And welcome back to the Wellness Paradox podcast . I'm so grateful that you can join us on this journey towards greater human flourishing . As always , I'm your host , michael Stack , an exercise physiologist by training and a health entrepreneur and a health educator by trade , and I'm fascinated by a phenomena I call the Wellness Paradox .
This paradox , as I view it , is the trust , interaction and communication gap that exists between fitness professionals and our medical community . This podcast is all about closing off that gap by disseminating the latest , most evidence-based and most engaging information in the health sciences . And to do this , in episode 116 , we're joined by Dr Anaja Nusam .
Dr Nusam is an exercise physiologist by training and she's progressed into a research area focusing on physical activity and mental health , and I'm always very excited to talk about this topic because I do think we are in the midst of shifting the narrative away from exercise and physical activity just being about physical health to being about physical and mental health
and , as you're going to hear Dr Nusam talk about in this conversation , it really is about treating the whole person . When you're talking about overall health , it's not just their physical health , it's not just their mental health , it's both .
So we're going to dive into the role that physical activity and exercise play in mental health and how it can actually be used as a part of mental health interventions .
And then , more importantly , we're going to talk about what actually needs to happen to get it there , because right now , physical activity and exercise interventions aren't broadly used in the mental health space . But after you hear this conversation with Dr Nusam , without a doubt , you're going to understand why that is so important .
Any information we'd like to share with you from today's episode can be found on the show notes page that's been going to wellness paradox podcom forward slash , episode 116 . Please enjoy this conversation with Dr Anjana Nusam Today . We're delighted to be joined by Dr Anjana Nusam . Anjana , thank you so much for joining us .
Thrilled to be here . Thanks for having me .
I'm very excited for this conversation because I think it's such a pertinent and salient issue right now , just in our society , with all the challenges people are having with with mental health , and I'm always excited when exercise professionals can get involved in the process of improving mental health and we're going to really dive into that in this discussion .
But before we get into it , can you just give us an idea of your background so our audience has some context for the discussion ?
Yeah , absolutely so . I am a faculty researcher at the University of Central Florida . By day , that's what I do I . My primary interest is in the exercise physiology behind psychological distress disorders , how our body physiologically and neurologically and biologically respond to stressors that are placed in our life .
I really enjoy that type of research because I think it's really important to move the narrative forward about exercise beyond the physical , which is largely what the narrative is . I'm also a sports conditioning coach . I coach Olympic weightlifting , the snatch and the clean and jerk , and so I really enjoyed that .
And then I do have my own podcast that I go on and talk a lot about these psychological traits and individual traits behind exercise , training and physical activity .
Awesome . So so , like many of us listening , and myself included , sounds like you wear a number of hats , so very exciting that a researcher is also someone who coaches Olympic weightlifting , that that kind of harkens be back to to my past , although this is is not the Olympic lifting podcast .
This is the talking about how physical activity can improve mental health , and I want to start with something you said a second ago which is traditionally for decades and decades and when I went to school , when you went to school , we had so much information about how physical activity and exercise was great for improving your bone health and your heart health and
all these physical areas of the body , and although exercises definitely realize that exercising improves your mental health , it seems like this is only recently became something that's more in the consciousness of our profession .
Can you summarize some of the research maybe that's came out as of late that has led to this emphasis on not just to focus on physical health , but also mental health ?
Sure , sure , and I think that , just like anything research related , it's nuanced and I want to just I want to give that disclaimer before people jump into my inbox .
It is nuanced right , such as science , but what we're learning is that from a from a neurological and from a physiological standpoint , we do see that movement consistent , moderate to vigorous physical activity changes how we process information , how we respond to stressors and traumatic events in our lives .
A study that I'm doing right now is the hypothesis is that if we can increase moderate to vigorous physical activity in a person , it will change the level of brain derived neurotrophic factor in their in their brain and in their blood , which is associated with levels of depression , which is associated with executive functioning , cognitive functioning , and so we can get
people to understand that it's more than just losing weight , building muscle . Those things are important .
