Exercise Psych - exam Flashcards
Define affect
Expression of value given to a feeling state
Positive or negative
Define emotions
Brief responses of negative or positive feelings evoked by particular situations
Can contribute to mood
Define mood
Host of transient fluctuating affective states that can be positive or negative
Types of Factor that can affect mood
Exogenous- transient conditions in the environment
Endogenous rhythms- innate biological processes eg menstrual cycle
Traits and temperament -general tendency people have in experiencing affect
Characteristic variability- individual differences in the magnitude of mood fluctuations
Other things that affect mood
Repeated intense emotions
Physiological changes - sleep, drugs, exercise
How does exercising affect mood
Hormones - endorphins, serotonin, noradrenaline, adrenaline, dopamine (runners high)
Self - esteem + self efficacy
Previous experience exercising
Task variables that affect mood
Intensity - Inc intensity inc arousal, effects depends on participants response to arousal
Duration
Mode
Situational variables affecting exercise and mood
Physical environment
Social environment
Interact with personal and task variables to influence mood
Describe the mastery hypothesis
Improved emotional stability, self sufficiency + conscientiousness from persistent involvement in meaningful activity
Inc sense of global wellbeing, euphoric highs, sense of accomplishment
Improved concentration
Experience vivid physical sensations
Describe the distraction hypothesis
Decreased awareness of feelings of fear, tension and irritability
Distraction from worry and rejection
Countering effect on inertia, fatigue + depression
Theories on psychosocial benefits of exercise that enhance mood
Mastery theory
Distraction theory
How do you measure affect
Self report - likert scale or circumplex model of affect
Describe likert scale
Measures response to each adjective on a scale typicallly 1-5
Can be done on how you feel in the moment or over 4 weeks
Describe circumplex model of affect
Can be used for single terms
Rate each term by feeling -5 to +5 and arousal 1-6
These are mapped onto plot
Consideration for self report of affect
Single items may be better - less likely to change variable being measured through act of measurement
Other ways to measure affect
Skin conductance
EMG
EEG
Neuroimaging
Describe hedonic principle
Humans seek pleasure and avoid displeasure so positive reinforcement + feeling good encourages participation
Describe the affective-reflective theory
Dual process depending on affect and automatic response
An exercise related stimulus causes an automatic association (type 1 process)
This causes automatic effect valuation + encoded effect + cognition
Automatic effect valuation causes action impulse + allows reflective valuation
Reflective valuation (type 2 process) allows action plans
Action impulse + action plans lead to behaviour
Exercise intensity + motivation to exercise
Intensity Inc above ventilatory threshold- feels unpleasant may put people off BUT often get affective rebound at end (due to sense of accomplishment etc)
Exercise below threshold feels more pleasant
When do people have most positive affect
Self - selected physical activity below threshold
As
Perception of control and ability
Exercise outcomes
Describe attention restoration theory
People have limited capacity to direct attention to something that’s not interesting- directed attentional fatigue
How to counter direct attentional fatigue
Fascination - different/ novel objects/environments
Being away - from noise/busyness/normal environments
Extent of connectedness - doing it with others
Compatibility
What is natural environment
Characterised by variety of different + novel objects of interest that replenish depleted energy and attention
Why is exercise in the natural environment better
Less noise / over crowding which can overwhelm ability to direct attention + cause further negative emotions
It promotes positive emotions and affect due to aestically pleasing factors that use effortless attention or fascination
Who gets the biggest effects from being in natural environment
Extremely stressed/fatigued individuals
Get more positive mood changes and perform better on stress tasks
Effect of sitting on mood and affect
Negatively influences situational negative affect, tiredness and energy levels
Restoration still occurs when sitting in a natural environment but to a lesser extent
Effect of exercise duration on mood
Favourable effect on various mood profiles regardless of duration
Define mental health
Whole state can be flourishing and good or bad.
Who is more likely to have mental health problems
Smokers
Poor social-economic background
Potential consequences of poor mental health
Likely to die earlier
NHS 5 steps to mental well-being
Connect, be active, take notice, learn new skills, give to others
Exercising can tick off most of these
Impact of physical activity on mental illness
Decreased risk + helps mx of major depressive disorder, anxiety + psychosis
Improved sleep quality (+ cardiorespiratory fitness)
But the more severe the mental illness less impact PA has
What mental health Sx / problems can PA help
Illness duration
Dec suicide attempts (but not ideation)
Global functioning
QoL
Normalising
Dec antipsychotic prescriptions
Social inclusion
Memory
Type of PA best for mental health
Sport- most favourable mental health outcomes, positive social development, dec social exclusion
Leisure time PA - more enjoyable, Inc participation + motivation
Work time PA - has no association with mental illness
Facilitators for participating in community mental health exercise programs
Good, easily accessible facilities
Education + training
Flexibility
Peer support - buddy system
Consistent communication
1ST SESSION V IMPORTANT
What is the moving for mental health report
Used to help inform govt policy + promote benefits of community based PA
Why was the moving for mental health report needed?
