Exercise and Mental Health

Suicide is a complex and devastating public health issue that affects millions of people worldwide. Despite advances in mental health treatment and suicide prevention efforts, rates of suicide continue to rise, particularly among vulnerable populations such as those with mental or physical illness. Previous research demonstrated that teens with high sedentary behavior had twice the risk of a suicide attempt vs those with low daily sedentary time. There is growing interest in interventions that may reduce the risk of suicide, including promoting physical activity.

Exercise has been shown to have numerous physical and mental health benefits. But can exercise also help prevent suicidal behaviors? In this systematic review and meta-analysis, researchers explore the potential protective effect of exercise against suicidal ideation, suicide attempts, and death by suicide in people with mental or physical illness. By examining the existing evidence on this topic, we hope to shed light on a promising new avenue for suicide prevention efforts.

The key findings of this systematic review and meta-analysis were that exercise may have a significant protective effect against suicidal behaviors in people with mental or physical illness. The study found that even though people who exercised had thoughts about suicide just as often, the likelihood of acting on those thoughts by attempting to end one’s life was 77% lower among people in exercise interventions compared to control groups. Death by suicide was 36% less likely among exercisers, but this difference did not achieve statistical significance. The randomized controlled trials included in this study were selected through a comprehensive search of multiple databases and were analyzed using established methods for meta-analyses. However, there was a high risk of bias in many studies. Depression was the most common condition in these studies, but people with menopause, breast cancer, sickle cell, and Huntington’s were included in one study each.

Although further research is needed to better understand the mechanisms underlying this effect, and to identify optimal exercise interventions for different populations, these findings suggest that exercise reduces the chance that a person suffering with depression or a medical illness will act on suicidal thoughts. Possible mechanisms include exercise providing relief from distress, improving depression, generating optimism or facilitating social connectedness.

Promoting regular physical activity appears to have important potential as a suicide prevention strategy that could serve us well in an age of growing mental health and suicide crises.

If you are interested in learning more about the connection between lifestyle medicine and mental health, check out a previous post on how physical activity may affect symptoms of depression, anxiety, and psychological distress. Other lifestyle behaviors, such as diet and sleep, may also impact mental health, and this is outlined in detail here.

By: Helena Zhang & Douglas Noordsy, MD


  1. The effect of exercise on suicidal behaviors: A systematic review and meta-analysis of randomized controlled trials

What a 10-Second Balance Test Can (and Can’t) Tell Us About Longevity

A recent study found that standing on one leg for 10 seconds was independently associated with survival and that those unable to perform this test had double the usual risk of premature death. This relationship is an association and not causal – meaning, the test cannot predict when someone will die. It does, however, highlight the importance of monitoring and maintaining balance as we age. Good balance later in life can lower fall risk and help maintain independence, mobility, functional abilities, and overall quality of life.

According to Corey Rovzar, an expert in balance a postdoctoral fellow at the Stanford Prevention Research Center in the School of Medicine, balance is often overlooked in most people’s exercise regimes and is not regularly included in routine health checks for middle-aged and older adults. This study highlights the importance of monitoring and maintaining balance as you age since balance tends to decline most rapidly beginning in your 60s – and this decline can lead to faulty biomechanics and/or falls. The good news is that you can improve your balance through training! This could be as simple as standing on one leg while you brush your teeth, performing single-leg exercises, or engaging in activities such as tai chi and yoga. Strength training is also important, especially for the lower body, because stronger muscles allow you to have greater stability as you move and to move at an ideal speed. The key to any exercise program is consistency – find something that you enjoy and stick with it!

By: Corey Rovzar, PhD


  1. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

HIIT Exercise May Counteract Heart Disease Progression

As we know, exercise is an essential component of a healthy lifestyle and has many benefits from an evolutionary perspective. However, healthcare professionals have debated the type and intensity of exercise most beneficial for individuals with coronary artery disease.

A recent study published in the European Journal of Preventive Cardiology sheds new light on this issue by examining the effects of high-intensity interval training on coronary atheromatous plaques. After selecting patients with stable coronary artery disease who had undergone percutaneous coronary intervention (PCI), patients were randomly assigned to follow high-intensity interval training or current preventive guidelines. The atheroma volume of patients was measured at baseline and after 12 months.

The results indicate that high-intensity interval training can counteract atherosclerotic coronary disease progression by reducing atheroma volume in residual coronary atheromatous plaques following percutaneous coronary intervention (PCI).

