Expert Q &A: How does exercise affect the brain?

An interview with Dr. John Ratey, the Associate Clinical Professor of Psychiatry at Harvard Medical School, a researcher, speaker and author of “Spark: The Revolutionary New Science of Exercise and the Brain”. Dr. Ratey explains how exercise relates to the brain, an individual’s mental health and wellbeing. He answers a variety of questions on the topic, including the role of physical activity and mental healthcare sectors in leading others to exercise.

Q: Can you tell us a little bit about you and how you came to write Spark?

I’ve been a psychiatrist now for 35 years. I started out working in the state system here and with the community mental health center, the Massachusetts Mental Health Center. I was associate director of training for psychiatry for all the medical students at Harvard Medical School and residency training at the Massachusetts Mental Health Center. For nine or ten years I did research there on aggression across a wide range of people with different diagnoses and wrote about 40 papers on treating aggression in schizophrenics, the mentally disabled, autism, personality disorder, etc.

I also worked at Medfield State Hospital, and at about this time I was very aware of the need for all of us to be moving, exercising. I used to lament about the group walks for our inpatients. They would go for 15-20 minutes to the store to buy cigarettes, of course, which was regrettable but that's what they did. My idea of a group walk would have been a two to three hour walk in the morning and then followed up by another walk like that in the afternoon. Never quite caught on but I felt and knew that getting our patients moving was an important aspect of their overall mental health.

I grew up professionally, in Boston, where at about the same time the Boston Marathon was taking off. I became very interested in the interaction between mental health and running. Research was just beginning to look at the effect of exercise, especially on moods. Duke University Medical School led the way in that back in the early 80s, late 70s in the USA. Research had certainly been started in other countries. Norway, in particular, had done a lot of work in that area and then it broadened to anxiety and my work on aggression.

I began to be interested in attention deficit disorder through my work in aggression and learned that exercise is a great way to help treat ADD. It was certainly one of our top three recommendations to our ADD patients. And from this I ended up writing three books on attention deficit disorder including Driven to Distraction (co-wrote with Ned Hallowell). I wrote a number of other books as well-eight books in total. I was always recommending exercise as a key component of treatment, and finally ended up putting Spark together when I discovered a school west of Chicago that was an amazing place, devoting 45 minutes a day to fitness-based physical education. It had become one of the fittest schools in the country, as well as one of the highest achieving schools in the country. That led me to write Spark which started off talking about how exercise affects mood, anxiety, stress, cognition, attention deficit disorder, the addictions and aging. So that's how it all came to be.

Q: In “Spark”, you talk about certain types of exercise, such as martial arts and gymnastics, as being ideal activities to challenge the brain - what makes these activities excellent for improving mental health?

You’re only reading part of it because I talk mainly about aerobic training as well as martial arts. It is great because it taxes the brain. The more you tax the brain with a recovery period, the more you challenge it. Then you have a period of time to rest and recover. The brain grows and you bring it into optimal function. So what exercise really does is it elevates all the neurotransmitters but certainly norepinephrine and dopamine are elevated almost immediately. Serotonin has more prolonged elevation. As I’ve stated in the past, and will again: a bout of exercise is like taking a little bit of Prozac and a little bit of Ritalin in just the right places in the brain.

Q: Would you say there's additional criteria that would complement exercise in improving the mind, such as social activities or health eating?

Sure. I think there is a ton of evidence for all of that. One of the things for sure we know is the benefits of Omega 3 fatty acids as well as-certainly people in Canada as well as folks in the Northern United States have to be very aware of- our vitamin D levels. We should be paying attention to those now that we have blood levels for the Omega 3s and certainly for vitamin D. It can offset very poor health, physical as well as mental health. Certainly for mood irregularities those two measures should be done. But in general I think the diet is extremely important - the more fit the individual is, the more emotionally fit they're going to be. Social involvement is key. The best form of exercise is running or playing with others outside, so that is a very important add-on.

Q: How does socializing interact with the brain in this context?

Well one, it helps promote the person to come back to their exercising. Two, on its own it elevates a lot of different neurotransmitters and makes for a challenge for the brain as well. It demands more to be in a social situation rather than doing it alone, which is great for the brain because the brain is like a muscle and the more it is exercised, the more it grows, responds and is ready for the next stressor or the next challenge that life may bring.

Q: I wanted to ask you a little bit about the clinician or the health professional in motivating people to exercise. How would you define their roles?

Well, first off, they have to be examples. Often, that's where the rubber meets the road. Many people who are involved in caring for people are not fit themselves and are obese or overweight and certainly if they're smoking - these are very big problems. They have to be the role models. I'd say that’s number one.

A lot of times here in the USA when going to places and having a dietician speak, the dietician themselves are grossly obese, which is a joke, but it occurs more than a few times. Why should anybody pay attention to somebody who's not living what they are preaching? So I think that's the biggest thing in terms of motivation.