Covid had significant impact on mental health + accelerated inequalities
PA is beneficial but only under right conditions - need to identify + promote these
PA decreased in Covid 1.2 million more inactive adults
Much of the sector stopped + never recovered from covid
Moving for mental health outcomes
- Develop cross-govt strategy promoting movement for mental health
- Office for health improvement + disparities responsible for this - should work with other departments to create more opportunities
- Prioritise cross sector partnerships and role of experts by lived experience
- Professionals + volunteers should receive standardised training + professional development
- Prioritise + fund more consistent + accessible evaluations to identify improvements
Depression prevalence
1in 6 adults worldwide
Affects 150 million worldwide
Define depression
Concurrent presence of at leat 5/10Sx which occur most of the day, nearly everyday for 2 weeks. 1sx must be low mood, anhedoinia, or low energy (core Sx of depression)
Depression Sx
Core - low mood, low energy, anhedoina
Others - difficulty concentrating, psychosis, sleep changes, appetite changes, feeling worthless, inappropriate guilt, fatigue, psychomotor agitation
Depression Mx
Mindfulness, exercise, SSRI, CBT, ECT
Impact of exercise on depression
Regularly active 15% less likely to get depression in future
150 mins exercise per week dec risk depression 30%
Psychological benefits of PA for depressed
Dec anxiety + depression sx
Dec psychological distress
Improved mood, sleep, energy + concentration levels
Improved self esteem, confidence and connectedness
What exercise has the biggest benefits for depression
Moderate intensity, aerobic exercise with supervision by exercise professionals
But exercise at any intensity likely to help prevent subsequent depression
Team sport = fewer Sx anxiety + depression
Motivation regulation spectrum
Ranges from
Autonomous motivation (I love doing it)
To controlled motivation (I have to do it)
Autonomous better in LT
What is needed for people to attend PA sessions
Focus on fun + enjoyment
Provide info on PA and well-being
Accepting of participants behaviours and beliefs
Acknowledge negative feelings, demonstrate trust
Show understanding + care
Advice on overcoming barriers
Define GAD
Excessive worry, difficult to control for >= 6 months on most days with >=3 sx causing distress or functional impairment
GAD SX
Restlessness, insomnia, fatigue, concentration problems, irritability, muscle tension,
Describe panic disorder
Recurrent panic attacks with fear of consequences and or avoidance behaviour >= 1 month
Panic disorder Sx
Palpitations, sweating, shaking, choking sensation, SoB, chest pain, nausea, dizziness, depersonalisation, fear of dying
Panic disorder Mx
Exposure therapy- exposure to feared sx can help reattribute to a recognisable cause
Eg exercise can also cause sweating + SoB
Exercise + anxiety
Exercise decrease anxiety but not as much as antidepressants
Use as adjunct
Not clear what h type of exercise is best
Anxiety + mindful exercise
Yoga dec anxiety
Larger effect in participants with previous yoga experience
Larger effect with no exercise control
Some evidence for Tai Chi
What is sleep?
