Feel Better, Live More with Dr Rangan Chatterjee - #97 How Exercise Changes Your Brain and Reduces Your Risk of Depression with Brendon Stubbs

Episode Date: February 12, 2020

Think of a physiotherapist and you probably think of someone who’s interested in muscles and joints; someone who gets you moving again after an injury, right? Well my guest this week is a physio with a difference. He’s concerned with the effect movement has, not on our bodies… but our minds.  Brendon Stubbs is head of physiotherapy at the South London and Maudsley NHS Foundation Trust, a clinical lecturer and a prolific researcher. His work is helping provide the medical profession with much-needed evidence for what we, as humans, feel instinctively: physical activity makes us feel good. For instance, did you know moderate exercisers are 30 per cent less likely to suffer a depressive episode? Or that being sedentary can actually cause depression? Finally, we have proof that exercise is as effective as many existing interventions for preventing and treating mental health conditions. And I would argue it goes one step further, by also boosting physical health and social connections. Whether you or someone you know is struggling with mental illness, you’re a healthcare professional, or you simply want to increase your emotional resilience, I think you’ll be persuaded into action by the surprising stories and evidence Brendon shares. And if you’re persuaded, please spread the word – let’s start a movement revolution. Show notes available at drchatterjee.com/97 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Hosted on Acast. See acast.com/privacy for more information.

What they showed in this randomized control trial is just 10 minutes of light, very, very, very light activity, the equivalent to just gentle walking, could result in meaningful changes in electrical activity happening within the hippocampus and also other emotional processing areas of the brain. So just 10 minutes today of light activity can get meaningful changes in the emotional processing areas of your brain. Hi, my name is Rangan Chastji, GP, television presenter and author of the best-selling books The Stress Solution and The Four Pillar Plan. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to

simplify it. I'm going to be having conversations with some of the most interesting and exciting people both within as well as outside the health space to hopefully inspire you as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier, we are happier, because when we feel better, we live more. Hello and welcome back to episode 97 of my Feel Better Live More podcast. My name is Rangan Chastji and I am your host. Now today's conversation is all about movement. What movement does to our brains and what impact it can have on our risk of developing mental health problems like depression. And my guest is the world-leading researcher and clinical physiotherapist, Brendan Stubbs.

When you think of a physiotherapist, you probably think of someone who's interested in muscles and joints, or perhaps someone who gets you moving again after an injury, right? Well, my guest this week is a physiotherapist with a difference. He's concerned with the effect movement has, not on our bodies, but our minds. His work is helping provide the medical profession with much needed evidence for what we as humans feel instinctively. Physical activity makes us feel good. For instance, did you know that moderate exercises are 30% less likely to suffer a depressive episode or that being sedentary can actually cause depression. Finally, we have proof that exercise is as effective as many existing

interventions for preventing and treating mental health conditions and I would argue it goes one step further by also boosting physical health and social connections. Whether you or someone you know is struggling with mental illness or you simply want to increase your own emotional resilience, I think you'll be persuaded into action by the surprising stories and evidence that Brendan shares. And if you are persuaded, please spread the word and together let's help to start a movement revolution. Brendan is one of the world's most prolific researchers in this field, and I think you are really going to enjoy what he has to say. Now, before we get started, as always, I do need to give a very quick shout out to some of the sponsors of today's show who are essential in order for me to continue

putting out weekly episodes like this one. Vivo Barefoot, the minimalist footwear company, continue to support my podcast. I'm a huge fan of Vivo Barefoot shoes and have been wearing them for many years, as have my entire family. They make really, really comfortable minimalist shoes that you can basically live your entire life in. So many of you have already taken advantage of the special offer that Viva Barefoot offer to my listeners and have fed back to me that you are really pleased and often surprised with how comfortable these shoes actually feel. They can be super beneficial for back, hip and knee pain, as well as general mobility. And I've been recommending them for many years now to patients and have seen great benefits.

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So Brendan, welcome to the Feel Better Live More podcast. Thank you so much for inviting me. I'm really pleased to be here. Yeah, no, I've been looking at your work. I've come across it, I think, first on Twitter for the last couple of years. And the amount of papers you publish is pretty incredible. I mean, how do you keep up that volume? I think it's a testimony to the great number of team and collaborators that we work with. So we've got lots of people work

across the UK and across Europe and internationally and really it's a result of great collaborations and networks and people are really passionate about the areas which we're going to talk about today it's certainly not my own hard work and endeavors it's great teamwork and collaboration yeah well look we're definitely going to get into a lot of the research that you've published, which is really, really interesting. But I think what strikes me, you are a physiotherapist. And most physiotherapists who I know and I've worked with are super interested in the physical body and they're interested in muscles and joints and, you know, how you get various muscles to work in collaboration with others and it's really fascinating for me that you are a physiotherapist who has a special interest

in mental health what happened there well i wish i could say i just woke up and had this real passion to go and work for people with mental health conditions and i set out that way but it was a bit of an accident to be honest um but as you're right most physiotherapists and most of my colleagues are doing exciting things like or perceived exciting things like sports injuries or working in stroke rehab but after I graduated I really wanted to do not much after I finished and wanted to take things easy after completing physio training but then my mum was a head pharmacist at a big mental health hospital so rather sort of you know just gently she said to me why don't you just go in brendan and just go and talk to the head of physio at this mental health hospital so really just to

keep my mum quiet i just thought okay i'll go and have a chat with the head of physio at this mental health hospital and then i went there and before I knew it was having a job interview and started working in a mental health environment and found it absolutely fascinating just this whole new world of mental health and working that particular environment and I've gone on to the things in the meantime sort of traditional sports physiotherapy stroke rehab older adult rehab I've always really been fascinated by mental health and the mind-body connection and I've always kept being dragged back to that. So when was that? When did you, you know, in order to keep your mum happy, go into that hospital where there is a head physio for mental health? What year are we talking about here? 2003. 2003. So look, you know, so I qualified

from medical school, I think in 2001, August 2001 is when I started as a junior doctor. So, I'm just trying to think back then, I don't think I would have known that there was, you know, I did psychiatry rotations, I did psychiatry jobs as part of my training. jobs as part of my training but I don't ever recall there being a head of physio at one of these sort of mental health units or wards so I'm really fascinated by that was that quite ahead of its time back then as well? Yeah well when I worked when I sort of walked onto the wards very early on I went to go and see one of the consultant psychiatrists and the consultant psychiatrist at the time i was developing a new service as a junior physio and and he sort of very politely looked around and just said oh physiotherapist what are we going to do with you um and within a relatively short period of time from sort of 2003 to where we are now we've seen enormous progress in terms of recognizing treating mind and body together and recognizing treating people's

physical health in mental health care settings and vice versa so there's been a huge transition recognizing that the mind and body are interconnected and now people very much sort of nationally and internationally recognize that we need much more physical health experts in mental health care settings and vice versa. So presumably you went into studying physiotherapy well actually I shouldn't claim to presume this why did you initially go on to study physiotherapy? Honestly I really liked football and I wanted to go and be physiotherapist for my favourite football team which is Newcastle United okay and that And that was the vision. However, I got sidetracked and I'm very pleased that I did.

And my sort of day-to-day clinical work now is about a million miles away from where you could be in terms of like a Premier League physiotherapist. And I'm delighted the path that I've gone and, you know, I sort of live our life forwards, but it's only understanding it backwards that it's all become clear

that this was the right path for me to go down. Yeah, it is amazing how many people I speak to on this podcast who to borrow a phrase from from a friend of mine A.N. Panja there's a happy accident that happens at some point in their life you know so you have this ambition or this dream of being Newcastle United's physio which I totally get and again that sounds a lot more like the physios who I have met and have come across um certainly in my career and in my personal life and that's why it was so fascinating for me even when I first started looking at your research it was interesting as a physiotherapist he's doing a lot of research in mental health this is something that I've just

not seen much of before so let's go back then to 2003 so you're you know you join this mental health hospital and the psychiatrist is like okay a physiotherapist what are we going to do with you so what did they do with you or what did you end up doing with yourself in a mental health ward there's a number of things which struck me enormously when i first went a mental health ward back in the early 2000s. First of all, when just how the lifestyle of people that are in mental health hospitals at that time, and still is to this day, just how sedentary people were at that time, people were still smoking on sort of hospital wards and staff would often go in and smoke with people on the wards and just the whole culture and lots of food particularly junk food

people not getting off the ward it was just it was just striking to me just how lifestyle was just not really given much sort of kudos or emphasis but then also just the number of physical health care complaints that people's are on the mental health units had it was just striking to me that people had so many mental physical health conditions at an often much earlier age so I just thought wow we've really got quite a lot of work to do in terms of changing culture and lifestyle but also in assessing and managing people's physical health in that setting. Yeah so I'm sort of trying to think that through. And so you've got patients who are presumably in there primarily because they have some sort of mental health diagnosis. I'm guessing whether it's major

depression or anxiety or schizophrenia or something that is deemed serious enough where they need to be in and getting some sort of treatment. So, was the role of a physio at that point, you know, you can't really separate physical health and mental health. Although I get why we do that because I think physical health has had so much of the spotlight with respect to health and lifestyle and well-being that I think in order to raise mental health and the awareness of it, it almost needs a spotlight of its own, even though I kind of think they are sort of the same thing. Was the job initially, okay, so the psychiatrist and their team are taking care of this patient's physical, sorry, mental health needs. I'm going to go in and actually look after their physical

health needs. Is that where it started? Yeah, pretty much. That's where it started. But that's not where it is now. That's not where it is now. It's much more of a cohesive, everybody whole person approach. But initially it was much more of, okay, you know, I'm coming in as a physical healthcare quote unquote specialist. Let's go in and raise the importance of people's physical health help get people moving and and emphasize just how important that is getting people off into open green space moving around more and treating and managing people's physical health care conditions and pain yeah so actually probably doing a lot of the things that because of a lot of research including a lot that you've published we now know those things are going to have benefits

for their mental health. But actually back then, and I guess in many ways, a very reductionist way of compartmentalizing everything. It's like, okay, this is, we're going to take care of your physical health and this team, we're going to take care of your mental health. But I wonder, you know,

