Forced Physical Exercise as an Intervention for Mental Disorders?

Studies have shown that regular physical activity has benefits for mental health: exercise can help people to recover from depression and anxiety disorders. However, not all people like exercise, and a mental disorder like depression can additionally decrease motivation for physical activity. So the disorder itself might inhibit behaviour that helps to overcome it.

We would assume that pressurising people is no solution here: several studies have shown that restricting freedom of choice or control increases stress in both humans and animals. However, new research tentatively indicates that controllability might play a smaller role than expected when it comes to exercise, and that even forced exercise might protect against depression and anxiety symptoms:

In a recent experiment, reported in the European Journal of Neuroscience, several laboratory rats were divided into three main groups that exercised for six weeks. The first group of rats were allowed to voluntarily exercise in running wheels. The second group were forced to run in motorised wheels which turned automatically, but were adjusted to the rats’ natural speed, distance, and activity pattern. The third group were forced to run in treadmills that were not adjusted to the rats’ natural running behaviour. An additional control group of rats remained sedentary. After these six weeks, half of the rats were exposed to stress, for example by being restrained in Plexiglas tubes. The next day, it was measured how well the rats recovered from that stress by assessing their anxiety levels, indicated by how long they froze for when being scared and how fast they were able to use their learned escape routines when being put in an aversive environment. Results showed that the rats that had been running in the wheels were less anxious than the control group that has been physically inactive. There was no difference between voluntary and forced running in the wheels: both groups proved equally resilient, on the same level as the rats that haven’t been exposed to stress before. The rats that were forced to run in the treadmills, however, were as high in anxiety as the control group. The authors argue that the rats experience in running the wheels as more rewarding than in the less complex treadmills. On a neuroscientific level, the study showed that the effect of exercise in preventing anxiety was not dependent on the medial prefrontal cortex (mPFC) of the rats being intact. This brain region is thought to be critical for the experience of control over stressors.

Hence, forced physical exercise increased resilience against symptoms of depression and anxiety as well as voluntary exercise did, and not experiencing control did not spoil this effect – however only if an exercise was chosen that matched natural behaviour.

I think this study raises interesting questions. The first are scientific in nature: are these findings transferrable to humans? Could the well-known negative effects of diminished control be outweighed by the positive effects of physical exercise in the case of mental disorders? What is the “natural exercise behaviour” of humans? But there are also ethical questions to be answered: should we aim to conduct research in humans to reveal whether forced exercise could be beneficial in the treatment of mental illness? And – in case we found that forced exercise could be an intervention – would that provide grounds to force patients to exercise even against their own will?

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11 Responses to Forced Physical Exercise as an Intervention for Mental Disorders?

  • Nikolas Schaffer says:

    “The first are scientific in nature: are these findings transferrable to humans? ”

    Easy way to find out – cage a load of humans and have them running on motorised wheels and treadmills etc, then restrain them in plexiglass tubes. Check the results against the rat results, then report the science.

    “Could the well-known negative effects of diminished control be outweighed by the positive effects of physical exercise in the case of mental disorders?

    Seems unlikely. People who are suffering anxiety or depression etc sometimes force themselves to exercise, and benefit from it. To be forced by someone else introduces a whole new category of intrusive anxiety, which is likely to have much more negative impact on ostensibly free human beings than on rats accustomed to captivity.

  • Right-Wing Hippy says:

    I have no objection to this provided that the orders to exercise are barked-out over a telescreen first thing every morning to all party members, and not just wasted on crimethinkers (as you suggest).

  • Anthony Drinkwater says:

    The answer to your second question is simple, Nadira : it is unethical (and illegal) to force medical treatment on someone against their wishes.
    See, for example, the GMC’s Good Medical Practice on the question of consent.

    If you are talking about patients who do not have the capacity to give consent, then I don’t see that forced exercise would intrinsically be different from any other forced treatment : the criteria for judging should be the same as for any other therapy : efficacity, risk, dignity…..

  • Lucy says:

    I think it’s important to put this question into the wider legal and political context. Anybody working in the field of mental health or mental capacity should be aware of the profound implications of the UN Convention on the Rights of Persons with Disabilities on any kind of forced, coerced or otherwise non-consensual treatment. The UN CRPD was drafted with high levels of involvement from people with disabilities, who resoundingly rejected the kind of medicalised view of disability – including mental disability – which underpins forced medical interventions like the one discussed here. The UN CRPD prohibits detention on disability related grounds (Article 14), non-consensual medical experimentation (Article 15), it protects the right to physical and mental integrity (Article 17) and there is a growing consensus that it prohibits involuntary treatment on grounds of ‘incapacity’ as well (Article 12). I strongly urge the author of this piece to get acquainted with the literature on the CRPD’s rejection of all kinds of involuntary treatment (for example, see: Amita Dhanda, Tina Minkowitz, Gerard Quinn, Bernadette McSherry, Genevra Richardson, Peter Bartlett, Janet Lord, Rosemary Kayess, Philip French, Michael Bach and Lana Kerzner). It is also worth noting that the approach taken by the CRPD has been recognised and endorsed by the Office of the High Commissioner on Human Rights, the Council of Europe’s Commissioner on Human Rights, the UN Special Rapporteur on Torture, and is increasingly influencing rulings of the European Court of Human Rights.

