Nobody doubts the benefits of exercise for physical health. What isn’t as widely known or discussed is how essential moderate exercise is to our mental wellbeing.  I created an online survey which sought to find out what health strategies helped people who have experienced an episode of depression or anxiety to bounce back from setbacks. I took a holistic approach, and asked people to evaluate the effectiveness of strategies such as exercise, good rest, good nutrition, emotional support from family, friends, and support groups, fulfilling work, hobbies, charity work, as well as traditional approaches like psychological counselling and medication. In all, over 60 strategies were evaluated, and 4080 respondents were asked to rate those they had tried. Exercise was in the top three.

Research shows that a 30 minute brisk walk (or equivalent) significantly improves your mood after 2, 4, 8, and 12 hours compared to those that don’t exercise (Mayo Clinic 2008). Exercise also boosts energy, confidence, and sexual desirability (American Fitness, 19 (6), 32-36).

We can’t control the slings and arrows that come our way on a daily basis, but we can control our daily habits. Incorporating moderate exercise into our day can inoculate us from the prolonged effects of a setback.

Why don’t people exercise?

People typically nominate two main reasons:

· I don’t feel like it – this is particularly applicable to people who are discouraged and/or depressed.

· I don’t have the time – our relentless 24/7 life usually means there are a thousand things to say “yes” to. An essential element of a thriving life is saying “no” to the trivial many, so that you can say “yes” to the vital few. Exercise is definitely in the latter category.

Principles to make exercise central to your life

Find something you enjoy – To sustain regular exercise, it is important to do something that you find pleasant. The traffic in gyms are 30-50% higher in January than other times of the year, as people are suddenly inspired to get fit and lose weight. By March, they have returned to normal levels. It’s not wise to sign up for a gym if you hate them!

I like walking because it allows me to get amongst nature, it’s free, and you can do it anyplace and anytime. Some people keep a walking journal so that they can write down the new things they see, hear, and smell each day. This keeps you present. If you prefer swimming, dancing, cycling, boot camps, or hiring a personal trainer, then do that. To experience the mood enhancement qualities of exercise it is recommended to do 30 minutes, 6 days per week. Although people with depression often don’t feel like exercising, it is important to go against that inclination.

Have modest goals – many people believe that to get the benefits of exercise you have to spend 2 hours in the gym or run a marathon. As highlighted above, this is simply not true. If you have been doing no exercise, start with 15 minutes per day. If you are catatonic and spending all day in bed, just getting out to the letter box each day is a good start that you can build on. Build activity gradually.

Introduce rituals – As highlighted with the gym traffic trends above, changing behaviour requires more than intention. To make it stick, it is essential to introduce daily rituals that prompt the behaviour. For example, rituals could include:

· Laying your clothes out each night when you go to bed so that when you wake up you can dress without thinking and head off.

· As you brush your teeth each morning, put on a pedometer. When you brush at night, take it off and record the steps taken.

· Set a regular time to walk with a friend or work colleagues. Consider walking meetings.

· Consider using a free smart phone app like FitnessPal, which allows you to monitor your exercise and your calorie consumption.

Begin it now.

Graeme Cowan is the author of BACK FROM THE BRINK TOO: Helping your loved one overcome depression, which was SANE Australia’s 2009 Book of the Year – www.IamBackFromTheBrink.com . He went through a 5 year episode of depression which his psychiatrist described as the worst he had ever treated. He now speaks and consults about how to inspire the discouraged to bounce back and thrive. Over 40 free resources can be found at www.Facebook.com/BackFromTheBrink

Tags: back from the brink, Bounce Back, depression treatments, graeme cowan, mood enhancers, natural depression treatments, robust mental health, thrive

In research undertaken for my book BACK FROM THE BRINK TOO, people who had been through a severe bout of depression told me that if they had their time over, they would seek expert help much earlier. How do you access that expertise?

