When I set out to write my latest book, Spark: The Revolutionary New Science of Exercise and the Brain, I knew exercise had a powerful effect on our brains, our biology, and our psychology. But after delving into the science, speaking to patients and peers, and looking at my own personal journey, I am convinced working up a sweat could very well be one of the most potent, underused prescriptions we have today to help ourselves, our patients, and ultimately our world.
I was a young, skinny kid in a Pennsylvania mill town when I first saw what magical properties exercise held. This was the real steel town area, mills running day and night up and down the Ohio and Beaver Rivers and the threat was that if you did not escape, you too would be working in the blast furnaces and having to shower well before you left work. Sport was the way out. While I came from a place where football ruled, churning out quarterback greats like Babe Parilli and Joe Namath, and five miles up the river from Joe Walton, Mike Ditka, and Tony Dorsett, my lack of girth led me to pick up a racket and make tennis my game. My best friend and I, both scrappers from the wrong side of the tracks, took on the country club set and achieved regional dominance, culminating in a trip to the Junior Nationals where we faced off with the best of the nationally ranked players. This led to a college scholarship. Bolstered by scholastic achievement, I had escaped. As an ADHD teen, brought up in a time before such a diagnosis, I now recognize how important exercise was in providing me with emotional equilibrium, steadying my focus to improve my grades, and helping manage my behavior.
This only became apparent later, when I was in medical school soon after antidepressants were discovered and I read about a psychiatric hospital in Norway that was offering depressed patients an option of the new wonder drugs or an exercise program along with psychotherapy. The initial reports were that the results were similar. This was mystifying to me. I was a beginning student of psychoanalysis, Freud, Ferenczi, Horney, Anna Freud, and many others.
John Ratey, M.D., is a clinical associate professor of psychiatry at Harvard Medical School and a psychotherapist Associate of APsaA. He is an author or co-author of eight books and lectures internationally on ADHD, aggression, and the psychological effect of exercise.
My goal was to come back to the Massachusetts Mental Health Center where I felt I was in the midst of ancient Athens. Here I was blown away with the knowledge and learning that permeated the cockroach-infested halls, though no one seemed to notice. The richness of the teaching and the hunger for learning from the wise men and women who carried the secrets of the universe made the surroundings seem heavenly to those captured by the desire to take it all in.
Like most of my colleagues, I wanted to become a psychoanalyst and was a control analysand in medical school and started my own analysis when returning to Mass Mental. I was captivated by Freud's Project of a Scientific Psychology and a colleague and I had a paper presented at the 100th anniversary at the New York Academy of Science Celebration. My interest has always been to try to make clear the connection between biology and psychoanalytic principles that with our tools we could now begin to explore. The question in the '70s was whether or not to use drugs; to think of exercise as a way to help out therapy was beyond anyone's wildest proposals. It was truly something akin to Esalen and Aldous Huxley and the California crew to pop LSD, which had been ruled out a decade earlier at Mass Mental, Columbia, and Stanford. But exercise, this was seen as ridiculous.
Candace Pert discovered the endorphin receptor in 1972, and the nirvana syndrome experienced by marathoners was studied and linked to high levels of these internal morphines and thus the “endorphin rush” was born. So common in use, these terms have made their way into the vernacular, and today people say they need to get back to exercising to get their endorphins up when they are feeling down or lethargic. Although not quite scientifically inaccurate, the endorphin high has the connotation that exercising does change the mood chemically, much like our vaunted antidepressants.
As their neurochemistry changed, their sense of being masters of their own fate was challenged.
In the '80s, my own patients presented dramatic supportive evidence. Runners who stopped due to injury fell into depression, dampening their self-esteem, motivation, and confidence. As their neurochemistry changed, their sense of being masters of their own fate was challenged. Chemically, we now know that exercise does not just alter the endorphins but also raises the more familiar targets of our psychiatric drugs: norepinephrine, dopamine, and serotonin. These neurochemicals are immediately, then chronically, changed to help mood, anxiety, hostility, ADHD, stress, and even addictions.