do you remember seeing some of those patients initially? Because I guess trying to think back to when I, I think it was at the Royal Edinburgh Hospital when I did a lot of my psychiatry rotations when I was at Edinburgh Medical School. I guess, was there a different dynamic, do you think, between you and the patients? Because they can almost switch off a bit in the sense that okay with the psychiatrist I have to talk about my mental health problems what I'm struggling with oh but it's now you know Brendan's here to just oh I can go for a walk with him I can actually sort out my physical health would I don't know was there something about that dynamic that allowed them to open up and teach you

things that maybe you weren't aware of absolutely um the people I've worked with you know patient service users have always been the greatest teachers. But that sort of unique dynamic is still here very much to this day where I am part of the core multidisciplinary team, but I'm often coming in to address people's physical health care needs and help people there and then on the spot. So I'm not seen as day in and day out as a core part of the multidisciplinary team. not seen as day in and day out as a core part of the multidisciplinary team so i can sort of you know covertly come in and talk to people and build up this therapeutic relationship which is very different to people who are on the ward day you know every day or the ward doctor or the psychiatrist or the psychologist and i can say let's go for a walk let's go and do some exercises

let's go to the gym and it's just a different dynamic where people can open up and talk in a very sort of different way because the primary focus is really about their physical health and getting people moving more and feeling better and not so much primarily focused on the mental health aspect. But naturally, much of that does tend to come out and develop very sort of good therapeutic relationships, which is great. There is research, of course, now showing the benefits of exercise on our mental health and we're going to spend a lot of time diving into that i think that's super super interesting for people to hear um but i'm still really interested in terms of your story do you remember were there some patients for example or some cases where actually you were you know quote unquote dealing with their cases where actually you were, you know, quote unquote,

dealing with their physical health, but you were starting to see, wait a minute, although that's helping their physical health, their mood's lifting and they've got more energy and they're able to engage in other things better. Or was it that clinical experience that came first? Or was there a paper that you read and you thought, oh, wait a minute, I should be doing this for this reason. I don't know. What was the ordering in terms of your career? first or was there a paper that you read and you thought oh wait a minute I should be doing this for this reason I don't know what what was the ordering in terms of it in terms of your career I think it was just an amalgamation of all of those things really I mean what really started it off from a sort of a clinical and a research perspective was I was working at this time in older adult mental health inpatient units including people who are

in secure services and I just noticed just the culture at that time on the wards was let's just get everybody sort of safe and secure sitting down not moving so we can see everybody in sight and we know that they're well and being looked after and safe and I was starting to take an academic interest in terms of physical activity and movement and how it could influence our physical health and there was a bit around our mental health and I just saw these people sitting around for large portions of the day and started to run a number of exercise and activity groups where we'd get people off the ward and you just see people's faces and dynamic shift when people were taken off the ward into an open green space and you could see the immediate benefits that access to open air and fresh space would have on people.

So that was really the kickstarter off that and recognising that people were really really sedentary we just developed this very very simple audit and it was my first attempt at research really is notice on this particular unit that people were sitting around virtually from all of the time apart from getting up going to breakfast going back to the lounge maybe going off the ward to do a bit of ot sitting down for lunch then sitting around watching tv and maybe doing a few activities so what we did was something very very simple when it was the best that i could do at that time in my sort of research training which was minimal was we developed an educational session about the benefits of physical activity from a physical and a mental health viewpoint and we gave everybody

pedometers and this was around 2006 and put up a bit of a chart on the the wall and just put how many steps so at the end of every day people could come and write up how many steps they'd done over the course of the day and we'd monitor people's time over weeks after we'd had this educational session it was just great to see the people at the end of the day and i'd go on after you know sort of shift and people coming and writing up their scores and say look how i've done compared to the previous day and and just seeing how it built this sort of cohesion and and formation amongst the group which is just really really nice and people became really interested that they could make a change in their life compared to yesterday, which they knew from the education session,

which we discussed with them would help their health and well-being compared to yesterday. It was giving them the power to make a meaningful change each and every day, and they could write that down and see it for themselves. Yeah, Brennan, that's such a lovely story to think about. I think you were way ahead of your time doing all that sort of stuff back then. Was there an element of friendly competition at all between the patients? Did you see? But it was, I can still clearly remember it coming at the end of the day and all of these, you know, older adults with, you know, severe and often enduring mental health issues who were really excited to come and write up their scores at the end of the day. At the end of the week, we'd look at the scores together and discuss it with this consultant psychiatrist who then started to become a bit aware about what physiotherapy may offer. And it was just a complete shift in paradigm what we were doing. Yeah, it's fascinating to think about that.

Obviously, you've come up to my house, you've just been in our kitchen and you've seen the charts that we've got up on our wall yeah uh which are basically you know my attempt to try and teach my kids about how do you create a new behavior and we'll get on to behavior change because i think it's really important part of all the research you're doing but it's interesting for me that one of the components of trying to create a change in someone's behavior is tracking it and actually, you know, celebrating when you've achieved something. Yeah. Something Professor BJ Fogg talks about a lot. But it's about connecting an emotion to that positive habit that you're trying to create. And it's been incredible for

me because I think it's now three weeks my kids have been taking off that chart. They've hardly missed a day. They've chosen, I mean, my book only asks people to choose three health snacks a day, one for your mind, one for your body, one for your heart. And I'm trying to caution them against going too much. I said, look, if you're trying to do too much in one go, often we end up doing nothing and that's not really how you create a new behavior. But it's working and they're coming down each morning and they're actually, as we're waiting for breakfast, they're trying to get their ticks in. And it's fascinating for me to compare that, which, you know, we've just been commenting on in my kitchen. And then comparing that to a ward maybe 10, 15 years ago with patients with quite severe mental health problems, feeling a

sense of agency over their lives because that's what i that's why i'm such a fan of small changes because it doesn't have to be as big as we think because even that act of going on and writing their number each down and doing it in a supportive environment in a group it gives them a sense of agency right but also helps to build a bit of self-esteem which i think is really important so important and you know bringing that sense of achievement and for many of the people in this particular instance they'd been in hospitals for a long period of time so their um you know control or ability to sort of function their daily life was relatively limited so for them to be able to make small and meaningful changes where

they could write down and see objective differences you know could really enhance their self-esteem and give them a sense of self-worth knowing that they could do this change from tomorrow and it was just a relatively small change in number of steps you're asking people and it's really really powerful once you start to achieve those goals and small changes then it's really really powerful and you know the motivation ball starts to snowball. Are there any patients in particular that come to mind for you where increasing their physical activity had you know what I call a ripple effect knocked on to various

other aspects of their life whether it's their mental health how they feel about themselves any any sort of key key cases that you remember? Yeah so I perhaps use one um who we'll call david for now um so uh david was uh he was actually a relatively young chap um who came on to award actually relatively uh about three years ago he was admitted after a you know a particular psychotic episode where he became unwell and started to believe that people were were after him and he uh you know during when he was unwell he jumped out of a window because he thought his life was in danger and broke a number of bones and he came into care of the hospital for treatment for his mental health and for treatment of his psychotic symptoms and unsurprisingly once he was in hospital he started

to become really demotivated um you know and quite depressed and quite withdrawn and previously he'd been really active and into into sport um so what i did with uh david at this particular time was just get alongside him and just start saying even though he had some casts on his feet it's just saying let's come down to the physiotherapy area and gym and let's just try and do some very small, simple things, which we can get you doing each particular day. And from this really withdrawn, sort of depressed person who's experiencing psychosis, you could just see this really profound shift in his mental health day by day.

He could really look forward to his physio session where he could get off the ward, engage in some exercise and meaningful activity activity and you could really see this shift within him and and in david's instance his mental health you know went on to go and greatly improve as a result of the whole care which is receiving his physical health completely improved and now he's a great ambassador for exercise and mental health generally and he helps me in a lot of my research that we do because all of my research that we do because all of the research that we do is very much informed by people who've got personal experience as well and he's just become a great ambassador from those early conversations about how it's

changed his life when he was at his lowest point um you know and he's living like a you know a great life now and coincidentally not as a result of my direct intervention he's in the process of applying physiotherapy training as well which is just um great to see and he comes along some of the lectures that i do it's just really really nice to see so he really sticks out yeah what a heartwarming story um and again really nice to see people you know feeling the benefit themselves helping you but then also wanting to go and give back and actually go well i want to study this now i want to go and actually help other people like i've been helped which is very common i i find you know a lot of people when they when they've not been doing so

well and they find things that help them yeah they really they want to go and spread that that message and want to go and help other people say look i didn't know this stuff either i want to help you get that information and it's so much more powerful as well when it's so when you've got someone who's you know who's been there and you know you can really come and reach out to people in a unique way and say this was my experience this is what happened to me and this is how it helped me in my particular situation so it's it's really really powerful and that's why we're you know it's just it's just an amazing example to me of just positive change and using you know that particular experience to be in such a positive force to influence others you know around him and also the research that we're doing

so he's involved in helping us in developing all of the research we're doing on exercise and mental health which is great as well and wants to help people you know as a clinician in the future too yeah amazing i think for me that's what gives you um you know you're pretty unique in the sense that you're doing a lot of research but you're also still seeing patients and i i of course you don't have to do that but i do think it gives you a very very valuable insights because some researchers only do research and that's completely fine as well and some people only see patients again all of these things are completely fine, but I think there is something quite unique about doing both, that you can sit on both sides of the fence a little bit and see guidelines are great, but also

how do these guidelines actually get put into real life clinical practice? What's working, what's not? I think you must have some real unique insight onto that. It's an enormous privilege to be able to be a clinician but also be involved in research and i've had times and i've been a clinician full-time in research and definitely for me personally having a balance is is wonderful because in research often we're analyzing data of you know thousands sometimes millions of people and it become it can become quite depersonal when you're looking at millions of data points on a particular research topic.

