“When we're physically active, our mental health is better. But also, when we have good mental health, we're more likely to be physically active,” Dr. Guy Faulkner, professor at the UBC School of Kinesiology, observes.
You've probably heard this before—taking a walk and getting some fresh air tends to help when you’re feeling overwhelmed or low-spirited. The bidirectional relationship between exercise and mental health, however, may hold potential beyond alleviating stress during those hectic exam seasons.
Through a new project, Mind In Motion, Dr. Faulkner, Postdoctoral Research Fellow Madelaine Gierc, and Master's student Cassandra Kell-Cattrysse are focusing the Population Physical Activity (Pop-PA) Lab research team on investigating the feasibility of an exercise-based approach towards treating students experiencing ongoing mild to moderate depressive symptoms.
Mind In Motion is also a Campus as a Living Lab funded project, which provides a collaborative framework for researchers, students, and operations staff to explore, develop and test new ideas, and to share the knowledge gained from these experiences.
How can exercise improve mental health?
In a recent survey examining the health of Canadian post-secondary students, up to 70% of students reported feelings of loneliness and 52% reported feeling so depressed that it was difficult to function. In combination with long wait times stalling treatment, meeting demands for mental health support has never been more urgent.
How can exercise be a solution?
“The evidence is quite robust and mature now that demonstrates that exercise is an effective treatment for depression,” Dr. Faulkner elaborates, “and the effects of exercise appears to be comparable with medication and therapy.” In fact, the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines recognized exercise as an effective frontline treatment for mild to moderate depression back in 2016.
Since then, a wide body of research now suggests how multiple mechanisms may be at play to explain why. Physical activity may contribute to better mood on a neurological level by boosting “feel good” chemicals like serotonin and dopamine, as well as psychologically by improving physical self-perceptions and self-esteem.
Exercise also addresses several barriers. It may be more accessible for groups deterred from seeking more commonly prescribed mental healthcare treatments, like medication and therapy, due to stigma. With the possibility of self-led sessions, it is also cost-effective.
In general, “exercise has so many health and wellness benefits in addition to antidepressant effects,” Madelaine explains, such as improving sleep quality and cardiovascular function. Because of this holistic approach, she concludes, “[exercise] is really appealing to a lot of people.”
Why has exercise been sidelined as a treatment option?
Though accessible and inexpensive, “it's only relatively recently that exercise has been recognized as a frontline treatment for depression,” Dr. Faulkner explains, leading to what he calls an “implementation gap.”
Mental health providers may lack established referral strategies to adopt and recommend an exercise-based intervention. And exercise practitioners may lack the appropriate skills and competencies needed to best guide students with depression.
Because of this, there is an absence of well-tested referral pathways in real-world settings to show if carrying out an exercise-based intervention is possible and effective.
How UBC can help bridge the implementation gap
Sitting on over 400 hectares and equipped with facilities to serve over 50,000 students, UBC’s Point Grey Campus is, “this kind of ideal, optimal environment,” Dr. Faulkner says, “where mental health professionals can refer students to a dedicated exercise program that is tailored to their needs.”
To be more precise, mental health professionals at UBC Counselling Services, led by Associate Director of Clinical Services Lauren McBride, and exercise practitioners at BodyWorks - a fitness facility on campus - led by Exercise Physiologist André Pelletier, can work together to implement a cohesive referral pathway. On the Pop-PA research team’s end, they are responsible for leading the design and development of this pathway, along with any necessary training.
Madelaine also notes that what has sparked their enthusiasm to collaborate may be a, “growing recognition within professional fields that [exercise] is a really great treatment option.”
Even after being stalled by the COVID-19 pandemic, “when [the Pop-PA research team] decided to reimplement the program last year [in 2023], [BodyWorks and UBC Counselling Services] were really excited to get it going,” Cassandra recalls.
To sum up the referral process: first, students seeking support are assessed at UBC Counselling Services, where mental health providers take into consideration the severity of their symptoms and their exercise background. If eligible, they enrol in a six-week exercise program at BodyWorks. Every week, students attend two one-hour long sessions, led by a BodyWorks trainer, tailored to their personal goals and abilities. Students are also recommended to do one more self-led session on their own.
What advantages does a guided exercise program have compared to exercising independently?
First, trainers offer the structure, support, and encouragement to help students grow their 1) sense of control and 2) confidence in sticking to and achieving their fitness goals. Further, the program helps students 3) feel connected by exercising with trainers in a safe, non-judgemental space. Overall, all three factors are crucial contributors in how exercise alleviates depressive symptoms.
Throughout the process, the Pop-PA research team facilitates communication and provides support within and between the two.
Together, they make taking the first steps in materializing a referral strategy a reality.
Exercise—does it really work?
“Perhaps many people may feel that someone with depression, maybe they would have more difficulties becoming more physically active and engaging in an exercise program,” Dr. Faulkner begins. The diagnostic criteria backs this up: depressive symptoms outlined in the Patient Health Questionnaire (PHQ-9) includes having little interest in doing things and low energy, factors which may affect students’ abilities to function at school, work, and do other daily activities.
