Barriers to exercise and how to overcome them: CrossCurrents Spring 2004

CrossCurrents

Research evaluating the benefits of physical activity in treating mental illness is impressive and hopeful. But many systemic and individual barriers need to be overcome before advocates may see exercise surface as a routine part of mental health treatment.

The very root of the problem, according to Dr. Dori Hutchinson, director of the Center for Psychiatric Rehabilitation at Boston University, may be the separation between mental and physical health treatment. "What we've done as a field is to work so hard to treat illness that, without meaning to, we have disconnected mind/body/spirit. We are not approaching wellness in a holistic way. Certainly, the mental health process does not work to promote wellness - it works to treat illness."

Dr. Guy Faulkner, an assistant professor at the University of Toronto Faculty of Physical Health and Education, says physicians who wish to prescribe exercise are met with a systemic lack of resources and trained professionals. "The structures are not in place," he says. "A clinician can't say, 'I will refer this client to a certain facility,' knowing that the person running that facility is qualified and has the expertise to work with people with mental health problems."

Faulkner and Hutchinson agree that people with mental illness are often financially unstable, and in the absence of a funded facility, it is unlikely they will pay for a gym or facility membership themselves.

It is also hard to pinpoint exactly why exercise works to ease symptoms of mental illness. Therefore, research-oriented practitioners overlook exercise in favour of more readily measured treatments. "To put it simply, exercise perhaps is too simple," says Faulkner. "Is it even a mental health treatment? We can't specify dosage and I don't think we ever will. We don't know why it works. But if you look at anti-psychotic medications, we don't know how they work either; yet they are routinely prescribed. We need more research and an attitude shift."

A 2001 study led by Faulkner, published in the Journal of Sports Sciences, stresses that more research is needed to overcome these individual and systemic barriers. "Until it is easier for mental health professionals to access opportunities for their clients, the use of exercise as a therapeutic medium will rely on serendipity," write the authors.

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