So going back and helping someone like David or Bob or Sandra on a one-on-one basis where it's just me as a physiotherapist is just truly wonderful. And so I went in to go and help people and having that balance is really, really special. And I think it really helps my research because I'm on the wards or i'm helping people as well real life people so i i know the realities of daily practice and how difficult it is to help someone who's experiencing quite profound mental health symptoms to get people motivated and engaged but i also know the research viewpoint and how we can try and translate that

and meet them both together and and it helps when i go into clinical you know environments as well and i can say this is what we're doing about research and talk to the clinical team and say what do you think or if often if i'm working with a patient i'll say i'm considering this research idea what do you think and we just have a casual conversation i can get informal feedback which is which is great awesome absolutely awesome well look we're mentioning research a lot. Let's dive into a bit of the research. So, you've got a lot of different people who listen to this podcast. A lot of people are, you know, members of the public.

There's a lot of healthcare professionals as well. You publish so many research papers. Are there, I mean, are there some key salient points that actually a lot of people listening to this podcast may not be familiar with? We're familiar with the idea already, aren't we, that exercise is really good for our physical health, whether it's our body composition, our weight, although there is a debate on how much it influences that, but of course it is an important factor to consider nonetheless. but have we understood enough that exercise is just as powerful for our mental health as it is for our physical health i think now we're at the point where we can say you know without reservation that moving

around in your daily life is beneficial for your mental well-being and your mental health just as much as it is your physical health you're right and that the focus generally and in society and in medicine has been about how does it improve our physical health and often an individual or societal level it was if I move around and exercise more how does it make me look how does it make me feel or fit into my my clothes but really we're trying to frame the the conversation to be quite different around saying how does physical activity and exercise make you feel does it make you feel good and that's very much the focus of the research what we're doing and we can say really really strongly that when you look at big populations of people moving around in your daily

life and different types of exercise can really help build up resilience reduce the risk of developing adverse mental well-being and even mental health conditions also yeah it's fascinating for me that we sort of intuitively know that as humans don't we that when we move when we get our heart rate pumping a bit when we get a little bit sweaty from something you know we tend to feel good you know our moods been elevated so i think intuitively we sort of know even though we may not think about it enough we know that moving makes us feel good yeah but i think what you've done so well is move it beyond that sort of human intuition to actually get some hard science on this to really inform guidelines. Are there any particular papers that you consider to be quite landmark in this? Yeah, so there's probably a few different papers I think are quite landmark and quite key. And you're right to say that people have, you know, we've as individuals been experiencing the

movement makes us feel good for a long period of time. And people have been saying this as philosophers for a very, very long period of time. Movement is good, but the data and the scientists, you know, have only just about caught up to provide the hard evidence for it. So I think there's a few key research papers which, you know, provide good data. One is which we published in the American Journal of Psychiatry in 2018. It was led by Professor Felipe Schuch, who's a professor of physical activity in Brazil. And essentially, we did something really, really simple, is we wanted to look at everything that had ever been published on how active people are in their daily lives, and the risk or odds of developing depression in the future and we looked at data

points from over 46 individual studies we brought them all together because bringing studies together gives you a clearer answer than when you look at individual studies and you try and make sense of it and we followed those 260,000 people who are free from depression or any adverse mental health or well-being at baseline followed them for an average of seven and a half years and we found that people who were most active compared to the least active were around 15 less likely to develop depression in the future but the most potent effect was when people were meeting recommended government guidelines of say 30 minutes five times a week 150 minutes minutes over the course of a week.

And it was around a 30% reduced risk or odds of developing depression in the future. So longitudinally... 30%? 30% reduced risk or odds in the future. So we've been able to... So we're following people free from depression at baseline, following them over time. So we've prospectively or over time shown there is a direction in the relationship between being

more active and reduced risk or odds of depression in the future so that's predictive in a sense that if someone's listening to this now and goes okay what does that mean for me if they currently do not have a mental health diagnosis and they're feeling pretty good you know they feeling okay, but let's say they're worried about the growing rates of mental health problems or they have a family member, let's say, what that particular paper is suggesting for them is that if they meet those government guidelines of activity, they are 30% less likely to develop depression at some point in the future. Yes, that is essentially the message. Now, depression and mental health is a very complex and multifactorial condition in its own right. But it is suggesting that for people who are more active,

then you're less likely to develop depression in the future. Perhaps just before we disentangle that a bit more, or just to add to sort of some gravitas to that there's been some big genetic studies that you know are a bit beyond my circle of competence but essentially they've looked at is there a causal relationship between proven genetic markers of depression and objective physical activity so can being more active reduce your risk of developing depression through a technique called mendelian randomization studies and what they've shown in the uk biobank and over 100,000

people is that for people who are even genetically predisposed to develop depression that if you are more active there is a causal pathway i.e it can help reduce your risk of developing depression even if you're genetically predisposed so that adds further evidence to what we've done observationally also i love that and that really i think there's a wider point there um yes we're talking about mental health and physical activity but we're seeing this across the board with a whole variety of chronic um medical conditions that are affecting so many people these days, this idea that genetics are a component and different conditions can be more of a component. But even if you are born with genes that predispose you to develop one

of these conditions, actually the way you live your life, your environment, your lifestyle can absolutely influence whether those genes sort of play out or not, you know, the expression of those genes that can help switch them on or switch them off, this whole field of epigenetics, which we have covered a couple of times on the podcast before, but I really feel, you know, it's really worth hammering home that point for people that, yes, you may have a genetic predisposition yeah but much research but including that paper you just talked about just now if you are physically active even with the genetic predisposition you can reduce the likelihood that you're going to develop it in the first place absolutely and it's just this abundance of evidence just demonstrating this point time and time again

which is just fantastic so we're're really, really catching up. So even if you are genetically predisposed to developing depression, being more active, adopting healthier lifestyle habits can help reduce your risk and odds. Now in research, in order to show does something really causally have an influence and outcome, so in this case depression, you need to do something called a randomized control trial, which is where you may randomly allocate groups of people to an intervention and a control group where you may give people nothing, or you could give people an exercise intervention or a medication

or a psychological intervention. Now people have built upon this observational work and have done some you know quite neat randomized control trials where the intervention has been looking at um quote and quite healthy people young young people in their 20s and the intervention instead of being you know medication or giving people exercise has been sit still be more sedentary do not move over and above what you would usually do and the control groups carried on as usual so this is randomized control trial and is enforced sedentary behavior and

enables us to make look at causal pathways so just just to clarify this one so um well randomized control trials just again just to reiterate are considered the gold standards gold standard um and so there's different levels of research and and to be super super straightforward with people let's say you were trying to test if a new pharmaceutical drug was going to work you might take uh 50 people and put them in one group and 50 people in another group um in the control group those 50 people don't get the drug in the uh the test group those 50 people do get the drug and then you measure and you see and then you make you know you see is there a difference between

the two groups that's how we determine if drugs actually have value and you're saying that you're now trying to do the same level of evidence or or require the same level of evidence for you know what can be considered softer interventions like lifestyle so just going back to this study so you're saying enforced sedentary behavior so i didn't quite follow that so the patients have they're healthy so these are healthy people in their early 20s there's a few randomized control trials which have done this so they've randomly recruited people who didn't have any mental mental or physical health conditions at baseline. And instead of giving them something helpful randomly,

like a medication or giving them exercise, they were told to sit still, be more sedentary, not move, and the control group carried on as usual. And what they did in this first randomized control trial is they measured people's mental health at baseline, and they measured it after a week, and then they measured it so the intervention lasted a week where they're enforced or told to be sit still and be more sedentary and then they measured it again once the intervention stopped and what they found essentially is after a week is you can get an increase in people's stress levels and also people's depressive symptoms from just this

enforced you know sit still do not move and be sedentary compared to a control group and this is a better level of evidence to show that not moving around is really not very good for our mental health and in addition to this one week study there is another four week study where they did exactly the same thing a randomized control trial the intervention was sit still be more sedentary do not move the control group carry on as usual people with no mental or physical health conditions and after four weeks the people who were told to be more sedentary started to become stressed depressed and they started to have increases in peripheral inflammation or you know what's been linked to depression compared to the control group so it builds on the observational evidence

i mean that's incredible when were those studies done 2016 and 2017 and there's a few other studies yeah it was interesting for me is that you can almost interpret that the studies and again i'm not i'm not making a sake they're almost like torture i know i know it's it like we're gonna you know we're not we're gonna take away something from you that is fundamental to being a human being which is movement yeah and see what happens and you mentioned depressive symptoms go up and these, this is a healthy population without preexisting mental health problems. So effectively what we're saying is that if you are well and you stop moving, your stress levels are likely to go up.

You are much more likely to, your mood is much more likely to be affected negatively. And then you think about the population around us, and this is a much wider point, how society is set up these days, and how for so many of us, sedentary living is the default norm. Particularly this time of year, we're recording this in January, you know, it's dark, it's, you know, Christmas and New Year seem like a you know a distant memory and you know a lot of the time people come back they've been sitting in a car or on a train on the way to work and they're sat at a desk all day and they come back and they're too tired so they might put on netflix

in the evening to chill actually there may well be a significant implication for your moods and your mental well-being absolutely absolutely and i usually caveat when i describe those studies saying i have no idea how they've got ethical approval for those for those particular studies um but they did but it really builds on that observational data as well and then you think about people who may have an injury or some other reason um just how much that could really influence your um risk of you know, poor physical health. We know, but also people's mental health.

And if people, I mean, I'm sure there's many parents who listen to this podcast. We know that with our children, like if you are at a weekend, if you don't get your kids active, if you don't take them out after a while, they start to,

they start to play up. They get a bit moody. Their behavior goes off and often simply going outside for 20 or 30 minutes they're just like different kids yeah and again i just it's something we've intuitively know but as i say what you're doing is you're building up the research base which is so needed in order to give this credibility particularly within my profession yeah and and that's the thing we're providing the data and the evidence to have you know a credible option that

physical activity should be you know the core of you know improving people's mental health but then also be used as a viable intervention as well for people who do have mental health symptoms or a mental health condition and we need this level of evidence and some of the research that we do i describe to my non sort of academic friends and say well isn't that obvious and i say well yes but we need this level of evidence to to get sort of you know medical colleagues or or guidelines to listen and say that this is really important for our mental health i think brendan that's a great point about isn't this obvious because on so many levels it is, but then, you know, I've been a practicing clinician for almost 20 years now. And I can tell you that still in consultations, let's say in general practice, and I understand that there are pressures on people in general practice,

time pressures, stress pressures, workload problems. I totally get that. I'm just removing that from the equation just for the minute. So many people are coming in with mental health problems and their physical activity levels are not being asked about. And the clinician often doesn't feel that they know enough about A, how to ask about, and B, what to do with that information, what to say to the patient. And I think this is why I'm so passionate about educating doctors about this kind of material, because I think there is this real value for a patient, I think, when a doctor or one of the healthcare professionals looking after them says, actually, I think this is going to be really, really valuable for your mental wellbeing. And I don't think that happens enough.