We're also talking about changing how we physiologically respond to what everyone experiences every day , and that is stress , and I think a lot of the research that is coming out now looks specifically at , you know , three different types of stressors or psychological disorders depression , anxiety and stress related , and those are the big three .
We see aerobic and resistance training largely affects depressive symptomology . It's kind of fluid about anxiety , because we know that anxiety is already associated with high levels of heart rate .
Well then , you tell someone to go and exercise at a bigger intensity and that's not going to be as appropriate , and so we're still looking at some of the modalities and the intensity levels for that .
But we also know that , from a stress related standpoint , we're able to process stressors better after an acute bout of exercise , and we know that there are some mental health benefits that I think people should take into consideration .
Yeah , that's fascinating , and I've , too , read some of the research on BDNF and you know , I've heard that described as almost , you know , miracle grow for the brain , to oversimplify it and it's fascinating to think that , you know , we're doing something in the brain that actually is kind of similar to what we thought of as what happens in muscle cells when we
exercise . So I think that's exciting . I'm curious , you know . So we have depression , we have anxiety , and then you just sort of said life stressors , and you know , when I think of those , I think your depression , anxiety , kind of you know , pathological state life stressors are things that we're dealing with all the time .
So it doesn't sound like this is just something , you know , that's only for the clinical population , this is , for you're , just kind of everyday function .
Absolutely , because and this is something that I , when I'm teaching my students we're not trying to reduce stress , and I think that used to be the narrative . We're trying to , we're trying to , we're trying to eliminate and reduce and minimize stress . Well , we're all experiencing stressors , right , but it's about how we process and how we cope with them .
And if we can teach folks to use Exercise as a positive coping mechanism for everyday life stressors , then we're less likely to compound those stressors into what eventually turns into anxiety and depressive related disorders . And so it's .
It's more of a coping mechanism and a positive appraisal of the stressors that are happening around us that we're trying to teach people to Connect the dots between exercise and stress .
Yeah , no , that's great . So you mentioned , you know , talking with your students about this and kind of you know , teaching them about the topic . How , how do you get them to start to shift the , maybe the Expectations around exercise for people , like you said it earlier , you know , the muscle gain , fat loss , although , you know , thanks to the GLP ones .
I don't know if we're gonna be having that conversation as much as what we once used to have that , but again , I think people come to most exercise professionals with the assumption that , hey , this is an endeavor for my physical health , not necessarily mental health .
How do you suggest that exercise professionals start to not diminish the physical health , the importance of it , but start to you add in and kind of shift the narrative towards those mental health benefits ?
Yeah , and that's a really great question and that's a largely what I'm hoping to translate my research in we're . Right now we're looking at this idea of the 24-hour activity cycle and . I think largely what exercise professionals have focused on is that Leisure time moderate to vigorous physical activity and how that impacts someone's overall health .
Yeah , but when you really think about that , it's less than 10% of our entire day . Right , it's in for most people is five to eight percent on average of of our entire day .
And so what I think with the first step for exercise professionals is we have to understand what the , the fit principles , the frequency , the , the intensity for Exercise to improve mental health .
But we also have to help people understand how to get activity in throughout the other parts of their day active , transport , domestic , as well , as you know , household , occupational and we have to take all those things into consideration because we're learning that the different domains of physical activity are also really important considerations for not just mental health
but also physical health . Right , where you know active transport and leisure , leisure time , physical activity are more beneficial for cardio , metabolic health or mental health , and in and etc . Occupational physical activity not so much .
And so where people are getting physical activity and how they're integrating physical activity throughout their entire day , I think is a really point of emphasis for exercise professionals . Yeah absolutely .
I think that's so important and you're so right . You know , as an exercise professional , you think of what somebody does it when they're in the gym and the reality is , unless you work in a gym , you're not in a gym very much , so what you do during the rest of the day is very important . So we're gonna .
I want to drill down on both of those a little bit deeper . You mentioned the fit principles earlier frequency , intensity , time type .
