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

Racism and Heart Disease Risk

Our experiences, emotions, and behaviors are interconnected and can profoundly influence one another. While there are times one part of your life can seep into and impact another positively, problems in one area can also have a negative impact if not addressed. One area we aim to highlight is the connection between social relationships and physical health, particularly heart health.

The impact of racism on physical health is a critical area in the healthcare space, and it warrants our attention. In an article published by Boston University, Andrew Thurston sheds light on a groundbreaking study that establishes a strong correlation between experiencing racism and an increased risk of heart disease among Black women.

The study, spearheaded by Dr. Yvette Cozier, an epidemiologist, and professor at the Boston University School of Public Health, analyzed data from the Black Women’s Health Study (BWHS) – an ongoing, long-term research project initiated in 1995. With a cohort of over 59,000 Black women from across the United States, the BWHS has made significant strides in understanding the health disparities faced by this demographic.

To determine the association between racial discrimination and heart disease, the research team employed a detailed questionnaire that assessed participants’ experiences of racism in various contexts, such as work, housing, and public spaces. The questionnaire also considered the frequency and severity of these encounters.

After examining the self-reported data alongside medical records, the researchers found that perceived racism in employment, housing, and interactions with the police was associated with a 26 percent higher risk of coronary heart disease for Black women.

Sheehy, who’s also affiliated with the BU Slone Epidemiology Center, explains, “When we think about how racism impacts our health, it’s a psychosocial stressor… it increases your blood pressure, your level of inflammation—[and] all of these biological mechanisms increase your risk of coronary heart disease”.

The study forces us to examine how the interconnectedness of our lives allows racial discrimination to have far-reaching consequences on one’s health, wellness and lived experience. While the study underscores the importance of providing holistic and culturally aware patient care, further research is needed to elucidate how coping mechanisms can counteract the effects of racism. We must recognize how structural racism within the healthcare system can impact lives, advocate for, and work toward change.


By: Helena Zhang, BS & Michael Fredericson, MD


  1. Study Abstract: https://newsroom.heart.org/policy?id=63ed57d8b3aed303f1737879
  2. Black Women’s Health Study: https://www.bu.edu/bwhs/

Box Breathing: A Calming Technique

The Research Behind Box Breathing

Picture this: you’ve just encountered a stress-inducing event, such as a disapproving email or a tense phone conversation. Almost immediately, you begin to worry, your heart rate quickens, and your breaths become more rapid.

A study published on in Cell Reports Medicine by Yilmaz Balban et al. revealed that participants in controlled breathing groups – box breathing, mindful meditation, and cyclic sighing – experienced notable improvements in problem-solving, peacefulness, and positive thoughts.

On average, those in the controlled breathing groups reported a daily uplift in positive affect of 1.91 points on the Positive and Negative Affect Schedule scale, compared to 1.22 points for the mindfulness meditation group – an increase of roughly one-third.

The Technique

Box breathing consists of a series of four breaths, ideally inhaling and exhaling through the nose. Inhale deeply for 3-10 seconds, then exhale for the same duration. Be sure not to hold your breath when your lungs are empty!

To determine the optimal inhale and exhale duration, take a deep breath, filling your lungs to capacity, and then time how long it takes to empty your lungs as slowly as possible.

If it takes 0-20 seconds, your inhales, exhales, and breath holds should last 3-4 seconds.

If it takes 25-45 seconds, your inhales, exhales, and breath holds should last 5-6 seconds.

If it takes 50-75 seconds, your inhales, exhales, and breath holds should last 8-10 seconds.


The next time you face a stressful situation, remember to take control and simply breathe.

By: Helena Zhang, BS & Bruce Feldstein, MD


  1. https://pubmed.ncbi.nlm.nih.gov/36630953/
The Healing Powers of Art

The Healing Powers of Art

What are the healing powers of art? And can art therapy be used to improve mental health?

The Healing Powers of Art

From the animals dancing on the walls of Paleolithic caves to the Harlem Renaissance, the resonance of art in our world is loud and deeply felt. As we continue to carry histories and emotions, our propensity to turn to art has spanned across the desert of time.