And, you know, we're talking about physical activity. We could also talk about diets. We mentioned just before we came on air, you know, a mutual friend, Felice Jacker, Professor Felice Jacker, who published the SMILES trial, the first randomised control trial, showing how changing your diets for 12 weeks can put some cases of major and moderate to severe depression into remission. Remarkable. Absolutely remarkable.

We've had Felice on the podcast before. I think it was episode 71, I believe, if people want to go back and check that episode. But what's fascinating about that is that that research had been out for a couple of years and I was in, I can't remember where, but I was lecturing some GPs. I was teaching them and I asked them how many, how many of you actually, when you see a patient who comes in with a mental health problem, let's say depression, for example, how many of you ask them about their diets and talk to them about their diets? And I think only 5% of the room put their hand up. And then I just for 20 minutes, 25 minutes, just went through a quick overview of some of the papers that had been published, including Felice's SMILES

trial in 2017. I think it was 2017. And then I asked them, now how many of you are going to raise that as a topic with your patients? And pretty much the whole group put their hand up. And so even if there's research there, it's still not getting translated into clinical practice. And that's just why podcasts like this and going out and talking to people is so important. Because most people are not going to go and read academic papers because we write in a language and in a way which is just not accessible by you know clinical people or or people who are not in an academic space it's often difficult to interpret as a researcher myself so getting out

the message and the interpretation in in everyday language is so important to change clinicians or general people's behaviours and beliefs and attitudes towards particular interventions, which is why it's so important. Yeah, absolutely. And I think there's a wider point there for me, which is also, you know, sometimes people say, why do doctors need to know about this stuff? You know, you've got physios that you can refer to, or they'll say the same about nutrition. You know, we've got dieticians or nutritional therapists that people can send their patients to. The reason I'm passionate that doctors need to know

about this research and this stuff is because even if we're not the ones delivering the treatment or the intervention, at least having this knowledge means we're going to think about, oh, you know, this patient's come in depression. Maybe I need to refer them to a nutrition specialist, or maybe I need to refer them to a movement specialist or a physiotherapist to help with this aspect of

their health. But if we're not familiar with it, because ultimately the way the medical system is set up in most countries around the world, but certainly here in the UK, people come and see their GP first, right? That seems to be the first course of course. So, if all your training as a GP has been about the pharmaceutical solutions to a mental health problem, that if a patient's in with you, your bias is always going to be down towards that as the treatment that you're going to give. I just, I know what it's like in the trenches. That's going to be your bias. And you may mention something as the patient leaves the room, you know, try and be a bit more physically active. I don't think that's good enough anymore,

right? We need to be much more specific in what are we asking that patient to do? Why are we asking them to do it? And I agree, having some research, if you can say to your patient, hey, did you know, and I know we're talking about physical activity we're just going back to felice's work for a second did you know that actually the way you're eating may not be helping your mental health you know there was a trial where for 12 weeks when they followed something called a modified mediterranean diet it helped to put some cases into remission would you be interested in me referring you to a dietitian or a nutrition therapist to help you do that i bet you most patients at that point will be like hey yeah well you know what i wouldn't mind you know if i can

get some help for that that would be amazing yeah but i don't think we're giving our patients the option and that's what i find incredibly frustrating fully agree and that's why i think it's so important to advocate and to illustrate this evidence to practicing clinicians and also with patients and service users as well often i'll spend a bit of time talking to them did you know this is a piece of research in everyday language that just just doing you know a few minutes a day can improve your mental health and this is the impact it could have on you these are some relatively simple changes you can do today to improve your mental health and well-being these are some things that

i do and talk about what i do as well when people find it so empowering that they can make a change there and then today to improve their mental and also their physical health is so powerful so you mentioned that paper whereby well people if they had enforced sedentary behavior they got worse yeah do we have any papers on certain conditions, let's say like depression or schizophrenia or anxiety, where actually an intervention of physical activity has helped improve symptoms? Yes, we do. So perhaps I'll start off with depression and clinical depression and also depressive symptoms. So we've got a good amount of evidence. And by that, I mean, So we've got a good amount of evidence and this can have a real meaningful change for people

whether that be aerobic and there's also some emerging evidence for resistance training or strength training work as well so really really good evidence for clinical depression and depressive symptoms that exercise can improve people's symptoms and also we talked about the mind-body connection earlier and often for the people that I see and people describe in literature people who may have depression often more likely to have physical health care complaints and vice versa so when we think about the physical health benefits of exercise as well it could be this double win that we can have an evidence-based treatment to improve people's mental health symptoms get people more socially connected and out but also improve people's physical health as well so there's really good evidence in in in depression what was the time period there

so around 12 to 16 week you can get meaningful improvements in people's depressive symptoms. And what sort of activities were they doing? So often aerobic exercise led by an exercise instructor, sort of 30 minutes a couple of times a week or three times a week. You know, some interventions around walking or strength training as well. some interventions around walking or strength training as well but I would like to illustrate perhaps the best randomized controlled trial for exercise in depression was done in Sweden by a colleague at the Karolinska Institute, Mats Hallgren and the fair point around exercise for depression generally is that they've been relatively short in terms of the length of time they've followed people up so they've often been less than six months. And in randomized control trials, we like big numbers, often people more than 100.

But most trials had had less than 100 people in them. So Matt's did this wonderful trial published in 2016, where he had three groups and over 900 people. So around 330 people in each group. And he followed people up for 12 months so we've got a huge randomized control trial big numbers mean we can be more confident in the data we've got long-term follow-up for these people with moderate depression so at baseline they're randomized to receive usual care so that would be whatever they receive in a standard care by their gp and other access to services the other two groups also had usual care another group had usual care plus internet

delivered cbt so cognitive behavioral therapy which is recognized as a valuable treatment and commonly endorsed and very effective for people with depression and the other group had usual care and exercise as an intervention where people would meet two or three times a week and do 30 minutes of moderate intensity exercise over 24 week period so this was the intervention and they followed for 12 months and what they found is that both the exercise and the CBT were equally as effective as each other. There was no significant or clinical difference between them. So they were both just as good as each other, but they were both better than usual care. So both of them were significantly or clinically better than usual care.

clinically better than usual care but cbt which is commonly advocated and recommended was an exercise was just as good as this in this huge trial when we go back again to the physical health care benefits the social connectedness which you can get from exercise this is you know addresses some of the common criticisms of exercise as an intervention yeah very very powerful and again no one's saying anything negative here about CBT. Absolutely not. CBT is wonderful. as uh cbt as you say you know exercise doesn't just help with the mental health it also helps with your physical health and if you bring in some sort of social element to that exercise you know like parkrun for example um then you know there really are multiple different benefits and and also kind of access right if you think you think about access, I'm always thinking with patients,

how it's all very well talking about stuff that is going to benefit people, but if it's too hard to access, then you can have the best research in the world, but no one's going to do it. Getting more active for many of us, and I appreciate some people find it hard, it's a lot easier to access

than maybe getting your own therapist or maybe it's quicker than waiting, access than maybe getting your own therapist or, you know, maybe it's quicker than waiting, you know, certainly on the NHS anyway, of course you can access a therapist privately. But, but I really feel that I really feel that in many ways,

the way we look at nutrition and lifestyle and things like exercise, it's never really been deemed real medicine and therefore it's almost as if we have to the onus is on us to prove to a much higher degree that you know this kind of basic stuff can really work do you know what i mean i kind of do it's really frustrating because it's so powerful, so powerful. And it's just, you know, the evidence now is accumulating in such mass, which is just wonderful because we have the credibility to say this can help to help prevent adverse mental health, but also be used as a real viable treatment for people who are presenting

with depression as well. And perhaps one of the examples I use when I work with people as well and perhaps one of the you know examples i use when i work with with people as well is saying you know you don't have to wait 12 or 16 weeks to feel the benefits um there was a really nice randomized control trial done in japan and um one of the areas which is implicated um as being reduced in people with depression and other cognitive disorders is the area of the brain called the hippocampus which is really important to consolidate our memories from short to long term and processing of emotions so this is often reduced in mental health conditions and what they

did in this study in japan was something really really simple they randomized people so again gold standard evidence to sit still in a functional magnetic resonance imaging scanner or to sit down in a functional magnetic resonance imaging scanner and cycle very, very lightly on the spot. And they looked at people's brains live, which an fMRI enables you to do. was you to do and what they showed in this randomized control trial is just 10 minutes of light very very very light activity the equivalent to just gentle walking could result in meaningful changes in electrical activity happening within the hippocampus and also other emotional processing areas of the brain so just 10 minutes today of light activity can get meaningful changes in the emotional processing areas of your brain and the volume of the hippocampus as well i think on one study i saw yeah so we've also done studies as well where we've looked at changes in the volume and obviously that's really exciting because

neuroplasticity or changing the structure of the brain is is really important and and changed in many mental health care conditions and we've shown that with aerobic exercise over a 12-week period you can get changes in the volume of the hippocampus i mean this is 12 weeks this is mind-blowing information because ultimately what we're saying is that 10 minutes well that was a slightly different study i should you know i think but uh moving regularly can change the size of a very important part of your brain you know the memory center in many ways the hippocampus you can change in size by regularly being active and it's again it's about for me it's about how do you reframe the conversation around movement and exercise so it So it's not about your appearance and your weight.