Alarmingly, during a doctor’s initial six year university education, most institutions devote miniscule coverage  to depression, anxiety, and other mental illnesses. However, the research firm Ultrafeedback surveyed 2434 Australians, and found that 26% of those surveyed had discussed depression with their GP in the last 12 months (second only to back pain with 33%).

To be fair, GP’s have a huge number of specialty areas to cover and many choose to focus solely on physical health. If you are really struggling emotionally it is quickly evident how important it is to have a well-trained GP with a caring manner. A good GP can be a lynch pin - integrating care involving other specialists such as psychologists and psychiatrists.

Understanding a GP’s Qualifications

There are GPs that are interested in mental health and study much more about it after graduation. There are some special Medicare item numbers related to mental health which all GPs can use and another set which are only available to GPs who have undertaken a certain amount of extra training. The most that is required of a GP to be accredited by Medicare to claim Mental Health item

numbers is 20 hours of specific training. This may be all the training your GP has had or they may have had much more.

A body called the GPMHSC accredits GPs for the special mental health item numbers. Six hours accredited training gives a GP a “Level 1” qualification. An additional 20 hours training provides a “Level 2” qualification. These levels of qualification allow a GP to claim or charge the special mental health item numbers. Most GPs do not display these qualifications but you can ask the GP or the reception staff whether the GP has Level 1 or Level 2 mental health accreditation. They should know the answer because of the item numbers they claim or charge.

Sources for finding a good GP

1. Family and friends – If you have a loved one who has had a positive experience interacting with a GP about depression or anxiety, ask them about the experience to see if the doctor might be right for you.

2. Postcode search on beyondblue website – On the home page of www.beyondblue.org.au there is a facility that allows you to enter your postcode. This will allow you to access a list of GPs and psychologists in your area that have a special interest in mood disorders.

3. Call your local General Practice Division - The Australian General Practice Network (AGPN) is the peak national body representing 111 general practice networks and eight state based organisations around the country. Go to www.agpn.com.au and identify your local division. Call and ask which local GPs have completed further studies in mental health.

Preparing for a mental health discussion

These suggestions are designed to maximize the probability of an accurate diagnosis and appropriate treatment plan. This will also allow the GP to determine if they are able to meet all your care needs or whether additional assistance may be required from a psychologist or psychiatrist.

Consider taking a loved one with you to assist in getting the most out of the visit.

1. Advise the receptionist that you would like to book a “long consultation” to discuss a mental health issue. If they don’t do this, it is unlikely that the practice is the right one for you.

2. Prepare to describe as succinctly as possible what symptoms you have been experiencing and for how long, the level of your disability as it impacts your home and work life, any triggers such as stressful events, the level of emotional support you have access to, family history of depression, and whether you are attempting to self-medicate with alcohol or drugs.

Assessing the visit

Ask yourself:

1. Did the GP seem to care?

2. Did they ask the right questions to understand my situation?

3. Did they propose a preliminary diagnosis and outline a holistic treatment plan that you have confidence in?

If you can’t answer yes to all three questions, it would be advisable to explore other options.

A more rigorous diagnosis

Mood Assessment Program (MAP) – The Black Dog Institute has developed MAP as a tool to help GP’s and psychologists make more accurate mental health diagnoses. It incorporates nearly a quarter of a century of sophisticated clinical expertise in assessment, diagnosis and management planning for people with mood disorders (both depressive and bipolar disorders). Your GP or psychologist must be a registered MAP user and can then provide you with a unique access code to complete an online assessment. Your doctor will receive the report to discuss with you at the next visit. There is no charge for MAP. See www.BlackDogInstute.org.au

Graeme Cowan is the author of BACK FROM THE BRINK TOO: Helping your loved one overcome depression, which was SANE Australia’s 2009 Book of the Year. He went through a 5 year episode of depression which his psychiatrist described as the worst he had ever treated. He now speaks and consults about how to inspire the discouraged to bounce back and thrive. Over 40 free resources can be found at www.Facebook.com/BackFromTheBrink

Tags: anxiety GP, depression GP, depression treatment, mental health GP, natural depression treatment, overcoming depression