The Unhappy Consequence of Not Being Able to Exercise

I knew she was going to become depressed. The email she sent said that her doctor said no tennis, swimming, golf, or rapid walking until the wound on her leg healed. She had fallen off her bike, the wound became infected, and a short healing time turned into weeks.

“I don’t know what to do with myself,” she  wrote.  “I am irritable, worried, depressed and anxious.  This is the longest I have gone without any physical activity.”

She exercised all her life, and has a master’s degree in exercise physiology. Her outside activity used to change with the seasons, but now that she had traded life in a cold European country for the warmth of Florida, she had been able to engage in outside physical activity year-round. But, for the time being, she could only prop up her leg and hope the healing would occur quickly .

My friend’s mood changes are well known among  committed exercisers who must stop exercising.  Magazines devoted to particular sports, such as running, devote columns to alternate types of exercise while recovering from an injury sustained during a race, for example. And the Internet is replete with articles, blogs and anecdotes written by those who find themselves unable to pursue their sport because some part of their body has been injured.   Moreover, many research studies have been carried out quantify, to some extent, the degree of mood changes brought on by experimentally-induced cessation of exercise.

In an experiment designed to see whether runners really do experience mood changes when they stop running, forty male runners who ran regularly were divided into two groups. One group was allowed to run during the six weeks of the study, and the other group was not allowed to run for two weeks in the middle of the study. Depression and other mood states were rated weekly and confirmed what my friend and others have experienced.  Depression, anxiety, insomnia and general stress were elevated during the non-running weeks among the runners. When they were allowed to go back to running during the last two weeks of the study, their moods were the same as the group that never stopped running.

Similar findings were reported among 40 women who engaged in aerobic exercise regularly and were told to stop their aerobic activity. Their moods were compared to a placebo group that had continued to exercise.  Those who abstained from exercise exhibited depressed mood and increased fatigue compared with those who did not stop their physical activity…And these below-listed studies are a small example of many that have been published.

And yet, exercise withdrawal due to injury, or other factors such as caring for a sick parent or child, overwhelming work obligations, prolonged adverse weather conditions, and numerous other life events, may be overlooked as a cause of significant changes in mood. Mental health professionals recognize exercise addiction and the mood changes that occur when the exercise is stopped, either due to injury or because the amount of exercise is pathological. But my friend exemplifies an individual who is not addicted to physical activity but does it, like brushing her teeth, as part of her daily routine. Indeed, soon after we spoke, another friend who had a surgical procedure on her leg called to tell me that she was “going crazy” because she was not allowed to swim until the surgical wound was healed.

“What am I going to do?” she almost wailed to me on the phone. “How can I survive without swimming?”

How many primary care physicians inquire about change in exercise patterns when investigating depressed or anxious mood, or increased fatigue in a patient?  Would it even occur to many (unless they also exercised regularly) to ask about changes in activity? Or when a physician tells a patient that he or she can’t run, or go to a gym, or play tennis, or walk quickly for several weeks, is there any thought given to the impact of such prohibition on the mood of the patient?

Conversations about exercise focus heavily on the benefit of physical activity on mood, weight loss, sleep, cognition, and on and on to convince those who would rather sit than walk on a treadmill to start to move for their health. But has enough attention been paid to helping patients deal with the mood and energy changes that occur when it must cease for a period of time?

One problem is understanding why stopping consistent exercise should have such a negative effect on general well-being.  Many who have experienced the inability to exercise for a period of time often cite an increase in stress and worry that no longer can be dampened by vigorous activity. Exercise allowed them to cope; without it, they must seek out alternatives and often don’t find them.  But what is it about running or biking or swimming or working out in a gym that allows our brains to increase their coping skills? Moreover, even when we find out the answer beyond such things as endorphins—which not everyone experiences, and certainly not all the time—the problem remains: what to do until exercise can begin again?

Magazine articles, Internet chatter and blogs offer some suggestions, but what about professional help? Shouldn’t a patient who is told, “No exercise for X weeks!” be referred to a physical therapist to learn what physical activity can be done? My non-swimming friend did learn from a physical therapist that she could do Yoga and Pilates; my other friend decided to do upper body strength training. When I last checked, both were considerably less grumpy.

 

 

 

“Effects of temporary withdrawal from regular running,” Morris, M, Steinberg, E , Syeks A et al,  J of Psychosomatic Res. 1990; 34: 493-500.

“Depressive mood symptoms and fatigue after exercise withdrawal: the potential role of decreased fitness,”  Berlin A,1, Kop W,, Deuster P,. Psychosom Med. 2006 Mar-Apr;68(2):224-30.

“Mental health consequences of exercise withdrawal: A systematic review,” Weinstein A, Koehmstedt C and Kop W,. General Hospital Psychiatry 2017; 49:11-18.

 

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