belux-_efe-_unbranded_hcp_slidedeck_wellness_and_exercise_dr._jain-_180649-_july_2018

Focus on physical exercise Rakesh Jain, MD, MPH Clinical Professor Department of Psychiatry Texas Tech Health Sciences Center School of Medicine Midland, Texas Focus on EXERCICE 180649 - 07 2018 Speaker Rakesh Jain, MD, MPH Department of Psychiatry, Texas Tech University School of Medicine, Midland, Texas Clinical Professor in the Department of Psychiatry, Texas Tech University and in private practice in Austin, Texas Completed a Postdoctoral Fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston Awarded the National Research Service Award for the support of this postdoctoral fellowship Involved in over 100 research projects and is the author of over 50 articles Financial Disclosures Rakesh Jain, MD, MPH has received research support, and/or served as a consultant, member of advisory boards, and speaker for the bureaus of Addrenex, Alkermes, Allergan, AstraZeneca, Forum, Eli Lilly, Lundbeck, Merck, Neos Therapeutics, Otsuka, Pamlab, Pfizer, Rhodes Pharmaceuticals, Shionogi, Shire, Sunovion, Takeda Saundra Jain, MA, PsyD, LPC has served as a consultant for Eli Lilly, Otsuka, and Pamlab Health: Defined by the World Health Organization “ … a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ” World Health Organization Promoting Mental Health Concepts, Emerging Evidence, Practice 2005 www.who.int/mental_health/evidence/MH_Promotion_Book.pdf Accessed on January 8, 2016 Traditional treatment goals SYMPTOM REDUCTION IMPROVED FUNCTIONALITY IMPROVED OUTCOMES Certainly important… BUT is this enough? A more complete formula? SYMPTOM REDUCTION IMPROVED FUNCTIONALITY WELLNESS IMPROVED OUTCOMES WILD wellness – Wellness interventions for life’s demands NUTRITION EXERCISE SOCIAL CONNECTEDNESS SLEEP MINDFULNESS SIMPLE PRESCRIPTIVE TRACKABLE WILD wellness elements PROGRAM EXPECTATIONS EXERCISE Exercise 30 minutes each day for 30 days, at least with moderate intensity* MINDFULNESS Practice mindfulness for at least minutes each day for 30 days SLEEP Implement at least of the pro-sleep hygiene practices each day for 30 days SOCIAL CONNECTEDNESS Text or call family members or friends each day for 30 days NUTRITION Log your daily meals / snacks / beverages / alcohol intake each day for 30 days** * If you're unable to reach moderate intensity as you begin the program, that is fine Do whatever you're capable of doing The goal is to increase your intensity to a level of moderate intensity as you're able ** We highly recommend you follow the MIND Diet during the program as it’s shown pro-brain and pro-health benefits Mind-body interventions offer significant improvements in multiple psychiatric disorders Physical Exercise Nutrition Improvement Social Connectedness Mindfulness Sleep Hygiene TAMING DEPRESSION AND IMPROVING WELLNESS WITH EXERCISE Exercise’s impact on the immune system Chemotaxis index Single bout of 45-60 minutes of exercise in sedentary women 300 250 *** 200 150 * +++ ++ 100 50 Phagocytosis index Before Exercise 24h later Before Exercise 24h later 200 150 *** ** +++ 100 ++ 50 Before Exercise 24h later Before Moderate exercise = 45 minutes at 55% VO2 max Intense exercise = 60 minutes at 70% VO2 max Giraldo E, et al Neuroimmunomodulation 2009;16:237-244 Exercise 24h later How well does physical exercise work in combating depression? Meta-analyses of 39 studies Exercise did improve symptoms of depression Evidence suggests that exercise probably needs to be continued in the longer-term for benefits to be maintained Comparison made with