A natural Re-occurring reversible state of suspended awareness and inhibition of voluntary muscles and sensory activity
What Does sleep enable
Body And brain recovery muscular repair, hormone release, protein synthesis tissue growth, CNS clearance
Describe Sleep regulation
Driven By circadian rhythm and homeostatic pressure
Describe Homeostatic pressure of sleep
Adenosine Builds up in brain making you feel sleepy, then dissipates when you sleep
Symptoms Of acute sleep loss
Fatigue, Drowsiness irritability, low mood, anxiety, hormone, dysregulation, impaired attention increased errors, perceptual disturbance, Paranoia hallucinations
Chronic Sleep loss symptoms
Increased stress reaction, HTM, dyslipidaemia, insulin resistance, increased risk of cardiovascular, disease, cancer, dementia, mental illness
Effect of sleep on exercise
Poor Sleep quality is associated with lower levels of physical activity
Shorter sleep duration is associated with less vigourous activity
Lack of sleep results in more sedentary time, higher fatigue and lower alertness
Effect of sleep on exercise performance
Short term sleep loss has a limited impact on single bouts of muscular or aerobic exercise
Negative Impact on fine motor skills such as darts and on cognitive and mood parameters such as reaction times
Does Exercise predict sleep
426 adults reported her sleep and exercise for two years physical activity didn’t predict subsequent sleep quality
Vigourous Activity was associated with shorter asleep duration at night
Meta analysis Of Effects of exercise on sleep
Overall Improvement in sleep, quality with exercise
Supervised facility based programs were more effective
Sleep Hygiene methods
Maintain Regular bed and wake times
Bedroom Dark, cool, quiet and comfortable with bed reserved for intimacy and sleep
Minimise Bright light and avoid screens for two hours before bed
Exercise In the day, avoid 4 hours before bed
Increase Exposure to natural light in the morning
Does Exercise, timing effect sleep
Morning Exercise is significantly beneficial
Evening exercise doesn’t appear detrimental other than vigourous exercise, very close to bed
Define Pain
Unpleasant, sensory and emotional experience associated with actual or potential tissue damage
Describe The pain pathway
Harm is detected by nociceptors
Messages Sent through the nervous system via spinal cord to brain
B-Endorphins released via opioid receptors in brain, provide a natural painkiller
Describe Chronic pain
Pain that persists or occurs over three months
Can Be primary or secondary
Often Linked to hypersensitivity of the CMS
Strong Psychological components
Vicious cycle of chronic pain
Pain
Distress/ anger
Catastrophising
Fear
Hypervigilance
Activity avoidance
Disuse disability
What Increases chance of recovery in chronic pain
Ability To confront and accept the pain
None Pharmacological management of chronic pain
Acceptance And commitment therapy ACT
CBT
Supervised, exercise programs considering specific needs preferences and abilities
Effect of exercise on chronic pain
A. Meta analysis showed small to moderate improvements, following exercise for pain, physical function, and quality of life
Effect of combined approach for chronic pain
Combines exercise and psychological therapy
Reduction in pain is not significantly different to exercise alone
Higher pain self-efficacy , safe and lower pain catastrophising and fear of movement
Exercise Analgesia methods
Tissue healing, increased blood flow and inflammation
Cardiometabolic - Inc aerobic fitness, body composition
Neuromuscular- flexibility, postural stability,
Psychological- fear avoidance, catastrophising
Is Exercise a placebo for chronic pain
Exercise Was more effective compared to no treatment
No Difference in pain reduction between exercise and placebo
Placebo biology
If You are expecting an end, result, your body sometimes releases what is required to get the result expectedly.
Release of endorphins- reduce pain
Release of dopamine - reduce tremor
Sham O2 - dec prostaglandin levels + HR
Define Dependent use of a substance
Habitual and compulsive use, despite adverse consequences
Substance Use disorder criteria Pharmacological
Developing Tolerance?
Withdrawal
Substance Use disorder criteria, risky behaviour
Repeated Use in risky situations
Continued Use, despite it causing health problems
Substance Use disorder criteria impaired control
Consuming More than intended
Failing To control use
Spending A lot of time gaining or using substance
Substance Use disorder criteria, social impairment
Failure to fulfil role obligations
Continued Use despite relationship damage
Giving up or reducing activities due to substance use
Amount Of alcohol consumed by population
None = 20%
</14 units = 57% population
Excess (>35 f or 50 m units) = 4 %
How To assess for alcohol dependence
AUDIT - Alcohol, use disorders identification test
CAGE questionnaire
Relationship between exercise +alcohol
Higher level’s exercise = higher levels drinking
People drink more on days that they exercise
Why is exercise associated with higher alcohol intake
Age - young drink more and exercise more
Health status - poor health - less likely to drink or exercise
Alcohol is a reward for exercise
Exercise compensates for alcohol calories
Exercise relieves guilt of drinking
Personality- extroverts more likely to exercise + drink
Social
Brain circuitry of exercise + alcohol
Both represent rewarding stimuli- activate brains mesocorticolimbic pathway
Exercise as a treatment for alcohol dependence
As a substitute it decreases cravings + intake