André explains how this knowledge impacted their approach: “we had basically told our instructors that they should anticipate that there was going to be times when [students] did not attend.” However, they found this was not the case.
“Students were registering for sessions, and they were regularly attending,” he recalls, saying it was a “pleasant surprise.” Such warm reception suggests that the referral process, in both making students aware of exercise as an intervention and how the program was run, was well-received enough to warrant most students’ retention.
Most importantly: does exercise improve depressive symptoms?
With optimism, Dr. Faulkner says “there was an improvement in mental health and an increase in physical activity as a result of participating in the program.” On average, during the 2023 to 2024 academic year, out of the 11 students who completed the program, the severity of anxiety and depressive symptoms decreased, while wellbeing and weekly minutes of moderate-to-vigorous physical activity increased.
André also touches on the how students saw changes in the aforementioned contributors, potentially motivating these improvements: “[students] felt a sense of relatedness from coming here and working with the trainers. They also said that they felt more confident in their abilities to be active on their own.”
Tackling biases in mental health services
Outside of the student population, Lauren also reflects on the assumptions that came to light during her involvement with Mind In Motion.
Speaking from the perspective of mental health providers in general, Lauren reflects on how “[they] can get very attached to the ways that [they] work and sometimes forget about the other resources that may not seem as, perhaps, standard.” Getting involved in the actual referral process meant having to apply the research in practice, which she believes “really helps [them] as practitioners to remember this is a very valid, reliable, research-supported intervention.”
Seemingly a minor piece, awareness on the providers’ ends, serves as a significant first step that may prompt them to more carefully consider when it would be better to refer students to an exercise-based intervention, rather than more conventional ones. In turn, this ensures students are getting the specific care and resources that best aligns with their current mental health needs.
Long-term considerations for Mind In Motion
At its core, Mind In Motion is a learning, growing research project, with Cassandra expressing hopes that “[it will] continue on campus for many more years as a treatment option for students.” Hence, part of its research design involves getting insight from mental health providers, exercise practitioners, and student participants to improve further iterations.
First, there is a need to strengthen current educational structures to ensure there are sufficient well-trained practitioners to meet demands for these type of interventions in the future.
In turn, the Pop-PA research team hopes to include a work-learn training program as part of Mind In Motion in the future; under the guidance of a BodyWorks trainer, “fourth year kinesiology students will be leading the exercise sessions for Mind In Motion as a part of their coursework,” Cassandra details.
Moreover, in Canada, psychology has often been sidelined in traditional kinesiology curriculums, despite such strong connections between physical and mental health. In hopes of rectifying this, Madelaine discusses the valuable career-relevant skills that students will be able to learn and apply: “we're going to be able to connect students with the opportunity to learn about mental health, mental illness, and what person centered, responsive, ethical, and safe care looks like.”
Second, there is a need to account for demand efficiently.
Regarding referrals, Lauren commends the Pop-PA research team’s responsiveness to feedback as it has allowed Counselling Services to better integrate Mind In Motion into their existing services, reducing the time it takes for students to enrol into the exercise program: “we've streamlined the referral process, we've embedded it into our electronic health record, and when we've really tried to make it really easy and simple for our clinicians to make the referrals to get students connected as quickly and as smoothly as possible.”
Other possibilities to increase accessibility for students include implementing a self-referral system and allowing practitioners outside of Counselling Services to make referrals.
In consideration of how this intervention can be made available to more students, Mind In Motion is running as a group exercise program, in contrast to its initial model of having sessions be semi-private, during the 2024 to 2025 academic year.
There is also a social advantage to group sessions. “The program is designed to connect [students] with other peers who are also experiencing similar challenges and symptoms,” Lauren outlines, “and it's really kind of creating, in and of itself, a small community of support as well.”
Taken together, ensuring referral pathways are sustainable in the long run requires sufficient resources, adaptability, and persistence from all involved. If done right, Mind In Motion can foster a healthier student population where students have the tools and abilities to thrive to the best of their abilities.
Hopes beyond the campus grounds
Ultimately, the benefits establishing an effective referral pathway for an exercise-based mental health intervention are boundless.
Exercise, being a cost-effective, accessible, and holistic option, holds the potential to improve the mental wellbeing of many. Lessons from Mind In Motion may be used as a foundation for how similar interventions can be carried out within the community, outside of the “optimal environment” of UBC’s Point Grey campus.
Eventually, the greatest wish is for exercise to be seen as a conventional treatment option, like medication or therapy, rather than an unusual one. Or as Madelaine puts it: “what we'd love to have happen is: exercise [is] offered as a standard treatment option to people experiencing depression—both in Canada and across the world.”
More information on Mind In Motion can be found on the School of Kinesiology’s Speciality Programs page. A thorough record of how Mind In Motion was developed, implemented, and evaluated during the 2023 to 2024 academic year can be found through Cassandra’s Masters Thesis.