controls, psycho-therapy and pharmacotherapy Cooney GM et al Cochrane Database of Systemic Reviews 2013 Sep 12;9:CD004366 A quick primer on effect sizes EFFECT SIZE MEAN OF ONE POPULATION large 0.8 MEAN OF ANOTHER POPULATION medium 0.5 small 0.3 STANDARD DEVIATION Effect of different types of exercise 1,20 1,03 1,00 0,85 Effect size 0,80 0,60 0,55 0,40 0,20 0,00 Aerobic exercise Resistance training Cooney GM et al Cochrane Database of Systemic Reviews 2013 Sep 12;9:CD004366 Mixed If you want to be fit, then you must “FID” FREQUENCY INTENSITY DURATION “F”ID: “FREQUENCY” Effect On Depression 4,00 3.51 3,50 Effect size 3,00 2,50 2,00 1,50 1.04 1.06 2/week 4-3/week 1,00 0,50 0,00 Rethorst CD, et al Sports Medicine 2009;39(6):491-511 5/week F‘‘I’’D: “INTENSITY” Effect On Depression 0,90 0.78 0,80 0,70 Effect size 0,60 0,50 0,40 0,30 0.26 0,20 0,10 0,00 61-74% of VO MAX Rethorst CD, et al Sports Medicine 2009;39(6):491-511 > 75% of VO MAX FI‘‘D’’: “DURATION” Effect On Depression (in minutes) 1,80 1,60 1.60 1.50 1,40 Effect size 1,20 1,00 0.82 0,80 0.49 0,60 0,40 0,20 0,00 20-29 30-44 Rethorst CD, et al Sports Medicine 2009;39(6):491-511 45-59 60> FI‘‘D’’: “DURATION” Effect On Depression (in weeks) 1,60 1.34 1,40 Effect size 1,20 1,00 0.90 0,80 0,60 0,40 0.26 0,20 0,00 week Rethorst CD, et al Sports Medicine 2009;39(6):491-511 4-9 weeks 10-16 weeks Exercise, medication – compared to medication Medication = sertraline 50-200 mg per day Exercise = times per week, total 45 minutes, at least 30 minutes at 70-85% MHR Medication treatment, n = 48 Exercise, n = 53 Combined, n = 55 22 20 HAM-D score 18 16 14 12 10 Before treatment After treatment Medication Exercise Treatment Group Blumenthal JA, et al Arch Intern Med.1999;159:2349-2356 Combination What’s the right dose of exercise? For general health: >  Minimum 30 minutes a day, at least moderate intensity, 5+ days a week >  One session or through several shorter bouts of activities 10 minutes or more For depression: >  14 miles of walking per week >  Sounds like a lot… BUT >  That equals 30 minutes of brisk walking per day (2 miles per day @ 4miles/hour speed) Daley A J Clin Psychol Med Settings.2008;15:140-147 Exercise Rx Exercise prescription Please discuss with your healthcare provider I agree to exercise the following number of times per week (please circle one option below) 1/week 2/week 4/week 5/week 6/week 7/week I agree to the following type of exercise (please circle one option below) Aerobic exercising 3/week Weight lifting/Resistance training Mixed (both) I agree to the following minimum number of minutes of exercise each day I exercise (Please circle one option below) less than 15 minutes 15-20 minutes 20-30 minutes 30-45 minutes 45 minutes – hour greater than hour Challenges we faced and solutions we found Challenges Solutions >  My participation isn’t perfect I want to quit! >  Perfection is not the goal Do your best to practice daily >  Pain stops me from exercising 30-minutes daily >  Negotiate intensity and duration based on patient’s health >  I can’t disengage from electronics 90-minutes before bedtime! >  Negotiate fewer days a week to demonstrate the benefits >  I don’t have time to mindfully meditate! >  As little as minutes of meditation twice a day is a good start >  Logging food and snacks is a hassle! >  This practice promotes fewer calories consumption “Physical fitness is not only one of the most important keys to a healthy body, it is the basis of dynamic and creative intellectual activity.” ~John F Kennedy Discussion and Q&A Focus on EXERCICE