EXERCISE: What DEPRESSION and EVERY Disease Needs

Clear Skin and Improved Mood—Two Oft-Forgotten Benefits of Exercise

By Dr. Mercola

One of the primary reasons why exercise is such a potent medicine for chronic disease is because it optimizes your insulin and leptin receptor sensitivity. Normalizing your glucose, insulin, and leptin levels will have a beneficial effect on virtually every disease state you could ever acquire.

But exercise also promotes the release of mood-boosting brain chemicals that help combat depression, and more superficially, it can go a long way toward improving your complexion; clearing up acne and warding off signs of premature aging.

How is it that physical movement can achieve such effects? It's easy to forget that your body is actually designed for more or less constant movement. When you do, all of your biological systems can work properly and efficiently, creating all-around beauty, health, and well-being.

It's just not natural to remain seated for hours on end like we do today, courtesy of computers, cars, and other gadgets that remove our need to get up, stretch, reach, bend, and move from one area to another. In fact, we're now starting to realize just howe bad it is to sit for long periods of time.

I've previously written about this, and the importance of what I call "intermittent movement" throughout the day. That said, more vigorous exercise is equally important for optimal health, beauty, and happiness, and here's why.

What Happens in Your Body When You Exercise?

As previously reported by the Huffington Post,1 a number of beneficial biological effects take place when you exercise. It quite literally affects your body from head to toe. This includes changes in your:

• Muscles, which use glucose and ATP for contraction and movement. To create more ATP, your body needs extra oxygen, so breathing increases and your heart starts pumping more blood to your muscles. Without sufficient oxygen, lactic acid will form instead. Tiny tears in your muscles make them grow bigger and stronger as they heal.
• Lungs. As your muscles call for more oxygen (as much as 15 times more oxygen than when you're at rest), your breathing rate increases. Once the muscles surrounding your lungs cannot move any faster, you've reached what's called your VO2 max—your maximum capacity of oxygen use. The higher your VO2 max, the fitter you are.
• Heart. As mentioned, your heart rate increases with physical activity to supply more oxygenated blood to your muscles. The fitter you are, the more efficiently your heart can do this, allowing you to work out longer and harder. As a side effect, this increased efficiency will also reduce your resting heart rate. Your blood pressure will also decrease as a result of new blood vessels forming.
• Brain. The increased blood flow also benefits your brain, allowing it to almost immediately function better. As a result, you tend to feel more focused after a workout. Furthermore, exercising regularly will promote the growth of new brain cells. In your hippocampus, these new brain cells help boost memory and learning. As stated in the featured article:

"When you work out regularly, your brain gets used to this frequent surge of blood and adapts by turning certain genes on or off. Many of these changes boost brain cell function and protect from diseases such as Alzheimer's, Parkinson's, or even stroke, and ward off age-related decline."

A number of neurotransmitters are also triggered, such as endorphins, serotonin, dopamine, glutamate, and GABA. Some of these are well-known for their role in mood control. Exercise, in fact, is one of the most effective prevention and treatment strategies for depression. 
• Joints and bones, as exercise can place as much as five or six times more than your body weight on them. Peak bone mass is achieved in adulthood and then begins a slow decline, but exercise can help you to maintain healthy bone mass as you get older.
Weight-bearing exercise is actually one of the most effective remedies against osteoporosis,  as your bones are very porous and soft, and as you get older your bones can easily become less dense and hence, more brittle -- especially if you are inactive.

How Exercise Can Improve Your Complexion

Exercise can also go a long way toward "cleaning up" and toning your complexion. Makeup artist Michelle Phan has blogged about the beauty benefits of exercise.2And, according to Dalton Wong, a celebrity trainer featured in a previousTelegraph article,3 engaging in the correct exercises will help you tone your skin in much the same way you tone your muscles. Katy Young writes:

"'The key in training to tone your skin is to focus on increasing lean muscle mass,' explains Wong. As we age, our skin naturally loses its plumping, youthful layer of fat. But if you exercise the right way, you can build up muscle which gives that same volatizing effect. As Wong explains; 'it's the lean muscle mass that sits just under the surface which can create a lifted, taught looking, skin.'"

According to Wong, to improve your skin, you'll want to focus on resistance training, where you're using your own bodyweight to challenge your muscles. Lunges, pushups, and planking are examples of resistance exercises. To tone both muscles and skin, and help eliminate cellulite, he recommends implementing a circuit routine consisting of three to four sets of weight bearing exercises with two to four minutes of cardio in between, repeated four times.