And then participating with your clients if possible, if that's appropriate, and also being reasonable to not saying go run a marathon to everybody. Just have them do a walking program if they're obese or a small weight training program. We find now looking at the people that are really far from fit and are obese; it's most helpful to have them begin to do strength training because they can begin to see changes there. Next, add in small aerobic challenges like walking through a walking program, getting them a pedometer, and setting reasonable goals at first. This may only be a couple of thousand steps per day. We're not talking about a huge financial investment. Most people would find a good incentive to be something that they could earn points for or just to keep track of it themselves and eventually get up to 10 or 20,000 a day.

Q: Would consider writing exercise as a prescription a viable option? 

I certainly do. I do, and I would. I think it can be very, very useful. You know, it's one of the recommendations by the Institute of Medicine here in the United States some time ago-three or four years ago. It talked about and recommended to all our doctors to be aware of what their patients are doing in terms of exercise and helping them write a prescription for it.

Q: It is great how you broke down the many mental health issues into chapters, and you made it pretty easy for the average reader to understand the biology behind the theory - are you aware of how this information has been used in other sectors, particularly with serious mental illness? Is there any, like, practical applications you'd see?

Oh yes, I think there are groups all over the country and all over the world. For instance, there is a group that started in Taiwan. They are a walking/hiking group that hikes up mountains specifically for very depressed people. I met with over 50 volunteers when I was there who had already started and had nothing to do with me other than using my book as a bit of inspiration. They began it on their own, and it's still going strong.

They take groups of depressed people out with doctors' advice or consent and have them spend a day and a weekend out with the group, climbing as much as they can up mountains. They spend the morning walking. It has a lot of the social involvement as well as the physical activity.

We worked with one group of halfway houses in Western Massachusetts here who have over a thousand clients in working to integrate exercise in their daily life. Hopefully they will get some grants to study the outcome. But it's starting. I think every practitioner in psychiatry is soon going to pay much more attention to this.

Q: So you've been saying that you've seen a growth in research as well and you believe more research is needed?

More research is needed all the time but the growth in research is phenomenal around the world. It's not just here in the US and Canada. Everybody—almost all countries are-a very popular research topic is the effect of exercise on mental health and intellectual health.

Q: You were stating earlier that Prozac is the same as exercising in some ways - what advice would you give to someone who wanted to switch from antidepressants to exercising?

I would not switch until they're ready. I would be exercising at a pretty high level before they began to think about getting off of their medication. And by high level I would mean exercising for about 40 to 50 minutes a day for five—at least five days a week. And by exercise we mean pushing yourself; it's not just being comfortable, it's not just walking through the malls, but really getting to the point where you're sweating, where you're out of breath a bit - and that's what exercise is-and not just walking. Although walking is the way to start because a lot of people are so out of shape that that's the best they can do.

Q: You mentioned that there was little scientific evidence of the benefits of exercise for bipolar disorder. Have you found that exercise is more beneficial for some disorders than others?

No, I have not. And I think the exercise for bipolar disorder-that area is just beginning. People are beginning to exercise and make that part of their recommendation because it does help balance out both the overactive and the underactive mood and patient.

Q: Have you found any other evidence for disorders such as schizophrenia or borderline personality disorder?

I think both of them are very responsive. Schizophrenia, in a lot of other countries, has more research going on and being done in clinical applications; for instance, in Italy and Germany. In England, there are soccer teams made up of chronic schizophrenics and staff that play all over the country. In Italy, there are 80 some teams that have a league that are made up of chronic patients. Most of them are in-patients and staff. They play and they travel and they practice and this has led to lowering medication and a return to normality quicker.

Q: Do you have any recommendations about how patients can start an exercise regimen?

I would start slow, with a certain amount of walking. I would use a pedometer as well and begin to do calisthenics together in a group much like we should have been doing all through high school and at college. But you want to get more muscles involved and I would do it slowly. I'd try to make it fun, you know, because that's an important variable. Playing soccer or basketball or volleyball or depending on the ability and the age, you might want to play tag. You want to have something going on that the patients would adhere to.

Q: What about for the healthcare professionals, how would recommend to them to start?

Well, I would say that they need to see it as part of their profession to be fit. I think the unfit teacher, doctor, healthcare professional is a bad example. I really believe that. I think our healthcare people should be the models as opposed to the negative models. Unfortunately so many of our people are in a situation where they sit all the time and that leads to physical health problems as well as mental health and motivation problems. This is much more so than if they were up and moving and active or at least active for part of the day.

Q: Have you found animal companionship to also be beneficial to mental health and well-being? 

Oh sure. I think it's a huge thing because it helps with loneliness. It's nice to have this unrequited love coming at you and caring for another living being. I think there's so much positive stuff that comes out of that.

Q: What about pets being a motivator for exercising?

Sure- the general statistic is that people who own dogs live longer and are probably much healthier than those that do not.

Q: Is there anything you would like to add, or any messages or upcoming events you'd like people to know about?

We’re working in Ontario a lot with many of the schools in Barrie and Niagara and in Burlington. We’re hoping to put in a grant with the Ministry of Health Promotion and Sport. We've met with the Ministry of Education and with the Speaker of the House, so the Ontario Legislature. We’re hoping to put together a grant to make our presence more felt up there in Canada.

To learn more about Dr. John Ratey and his book “Spark: The Revolutionary New Science of Exercise and the Brain”, please see www.johnratey.com