I'm curious , based upon your research and the emerging research , is there a substantive difference and if there is , you know , what does it look like between kind of the standard fit principles for physical health and the fit principles for mental health ?
So on paper we haven't created a framework right . One day I will and I'll come back on the podcast and I'm gonna share that beautiful framework with you . But some of the things that I've kind of come up with as I'm formulating research designs and even just talking to clients and what we've learned is that we have fit .
But then we also have things like psychological traits and preferences and I think that we have to incorporate things like personal preferences , what people like to do , what's gonna bring them enjoyment .
If I don't like to run , I'm not gonna prescribe someone run at vigorous physical , vigorous intensity for their mental health , because that is going to deter them from that . We also have things like social support .
We know social support is a major contributor to exercise adherence and that is also a major contributor to things like depression and anxiety and quality of life .
So we need to make sure that when we are thinking about exercise , especially the maintenance of exercise , how do we integrate significant others Whether that's a family member , whether that's a friend , whether that is a colleague into the exercise program ?
For example , when I'm coaching a client and I have a new client come in , a part of that intake form says who is going to be your social support person . What is that person's name , contact information ?
Because I want that client to really think about who's going to support them on their journey , who's gonna advocate for them on their journey , and I think that's a major factor in exercise prescription exercise programming outside of the general fit principles .
Right . So it may or may not mean at one day that the fit is different than what it is now . I think probably we both suspect it's not gonna be substantially different than probably what it is now . But it is layering on these other critical aspects .
And you said it I gotta tell you , if you talk to me about running I'm going to get anxious and then if I do it , I'm probably gonna be depressed when I'm doing it . So finding activity that is relevant and that social component is so important . I think this is in part why we've seen the group exercise craze , you know , proliferate to .
You know whole franchise business models , like you know , orange Theory and F-45 and CrossFit and all these things , because people love that social support . It's a big part of it .
It's a community and I would say that community also holds us accountable , and there are lots of people who , when they are held accountable and they reach that goal , that's a sense of building self-efficacy . And self-efficacy is another major contributor to any health behavior change .
But we also see that a lot in physical activity behavior change , which then contributes to things like mental health , mental wellness and mental wellbeing .
Yeah , and so you talked about the exercise component , and then there's this physical activity component and I think too often we conflate the two , like they are different things and certainly they happen in different ways , and I often think of the person that is not an exerciser . You know , we know these people .
They flat out tell us , hey , I'm not an exerciser . So telling that person to go from nothing to the gym is generally a bridge too far . So I tend to look at you know , physical activity is not only a thing you can do throughout your day , but also is maybe the gateway to exercise .
So tell our audience a little bit about how you get people to think about that in terms of just their daily routines , and maybe how you'd have exercise professionals present that to their client who thinks , hey , I've checked the box of doing my 30 or 45 minutes in the gym , like I'm good for the day . How should they think more broadly ?
Absolutely , and I love that you prefaced this question with . Physical activity and exercise are not the same right . Physical activity is any general movement that we do for our body , and exercise is a subset of that . That is very structured and on purpose , and a lot of people are scared of that word exercise .
Both of us are familiar with ACSM and I do a lot of work with exercises medicine and some of the pushback that I get from folks that are not exercises or don't have that identity is that they don't want to exercise .
Exercise is too scary , and so I think that for exercise professionals , fitness professionals , health professionals in general , we need to be mindful of the language that we use when we're speaking to folks . I might go into a gym and talk with some client who's been with me for years and we're talking about exercise . Right , that's what we're talking about .
Then I might approach someone who's just kind of testing out the waters and I might just say movement , how are we gonna move better today ? How often can we move today ? And when I put it into the term of just move , it opens up this gateway for people . Well , I can move with my child out on the scooter .
I can move as I am walking up and down the stairs , I can move in my neighborhood . It was interesting . I'm doing a research study right now where we're looking at the dose response effective exercise . So taking someone from sedentary to walking to the public health guidelines , the 150 minutes of moderate to vigorous , and then double that .