It's so much more varied than that. There's so much more exciting things to talk about than that. It changes the structure of your brain, your nerve cells. We don't even mention BDNF today, brain-derived neurotrophic factor, this hormone that goes up when you exercise, which helps to create new nerve cells, sorry, new nerve connections. And it's like, this is exciting stuff that we have access to if we move more. Exactly.

And today, you, I, anybody can get meaningful changes in the electrical activity in the brain fertilizer. You mentioned BDNf just from moving around more today and we've we've shown that in randomized control trials as well you can increase bdnf we can change you know our brain connectivity and actions today yeah i mean that's so exciting i mean but just to really um follow up on the point that that study was talking about 10 minutes which again pretty much most of us if not all of us even if we're super busy can fit about 10 minutes, which again, pretty much most of us, if not all of us, even if we're super busy, can fit in 10 minutes of physical activity a day. Just to take that a step further,

my latest book was called Feel Better in 5 and everything in the book takes five minutes to do. And, you know, there are some five minute exercises for your mental health, some for your physical health and some for what I call heart health, which is about human connections. But there's a lady who contacted me recently on my Instagram, and she suffers from anxiety. And she has been updating with me on her progress since she got the book a few weeks ago. I said, Dr. Tashi, I just want to share this with you. I have literally transformed my life in the last two weeks because I do five minutes of breathing every morning. I do five minutes of,

there's a workout in the book called the classic five workouts, which is a strength body weight workouts, which is super easy. You don't need any equipment, you don't need to go and join a gym, you know, it's super, super simple. And I can't remember the one she does in the heart section. But the point is, within two weeks of doing three five-minute chunks a day, and if we're talking about physical activity, just five minutes of a day, she's saying, actually, I'm really not feeling anxious anymore. I'm actually just not getting these stats. I hope this continues.

And actually, I've got another message following saying it still is continuing. And it's just remarkable how small changes, small things when done consistently add up very, very quickly. And that's just one thing. I'm getting so many messages like that. So I really want to hammer home the point that it's not about a one hour spinning class three times a week if you can do that go for your life but if you can't don't let that put you off absolutely and i think that's that's you know so encouraging to hear story you know stories like that lady as well and as many people i work with and and often we hear about public health guidelines around say 150 minutes per week and that's a scary number and there's been many times in my life when i've not met those guidelines as well but there's a recent reframing within those

guidelines um which i talk about in my clinical practice which is just very much small changes just getting up and moving around every minute 20 minutes half an hour going out and having a bit of fresh air can make a big difference just these small cumulative changes can make big differences to our physical and also our mental health and it's just when it becomes to being more active just making those small changes can help you move along that physical activity continuum and the key thing for any behavior is finding something which you enjoy getting started finding something you enjoy and and do it and if that is a spin class then then great if that is a hit class then great but if that is going out and having a walk for five minutes then that is absolutely perfect too yeah i just add if it could also be dancing it could be

dancing it's a brilliant form of activity it's fun a lot of people a lot of people don't think about dancing when they think about physical activity. They think it's got to be a prescribed movement class that's got a particular name that you have to get a particular outfit for. And I understand where these things have come from, but I really feel that we've overcomplicated movements. And I've written several times about a case study of some patients who I saw, a mum and her 16-year-old daughter, who were struggling with moods, struggling with weights. They tried all kinds of things that you just could never stick to. And actually, they felt as if, you know, they were failures, that they couldn't, you know, that nothing was working for them. And that in itself would make them feel low. And they were having relationship

problems between the two of them and i i hate i don't really like using the word prescription in this uh contest but i prescribed for them five minutes of dancing and they said look guys why don't you dance every day when you because it was clear to me that they liked it you know the 16 year old girl always had um you know band t-shirts on she always had earbugs like hanging on her shoulders when she came in. So I was like, I got that feeling she was a big music fan. So okay, let's meet you guys where you're at. And literally from every day after school, they would dance together. Those five minutes would often become 10 minutes. They start to feel good about themselves and mood starts to improve. Their energy starts to improve. Their relationship gets better. And that leads to

what I call a ripple effect into other aspects of their lives. So they their relationship gets better and that leads to what i call a ripple effect into other aspects of their lives so they start to eat better yeah but it all started with those that regular dancing every day and i'm not saying you've done studies on dancing per se or have you uh written about dancing as an intervention yeah really so we have written about but and i've and i've and i have been known to dance on the wards as well have you people yeah not very well so what tell me about this dancing study just taking a quick break in today's conversation to give a shout out to the sponsors of today's show athletic greens continue their support of my podcast to To be really clear, I absolutely prefer that people get all of their nutrition from foods. But for some of us, this is not always possible. Athletic Greens is one of the

most nutrient-dense whole food supplements that I've come across and contains vitamins, minerals, prebiotics, and digestive enzymes. So if you are looking to take something each morning as an insurance policy to make sure that you are meeting your nutritional needs, I can highly recommend it. For listeners of this podcast, if you go to athleticgreens.com forward slash live more, you will be able to access a special offer where you get a free travel pack box containing 20 servings of Athletic Greens, which is worth around £70 with your first order. You can check it out at athleticgreens.com forward slash live more. So we did a dancing study looking at how dancing may be useful for older people, actually, as an intervention to help them sort of healthy age and not fall over.

And we found that it could be a promising intervention to help people's balance, because obviously if you're dancing, you're shifting your weight and using your muscles and could be useful to help stop people falling over as well and I think dancing is a great way to get in your activity over the course of a week and I like what you said about you know over complicating physical activity it shouldn't be it's easy to. And again, just to highlight what you've already said, which very much sort of echoes my view, which is choose something you like. Choose something you love doing.

Yeah. Because long-term, that's the only way you're going to be able to stick to it is if you actually enjoy it. And I think that's why I think for some people, dancing is the best thing they could do. A lot of people already like to dance, but they just don't think it counts. They don't think it counts as physical activity.

And it absolutely does. And dancing, particularly when you combine that with the powerful emotion of music, particularly music that you may enjoy as well, can be a real powerful experience for people to move around. And fundamentally, physical activity is any bodily movement where you're moving and you're expending energy so dancing you know moving cycling you know walking to make a cup of tea all of this can help to you know make you feel better yeah for sure now Brendan if we think about

guidelines and we think about patients who are struggling with their mental health now guidelines are all very well they're great to sort of you know you build the evidence space you pop them in the guidelines but for me sometimes guidelines can appear quite dry one of the reasons i do this podcast actually is to try and bring guidelines and and health advice to life for people and inspire them to go, well, okay, that guideline's there, but what does that mean for me in real life? Because I think for a lot of patients, as you've already touched on, 150 minutes, a week sounds intimidating. And so, because it doesn't feel real to so many of my patients, so it sort of goes in one ear and comes

out the other way. What does 150 minutes even mean and i think what we have to do as clinicians and researchers is really think of ways that we can create a better story around physical activity a better emotional connection with people as to why it's important and then if you think about mental health um a lot of patients who are struggling with their mental health often motivation is super low at that point so i think about some of my patients who i've seen in the past who've really struggled with depression often you know they're stuck at home all day they're not at work um you know they're feeling down they've got no motivation to do anything they're in fact living the life that that trial we spoke about where they enforce sedentariness on them that's their life and it's very hard to know which one comes first sometimes

you know has that caused yeah the depression or is it just making that depression worse but do you have any insights into how do you actually motivate patients who are really struggling? You've seen the research, you know that you want them to be more physically active. How do you get them to do it in real life? So, what I will do if I'm working with a patient is I will go and have a brief conversation about physical activity and just re-emphasize those points that just moving and finding something you enjoy is just really important to get started and then often I'll

just say do you want to come for a walk and then go for a walk with an individual and just emphasize the point that just making these small changes can make a big difference to your physical and also your mental health and this doesn't need to be you know particular going to the gym for instance or doing a particular exercise just moving around just a couple of minutes a day and experiencing some success early on which is really important when you're low in motivation you have you know mental health symptoms not being able to achieve something you know making it achievable for someone is really really key early on so make sure it's achievable and they experience some success and then they can experience that inner joy and you

know satisfaction that they've achieved a goal and then move people on that activity continuum where it's perhaps the external motivation where i'm going to talk to them on a particular day about let's go for a walk this you know let's not talk about something it could be good for your mental health where they've gone and gone for a walk and experienced some success and have some intrinsic motivation where they may want to continue with that behavior yeah absolutely do we know much about the mechanisms as to why increasing physical activity can help people suffering from a variety of different mental health problems it's very complex and very multifactorial so the short answer is we are not clear the longer answer is that it's very complex and multifactorial um so a phd student

we're working with uh ucr and candola recently looked at all of the sort of evidence around why does physical activity make us feel good and why may it protect us against depression and really it's very very complex so we've talked about some of the neurobiological mechanisms such as improving brain connectivity volume of the hippocampus we've talked about BDNF and there's also some evidence around reducing inflammation so there's a number of biological mechanisms which are real which can happen for people but also it can really influence our you know psychosocial mechanism and our mental health in that we can feel a sense of achievement it can improve our self-efficacy make us feel good

and just feel a sense of connection and purpose and it's probably a combination of these neurobiological and psychosocial factors particularly when you add in factors such as being part of a group achieving a goal that all contribute and combine together to help improve our mental health and make us feel better yeah for sure and i would completely echo that it's i think it's unlikely we're going to find one key mechanism that accounts for everything i think physical activity is just so it's so fundamental to who we are as human beings and you know you've listed a whole number of five six different possible mechanisms probably a bit of everything right absolutely you know it's which is which doesn't give a neat reductionist

scientific answer that we've we've got used to expecting and wanting but i just think that's a reality of well you know you could make the same case of foods yeah food helps change genetic expression food can help change your hormones food can change the composition of your gut microbiome food can be pro-inflammatory or anti-inflammatory you know it's the same kind of principles that you know again i could bring in sleep and stress and make the same case for those as well so these kind of softer lifestyle interventions that we might recommend actually have very powerful biological effects physiological effects but we don't think of it like that no and they do have real meaningful biological changes as well but we can't ignore

the psychosocial factors as well which really contribute as well and you know just to bring it back to medication for instance for example so some i don't know take antidepressants there's particular theories or mechanisms how they may work and you know there's no doubt that for some people they do help and improve people that's important part of people's journey but the mechanisms which they work as has changed over time as we've you know science has developed as well and it's often not a neat tidy answer about why it may help an individual as well yeah i remember i think it was back in 2016 um i think the paper came from

king's college london from memory because i spoke widely in the media and on bbc breakfast about this study when it came out and the researchers basically looked at a group of patients who suffered from depression and they measured a marker of inflammation in the body i think what they measured was interleukin-1 beta, which is basically just a messenger from the immune system that can send signals of inflammation around the body. That's a very, very simplistic explanation of what that compound does. But essentially, the patients who had minimal or no levels of inflammation in their body seem to respond well to antidepressants but the patients who had significant levels of inflammation in their body did not respond to antidepressants so

essentially the conclusion of that study was that if you have inflammation they could they could basically predict who is going to respond to an antidepressant or not based upon levels of inflammation in the body, which sort of made sense if you take the view that an antidepressant is there to try and change chemistry in your brain. Well, what if the problem that's causing that problem in your brain actually is coming from inflammation in your body? And it was really, really fascinating. It got a huge pickup in your body. And it was really, really fascinating. It got a huge pickup in the press. And for guys who are listening to this, what I'll do, I'll link to all the studies that you've already mentioned, Brendan.