Duke, University of Texas, and medical schools in Germany began to plumb the effects of exercise on mood, anxiety, and, later, on intellectual capacities. Exercising groups fared better overall. The components of self-mastery and the sense of accomplishment were attributed to the success. In 1999, Duke conducted the seminal research, comparing a group of sedentary depressed patients who were given increasing doses of sertraline and a group who were started on an exercise program four times per week for 40 minutes. After four weeks, the resulting changes in depression scores were similar and again, after four months, there was no difference. Long-term follow up, however, showed that those who continued exercising at 10 months were significantly more improved than those on medication. Self-efficacy, a key factor for positive feelings generated by exercise, enabled patients to triumph over their depressed moods and cementing their gains, gave them tools to help prevent the recurrence in the future. They had learned the important lesson: One's actions can help regulate one's emotional life. Today many studies document that exercise can prevent the fall into “learned helplessness” and exercise triggers the release and emergence from this psychic paralyzed state.
More recently, new body and brain factors stimulated by exercise have been identified as essential to correct and maintain our psychic equilibrium. The endocannabinoids (our bodies' own marijuana), like the endorphins, reduce pain sensation, help make our mood positive, and improve our sense of contentment. Also, atrial natriuretic peptide (ANP), a substance that is made with each heartbeat, that among
other duties travels up to the brain, is a necessary factor in controlling stress, anxiety, and panic. ANP attaches to receptors in the hypothalamus to modulate its activity, and it is the only peptide that inhibits fight or flight activity in people at all levels of the system. I think it is one of the key reasons that people are more able to do the psychic digging that psychotherapy demands. Hippocrates and psychoanalysis had it right: The heart does play a key role in our emotional regulation and ANP is one of the markers of exercise contribution.
“In order for man to succeed in life, God provided us with two means, learning and physical activity.”
The interest in the neuroscience of exercise surged in 1995 after a large MacArthur study looking at the activities that prevented the onset of Alzheimer's showed exercise to be the strongest variable. Carl Cotman, at UC Irvine, began to look at what was really going on in the brains of running mice versus sedentary mice that allowed them to be 20-30 percent quicker on some tests of intelligence. He discovered that they had thicker brain cells and more of them in the hippocampus. This correlated with a tremendous increase in a newly identified substance called brain derived neurotropic factor (BDNF)—our brains' fertilizer—made when exercise or learning causes our brain cells to fire and produce what I see as one of the many gifts of evolution. Brain Miracle Gro or BDNF has almost magical properties that promote cell growth and development and is a key to learning. It adds resilience, keeping our neurons young and perky, and is necessary for a newly discovered process called neurogenesis, or the growth of new neurons in the brain from our own innate stem cells. As well, this mother of all brain growth factors helps us fight stress, has antidepressant and anti-anxiety properties, and has been the center of interest in efforts to beat the clock in keeping cognitive decline and Alzheimer's from our doors. From this study onward, there has been an avalanche of studies looking at how exercise affects the brain, both clinically and physiologically, and now I receive at least 40 new abstracts per week on exercise's effects on the brain and psyche from the National Library of Medicine up from about 2 to 10 per month prior to this seminal work.
Another key area that is just as dramatic occurs when programs that offer vigorous daily exercise are brought into an inner-city school; there is an immediate and persistent rise in attendance and drop in discipline problems. An inner-city charter school in Charleston, South Carolina, started just 30 minutes of active participatory games in the morning for 125 children in grades 4 to 8 and found an amazing 82 percent drop in discipline referrals compared to the previous year. Another school in Colorado has been using a “time in” procedure of vigorous exercising for their out-of-control elementary school students rather than the classic “time out” and they have found much better results. Now the children are being taught that they can do something to bring their impulsivity under control. They can be the agent of change and this has helped the program gain national attention. Many studies are now showing that physical exercise is a causal agent in increasing human brains to think better and more clearly; in the schools this leads to better test scores as well as an improvement in emotional regulation.
I think it is high time that all of us recognize and pass on to our patients the benefits of Plato's wisdom: “In order for man to succeed in life, God provided us with two means, learning and physical activity. Not separately, one for the soul and one for the body, but for the two together. With these two means, man can attain perfection.”