Animal studies suggest exercise may ameliorate alcohol related neural damage
No difference between exercise + the standard tx in reducing alcohol intake but exercise superior for fitness + depression
Exercise as an adjunct for alcohol dependence tx
Superior for drinking volume + aerobic fitness
No difference in binge drinking
What are cravings
Strong desires, urges or compulsion to drink
Triggered by a conditioned response to cues associated with drinking
Lead to alcohol seeking behaviour + associated with relapse
Exercise and cravings
Exercise may provide a distraction + alleviate negative mood states that can precipitate drinking
Study comparing exercise, active control eg colouring + passive control
Cravings significantly lower than in passive control
Mood Inc after exercise + active control
WHO mental health definition
A state of wellbeing in which the individual regocnices their abilities, can cope with normal Stresses of life, work productively + fruitfully + is available to make a contribution to their community
NHS Stepped care model
Step 5 - crisis inpatient
Step 4 - Specialist, high intensity intervention
Step 3 - High intensity, intervention, evidence-based formal therapy
Step 2 - Low intensity interventions, such as facilitatedself-help, Psycho-education, and CBT
Step 1 - Recognition of a common mental health problem by GP or self
- Elements to diagnose severe mental illness
Diagnosis - Psychosis, bipolar, personality disorders
Disability - Disorder causes significant disability
Duration - At least two years
Mental Illness, incidence
1 in 5 adults experience mental illness
1 in 24 SMI
1 in 12 substance misuse
Aetiology of mental health difficulties
Indicator Of psychological distress
Adverse Childhood experiences and trauma
Societal Contributers to inequality, poverty, racism, discrimination
Genetic + environmental vulnerabilities
Physical health inequalities in severe mental illness
15 - 20yrs earlier death
Multi morbidity common
Deprived areas Increased physical and mental health problems
Antipsychotic side-effects
Weight gain
High BP
high cholesterol
High blood sugar
Sedation
Agitation
Dec sleep
What Should interventions to improve physical health in SMI include
Integrated care and joined up systems
Address Multiple risk behaviours at once
Difficulties In SMI. Interventions to improve physical health.
Often Have poor self management
None compliance
Difficulty accessing treatment
Benefits Of physical activity in SMI
Tend to engage in less physical activity from the general population
Improvements In weight cardiovascular fitness and BMI
Improved Quality of life and social functioning
Decrease In depressive and psychotic symptoms
European psychiatry, research guidelines
Focus On implementation and culture in clinical practice
Examine Effects of interventions to decrease sedentary behaviour and increase physical activity
Undertake Long-term and cost effectiveness analysis of physical activity interventions
European psychiatry, practice guidelines
Use physical activity as a treatment for mild to moderate depression and to improve physical fitness
Use as an adjunct for schizophrenia spectrum disorders to improve symptoms, cognition and quality of life
Use To improve physical health
Screen For physical activity, habits in primary and secondary care
Barriers in SMI
Low mood
Stress
Lack support.
Lack energy
Poor physical health
Low motivation
Reasons to exercise in SMI
lose/maintain weight + fitness
Mx mood
Dec stress
Inc physical health
Inc sleep
Overall mental health Mx
Motivations to exercise is SMI
Used self determination theory
People with affective disorders had higher levels of introjected regulations compared to people with schizophrenia
No difference for other motivational regulations
Suggests autonomous motivation may be important for adoption + maintenance of health behaviours
Trauma informed PA
85% people on secure wards experienced trauma - important to recognise complexity
Need to feel safe emotionally + physically
Good communication
Modifications and adaptations
Instructor training and qualifications
Sedentary behaviour + mental illness
Secure wards are very sedentary
Interruptions to sitting time have positive physical health benefits but little research into mental health benefits
Are there downsides to exercise in SMI
mania some types exercise may make symptoms worse - eg football
SMI + PA in secure services
Average length stay 18-24 months
Little PA average 775.54 mins stationary
Why is there so little physical activity on secure ward
Individual- Sx, med S.E, lack motivation
Social - no one else exercising, staff risk adverse
Physical environment- may not have facilities
Organisational - no routine, appointments etc can be at any time
Measuring PA in secure ward
Accelerometry- accurate but limited access + expensive
Self report - issues accentuated in SMI
SIMple physical activity questionnaire
Describe MULTI study for PA in secure hospitals
Intervention includes multiple components- diet, PA, psycho education
Used qualified professional + required culture change for Mx
Study 1 18 months with inpatients>1yr,
Improved total activity , BMI, Waist circumference, HDL cholesterol
MULTI study barriers
Programme complexity
Lack of time
MULTI study facilitators
Positive attitudes of staff + patients
Strong commitment
Ownership towards multi
What is the ‘move it ‘ toolkit
Mandatory staff training module for psych ward staff, to improve knowledge of PA on mental health
Result of a paper commissioned by MRC for development of complex interventions
