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In addition, the physiologic benefits of exercise are largely reliable and well understood and can easily be measured-in blood pressure, blood glucose, cholesterol levels and body composition.
What is not as well known are the benefits exercise has for one's psychological health, or sense of "well-being."
Beyond the 'Runner's High'
Innumerable studies have shown that physical exercise can improve not only your physical health but your mental health as well. This is important. After all, what good is it to be free of disease and live to be 100 if you are depressed and miserable much of the time?
Although it doesn't get as much press as the latest medications, glucose monitors or diet revolutions, depression is a significant issue for many people living with diabetes. The incidence of depression among people with diabetes is twice as high as it is for the nondiabetic population. According to a study published in the June 2001 issue of Diabetes Care, re-searchers from the Washington Uni-versity School of Medicine in St. Louis, Missouri, concluded that the presence of diabetes doubles the odds of depression.
When we look at the many studies that have examined the effects of exercise on psychological health, we find what appears to be a consistent association between exercise and an enhanced feeling of psychological "well-being."
For example, studies have demonstrated that exercise can confer benefits such as these:
Researchers from the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, North Carolina, found that in adults with major depressive disorder, exercise therapy was "associated with significant therapeutic benefit, especially if exercise is continued over time." Their research was published in the September-October 2000 issue of Psychosomatic Medicine.
When people start to feel overwhelmed, their exercise routine is usually one of the first things to be abandoned. They begin to view exercise as yet another burden. The belief that exercise drains your energy and vitality is erroneous, however, and can direct you into a vicious circle of perpetual exhaustion.
You will feel less energy when you neglect your workouts-not more. Any time you may have saved by skipping your sessions will likely be negated by an overall dip in your productivity.
Of course, when you are feeling stressed, overwhelmed or depressed, exercise isn't the only thing you ne-glect. Physical health and mental health are intimately linked. A strain on your mental well-being can cast a huge shadow over how well you care for all aspects of your diabetes, including taking your medications, having your lab tests performed or your eyes examined, and controlling your diet.
Exercise can serve as an outlet for releasing negative emotions such as anger, frustration and irritability. It may have a protective role, providing you with a kind of resilience to stress and depression. By helping to keep your energy and self-esteem up, exercise can help you feel better, cope better and take better care of your diabetes. Don't blow off your workout the next time you're having a bad day!
What, When, How?
Although most studies focusing on exercise have their participants perform aerobic exercise (usually for about 30 minutes per day, three or so times per week), just about every type of physical activity, from strength training to yoga, has demonstrated the ability to improve the mood of those who participate in it.
Please note, however, that if you believe you are suffering from depression and have been for some time, exercise alone may not be enough to make you feel better. It is important for you to address the issues causing your depression.
Don't spend another year berating yourself about your worsening blood glucose or beating yourself up over your "poor will power and lack of self-discipline." Seek treatment for your depression. Ask your doctor for help.
Remember, taking steps to stay mentally fit is every bit as important as taking steps to keep physically fit. The two are inseparable. n
Seven Important Points About Depression and Diabetes
"Often unrecognized in the clinical setting and hovering all but invisibly in the background, depression may explain a significant proportion of poor adherence to diabetes self-care behaviors," states William H. Polonsky, PhD, CDE.
Polonsky, an assistant clinical professor in psychiatry at the University of California, San Diego, outlines what he believes are seven important points about depression and diabetes:
1. Depression is widespread among patients with diabetes.
"A recent meta-analysis of 42 controlled studies concluded that depressive disorders are twice as common in patients with diabetes as in those who do not have diabetes."
2. Depression may be more severe in diabetes.
3. Diabetes may negatively influence depression.
"In the face of unending and often burdensome demands, many patients may become overwhelmed or 'burned out' by the frustrations of the regimen and the illness."
4. Identifying depression is relatively easy.
5. Depression may negatively influence important diabetes outcomes.
"Depression is broadly linked to lack of physical activity, smoking and obesity, and depressed patients may be less responsive to appropriate interventions in these areas."
6. Moderately effective treatments exist for depression in diabetes.
"... Randomized, controlled trials for depression in diabetes demonstrate that patients with diabetes respond well to common pharmacologic and psychotherapeutic approaches, at least in the short term."
7. Treating depression in diabetes is worth the effort.
Ron Zacker, RD, CDE, is currently working as a diabetes educator at Froedtert Hospital while attending the Graduate Physician Assistant Studies Program at Marquette University in Mil-waukee, Wisconsin. He can be reached at Ronald.Zacker@marquette.edu.
0 comments - Apr 1, 2003
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