The evidence of how high-intensity interval training can effectively reduce atherosclerotic coronary disease progression and improve cardiovascular health has significant implications. First, the possibility of HIIT as an effective way to mitigate atherosclerotic coronary disease progression introduces the idea of incorporating HIIT into patient rehabilitation programs. Moreover, adding HIIT into their lifestyle may improve their quality of life.

Healthcare providers may consider incorporating HIIT into rehabilitation programs for patients with coronary artery disease, and anyone hoping to optimize their heart health may create personal lifestyle goals and add HIIT to their routine.

By: Helena Zhang, BS & Michael Fredericson, MD


  1. https://academic.oup.com/eurjpc/article/30/5/384/6958432?login=false&inf_contact_key=552ddfe8914eee6ffd2876881ec8ef831b0a3f0fd3ee5d9b43fb34c6613498d7
What Does Grip Strength Indicate About Your Health?

What Does Grip Strength Indicate About Your Health?

What Does Grip Strength Indicate About Your Health?

Your future lies in the palm of your hand… kind of. A popular topic in longevity and exercise science involves the association between grip strength and life span, but what exactly are people talking about? Two recent studies describing the relevance of grip strength in the field have started to analyze what information one’s grip strength actually provides. “Grip strength is inversely associates with DNA methylation age acceleration” covers cross-sectional and longitudinal associations between hand grip strength and three different clock models to describe the pace of one’s aging in American adults over the age of 50 years old. Essentially, these three different clocks take in information from a DNA methylation sample, and output a relative estimate of how quickly someone is aging based on the different health outcome risk biomarkers they are entrained on. As it pertains to grip strength, the three age-acceleration clocks looked at in the study found significant associations to suggest that greater grip strength can help one protect their body from physically aging faster. These clocks could be useful tools in future clinical applications to begin to better understand the needs of different patients later in life. However, there is still work left to be done as the sample of this study may not be representative of the diverse middle and older aged populations in the larger United States or on a global scale. When reading information from the study above, it can also be easy to believe that increasing the amount of grip-strength exercises you’re doing will help you slow down how fast you’re aging and live longer, which is not exactly the case. Another study from the Journal for Clinical Interventions in Aging, reviews the literature to suggest how grip strength’s relevance to aging science may be due to its associations with total body strength, bone density, reduced risk of falls and fractures, etc. Knowing that there is ample research on the protective effects of these measurements on later-in-life life expectancy, grip strength may be a starting place to begin to clinically understand risks the potential mobility and functionality risks for some patients.


To read the full article from the Journal of Cachexia, Sarcopenia, and Muscle, follow this link: https://doi.org/10.1002/jcsm.13110

To read the full article from the Journal for Clinical Interventions in Aging, follow this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778477/.


By: Carly Mae Smith


Dysfunctional Breathing Patterns Have Been Associated With Several Musculoskeletal Conditions

Have you ever thought twice about the way you breath?

Properly diaphragmatic breathing results from using our primary respiratory muscles (the diaphragm and external intercostals), causing expansion of the abdomen. However, many rely on accessory respiratory muscles in the upper chest and shoulders rather than the diaphragm – which result in dysfunctional breathing patterns. Dysfunctional breathing patterns have been associated with musculoskeletal conditions such as low back pain, chronic neck pain, and chronic ankle instability. And on the contrary, diaphragmatic breathing patterns correlate with improved postural and core stability, reduction musculoskeletal injuries and in physiological stress.

The prevalence of dysfunctional breathing has been reported as between 29 and 74% in asthmatics, and 62-73% in physically active, healthy adults. In athletes, the prevalence of dysfunctional breathing patterns is not known, nor is it known whether dysfunctional breathing in athletes confers a greater injury risk.

A study was performed in a Japanese population on a wide variety of athletes in competitive sports ranging from elementary school athletes to professional athletes (maximum age 25). It demonstrates that the prevalence of dysfunctional breathing was extremely high (90.6%) in athletes.  The authors hypothesized that the higher proportion of dysfunctional breathing in athletes may be due to greater physiological and psychological stress due to the demands of competitive sport, but this remains to be further studied. There are a few drawbacks of this study. Of note, these athletes were only assessed in the standing position, which may increase the proportion of dysfunctional breathers due to the increased respiratory demand (as compared to supine and sitting). Prior studies have suggested assessing breathing in multiple positions. Also of note, this study does NOT determine the clinical significance of dysfunctional breathing patterns – i.e. we do not know if these breathing patterns actually confer a greater risk of injury.

