David Tomasi didn’t reinvent the wheel with his latest research on exercise; in fact, he’s well aware that the core concept has been common knowledge for centuries. “The Romans used to say: ‘Mens sana in corpore sano,’” he recites in Latin, “which means ‘healthy mind, healthy body.’” But what he is proposing is a new application for the tried-and-true wheel.
A lecturer at UVM and inpatient psychotherapist at UVM Medical Center, Tomasi notes that the number of psychiatric patients seeking acute, inpatient treatment has steadily increased since the ’90s at the start of the opioid crisis. A majority of the patients he treats at UVMMC are young adults suffering from dual-diagnoses of a mood disorder and addiction, typically to opioids. According to Mental Health Care America, Vermont is ranked the sixth most prevalent state for mental illness and substance disorders.
“There aren’t enough beds. We have struggles with opioid addiction and suicidality, and it's a crisis we've never seen before on a national level in the United States. Especially in the northeast, especially in New England, but even more so in Vermont. We are really struggling,” he says.
In Tomasi’s line of work, inpatient facilities across the nation are often crowded, acute settings where patients experience severe distress and discomfort. When patients display symptoms like mania, angry outbursts, anxiety, or disruptive behavior, practitioners primarily prescribe psychotropic medications or rely on classical psychotherapeutic and pharmacological frameworks. To keep the revolving door in motion for the next patient, practitioners determine if or when patients are ready for discharge once their symptoms subside.
At UVMMC, where Tomasi and his colleagues Sheri Gates and Emily Reyns treat patients suffering from a range of mood and mental health disorders like dual-diagnoses, critical anxiety, depression, schizophrenia, suicidality and acute psychotic episodes, a new idea surfaced: What if practitioners prescribed patients exercise as part of their treatment plans?
To explore the potential of this mind-body connection, Tomasi, Gates and Reyns were awarded an inaugural University of Vermont Medical Center Fund grant that supported their study and enabled them to build a gym, exclusive to patients in UVMMC’s inpatient psychiatry unit. For roughly 100 patients in the unit, treatment plans included new 60-minute nutrition education programs and structured exercise classes that featured a combination of relaxation, stretching, and exercise techniques recommended by the American College of Sports Medicine, “all monitored by psychotherapists — that's the key. We were always there to support the emotional background as well,” Tomasi says. They surveyed patients on their mood, self-esteem and self-image both before and after the exercise sessions to gauge their effects on mood.
Given that benefits of exercise have long been known and studied, Tomasi admits that he and his team anticipated positive results. But what they found surprised even them: a whopping 95 percent of patients reported that their moods improved after doing the structured exercises. While nearly all patients reported an improvement in their general mood, an average of 63 percent of patients reported being happy or very happy after the exercises, as opposed to neutral, sad or very sad, and an average of 91.8 percent of patients reported that they were pleased with the way their bodies felt after doing the structured exercises. Overall, patients reported reduced levels of mood disorder symptoms like anger, anxiety and depression and higher levels of self-esteem and improved moods.
“The general attitude of medicine is that you treat the primary problem first, and exercise was never considered to be a life or death treatment option. Now that we know it’s so effective, it can become as fundamental as pharmacological intervention,” Tomasi says. “The fantastic thing about these results is that, if you're in a psychotic state, you’re sort of limited with what you can do in terms of standard psychotherapy. It's hard to receive a message through talk therapy in that state, whereas with exercise, you can use your body and not rely on cognitive or emotional intelligence alone.”
Unfortunately, Tomasi estimates that only a handful of inpatient psychiatric hospitals in the United States provide psychotherapist-supported gym facilities exclusively for these patients or incorporate structured exercise classes into patient treatment plans. In the midst of a national opioid epidemic, Tomasi argues that there’s never been a better time to try and reduce patients’ potential reliance on prescription psychotropic medications and promote a more balanced, integrated sense of self.
A Look Inside the Brain
As Tomasi points out, even the ancient Romans knew that exercise makes both our bodies and minds feel better. But what he, Gates and Reyns have found helps lay the groundwork for further evidence-based research about exercise’s ability to treat mental health and mood disorder symptoms naturally. While this phase of their study relied on self-reporting and evaluation by patients themselves — which Tomasi argues is one of the most important factors in psychiatry, to hear a patient say they’re feeling better — the next phase of their research will incorporate brain scans and MRI analysis to confirm what they expect is happening: exercise is balancing the brain’s chemicals naturally.
“You experience a level of neurofeedback, in which the thing you are doing makes you feel that you're doing the right thing and so the body, in turn, secretes neurotransmitters and makes you feel happier about it,” Tomasi explains.
Prior research has proven that when exercise occurs, the brain stimulates the nervous system — which releases neurotransmitters like serotonin and dopamine, targeted in the treatment of depression — as well as the endocrine system, which regulates hormones that impact everything from mood to metabolism. The specific combination of neurotransmitters and hormones released during exercise can reduce symptoms of anxiety, depression, anger, psychomotor agitation and muscle tension.
“We definitely overmedicate folks in this country, period. No doubt about it. Then on top of that, the medication that we put into the brain — neurologically speaking — is already produced by the brain. So, it's not that patients would be opting out of medication, they'd be increasing the level of those same neurotransmitters naturally, through exercise, as opposed to chemically,” he explains.
Tomasi understands that medication is necessary for some patients. By no means is he advocating for practitioners to replace their prescription pads with gym memberships. Instead, what he hopes patients and practitioners alike will consider are the ways in which the mind and body work in tandem, as well as holistic approaches to maintaining mental and physical health that reduce reliance on psychotropic medications alone.
“For instance, in Italy where I'm from, there is no psychiatric hospital. By law, there is no inpatient psychiatry, period,” he says, illuminating the stark contrasts in approaches to mental health. “There, mental health is considered to be a social issue, so if you're experiencing a psychotic episode, the community, the town or the city is responsible for your wellbeing. In Scandinavia, they have this open dialogue model in which the patient is part of every decision-making meeting, giving calls and providing feedback.”
In Vermont, Tomasi notes that a balanced and integrated approach to mental health is very much in the DNA of the state and could be just what the doctor ordered. Based on the study’s positive results, Tomasi believes that incorporating American College of Sports Medicine-approved exercises into inpatient treatment would not only improve patients’ symptoms faster than classic pharmacological intervention alone could — thus increasing facilities’ bed and patient turnover rates — but would also offer patients an alternative, holistic, and cost-effective approach to maintaining their mental health after discharge.
“It's something that we know, deep inside, to be effective, and the time is ripe for that,” he says. “I think Vermont, especially UVM, is going to be a leader in this field.”