We're going to try and compile a full list of them to put in the show notes page. So, there's many clinicians who I think will be fascinated at actually digging into the actual research papers. I'll also link to me talking about that study on the BBC News. I think it's really interesting to see just what that study showed. What's fascinating for me is, as you say, science is moving on, our knowledge is moving on. That was in 2016 and the real understanding now that chronic unresolved inflammation can drive many, yes, depression, some cases of depression, but also many other chronic conditions that we're now seeing. And I just, I feel, let me, I just want to explain that for people who are not quite familiar with that. So, inflammation is a normal process in the body. So, I would say to people, if you fall over and sprain your ankle

and your ankle becomes hot, red and swollen, that is inflammation. That is an appropriate response that's going to help that area heal up. When we talk about inflammation driving these chronic health problems, like some cases of depression, what we're talking about is chronic unresolved inflammation. So, this is different. This is when on a daily basis, your body is, you know, releasing inflammatory molecules, inflammatory mediators in the body. And essentially, because your body in some way feels as though it's under attack. So, it's acting as if it's under attack and it's driving inflammation. So, this is very different, but it's, I think, just a general way for people to understand the two different forms of inflammation. Has any of your studies, because we know that exercise can be anti-inflammatory, so it makes sense to me that that would be one of the main mechanisms, potentially, by which

exercise and physical activity is helping mental health problems. Because if the inflammation is driving the mental health problem and you can engage in physical activity which reduces the inflammation well it makes sense and that that might help have you have any of your studies particularly looked at the inflammation aspects of these problems yes absolutely so um within the review that i mentioned previously we looked at all of the anti-inflammatory properties of exercise in in mental health conditions and found that for people who do have mental health conditions you can get reductions in some of these inflammatory markers which you mentioned and we know outside of this mental health arena generally that physical activity structured exercise is a very very potent anti-inflammatory so it makes

perfect sense that if you add this into depression where some people many people may have increased inflammation you can get an important reduction in these inflammatory markers as well and i'll take you back and the listeners back to the study I mentioned earlier about enforced sedentary behavior and what they did in the four-week study in the British Journal of Psychiatry was they looked at in changes in one of these inflammatory markers interleukin-6 and they found that those who started to become depressed started to have this increase in inflammation that could be one of the mechanisms through which lack of activity could be contributing to an increased mental and also physical health care burden and we know as you mentioned and and we've published a paper in actor in in 2018 looking at all of the studies where we've looked

at people with depression 83 studies people without depression and the inflammatory profile of of all of these people shown is consistent inflammatory response so exercise can reduce inflammation yeah and i think even that message for people is so powerful that exercise reduces levels of inflammation in your body yeah i mean that's it's very powerful that but i guess we often you know you're you're you know knee deep in the research i've been talking about this for years. We can often forget what a powerful statement that is to people whose understanding of inflammation is,

if I'm inflamed, I need to take ibuprofen to reduce inflammation. And again, you know, we're not talking about exactly the same thing, but just the idea that food or movements can be anti-inflammatory, I think it's really, really powerful and not enough people know about it absolutely and the science is really really coming together now just to show what a potent anti-inflammatory exercise and movement can be to you know possibly prevent mental health conditions but also be act as an anti-inflammatory for those who do have mental health conditions as well yeah i might um get the the link to a couple of those papers because next uh saturday so i don't know when this podcast will

go out but we're running um this course that i created with a colleague called prescribing lifestyle medicine it's the first royal college of gp accredited lifestyle medicine course where we actually teach doctors um a lot of this science but also give them a framework like a real actionable clinical framework that they can use with their patients even in the even in the restraints of a 10-minute consultation which is challenging but it can be done although it's very very difficult and you know it's amazing the feedback to this course has been incredible you know we've had i think we trained over a thousand clinicians now. We've had everyone.

We've had GPs, we've had pharmacists, nurses, cardiologists, endocrinologists. We've had a lot of psychiatrists. That's really encouraging to hear. Yeah. And the reason, with colleagues reflects on this, why we have so many psychiatrists coming on it and i think that's because you know in psychiatry i think of course pharmaceutical medications have their place but i think for many patients psychiatrists are feeling they're quite limited and what they can do for their patients and i think a lot of them are quite keen to learn about you know like the

smiles trial or a lot of your research which i'm going to try and add some of it in for the course next i say that's okay because i think um there's a few new studies that i wasn't familiar with i think will be of incredible value for the clinicians coming um so yeah really really exciting i mean you you lecture a lot don't you you yes you you see patients but you conduct research but you also go around the world lecturing how are people receiving your research overwhelmingly people are receiving it you know enormously well people are really interested and and really engaged so people you know if i go and talk to sort of medical or psychiatry colleagues are like wow this is new information i wasn't aware of before so kind of like similar experience to what you were describing earlier so getting out and lecturing and giving people

information in a verbal format is just such a powerful way to convey the message and the evidence and people are really thirsty and hungry for knowledge to you know make changes in terms of people's lifestyle in terms of emotional well-being and also managing a mental health condition so many people are becoming much more interested in this area and accessing the science behind it are you speaking much to gps at all i do i do speak to gps and um i i sort of go wherever i get invited um largely but i do speak to gps and i speak to a lot of psychiatrists and psychiatry colleagues um particularly so um i go to a lot of psychiatry conferences and try and beat the drum around you know we there are alternative options that can help and also complement traditional approaches to people as well and i think that what you said that complement

traditional approaches might be a maybe a more palatable way for some people who are sort of entrenched in a certain way of treating people. And that's the way they've done it for 20, 30 years, that's saying their career. I think that's a much gentler introduction to it. It's like, okay, look, you can keep doing that. But actually, what about doing this as well? What about encouraging physical activity as well as your other treatments? about doing this as well? What about encouraging physical activity as well as your other treatments? It may help improve the efficacy of what you're doing, or it may just have additional benefits. I think that's fascinating. Even when the psychiatrist or the GPs are getting this information and saying, hey, look, this is amazing. I didn't know about that. Is there still a problem though, in terms of they've got the knowledge, but then do we need more resources so that, you know, the patient comes into the GP and the GP knows this research. Now they're thinking, okay, I need to help this patient be more physically active, but you know what, I can tell them to do that in my consultation, but how am I going to help them do that? So are we still missing the resource that's needed to actually bring these guidelines to life for people absolutely so it's definitely not a gap in knowledge there is a gap in terms of

translation of the knowledge to the appropriate people which are trying to address and you know great for podcasts and lecturing to people so we're trying to work on that but then also if we give people the knowledge and we translate that then people have time pressures but then there's also resource pressures as well so we really need investment in terms of you know trained professionals who can help deliver and make accessible interventions for people as well so we've done a number of studies both in people with severe mental ill health conditions and depression. And we've shown that if you want the best outcomes for mental health symptoms for nutritional interventions, when we're looking at physical health outcomes in people with severe mental illness

or exercise outcomes for mental health, you get the best outcomes. It's not my opinion. It's based on the data. When it's delivered by people with exercise backgrounds or nutritional dietitian backgrounds. So we need to invest in these specialists who can deliver the interventions because you do get better outcomes when you have the appropriate investment in people delivering the interventions.

Yeah, I'm just sort of trying to fast forward to 10 years in the future and imagining, you know, GP practices with a nutrition expert within that practice, a physical activity expert within that practice, you know, even a stress reduction expert within that practice. And I kind of feel that's what, for me, the GP practice of the future looks like is really giving priority and resource to all these various lifestyle professionals who've got great knowledge and have studied hard but still struggling to make inroads within the nhs because it's so set up in it for i i think actually the nhs is it's really like many healthcare systems set up for a different health era yeah you know an era where we used to see a lot of acute problems you know you come in the doctor sees the problem gives you a pill fixes it boom you know those

sort of things maybe 30 40 years ago were the bulk of what we were seeing but that health landscape has changed so much now whether it's with obesity whether it's toxic diabetes whether it's mental health problems insomnia whatever it is gut problems you know these kind of lifestyle related issues are huge and i must add whenever i say lifestyle i'm not putting blame on people it's the first thing to say the second thing to also acknowledge is that i recognize there is a huge socio-economic problem when it comes to health um you know we know if you live in certain parts of the country, your health outcomes may be 10 years worse than living in another part, which is scandalous. There are so many reasons for that. And I do accept that those things need to be corrected

and those things are societal issues. Having said that, I have worked in poor deprived areas and this advice, especially we can make interventions free and accessible to people it still makes a difference absolutely you know you mentioned that resilience distress well if you're regularly doing things you know I've used this example before but if you're a single mum who's struggling with her mood and you're working two jobs and you're on benefits, right? Of course, doing these things is not going to give you more money. But actually, doing a bit of this activity every day, if you can find something that's going to work for you and we can make it accessible for you, it's going to improve your mood. It's going to make you more resilient to stress.

