The Exercise Cure

CHAPTER 1

Brain and Psychological Problems

Neurologists used to believe that movement affected only the primitive areas of the brain, and that the more evolved areas--such the prefrontal cortex--were reserved for "higher" functioning: social interaction, planning, and emotional intelligence.

Turns out that the areas of the brain affected by movement are interlaced throughout the whole organ. Said one neurologist I know, "There's hardly a cell in your brain that isn't profoundly affected by movement." That means that you can directly affect your emotional centers by taking a run. You can literally light up your brain's decision-making circuitry with a trip to the weight room.

More and more, it's clear that exercise is a remarkably potent "way in" that helps us avoid, improve, and sometimes even solve psychological problems--from stress to sleep problems, from fatigue to addiction. Exercise and movement of all kinds grow and organize the brain in a very powerful and direct way that we're only starting to understand. So get moving--and start feeling better.

THE PROBLEM: Addiction

THE SYMPTOMS: You're drawn to some type of mood-altering behavior or substance, and you keep giving in to it, despite negative consequences. Symptoms include preoccupation with your drug or behavior of choice, a lack of control over it, and continued use despite adverse consequences. Another big sign: denial that a problem exists. If it feels good now, feels awful later, and you can't stop yourself from doing it, chances are it's an addiction.

WHAT'S GOING ON: Addictions come in many forms, some of which can cause physiological dependency, others of which are, more accurately, intense forms of compulsive behavior.

In the case of physiological dependency, the body begins to rely on the substance to function properly and needs more and more of it to achieve the original, euphoric feeling (this is called tolerance). When the substance is removed, withdrawal symptoms occur, and the person needs to go through a period of detoxification in order to relearn how to function without it. Common withdrawal symptoms include acute cravings for your drug of choice, headaches, cold sweats, anxiety, tremors, irritability, nausea, and hallucinations. Smoking, drugs, alcohol, and some medications can lead to this type of dependency.

Other behaviors, including gambling, playing video games, watching and obsessing over sports, and using pornography can be addictive to varying degrees, as can some types of behavior that are usually considered beneficial--including calorie-restricted dieting, sex, and even exercise. And a newer addiction: social media. Some people really do need their "Facebook fix."

Depending on the person and the substance, an addiction can take hold overnight or over many years.

Why do addictions happen? People typically have a genetic predisposition to addictive behavior--if your parents are addictive types, you are more likely to be as well. But addiction has an environmental component, too, as you can't become addicted to something you've never experienced (which is why the first one's always free).

At some point, the addictive substance or behavior gets hard-wired to a biochemical process in the brain, which creates an illusion of euphoria, relaxation, and happiness when you experience your drug or behavior of choice, and an increasing desire for and preoccupation with the drug. The behaviors around obtaining the drug, and hiding your use of it, may further add to the allure of the addictive substance.

YOUR EXERCISE Rx

Exercise can help combat virtually any addiction (except exercise addiction, naturally). Says one 2011 study published in Current Neuropharmacology, "Exercise leads to an increase in the synthesis and release of dopamine, stimulates neuroplasticity and promotes feelings of wellbeing. Moreover, exercise and drugs of abuse activate overlapping neural systems." Researchers have theorized that this might explain why regular exercise helps to prevent addiction from taking hold--and can play a role in curing it as well.

In many studies, exercise has been shown to have a pacifying effect on addictive behavior. It blunts the urge to take drugs, gamble, and smoke, for example. A review of studies published in 2012 looked at the effect of exercise in people who were trying to quit smoking. Several of the studies reviewed showed "significantly" higher abstinence rates for the groups that exercised versus those that didn't. In this study, two groups of rats were exposed to amphetamines: one group of normal rats, another group that had a fully ingrained exercise habit. The exercising rats showed no preference for amphetamines, whereas the nonexercisers couldn't get enough of them.

Overall, this may explain why, statistically, exercisers are much less likely than inactive people to become addicts.

When to Call a Doctor

This can be problematic. Most addicts will never call a doctor or even ask for help with their problem. They believe they can handle it. Or they don't want to face it. Even with family interventions, an addict won't pursue real change until he or she is ready. And "ready" can be a long way off and include some horrifying consequences for the addict and those close to him or her. If you know an addict, seek professional guidance for them (and for yourself on how to handle the problem), and try to help as best you can. If you're an addict, deep down you probably know it. Even if you can't imagine a life without your addiction of choice, that better life is out there. There is no shame in admitting you need help--and the professional help out there is very real and very effective if you commit to it.

