressive self-view. As in treating PTSD, the mantra here is to move slowly, and at

**2.8 Childhood negative affectivity and PTSD reduction through exercise**

in grades, standardized test scores, and feelings of well-being.

With the exception of the few studies noted above involving older children and early adolescents, there are few studies that examine the impact of exercise, anxiety, depression, and PTSD in children and yet anxiety and depression are key components of PTSD. It has been noted [12] that only about 36% of children and adolescents participate in physical education and this is unfortunate given the beneficial effects that exercise appears to have in relation to emotional disorders. The few exercise interventions that have been implemented with children do, in fact show that there is an exercise—anxiety reduction relationship. In a study involving children [13] 9–12 year olds engaged in physical activity, resistance training, and stretching for 12 weeks. Exercise resulted in reductions in anxiety, negative mood, and improvements in physical self-concept, and overall self-concept. There have been additional studies that correlated exercise among children with improvements

There are literally hundreds of empirical studies showing that exercise significantly reduces depression in adult samples and often to a degree equal to or greater than traditional cognitive therapies and psychotropic medication. As a result, there can be little doubt about the utility of exercise as an adjunct to traditional therapies or a stand-alone intervention for reducing depression. The problem with prescribing exercise, as clinicians are all too aware, is that the more depressed a person is the less likely they are to engage in exercise. They simply lack the energy or motivation to go to a gym or go outside and engage in brisk walking, jogging, or perhaps swimming. The research on childhood and adolescent depression is far less abundant

Children and adolescents who are depressed experience prolonged or temporary sadness, reduced interest in normal activity, negative and self-critical selfevaluation, difficulties in concentration and memory, socialization difficulties, and impairment in everyday functioning. In the United States, up to 2.5% or children and 8.3% of adolescents suffer from depression. The problems of depressed

youngsters can extend well past childhood and lead to substance abuse and suicide. Approximately 7% of adolescents who develop major depressive disorder, later commit suicide as young adults. In addition to the treatment options of traditional psychotherapies and medication, physical activity has been researched as an

A correlational study [14] examined the relationships among self-reported exercise levels, depression, and a number of other interpersonal characteristics including relationship with parents and peers, sports involvement, drug use, and academic performance. A sample of high school seniors completed questionnaires

**76**

than that of adults.

alternative for these youngsters.

and, on the basis of their answers, were divided into two groups: low exercise and high exercise. It was found that the high-exercise group reported significantly less depression, lower drug use and better relationships than the low-exercise group. While exercise appeared to produce these positive outcomes, it could be argued that those who were less depressed were more likely to have already been engaging in these positive behaviors, unlike the previously depressed individuals. The problems establishing causality from correlational studies are well known.

In contrast to the above correlational study, typical experimental studies randomly assign participants into groups: those who receive treatment and those who do not. Data are gathered before and after the intervention, and the participants' results are compared to one another. Doing so allows researchers to make inferences about the impact of the treatment, in this case exercise, on depressive symptomology. Another study [15] implemented an after school physical activity program with children 9–12 years of age. After assessing for depressed mood, the youngsters engaged in cardiovascular and resistance exercises three times per week for 12 weeks or did not engage in exercise. Upon completion of the study a significant reduction in depression was found for the exercise group.

A further investigation [16] examined the impact of a physical activity program on the psychological wellbeing of low-income Hispanic 4th grade children. A sample of children participated in a 6-week program. They were assigned to an aerobic group involving stationary bicycling, track running, and jumping on a trampoline or a control group that participated in shooting basketballs, walking, and playing foursquare. Pre and posttest depression scores were obtained and at the end of the intervention the aerobic group reported significantly less depression than the control group. The effect size of −.97 indicates a large impact of exercise on depression in this experimentally based study.

While the general thrust of the research shows that physical activity is associated with a significant reduction in depression, there are some who maintain that exercise can be a preventive measure as well. In contrast to other strategies that adolescents often use (substance use, emotional coping, and aggressive behavior), physical activity was found to decrease the likelihood of future depressive episodes. Again, this suggests that physical education programs within the schools can be a real benefit in promoting both physical and mental in youngsters.