    And on a related note, although I hope it’s the moral, legal and political arguments that convince you that forced physical exercise is problematic not the empirical arguments, the latest studies on humans show that exercise doesn’t help with depression after all:
    http://www.bmj.com/content/344/bmj.e2758

  • Rachel says:

    I would be happy to sign a form saying that if I am ever suffering from depression to the extent that I may be less motivated to take part in evidence based treatment that has no significantly dangerous side effects, I would like to be incentivised to do so. Of course if exercise doesn’t work, fine, but if it did, or if there is another treatment that works, I would like to be given the option to be pushed to do so.

    It must be possible to arrive at a balance between suggestion and force? Apps for supporting people with depression is an example. They surely put some mild pressure on people to behave and think in certain ways. Is this acceptable?

  • Keith Tayler says:

    Forcing people with mental health problems to do exercise does appear to be wrong. But does mean we should neglect people with mental problems and allow them to completely withdraw into a solitary immobile condition?

    I once knew a young man who spent 23.5 hours of the day in his darkened bedroom in a community care home, only venturing out at about midnight to quickly cook his only meal of the day. On the few occasions he kept his appointments with his psychiatrist he insisted on having a taxi to take him the three hundred metres to the medical centre. He fell into this state because those that were responsible for his care believed he had a right to choose his way of life and that they should not intervene.

    Would it of helped this man to take a little ’forced’ exercise?

  • Rachel New says:

    Would it seem more acceptable for him to be given incentives to talk to his therapists or to spend some time socialising, compared with exercise? If so, why does it seem worse to influence someone to do something physical rather than social?

    • Keith Tayler says:

      Rachel

      Why indeed.

      What we cannot do is nothing because we believe his right to choose his way of life trumps everything else. Obviously we have intervened with his initial hospitalisation and later provision of a place in a community home. To stop intervening once he had arrived at the home was ridiculous and struck me as neglect. I am not advocating intervention in the old psychiatric sense of the word, i.e. get two or three nurses to give him a good kicking until he changes his ways (unfortunately this is still in use in some institutions). Nonetheless it could be seen as being involuntary treatment if we intervened to change his way of life. But again, although not sectioned or under a guardian order, he and thousands of other residents in community homes are effectively sectioned because if they persistently went AWOL they would be sectioned and returned to hospital. He and others have to take their medication and would again take the risk of being sectioned and returned to hospital if they refused. So we have not escaped the involuntary treatment problem by allowing him almost complete freedom of choice.

      Incentives do not always work and in some cases, I believe, do not respect persons intelligence and self-understanding. Sometimes it is more honest to clearly explain the reasons and instruct somebody to do this or that. There is no perfect solution to this problem. But perhaps part of the difficulty is that we should not be seeking for a perfect solution.

  • Julia Wise says:

    Presumably any circumstance requiring forced exercise would be similar to circumstances under which people are currently forced to take psychiatric medications: rare and extreme. At least in the US, this is usually enforced for people with psychotic disorders, not depression and anxiety. Telling someone “You must swallow this pill or we will have to hold you down and inject you” is extreme. How would you even do that with exercise? “You must walk 2 miles today or…” what?

    As for incentives, some insurance companies here offer financial incentives to overweight customers to exercise. I would have no problem with offering similar incentives to people with depression and anxiety, or anyone for that matter,.

  • Julia Wise says:

    Presumably any circumstance requiring forced exercise would be similar to circumstances under which people are currently forced to take psychiatric medications: rare and extreme. At least in the US, this is usually enforced for people with psychotic disorders, not depression and anxiety. Telling someone “You must swallow this pill or we will hold you down and inject you” is extreme. How would you even do that with exercise? “You must walk 2 miles today or…” what?

    As for incentives, some insurance companies here offer financial incentives to overweight customers to exercise. I would have no problem with offering similar incentives to people with depression and anxiety, or anyone for that matter,.

  • Diego Caleiro says:

    “Forcing” people, if the technique is transferable to humans, may not be the best way to frame it. Usually when there is intervention for humans to do things they don’t feel like doing, it is through incentivizing. Some levels of depression may be so deep, that nothing is an incentive anymore. But in most cases, a few things are still rewarding besides food, sleep, etc… One of those things could be used to lure people into exercise.

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