Another study, however, conducted by the Beckman Institute for Advanced Science and Technology at the University of Illinois in Urbana-Champaign in 2012, offers a different and perhaps somewhat qualified perspective of the value of exercise in overcoming addiction.

Two groups of mice--one habituated to exercise, the other not--were exposed, and became addicted to, liquid cocaine. The formerly sedentary mice were then also habituated to exercise. When the cocaine was taken away from both groups, the mice that had only taken up exercise after exposure to cocaine were able to break their addiction much more easily than those who had the exercise habit in place before exposure. In some cases, the poor previously exercise-addicted mice continued to crave cocaine for the rest of their lives.

So does this mean that we shouldn't begin an exercise program unless and until we have an addiction to overcome? Or that exercising regularly will make you more susceptible to addiction?

It's hard to say: Mice aren't people, after all, and it was just one experiment. The big-picture lesson, say the researchers, may be that exercise primes the brain to learn, and adopt, new behaviors--regardless of whether those behaviors are self-destructive or beneficial. (This seems to be true at any age, by the way).

WHEN EXERCISE IS THE ADDICTION

Yes, it's possible. You can be addicted to exercise (the very definition of "too much of a good thing"). It stands to reason: Exercise can induce physiological pleasure responses the same way a drug can. Motor activity stimulates the release of dopamine, a naturally occurring narcotic in the brain that is also stimulated by many addictive substances and behaviors, including cocaine and methamphetamine. Natural endorphins, enkephalins, and endocannabinoids (opium- and marijuana-like substances also manufactured in the brain) also get in on the act.

There are signals for exercise addiction in both mind and body. In the mind: Does it dominate your life? Will you be seriously derailed for the day if you don't exercise? In the body: chronic overuse injuries. All these are signs that you're exercising in unhealthy ways and should talk to your doctor about it.

In my own case, I'm probably a borderline exercise addict. I need it every day and I recommend it every day for my patients. I watch myself carefully. I'll ask myself, "If I'm going to give up a workout, why? Am I going to miss a dinner I should go to, or an important meeting, or a special occasion?" I'm pretty good about this, but not perfect. And that's the overall point of this entire section: Recognizing your own addictive tendencies--stepping back and seeing your own behavior--is a huge part of recognizing a potential problem.

For you and me, that may mean that if you're trying to adopt or break a habit--be it eating less sugar, smoking fewer cigarettes, or shaking an Internet jones--you might want to begin or make a change in your exercise program at the same time: Start jogging or cycling or switch from rock climbing to martial arts, for example. The fresh neurons that your new or unfamiliar exercise program stimulates may make it easier to adopt the new behavior you're trying to master.

To recap:

• Exercise helps prevent addiction from taking hold.

• Exercise can help overcome addictive behaviors once they have taken hold.

• If struggling to overcome an addiction (or adopt a new behavior in general), you may benefit from making a change in your exercise program at the same time.

THE PROBLEM: Anxiety

THE SYMPTOMS: You're worried, concerned, and fearful, generally about some threatening event in the future over which you feel you have little control. You may feel nauseated, shaky, experience blurred or tunnel vision, a racing heart, fatigue, the frequent need to go to the bathroom, panic attacks, and difficulty concentrating.

WHAT'S GOING ON: Anxiety can arise as a normal response to an upcoming frightening or stressful situation. In some circumstances, the response may actually provide a helpful cue that prompts you to confront a nagging or difficult problem, or helps you avoid a dangerous situation. Studies have shown that people with anxiety are, in fact, less likely to die in accidents.

Performance anxiety, stage fright, or fear preceding a test or evaluation are all common forms of anxiety. A certain amount of arousal is necessary for high performance, of course--too much, however, can hinder performance.

But, like depression and other mood disturbances, anxiety can also come up for no clear reason, attached to no obvious external threat or event, and ultimately become debilitating. Obsessive-compulsive disorder, phobias, and social anxiety are all clinical forms of anxiety and should be treated with help from a health care provider.

YOUR EXERCISE Rx

Exercise can be a powerful tool in preventing anxiety in the first place: People who exercise consistently are 25 percent less likely to develop anxiety than those who don't. In cases of mild anxiety, exercise can be extremely helpful, easing symptoms in just a few minutes, and though it can't cure chronic anxiety, it can help diminish its symptoms.