While some believe that art can evoke emotions that go beyond words, others agree that art can captivate the soul, body, and mind. Recently, researchers studied the healing power of art. Through reviewing literature, they explored the effects of art therapy on mental health.[1]

Art therapy, which encompasses theater, dance, music, photography, drawing, painting, and crafts, is currently used in several recovery and treatment procedures. When art therapy became a formalized curriculum in 1940, our dependence on the arts for self-expression, healing, and communication became clear. Researchers found that art can improve mental health, slow cognitive decline, build self-esteem, and enhance one’s quality of life. Moreover, as a powerful, patient-centered tool, art can impart insight, decrease stress, heal trauma, increase memory and neurosensory capacities, and improve interpersonal relationships.

In a randomized control trial (RCT) by Ciasca et al., 60 stable, pharmacologically treated women with Major Depressive Disorder received either art therapy or care as usual. In the art therapy condition, therapists introduced artistic resources such as weaving, collage, clay modelling, drawing, and painting and guided participants in using them. Following the intervention, patients who received art therapy experienced less depression and anxiety symptoms than patients in the control condition. While these observations were consistent with other forms of nonpharmacological treatment, such as psychotherapy, the researchers found that during artistic output, emotions and feelings could be formulated and revaluated. Art as an outlet, allowed for new insights and forms of expression that led to less negative thoughts and feelings of sadness [2]. In another study, patients with Alzheimer’s disease who participated in art interventions experienced improved quality of life and self-actualization.

Currently, art therapy is used as a treatment modality for people with cancer, autism, HIV disease, Alzheimer’s disease, COVID-19, dementia, and Parkinson’s disease. The therapeutic and psychological impact of art is consistent. These findings demonstrate the healing power of art and the value it can bring to the lives of people who are managing medical and mental health disorders.

By: Helena Zhang, BS

Journal References:

  1. Shukla A, Choudhari SG, Gaidhane AM, Quazi Syed Z. Role of Art Therapy in the Promotion of Mental Health: A Critical Review. Cureus. 2022 Aug 15;14(8):e28026. doi: 10.7759/cureus.28026. PMID: 36134083; PMCID: PMC9472646.
  2. Ciasca EC, Ferreira RC, Santana CLA, Forlenza OV, Dos Santos GD, Brum PS, Nunes PV. Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial. Braz J Psychiatry. 2018 Jul-Sep;40(3):256-263. doi: 10.1590/1516-4446-2017-2250. Epub 2018 Feb 1. PMID: 29412335; PMCID: PMC6899401.
What Effect Can Physical Activity Have on Your Mental Health?

What Effect Can Physical Activity Have on Your Mental Health?

Physical Activity Have on Your Mental Health

How do you cope during times of stress? And what do you turn to when you’re up against difficulties?

In 2022, researchers investigated a possible outlet – physical activity (PA).To study the relationship between physical activity and mental health, the researchers synthesized evidence on the effects of physical activity on symptoms of depression, anxiety, and psychological distress.

Across 97 reviews with over 100000 participants, physical activity was found to have benefits across all clinical populations, with larger benefits for people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. On the other hand, usual care without physical activity, only had medium effects on depression. All forms of physical activity were beneficial, however moderate to high-intensity physical activity was associated with an even greater improvement in symptoms. The study found that different modes of physical activity have different psychological effects. While resistance exercise had the largest effects on depression, yoga and other mind-body exercises were most effective for reducing anxiety.

Moreover, the study highlights the neuromuscular mechanisms through which physical activity improves depression. Physical activity can lead to an increased expression of neurotrophic factors, greater availability of serotonin and norepinephrine, and reduced systemic inflammation. These mechanisms may prevent as well as treat mental health disorders. 

A key strength of this study is the umbrella review it uses to evaluate the effects of all types of PA on depression, anxiety and psychological distress in all adult populations. The study calls for more research and clinical actions. More research is needed to evaluate the different factors that can influence this relationship between physical activity and mental health, such as the exact type, duration, and intensity of physical activity, and the individual characteristics at play, such as age, sex, and socioeconomic status. Do team sports generate different effects than solo training? 