Excessive cardio training is not recommended if skin toning is your goal. It's also one of the least effective ways to improve your fitness, as discussed in previous articles, as your body is designed for great exertion in short bursts, which is how our hunter-gatherer ancestors used to move. Conventional cardio or long-distance running can actually do more harm than good, and this extends to your skin as well.

Wong warns that excessive cardio can actually cause your skin to lose its youthful elasticity, especially if you're over- or underweight. One of the reasons for this is because the stress placed on your body when you're running long distances produces excessive amounts of cortisol, a stress hormone responsible for inflammation. This can take a heavy toll on your skin, as cortisol tends to break down collagen, resulting in wrinkling and sagging.

Stay Well Hydrated When Exercising

It should come as no great surprise that sweating and improving blood flow is good for your skin. Your skin is the largest organ for detoxification, and sweating not only helps regulate body temperature; it also helps eliminate toxins. Improved blood flow, in turn, helps shuttle oxygen and nutrients to your skin, which is key for beautiful complexion. Water is another key ingredient. As stated in the featured article:4

"One of the things Wong tells his celebrity clients - who include Oscar-winning actress Jennifer Lawrence - is to stay well hydrated. 'It's not just that it helps you train better - no one can work out if they're not properly hydrated - it makes your skin look better, too. Conversely, if you're training without drinking enough water, you'll damage your skin pretty quickly,' he warns. How to tell if you're drinking enough? Try the hydration test by pinching the skin on the back of your hand; if it doesn't spring back fast, you're dehydrated."

In addition to hydrating your skin from the inside out, increasing your water intake will also help flush out trapped toxins, oils, and debris that can contribute to acne. The combination of being well-hydrated and boosting blood flow can also benefit your hair, as it will naturally stimulate your hair follicles and promote hair growth. 

Exercise Can Help You Feel Better from the Inside Out

Regular exercise is also one of the "secret weapons" to overcoming depression.  Indeed, it is a recipe for both looking and feeling better. A recent article in The Atlantic tells the story of Joel Ginsberg who, as a college sophomore, struggled with feelings of "an all-consuming hopelessness" and immobilizing self-doubt. For Ginsberg, as for so many others who decide to try it, exercise turned out to be a key ingredient for recovering his joie-de-vivre.  

"He thought getting some exercise might help, but it was hard to motivate himself to go to the campus gym," Olga Khazan writes. "So what I did is break it down into mini-steps," he said. "I would think about just getting to the gym, rather than going for 30 minutes. Once I was at the gym, I would say, 'I'm just going to get on the treadmill for five minutes.'"

Eventually, he found himself reading novels for long stretches at a time while pedaling away on a stationary bike. Soon, his gym visits became daily. If he skipped one day, his mood would plummet the next. 'It was kind of like a boost,' he said, recalling how exercise helped him break out of his inertia. 'It was a shift in mindset that kind of got me over the hump.'

There is plenty of research validating the value of exercise for the treatment of depression. As noted in the featured article, a 1999 study7 found that aerobic exercise was as effective as Zoloft. More recently, a 2011 study8 concluded that exercise led to a 30 percent remission in patients who had failed to get any relief from antidepressant medications.

Guidelines for Using Exercise as an Antidepressant

In 2006, a meta-analysis9 of 11 studies concluded that doctors would be well advised to recommend exercise to patients suffering from depression, anxiety, and eating disorders, as the evidence showed "substantial benefit." Yet according to a 2009 paper,10 a mere 40 percent of depressed patients reported that their doctors suggested exercise. As noted in the featuredAtlantic article:11

"Instead, Americans are awash in pills. The use of antidepressants has increased 400 percent between 1988 and 2008. They're now one of the three most-prescribed categories of drugs, coming in right after painkillers and cholesterol medications.

After 15 years of research on the depression-relieving effects of exercise, why are there still so many people on pills? The answer speaks volumes about our mental-health infrastructure and physician reimbursement system, as well as about how difficult it remains to decipher the nature of depression and what patients want from their doctors."

This is clearly a shortfall of modern medicine and psychiatry. Despite the evidence, many doctors still are not savvy enough to broach the subject of exercise and other lifestyle factors with their patients. And, of course, there's the lack of financial incentive... It may be worth noting that doctors who do not acceptance insurance tend to be more likely to prescribe non-drug treatments for their depressed patients. The other side of the coin is that many patients are looking for a quick fix, and resist taking physical action to improve their own situation...

If you were to view exercise as a drug, how much would you need in order to reap clinical results? According to research12 by Dr. Madhukar Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas, depressed patients would do well to exercise for 45-60 minutes, three to five times per week. He also recommends raising your heart rate to at least 50-85 percent of your maximum, in order to reap results.  

