People who exercise have better mental fitness, and a new imaging study from UC Davis Health System shows why. Intense exercise increases levels of two common neurotransmitters — glutamate and gamma-aminobutyric acid, or GABA — that are responsible for chemical messaging within the brain.
Published in this week’s issue of The Journal of Neuroscience, the finding offers new insights into brain metabolism and why exercise could become an important part of treating depression and other neuropsychiatric disorders linked with deficiencies in neurotransmitters, which drive communications between the brain cells that regulate physical and emotional health.
“Major depressive disorder is often characterized by depleted glutamate and GABA, which return to normal when mental health is restored,” said study lead author Richard Maddock, professor in the Department of Psychiatry and Behavioral Sciences. “Our study shows that exercise activates the metabolic pathway that replenishes these neurotransmitters.”
The research also helps solve a persistent question about the brain, an energy-intensive organ that consumes a lot of fuel in the form of glucose and other carbohydrates during exercise. What does it do with that extra fuel?
“From a metabolic standpoint, vigorous exercise is the most demanding activity the brain encounters, much more intense than calculus or chess, but nobody knows what happens with all that energy,” Maddock said. “Apparently, one of the things it’s doing is making more neurotransmitters.”
The striking change in how the brain uses fuel during exercise has largely been overlooked in brain health research. While the new findings account for a small part of the brain’s energy consumption during exercise, they are an important step toward understanding the complexity of brain metabolism. The research also hints at the negative impact sedentary lifestyles might have on brain function, along with the role the brain might play in athletic endurance.
“It is not clear what causes people to ‘hit the wall’ or get suddenly fatigued when exercising,” Maddock said. “We often think of this point in terms of muscles being depleted of oxygen and energy molecules. But part of it may be that the brain has reached its limit.”
To understand how exercise affects the brain, the team studied 38 healthy volunteers. Participants exercised on a stationary bicycle, reaching around 85 percent of their predicted maximum heart rate. To measure glutamate and GABA, the researchers conducted a series of imaging studies using a powerful 3-tesla MRI to detect nuclear magnetic resonance spectra, which can identify several compounds based on the magnetic behavior of hydrogen atoms in molecules.
The researchers measured GABA and glutamate levels in two different parts of the brain immediately before and after three vigorous exercise sessions lasting between eight and 20 minutes, and made similar measurements for a control group that did not exercise. Glutamate or GABA levels increased in the participants who exercised, but not among the non-exercisers. Significant increases were found in the visual cortex, which processes visual information, and the anterior cingulate cortex, which helps regulate heart rate, some cognitive functions and emotion. While these gains trailed off over time, there was some evidence of longer-lasting effects.
“There was a correlation between the resting levels of glutamate in the brain and how much people exercised during the preceding week,” Maddock said. “It’s preliminary information, but it’s very encouraging.”
These findings point to the possibility that exercise could be used as an alternative therapy for depression. This could be especially important for patients under age 25, who sometimes have more side effects from selective serotonin reuptake inhibitors (SSRIs), anti-depressant medications that adjust neurotransmitter levels.
For follow-up studies, Maddock and the team hope to test whether a less-intense activity, such as walking, offers similar brain benefits. They would also like to use their exercise-plus-imaging method on a study of patients with depression to determine the types of exercise that offer the greatest benefit.
“We are offering another view on why regular physical activity may be important to prevent or treat depression,” Maddock said. “Not every depressed person who exercises will improve, but many will. It’s possible that we can help identify the patients who would most benefit from an exercise prescription.”
So we all know that feeling that we get after exercise – we feel generally happier, less stressed, less anxious and also sleep better. Exercise produces a rush of happy hormones we also know as endorphins. So what are these endorphins and why do they make us feel happy?
Endorphins are chemicals that are produced in our brains in response to stress or pain. Running, doing a hard workout, playing a sport or any exercise at all that increases our bodies stress response has the ability to make our brains release endorphins. The endorphins have the ability to travel through our neural networks as a neurotransmitter. One thing we do know about endorphins is that they make us feel really good. So how does this work then?
A part of the brain called the hypothalamus sends a signal to increase endorphin uptake through our bodies neural network when we subject ourselves to certain activities like exercise, sex, eat certain foods or experience pain. The endorphins then attach themselves to specific receptor sites within our neural network – these are called opioid receptors. These special receptors have the ability to block out pain signals and also to increase that euphoric happy feeling we get after we exercise. It is the same receptors that are locked onto when we take pain relief in the form of opiates.
Once we achieve a positive result in something we do, either though through exercise or simple activities like sticking to a plan you’ve made, your brain will also release another happy hormone called dopamine. Dopamine is responsible for us feeling addicted to pleasure seeking behaviors. By setting regular and achievable exercise goals that you reach it is highly possible to make exercise the trigger for your brain to release dopamine.
Serotonin is another one of our brains happy hormones that act as a natural anti-depressant. When we exercise serotonin levels in our brain increase and so does your level of happiness.
I know all these terms may seem confusing but there is another very important happy hormone called oxytocin. Oxytocin is released when we feel loved, cared for and connected to others. Your brain will also release oxytocin when you are kind to others.
So no matter how hard it may seem to get yourself moving on some days, putting one foot in front of the other and pushing yourself to move and exercise is not only good for your muscles and joints but also stimulates your brain. You’ll produce your very own happy hormones, reduces your stress levels and have you wanting to repeat it all over again next time. Give your fellow team mates, friends and family an encouraging kind words regularly as well- it will not only help them feel happy but will increase your happiness as well.