And as for actions, it is critical for healthcare professionals to consider physical activity in treatment plans.  In our world today, one in two people will experience a mental health disorder in their lifetime. While the annual global costs of mental health disorders have been estimated at $2.5 trillion, hundreds of millions of people face the debilitating effects of depression and anxiety in their day-to-day lives. Therefore, lifestyle management approaches, such as exercise, sleep, and diet, need to be incorporated with psychotherapy or pharmacotherapy treatment to achieve best outcomes

The study shows that lifestyle changes can alter lives: to improve the mental health outcomes of people around the world, it is time that we turn towards the great benefits of physical activity.

By: Helena Zhang, BS

Journal References:

  1. Singh B, Olds T, Curtis R, Dumuid D, Virgara R, Watson A, Szeto K, O’Connor E, Ferguson T, Eglitis E, Miatke A, Simpson CE, Maher C. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med. 2023 Feb 16:bjsports-2022-106195. doi: 10.1136/bjsports-2022-106195. Epub ahead of print. PMID: 36796860.

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


Benefits of Prebiotic Supplements

A Mindfulness Program May Be Just as Effective as Medication at Reducing Anxiety

A recent study called Treatments for Anxiety: Meditation and Escitalopram (TAME) compared an 8-week standardized evidence-based mindfulness-based intervention (mindfulness-based stress reduction, MBSR) with medication for the treatment of anxiety disorders. The study included over 200 adults with a diagnosed anxiety disorder that were assigned to either 8 weeks of the weekly MBSR course or taking a medication for anxiety called escitalopram. The MBSR course involved weekly 2.5 hour classes, 45-minuter daily home exercises, and a day-long weekend retreat during the fourth or sixth week. The classes and home exercises involved mindfulness meditation, body scans (directing attention to one part of the body at a time to increase inward awareness), and mindful movements such as stretching.  At the end of the 8 weeks, the results showed that the mindfulness program was just as effective at reducing anxiety as medication. 

By: Vanika Chawla, MD


Journal Reference:

  1. Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2023;80(1):13–21. doi:10.1001/jamapsychiatry.2022.3679
Research Suggets Whole Food Diets Improve Mood and Quality of Life

Research Suggets Whole Food Diets Improve Mood and Quality of Life

When the substance of food culture is composed of highly processed goods and advertisements of snacks, alcohol and soda as avenues of happiness, the poor food choices that arise are unsurprising. However, sugar-laden and high-fat consumption are associated with rising mortality rates, increased prevalence of chronic diseases, and soaring rates of addiction and mental health crises.  

In a first of its kind study, Francis et al randomly assigned 76 young adults to either eat a healthy Mediterranean diet, that is rich in fruit, vegetables, fish, and lean meat, or to continue eating a diet high in processed foods, saturated fats, and refined sugars. After a brief educational video and a $60 incentive to purchase Mediterranean foods, the Med diet group reported decreasing their intake of refined sugar and saturated fat. After only three weeks, the Med diet group showed significantly lower levels of depressive symptoms. On the other hand, young adults in the control group, who consumed a diet high in processed foods, saturated fats, and refined sugars, experienced no change in depression symptoms. 

With diet as a modifiable risk factor for depression, education on healthy eating habits, diet changes, and interventions are more important than ever as we face a world of increased stress and anxiety from the pandemic and saturation with social media and virtual technology. In the study, the diet intervention consisted of vegetables, omega-3 fatty acids, wholegrain cereals, protein from poultry to eggs and legumes, nuts and seeds, olive oil, and spices such as turmeric and cinnamon. In addition to following a Mediterranean style diet, the recommendations provided in this study included avoiding foods that come in a package with multiple ingredients, foods with more than 10g sugar per 100g, soft drinks, chocolates, sweets, and fried take away foods.  

 There is no doubt that what we eat affects us from our head to toe. Therefore, eating healthy, whole foods, is a promising way to improve our mood and the quality of our life.  

By: Helena Zhang, BS and Marily Oppezzo, PhD, MS

Journal Reference:

  1. Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. PLoS One. 2019 Oct 9;14(10):e0222768. doi: 10.1371/journal.pone.0222768. PMID: 31596866; PMCID: PMC6784975.
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.