However, this is an interesting study that draws attention to an area where further research is needed – and is one which reminds us to think again about the way we breath:

  1. Place one hand on your chest and one on your abdomen
  2. Inhale slowly through your nose and focus on expanding your abdomen rather than your chest
  3. Exhale slowly

By: Sarah DeParis, MD and Helena Zhang, BS


Journal Reference:

  1. Shimozawa, Yuka1; Kurihara, Toshiyuki2; Kusagawa, Yuki3; Hori, Miyuki3; Numasawa, Shun4; Sugiyama, Takashi1; Tanaka, Takahiro3; Suga, Tadashi2; Terada, Ryoko S.5; Isaka, Tadao1; Terada, Masafumi1. Point Prevalence of the Biomechanical Dimension of Dysfunctional Breathing Patterns Among Competitive Athletes. Journal of Strength and Conditioning Research: May 24, 2022 10.1519/JSC.0000000000004253 doi: 10.1519/JSC.0000000000004253


Any Amount of Physical Activity Yields Health Benefits and Is Better Than None

Any Amount of Physical Activity Yields Health Benefits and Is Better Than None

 Most of us spend a large portion of our day sitting in office or at home. There is a price we have to pay for prolonged sitting – a detrimental cardio-metabolic health. This includes increasing risk for a group of preventable chronic conditions such as cardiovascular diseases, type 2 diabetes and obesity.  

 A large cohort study of Australian adults aged 45 years and older published by Van der Ploeg et al in 2014 showed a dose-response association between standing time and all-cause mortality. Increasing standing time from 2 to 5 and to more than 8 hours a day decreased all-cause mortality by 10% to 15% and to 24%.  Buffey et all in his meta-analysis and systematic review published recently in 2022 have shown that frequent short interruptions of standing (2 to 20 minutes of standing after every 20 to 60 minutes of sitting) and light-intensity walking (1.5– 4.4 km/hour or a comfortable pace down hallways) can significantly improve postprandial glucose metabolism (improve postprandial insulin, reduce post prandial glucose levels) when compared to sedentary time of prolonged sitting of 5 hours or more. Light-intensity walking was superior when compared to standing. So no matter how slow you go, you’re still lapping everyone on the couch. Any amount of physical activity yields health benefits and is better than none. 

By: Rusly Harsono, MD & Helena Zhang, BS

Journal Reference:

  1. van der Ploeg HP, Chey T, Ding D, Chau JY, Stamatakis E, Bauman AE. Standing time and all-cause mortality in a large cohort of Australian adults. Prev Med. 2014 Dec;69:187-91. doi: 10.1016/j.ypmed.2014.10.004. Epub 2014 Oct 16. PMID: 25456805.
  2. Buffey AJ, Herring MP, Langley CK, Donnelly AE, Carson BP. The Acute Effects of Interrupting Prolonged Sitting Time in Adults with Standing and Light-Intensity Walking on Biomarkers of Cardiometabolic Health in Adults: A Systematic Review and Meta-analysis. Sports Med. 2022 Aug;52(8):1765-1787. doi: 10.1007/s40279-022-01649-4. Epub 2022 Feb 11. PMID: 35147898; PMCID: PMC9325803.
Increasing Weight or Increasing Reps: Can Both Make You Stronger?

Increasing Weight or Increasing Reps: Can Both Make You Stronger?

This study examined whether progressive overload via increasing weight or increasing repetitions elicited similar muscular adaptations. Progressive overload is the continual increase of workload over time throughout a training regimen, which is necessary to stimulate ongoing muscular adaptation and is traditionally accomplished through increases in load (weight). This study investigated using continual increases in repetitions as compared to weight to progressively increase workload and the resulting outcomes for muscular strength, hypertrophy, and endurance.

Overall, there were improvements in all three variables in both groups that were similar between the groups. Strength (measured by 1RM back squat) increased in both groups and slightly favored the load group with an effect size of 2kg but a wide confidence interval. Muscle endurance increased in both groups and slightly favored the reps group by 2%. Hypertrophy improved similarly in both groups with the exception of one muscle (of 4 tested), the rectus femoris, which slightly favored the reps group.