Keep in mind that major depression is typically associated with thoughts of suicide, and feelings of deep hopelessness or helplessness, making it critical to recognize and address such symptoms. (To assess your or a loved one's risk factors, please review this previous article.)  If you are feeling desperate or have any thoughts of suicide, please call the National Suicide Prevention Lifeline,13 a toll-free number 1-800-273-TALK (8255), or call 911, or simply go to your nearest Hospital Emergency Department.

How Does Exercise Alleviate Depression?

A number of cascading changes occur when you exercise that contribute to improved mood and mental health. For starters, it helps normalize your insulin and leptin levels, as mentioned earlier. It also boosts the production of mood-boosting hormones in your brain.  According to Dr. James S. Gordon, MD, a world-renowned expert in using mind-body medicine to heal depression:

"What we're finding in the research on physical exercise is that exercise is at least as good as antidepressants for helping people who are depressed… physical exercise changes the level of serotonin in your brain. And it increases your endorphin levels, your 'feel good hormones.'  

Also—and these are amazing studies—exercise can increase the number of cells in your brain, in the region of the brain called the hippocampus... they're very important because sometimes in depression, there are fewer of those cells in the hippocampus. But you can actually change your brain with exercise. So it's got to be part of everybody's treatment, everybody's plan."

Aside from serotonin and endorphins (which are responsible for that feeling of euphoria you get with regular exercise), other chemical messengers also play a significant role.14 When you exercise, your brain recognizes the exertion as a fight-or-flight stress situation. To protect itself from stress-related harm, your brain releases a protective protein called Brain-Derived Neurotrophic Factor (BDNF).

This protein helps repair neurons, and acts as a "reset switch," which may explain why solutions tend to come into clearer focus after a bout of exercise. BDNF also activates brain stem cells to convert into new neurons, and triggers numerous other chemicals that promote neural health. Recent research15, 16 has actually made it quite clear that exercise and brain health are inextricably intertwined. The evidence shows that physical exercise helps you build a brain that not only resists shrinkage, but increases overall cognitive abilities—and feelings of happiness.17

Aim for a Well-Rounded Fitness Program

Whether you simply want to look better, or actually feel better—physically and mentally, I strongly suggest carving out the necessary time to exercise. Ideally, you'll want to strive for a varied and well-rounded fitness program that incorporates a variety of exercises. I recommend incorporating the following types of exercise into your program in order to truly optimize your results:

1. High Intensity Interval Training (HIIT): This is when you alternate short bursts of high-intensity exercise with gentle recovery periods. For more information, please see this previous article. 
2. Core Exercises: Your body has 29 core muscles located mostly in your back, abdomen, and pelvis. This group of muscles provides the foundation for movement throughout your entire body, and strengthening them can help protect and support your back, make your spine and body less prone to injury, and help you gain greater balance and stability.
Foundation Training, created by Dr. Eric Goodman, is an integral first step of a larger program he calls "Modern Moveology," which consists of a catalog of exercises. Postural exercises such as those taught in Foundation Training are critical not just for properly supporting your frame during daily activities, they also retrain your body so you can safely perform high-intensity exercises without risking injury. Exercise programs like Pilates and yoga are also great for strengthening your core muscles, as are specific exercises you can learn from a personal trainer.
3. Stretching: My favorite type of stretching is active isolated stretches developed by Aaron Mattes. With Active Isolated Stretching, you hold each stretch for only two seconds, which works with your body's natural physiological makeup to improve circulation and increase the elasticity of muscle joints. This technique also allows your body to repair itself and prepare for daily activity. You can also use devices like the Power Plate to help you stretch.
4. Strength Training: Rounding out your exercise program with a 1-set strength training routine will ensure that you're really optimizing the possible health benefits of a regular exercise program. You can also "up" the intensity by slowing it down. For more information about using super slow weight training as a form of high intensity interval exercise, please see my interview with Dr.Doug McGuff. 
5. Avoid Sitting for More Than 15 Minutes. Last but not least, while it may not have a direct effect on your mood or beauty regimen, there's a lot to be said for avoiding prolonged sitting. Chronic sitting has actually been shown to take years off your life even if you exercise regularly.  
To counteract the ill effects of sitting, I recommend setting a timer to go off every 15 minutes while you're sitting. When it goes off, simply stand up. I usually recommend going a step further; personally, I stand up and do one legged squats, jump squats or lunges when the timer goes off. The key is that you need to be moving all day long, even in non-exercise, or as I now like to call them, intermittent movement activities.