It's going to make you feel better about yourself that you're you know you're going to be able to handle those stresses in life a little bit better or i would say a lot better than had you not done that yeah and i i think it's such an important point because people often criticize the whole lifestyle medicine movement and say you know socioeconomic status is the biggest determinant of health i get that i recognize it but it doesn't mean you can't have a bit of both it doesn't mean you can't use lifestyle interventions with those people as well to help improve the quality of their lives and their resilience of course and you know it can like you said really help those people and i work in a very sort of socio-economically mixed but very deprived area in in south london and um you know and and providing lifestyle interventions in that context have real profound impact on people's physical and mental health and there's been some really

nice studies done outside of this context that when you do make interventions accessible or you know swimming lessons free for people who are lower socioeconomic circumstances and people are more likely to go swimming experience the well-being benefits but then as soon as you stop that free initiative then people are not able to access it so it's really important that we make it accessible to people um and and available where we reduce the barriers for people taking part as much as possible well let's get into some specifics of different kinds of exercise okay because you know even the term physical activity and exercise can be quite broad for people so

um do we know for example if for particular conditions or problems that you know is aerobic training better is strength training better is insuphore training better or are we not quite there yet with the research i suspect they're all beneficial but do we know much about the differences so as we've talked about evidence and levels of evidence and i would just say that anything that i say is my own opinion is a very low form of evidence but i will start off by saying i'll give you my opinion my personal opinion is find something you enjoy you find pleasurable and then stick to it whether it's aerobic resistance dancing whatever that should be what you go to what does the actual evidence say so the evidence says that you know within the context of perhaps we start off in

depression is that both aerobic and resistance training are very good and beneficial for people's mental health there's also evidence in anxiety symptoms and anxiety disorders as well including ptsd the aerobic and resistance training is positive for people and there's an emerging evidence base around other sort of mind body interventions such as yoga saying it can improve people's depressive and anxiety symptoms also but perhaps if we just shift to say schizophrenia a more sort of common uh more pronounced mental health condition not say any mental health conditions not more pronounced um but there is evidence in schizophrenia that um aerobic resistance and and yoga mind body

interventions can reduce mental health symptoms and improve physical health also so i don't think we can say that one is superior to the other i think we're very much moving towards what an individual prefers finding what they enjoy and there's evidence growing for each of them today the evidence base is largely focused in aerobic training because that's where most of the research and research funding has gone and by aerobic mean by moving around in any way where you get your heart rate up so that could even be walking that could be brisk yeah brisk walking and we tend to categorize physical activity or exercise in intensities so low intensity could be just

moving around the house or very gently walking moderate intensity activity could be where you're briskly walking and you're perhaps finding a bit difficult to talk when you're walking around and panting for your breath. And then hard or vigorous physical activity is when you're really sort of panting and struggling to maintain a conversation such as a vigorous game of squash or sprinting. But all of those have beneficial impacts for our physical and our mental health but to date the focus in guidelines generally has all been about how much can we do of moderate and vigorous physical activity and we've completely neglected the

importance and also the enjoyment of light activity and there's emerging evidence we've got a paper coming out in the Lancet Psychiatry suit looking at adolescents, showing that to protect against depressive symptoms in adolescents, that it's actually light physical activities such as moving around and perhaps light playing, which can protect against mental health symptoms in the future. And it doesn't have to be this really hard, fast sport exercise. really hard fast sort of sport exercise and again that's so important isn't it for making it accessible because if you say it's got to be vigorous and you've got to get sweaty and find it hard how many people's that going to put off especially if people are already struggling and lacking in motivation that may be just too much of them at that particular time so you're saying even light walking where you're walking but but you're not out of breath. We're still saying that appears to have benefits as well.

That appears to have benefits as well. Yeah. And what I love about the way you frame that with your opinion, then where the evidence is at, it does appear that the evidence, although most of it has been done on aerobic activity, because maybe that's where the bias was in the past or whatever, for reason we're now building a resistance training into that evidence base yoga i think tai chi i think i've seen as well coming into the evidence base but again coming back to what you originally said and what i've sort of echoed before about behavior change it's already well having acts you know there's all very it's all very well having recommendations, but if nobody does it, it doesn't matter. Right. And this is something that I sit with a lot and really was one of the

drives behind writing my latest book was this idea, people are sort of know what to do. We've got a lot of knowledge out there. Is knowledge the problem or is it putting that knowledge into action that's the problem and i'm really fascinated by what sits in that space between knowledge and action me too and i and i you know i'm so grateful to be given an opportunity to come into this particular you know podcast to be able to hopefully translate some of the knowledge because we do not have a gap in knowledge anymore when it comes to the the benefits of physical activity for promotion of good mental health and also management of mental health it is not a gap in evidence and knowledge it's a gap in translation it's a gap in action into real world and it's frustrating for me as a scientist and also as a clinician

as writing and um you know hundreds of academic papers that nobody in the real world reads. Hardly any clinicians read, hardly any researchers read, and it doesn't get translated. So, you know, it's the knowledge is there. Quite frankly, research papers are boring. So trying to translate them in a meaningful, understandable way where people can make changes in their life is so, so important. And I'm here to hopefully convey that the evidence base suggests physical activity is really beneficial for your mental health to promote positive mental well-being and also be used as an actual intervention as well. And compared to some other interventions, other interventions are great.

It's really, really safe as well. We don't need to worry about sort of you know side effects so much and and you know thank you for summarizing like that i think it's spot on um this is you know one of the reasons i do this podcast and get to chat to world leading researchers like yourself to actually talk to you about what the evidence actually says and try and communicate that to a large volume of people to hopefully inspire them to go actually you know what it's time to stop procrastinating it's time to just get out there and start moving he said actually even oh you know i don't like aerobic exercise but he said actually that yoga might be good as well oh brilliant why don't i stop doing five minutes of yoga a day yeah you know that's kind of on on the outros often to

these podcasts i talk about you know guys think about one of the things that you heard today. Think about just one thing that you can start applying in your life. Because for me, it's about really using this not just as inspiration, but also for action as well. For every single listener, I want them to hear that and go, oh, you know what? I'm going to just move more because it's going to help reduce the likelihood that I'm going to get depression in the future. Or they might go, you know what? I'm going to just move more because it's going to help reduce the likelihood that I'm going to get depression in the future. Or they might go, you know what? My brother really struggles with his mental health and he's stuck inside every day. Maybe I'll go and give him a real hand or, you know, sign him up for an exercise class or really take him out three times a week,

something to help someone close to them. You did mention quite a few times the social components of physical activity. And I found that really fascinating because there's a lot of research on, you know, as humans, we are social beings and we've always worked in supportive communities. That's what has got us so far as humans in terms of our evolution. And I remember when I had the CEO of Parkrun on this podcast quite a few episodes ago now, one of the most powerful things he said to me was, Rangan, Parkrun is a social intervention masquerading as a running event. Yeah.

And I thought it was so powerful. And really, that's what I view Parkrun as. It's not about the running, although a lot of us think it is. It's about the community. as it's not about the running although a lot of us think it is it's about the community yeah and have has any of your research particularly looked at the community and the social aspects exercise or is it just what you've seen as a condition that people actually get those additional benefits um when they're you know working out or moving with people around them there's a very strong narrative within the literature that social

connection and cohesion and social support you know feeling supported by a group is very very powerful in terms of improving outcomes in interventions full stop in particular physical activity interventions so one of the nice studies which we did relatively recently was we we looked at people with quote-unquote severe mental illness in the community so these are people with mainly with schizophrenia bipolar disorder and it was a randomized controlled trial and these people are often very isolated and community in the community um not going out of the house very often and we developed a really simple intervention kind of a bit similar to what i did back in sort of 2006, but in a randomized controlled trial where we got people together, talked about the benefits of an active lifestyle, set people up with a health coach in the intervention. And every

two weeks, they'd meet a health coach to talk about the benefits of an active lifestyle, address any barriers, and a weekly walking group where people could go out into an open space and walk together as a group and we compared it to treatment as well usual and and we looked at people's objective physical activity their well-being and various other markers and we just found within this randomized control trial that it was really the walking group that sense of community people coming together from these often ostracized people which is really really profound in terms of improving people's mental health and physical activity and for people with

really pronounced mental health symptoms this you know started to form great friendships and meeting outside of the group and going for sort of food and dinner it was really really you know powerful and nice to see so that social component is is you know really really powerful and there's great evidence base to say that just how important social cohesion and support can be yeah incredible i mean you know i've certainly um you know i've said this before but i you know i typically i don't really suffer with my mental health um very lucky in that in that regards um I don't think I've got a genetic predisposition and I'm in that area I've generally been okay um but something like parkrun for example has completely changed my life and my

family's life it's changed our weekends frankly it's a real focal point of our weekends um you know I will regularly on a Saturday morning go do the 5k with my son it's one real focal point of our weekends um you know i will regularly on a saturday morning go do the 5k with my son it's one of my funnest parts of the week and i know that if someone said run a 5k every saturday morning by yourself you know i might do it the odd time there's many times i've had a really busy stress a week and i've started down at 2k and i'm like i am knackered yeah but there's something about that community there that you keep going and i know all i need to do is get there with my son and as long as soon as i get there i'll end up finishing that 5k yeah and i feel fantastic about this saturday i felt just buzzing all day because i'd got out in the morning.

Yeah. And you know, without that, I probably wouldn't, I was feeling a bit tired. It's been a busy month with the book tour and all the kind of media engagements that, that, that goes along with that as well as trying to see my patients.