 A few caveats to note: this study started with quite a high rep range for both groups (8-12 reps as a starting point), and the reps group increased from there. This is quite a high rep range even at the starting point, and the practicality of implementing an increasing rep scheme from that baseline and maintaining good adherence to training might be difficult. Along these lines, the authors noted that the reps group seemed to have a harder time training to actual failure likely due to “greater metabolic acidosis and discomfort” (translation: it was difficult and painful). In addition, this study population was young people with prior weight training experience, and the results may not be generalizable to other groups. The authors attempted to control for dietary factors with self-reported food diaries, but the accuracy of this is questionable and there could be dietary related differences between the groups. Finally, this protocol included training to failure, which when implemented in the real world may increase risks (greater fatigue, injury) and may not be necessary to achieve substantial improvements in the desired outcomes.

Overall, this study suggests that progressive overload in strength training can likely be achieved with either increases in load or reps assuming sufficient training stimulus (effort). Further research is needed to determine if there are benefits for one protocol or the other for relative improvements in strength, hypertrophy, or endurance. Future study should also evaluate practicality/adherence and generalizability to other groups.

By: Sarah DeParis, MD

Journal Reference:

  1. Plotkin D, Coleman M, Van Every D, Maldonado J, Oberlin D, Israetel M, Feather J, Alto A, Vigotsky AD, Schoenfeld BJ. Progressive overload without progressing load? The effects of load or repetition progression on muscular adaptations. PeerJ. 2022 Sep 30;10:e14142. doi: 10.7717/peerj.14142. PMID: 36199287; PMCID: PMC9528903.
healthy lifestyle food

Exercise During Difficult Times May Have Prolonged Positive Effects on Mood and Stress

During periods of stress, many of us forgo exercising and indulge in unhealthy eating. This study provides insight into how physical acitivty can lead to stress reduction and enhance positive feelings if we are able to include exercise into our daily schedule during difficult times. The effect of physical activity lasts for hours after the session and has prolonged positive effect.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar

Journal Reference:

  1. Schultchen D, Reichenberger J, Mittl T, Weh TRM, Smyth JM, Blechert J, Pollatos O. Bidirectional relationship of stress and affect with physical activity and healthy eating. Br J Health Psychol. 2019 May;24(2):315-333. doi: 10.1111/bjhp.12355. Epub 2019 Jan 22. PMID: 30672069; PMCID: PMC6767465.
Healthy Lifestyle Habits Have Positive Effects on Mental Health

Healthy Lifestyle Habits Have Positive Effects on Mental Health

This review article clearly highlights the importance of healthy lifestyle choices on mental health. Whole plant based diet and daily exercise have remarkable effects on our mood. In many studies, the effect has been described as equivalent to taking antidepressant medications. In addition, good sleep, daily gratitude, positive thoughts about the future, and being of service to others has also been shown to have lasting positive effects on our mental health.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar

Journal Reference:

  1. Morton DP. Combining Lifestyle Medicine and Positive Psychology to Improve Mental Health and Emotional Well-being. Am J Lifestyle Med. 2018 Apr 18;12(5):370-374. doi: 10.1177/1559827618766482. PMID: 30283261; PMCID: PMC6146362.
A One-Hour Walk in Nature Decreases Activity in the Stress-Related Regions of the Brain

A One-Hour Walk in Nature Decreases Activity in the Stress-Related Regions of the Brain

A recently published study compared the effects walking in different environments has on the brain. Study participants were randomly assigned to go on a 60-minute walk in a natural or urban environment, and questionnaires and fMRI scans were administered before and after the walk. fMRI scans were used to measure the activation of different brain regions, while questionnaires were used to gauge participant’s perceived mood and stress levels. The study found that a one-hour walk in nature decreased activity in the amygdala, while no change was seen after a one-hour walk in an urban-environment. The amygdala is the part of our brain primarily associated with regulating emotions and processing stressful events. An overactive amygdala is associated with anxiety, while, decreased activity has an anxiolytic effect. Therefore, the findings of thisstudy suggest a walk in nature may be more beneficial for managing stress than a walk in the city. Additionally, our environment plays an important role in the cognitive benefits of walking. This study is a great example of how multiple components of lifestyle medicine can come together. Exercise and being in nature are both powerful tools for managing stress and improving mental health; however, their effect is even more potent when combined.

By: Maya Shetty, BS, Lifestyle Medicine Fellow


Journal Reference:

  1. Sudimac S, Sale V, Kühn S. How nature nurtures: Amygdala activity decreases as the result of a one-hour walk in nature. Mol Psychiatry. 2022 Sep 5. doi: 10.1038/s41380-022-01720-6. Epub ahead of print. PMID: 36059042.