• TRY YOGA. Anxiety is often accompanied by a response from the sympathetic nervous system--the "fight or flight" response that prepares you for challenging physical activity. If you're chronically anxious, this system is probably working overtime, keeping your mind racing and your body keyed up, even when you're trying as hard as you can to calm down.

A 2011 review of research published in the British Journal of Sports Medicine found promising evidence that yoga may help relieve the symptoms of some types of mild anxiety--probably because the slow, languid movements and focus on deep breaths help stimulate a parasympathetic, calming response from the autonomic nervous system. Two or three classes a week of yoga can be very beneficial in this regard. And once you get the hang of it, you can try a little yoga breathing or a few asanas (yoga poses) whenever you feel symptoms of anxiety start to come up.

• GO FOR THE GOLD. Another study, published in 2005 in Behavior Research and Therapy, found that regular aerobic exercise also reduced anxiety and "anxiety sensitivity," or the fear of the sensation of anxiety itself, and that a higher intensity of this type of exercise worked better than a lower intensity. So if you're anxious, hit up the gold standard of exercise as described in Part 3--and skew your aerobic workouts a little tougher.

When to Call a Doctor

Intense and ongoing anxiety can take a toll on your life, cutting into productivity and leisure time. If anxiety is starting to become chronic and unmanageable, see a doctor. If left untreated, anxiety can become a debilitating disorder. Exercise is terrific treatment for a mild anxiety disorder, but the more serious variants need the help of a trained mental health professional.

THE PROBLEM: Attention-Deficit Hyperactivity Disorder (ADHD)

THE SYMPTOMS: In children, an inability to concentrate, as well as difficulty following directions, sticking to tasks, and accomplishing household chores and schoolwork. Children with ADHD are easily bored and distracted, and often have difficulty sitting still and controlling their impulses.

In adults, ADHD often manifests in difficulty with time management, organization, goal setting, and emotional control--all of which can interfere with employment and relationships. Depression, low self-esteem, substance abuse, and addiction disproportionately affect adults with ADHD.

WHAT'S GOING ON: ADHD can be a very frustrating condition, both for the children and adults it affects and for those around them. Its exact causes are unknown, though heredity, chemical imbalances, and traumatic head injury may contribute to the condition. Women who eat poorly, smoke, or abuse drugs or alcohol during pregnancy are also more likely to give birth to children with ADHD.

ADHD is a behavioral condition and has no physical symptoms--though a doctor may take x-rays or a blood test to rule out any underlying physical conditions. Other psychological conditions, such as anxiety and depression, can cause similar symptoms, so doctors or specialists will take a thorough medical and personal history to verify the diagnosis.

ADHD does not come on in adulthood but is a lifelong condition. If, as an adult, you suspect you may have ADHD, a specialist will focus questions on your behavior, development, and relationships starting at childhood to determine the root cause of your condition.

Treatments for ADHD include prescription medications and various types of psychosocial interventions, including psychotherapy, behavioral modifications, special education, and social skills training. Left untreated, children with ADHD are at greater risk for teen pregnancy, car accidents, and drug and alcohol use. They are also more likely to have learning disabilities.

Since its causes aren't fully understood, ADHD can't be cured or prevented. But behavioral interventions, and drugs, if necessary, can go a long way in helping to regulate impulsive behavior and to help an affected child grow up to be productive and successful. Another helpful treatment: exercise.

YOUR EXERCISE Rx

Recent research suggests that exercise can be very effective in improving ADHD symptoms, in part by raising levels of dopamine and brain-derived neurotrophic factor (BDNF), two neurotransmitters responsible for growth and learning. In one 2011 study, a 28-day program of daily treadmill running, 30 minutes a day, raised levels of dopamine and BDNF in hyperactive rats and improved their ability to find their way around a complex maze.

In humans, exercise can temporarily raise levels of dopamine (and the adrenal hormone norepinephrine)--thus mimicking the effects of ADHD drugs like Ritalin and Adderall. In the brain, exercise can stimulate the prefrontal cortex, responsible for executive functioning, impulse control, and decision making, thus giving affected children more control and more time to evaluate moment-to-moment choices.

By heightening the senses, improving mood and focus, and relieving tension, exercise creates an ideal environment for a child to learn. At the same time, exercise improves neurogenesis--the building of new cells--which directly accelerates learning in itself.