I really think there is value in doing these things together. And we, we, we're in this stage now in culture where we're so busy that many of us, you know, we want to do yoga. And if we can persuade ourselves and motivate ourselves to do it we learn on youtube yeah i cannot there's nothing wrong

with that there's literally nothing wrong with that i know many people who i think i think yoga with adrian's a very very popular youtube channel that loads of my patients love and they actually watch her videos and do them along with her online. Brilliant. But I still think if that's you, there is still value in going to a yoga class maybe once a week where you actually meet like-minded people who like you also want to do yoga and you build that community around it. I think it's a really important part of behaviour change. It's so important. And once you feel a sense of that community it really helps you sort of feel a sense of belonging and a sense of wanting to go sort of back and be part of that group and a sense of connection and achievement and it's just it's just a core part of good interventions

it really really is yeah i'll tell you something super exciting that's happened um you know with the podcast over the past couple of years is that just really hammering home that point of community is that i set up last summer a private group on facebook anyone can join but it's just uh it's a group about you know people who listen to my podcast or who like my books and really who share that philosophy and want to engage with other people because otherwise this podcast is an online resource people are listening often in isolation by themselves you know on walks or runs or on their commutes which is great but i wanted to sort of bring all these people together in some sort of community and from that online facebook community i think we're up to seven or eight

thousand members now um someone had the bright idea. I think it was someone called Amelia who actually met a couple of weeks ago randomly. Well, not randomly at one of my events in London, but she basically came up with this idea for, should we do FBLM meetups? I feel better, live more meetups. I think there are 20, 30 regular meetups now around the podcast. That's amazing.

Yeah. So what they do- Yeah. So yesterday, and I couldn't go yesterday because it was my wedding anniversary. But basically, they all, I think about 30 or 40 people met up. That's in my local area. Yeah. To go for a walk. So they've all, they all listen to the podcast regularly. They all like, you know, some of my books and they all met together, go for walk discuss the ideas and so this this idea of community yes in terms of a an intervention for someone in terms of their physical activity

it's got relevance for everything right you know that's what we're missing in society today it's community community and connection yeah it's so so important i give a lot of talks at various workplaces around the country. And I often say to them, guys, you know, the workplace is one of the best places for well-being. A, because people often spend eight, ten hours a day here. But B, it's very hard to make change in isolation in life. And around you, you've got other people. And, you know, you can together encourage each other. You know i did this so powerful it's so powerful um i was on um i did this piece on five live last week and i went on to

the nahal arthur nika show to talk about well essentially to talk about my latest book field bretton five but what we did on there is we went to a local workplace and to put some of these interventions into life, into practice. So, we went around, we discussed with a whole variety of different people, you know, the problems that they're having, what they wanted help with. And I suggested a few of the interventions from the book. And one of them was this, was like an office workout that could all be done via body weights. And, you know, again, you don't need to buy any equipment, you don't need to go anywhere. You don't even need to get changed, right? So, removing all the obstacles for people to actually do something.

It was really incredible that we started doing it, more people started joining in and people got smiles on their faces and were like, oh, you know what? I thought exercise had to be really difficult. You know, I've not got time to go to the gym but this is really good fun yeah and um it went down really well on five live actually and we're gonna actually uh we're gonna follow up in a month's time i can't wait we're gonna go back and it's great because then you get to follow up and because you know radio five live are a national broadcaster it means you can bring this conversation yeah to millions around the country you know you can bring simple effective lifestyle solutions to a wider audience just to show what is possible in

the workplace it's so it's so important now we've not got onto this uh hugely detailed book that you've written and just to reiterate i'm so grateful to all the research you and the various teams you work with are doing because as i say it really helps provide that robust evidence base that is needed some of the time um you know to help people but also to confirm what we intuitively know yeah so it's a book co-edited with dr simon rosenbaum who's an exercise physiologist based in university in new south wales and he's actually sort of helping in the camps at the moment delivering exercise interventions for people's mental health there and and essentially what we wanted to do is for health care professionals is bring together

all of the evidence in a digestible format it could also be for personal trainers gym instructors nutritionists people who are interested in this area to say for lots of individual conditions whether it be anxiety, PTSD, schizophrenia, depression, why may physical activity be beneficial for this population, you know, what does the evidence-based say, what can I do if I've got an individual person in front of me at this particular moment and what would a good program look like across all of these other conditions you know including eating disorders in a digestible format so we could condense these hundreds of research papers and we've got lots of experts to help us to put it together in a condensable format for people amazing and what's

the book called exercise-based interventions for mental illness. Yeah, amazing. I mean, the amount of work that must have gone into that is incredible. And just to reiterate, if you are one of those healthcare professionals that Brendan's just been talking about and you feel that would be beneficial, I'd highly recommend you get a copy. We'll put a link to that book in the show notes section as well. So really, I guess the future is looking very optimistic because we know a lot of this stuff. We know movement makes us feel good,

but you're really putting together so much research that it's almost hard to ignore now for us, right? And it is only surely a matter of time before every single doctor, every single physiotherapist, every single psychiatrist is aware that moving your body is going to help improve your mental health. Absolutely. You know, the evidence is growing and growing and growing, showing consistently that moving around is a viable option to promote positive mental well-being and help people with a mental health condition as well. So within the traditional treatments which are very very helpful, medication, psychological therapy, we now have a robust treatment which we can also add in as a useful addition to that to help people with their

mental and physical health and the evidence really suggests it can be a powerful addition to the battery which we may be able to offer people to improve people's mental health and well-being yeah and hopefully within you know well i was going to say five ten years but hopefully within less than that these are going to be not only in guidelines but every medical students in the country is going to be learning this stuff at medical school put an ultimate question bre, Brendan. You've done incredible research. Obviously, you went to physio training to go and help people. Do you still want to be a physiotherapist for Newcastle United? But I think overall, I want to stay in this area, helping people with promoting the awareness of physical activity and mental health and mental well-being. But for me, as an individual, there's nothing quite like being on a secure or acute unit,

helping people with acute mental health care conditions where I'm helping them one-on-one. Just me, Brendan, the physio, and helping people in their lowest moment, because that's an opportunity to help someone on an individual basis in their time of greatest need it's tremendously satisfying yeah well brendan i'm glad you didn't go for the physio job in newcastle and actually uh went to just keep producing this volume of research it's going to help me and my job it's going to help other doctors it's going to help a lot of the public brendan look you're doing amazing work if people want to find out more about your work are you on the internet you on social media to be able to stay in touch with you i am at brendan stubs on twitter i'm also on instagram as well and i'm always happy for people to look me up and email me and ask me questions as well if you have any particular questions as well oh fantastic well thanks for that um when a lot this podcast

is called feel better live more when we feel in ourselves, we get more out of life. And I think the research you're doing absolutely epitomizes that as well as anything else. I always like to finish the podcast with some tips for people. So people who've, you know, gone through the hour, the couple of hours listening to this really feel inspired by the research you've done either for themselves or for someone close to them have you got some tips you will have mentioned a lot of them already i'm sure but just to really inspire people now they've heard the podcast they've heard your research but i want us to get them moving so i wonder if you've got your top tips to inspire the listeners to get moving my top tips are rest assured that any movement is good for your physical and mental health find something which you enjoy keep doing it physical and exercise is meant to be enjoyable and pleasurable if you look at psychological or any behavioral literature people who maintain behaviors whatever behavior it may be do it when they enjoy it so find something you enjoy and stick at it and continue to challenge yourself and change it as you go along but rest assured any movement is good and then just continue

with that particular movement and continue to challenge yourself get connected to groups and just rest assured that just a couple of minutes a day of movement can increase you know your feelings of happiness within your mental health and make meaningful changes within your brain as well. Brilliant thank you so much really inspiring thoughts there for people thanks for making the journey up to my house today keep doing the amazing research that you're doing and no doubt we will follow up this conversation at some point in the future. Thank you for having me. and no doubt we will follow up this conversation at some point in the future. Thank you for having me.

That concludes today's episode of the Feel Better Live More podcast. I really hope you enjoyed what Brendan had to share today. The research behind the benefits for physical activity on our minds is simply incredible and if you needed any more motivation to move regularly, I certainly hope that this conversation today provided it. As always, do think about one thing from this conversation that you can start applying into your own life immediately. Clearly, the take home message is to move more, to do some form of movement regularly that you love, even if just for a few minutes. Now, my brand new book, Feel Better in 5, is actually full of five-minute health snacks that you can do for your mental, physical, and emotional health.

So if you're looking to move more and want some new ideas and inspiration, this book has loads of five-minute workouts that you can do. There are five-minute strength workouts, interval workouts, dancing workouts, yoga flows, postural ones to help you with back and neck pain, and so many more. There will absolutely be something in this book that appeals to you. And importantly, all of the workouts are super easy to do. You don't need to join a gym, you don't need to buy any equipment, and you don't even need to get changed. I've really tried to make movement super simple in this book. If that appeals to you, please do consider picking up a

copy. It's available to buy now in paperback, ebook, and as an audiobook, which I am narrating. paperback, ebook, and as an audiobook, which I am narrating. Please do let Brendan and I know what you thought of today's episode on social media. Brendan is on Instagram at brendan.stubbs, Twitter at brendan.stubbs, and on LinkedIn. And if you can, please do use the hashtag FBLM so that I can easily find your comments. There were loads of different studies discussed today. My team have tried our very best to put links to all of them in the show notes page for this episode. You can find that at drchatterjee.com forward slash 97. I think that will be really interesting for so many of you, but particularly for healthcare professionals who might want to go and dive a bit deeper into that research, do go and check it out, drchatterjee.com forward slash 97.

Now, if you know someone who you feel would benefit from the information in this podcast, but does not listen to audio podcasts, this episode, like all of mine, are available to watch in full on YouTube. So the best way to go and find that channel is to go to drchastity.com forward slash YouTube. I know many of you have said this is really, really helpful, particularly for friends and elderly relatives who actually don't listen to audio podcasts. If you do enjoy my weekly shows, please do consider leaving a review on Apple Podcasts. Whichever platform you listen to podcasts on, this really does make a difference. I know in the last two months, there are so many brand new listeners to this podcast.

If that is you, please do consider jumping on to your podcast platform and leaving a review. It really does help to raise visibility of this podcast and help me get these messages out to more people you can also share with your friends and family on your social media channels or do it the good old-fashioned way and simply tell your friends about the show i really do appreciate your support a big thank you to richard hughes for editing and vidar to chastity for producing this week's podcast that is it for today i hope you have a fabulous week make sure you have pressed subscribe and i will be back in one week's time with my latest conversation remember you are the architects of your own health making

lifestyle changes always worth it because when you feel better you live live more. I'll see you next time.