HIP AND KNEE PAIN
Spacing exercise-based physical therapy sessions over a 12-month period while using three additional “booster” sessions periodically has been shown to be more cost effective than alternative physical therapy strategies in the treatment of knee osteoarthritis, according to research presented this week at the American College of Rheumatology Annual Meeting in San Francisco.
Osteoarthritis, sometimes called degenerative joint disease, is a slowly progressive disease in which joint cartilage breaks down. Normally, cartilage on the ends of bones allows smooth, pain-free joint movements. In OA, cartilage becomes thin and irregular, resulting in symptoms of joint pain and stiffness. Grinding or cracking sensations may occur. Joints that are under high stress due to repeated activity or weight bearing are most susceptible to OA. The hips, knees, hands and spine are commonly affected. OA becomes more common with aging.
Common pharmacologic treatments for OA include nonsteroidal anti-inflammatory drugs (called NSAIDs) and analgesics (e.g., acetaminophen and ibuprofen), and exercise is considered an excellent first line, conservative, treatment for the disease. Researchers recently compared the cost-effectiveness of four different physical therapy strategies among 300 people with knee OA participating in a two-year study across several different institutions.
Strategy one included 12 visits of exercise therapy alone over a nine-week period; strategy two included eight initial visits of exercise therapy within a nine-week period plus four booster sessions at 3 time points (two boosters at month five and one at months eight and 11) spaced across a 12-month period; strategy three included 12 visits of exercise therapy plus manual therapy; and strategy four included eight initial visits of exercise therapy plus manual therapy and four booster sessions. Total health care costs were estimated using patient-reported outcomes as well as data from the Healthcare Utilization Project and the Medicare physician fee schedule.
“We believed there was a need to improve both the magnitude and sustainability of treatment effects of exercise therapy for improving pain and function in people with knee OA,” explains G. Kelley Fitzgerald, PT, PhD, FAPTA; professor and associate dean of graduate studies, University of Pittsburgh School of Health and Rehabilitation Sciences and the principal investigator in the study.
“Previous research indicated that using manual therapy might be a way of improving the magnitude of treatment effects, and booster sessions might be a way of ensuring sustainability of treatment effects. We also believed it would be important to determine the impact on health care costs to inform best-practice approaches with regard to using manual therapy and/or booster sessions, should they prove to be clinically effective.”
The researchers noted that the booster strategies (strategies two and four) significantly lowered health care costs and showed greater effectiveness in the treatment of knee OA. Between those two strategies, strategy two cost $1,061 more, but gained .082 more quality-adjusted life years, which looks at the burden of the disease in comparison with the quality and quantity of life.
Overall, the study showed that, while exercise therapy remains effective in treating people with knee OA, it might be more effective to supplement exercise with manual therapy and space physical therapy visits over a longer period of time to maximize long-term benefits.
“These results indicate that supplementing exercise with manual therapy and spacing physical therapy sessions across a longer period of time may provide greater benefit to individuals with knee osteoarthritis, while simultaneously reducing downstream health care utilization,” explains lead investigator in the study, Allyn Bove, PT, DPT; assistant professor, Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences.
Based on these findings, Dr. Bove believes patients should consider consulting a physical therapist to treat the pain and disability caused by knee OA and notes they should be willing to potentially commit to re-visiting their physical therapist every few months to reinforce the benefits. Additionally, Dr. Bove says these findings may encourage physical therapists to add more manual therapy techniques, as well as booster sessions to their plans of care for these patients.
Materials provided by American College of Rheumatology (ACR).
Data from a review of U.S.-based clinical trials published in Mayo Clinic Proceedings suggest that some of the most popular complementary health approaches — such as yoga, tai chi, and acupuncture — appear to be effective tools for helping to manage common pain conditions. The review was conducted by a group of scientists from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health.
Millions of Americans suffer from persistent pain that may not be fully relieved by medications. They often turn to complementary health approaches to help, yet primary care providers have lacked a robust evidence base to guide recommendations on complementary approaches as practiced and available in the United States. The new review gives primary care providers — who frequently see patients with chronic pain — tools to inform decision-making on how to help manage that pain.
“For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects. As a result, many people may turn to nondrug approaches to help manage their pain,” said Richard L. Nahin, Ph.D., NCCIH’s lead epidemiologist and lead author of the analysis. “Our goal for this study was to provide relevant, high-quality information for primary care providers and for patients who suffer from chronic pain.”
The researchers reviewed 105 U.S.-based randomized controlled trials, from the past 50 years, that were relevant to pain patients in the United States and met inclusion criteria. Although the reporting of safety information was low overall, none of the clinical trials reported significant side effects due to the interventions.
The review focused on U.S.-based trial results on seven approaches used for one or more of five painful conditions — back pain, osteoarthritis, neck pain, fibromyalgia, and severe headaches and migraine — and found promise in the following for safety and effectiveness in treating pain:
Acupuncture and yoga for back pain
Acupuncture and tai chi for osteoarthritis of the knee
Massage therapy for neck pain with adequate doses and for short-term benefit
Relaxation techniques for severe headaches and migraine.
Though the evidence was weaker, the researchers also found that massage therapy, spinal manipulation, and osteopathic manipulation may provide some help for back pain, and relaxation approaches and tai chi might help people with fibromyalgia.
“These data can equip providers and patients with the information they need to have informed conversations regarding non-drug approaches for treatment of specific pain conditions,” said David Shurtleff, Ph.D., deputy director of NCCIH. “It’s important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations.”
Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings, 2016;91(9):1292-1306 DOI: 10.1016/j.mayocp.2016.06.007