And we had someone that reached the double that , the 300 minutes of moderate to vigorous physical activity and they said I have to pull out of this study and I go whoa , whoa , whoa why ? And they said there's no way I can get 300 minutes of moderate to vigorous physical activity . And yet when we checked their data , they were getting way more than that .
And when I asked them , they said yeah , but I can only go to the gym three times a week for an hour and so there's no way that I can get 300 minutes . And then when we broke down movement in general and we correlated movement that they were doing every day with what their heart rate was saying , it opened up a world of possibilities .
This person walks their dog every evening for an hour while listening to a podcast that's movement . This person goes hiking with their grandmother every Sunday afternoon that's movement . It's not in a gym .
So I think that we just have to broaden what we consider movement for the general population until they are able to cross that bridge or walk through that gateway to exercise .
Yeah , I think that's such an important point around language because for us you and I and probably many of the people listening the word exercise excites us . The word exercise scares a lot of people . I mean , we know that market penetration in the fitness industry is only about 20% and it is kind of stuck around that point forever .
So clearly the American public , broadly speaking it , doesn't have the kind of affinity towards exercise that you and I and a lot of our listeners have . So just that tweak in wording from exercise to movement , I think can be so powerful and your example from that study is so great .
Like well , there's no way I could possibly do this , and it turns out that the individual was doing it . So I think it really opens up a whole new realm of possibilities , absolutely .
So one thing that is not happening just yet , at least from my perspective broadly in the mental health space like it is in the physical health spaces , I don't see a tremendous amount of broad collaboration between mental health professionals and exercise professions . You see it .
You don't see it as much as we'd like to see it in the physical health space , but you certainly see it there clinical exercise , physiologists , you know physical therapists , you know medical fitness facilities , so what's your perspective about how you know this can actually be integrated into treatment for mental health issues and what's the exercise professionals role in
that process ?
And so I want to answer this question . It's a phenomenal question , and I think that if once we break that barrier , a lot more of my papers that are currently sitting on my desktop would be published , because that is a major barrier , and we see it happening outside of America .
We see it happening outside of the United States much more frequently , where clinical exercise physiologists are integrated into the health care system as a whole physical health care as well as mental health care .
The challenge is and this is what I learned a lot during my my doctoral work is that the modalities behind what is appropriate and effective exercise for mental health is so very , very new , and I think what that newness creates , this cautiousness that we see from our health , our mental health care professionals and partners it is it's we don't know exactly how
much to prescribe someone that that makes it effective , and what if there isn't an acute crisis ? That is more important than getting someone physically active .
We saw during the , the COVID-19 pandemic , that a lot of mental health professionals were treating things like houselessness and food insecurities , and so those became prominent over prescribing exercise and recommending physical activity , which is totally that's , that's totally appropriate , right , and so what ? We're kind of shifting gears a little bit , I think it comes .
There's three things that have to come here . The first is we need organizational support . So we need the health care organization to embrace clinical exercise physiologists in this country . We need insurance to cover exercise physiology services in this country , both on a clinical as well as a mental health care .
And then we need for supervisors and clinicians to be held accountable and responsible for integrating this lifestyle medicine .
The American College of Lifestyle Medicine has done a tremendous job of integrating lifestyle medicine , physical activity , nutrition , into things like diabetes care , some cancer care as well , and I think that with more work like that , we can help to integrate it into mental health professionals .
The second thing is I just did a study , and hopefully by the time this podcast comes out , I would have resubmitted it , but what it found was that exercise , or mental health professionals that exercise themselves , were more likely and more confident to prescribe exercise to others , but only 35% of that pop , that sample , were exercises , and so when you talk about
the penetration of fitness in the exercise market , we have to start with our health care providers more broadly in incorporating lifestyle medicine into their own lives . That's how we get them more confident . That's how we get them to understand the beliefs and the importance and the values behind lifestyle medicine .
And then the third thing I would say is that we have to again change how we are positioning exercise and physical activity as more than a weight loss component or as more than a , you know , physical thing .
And once we get this , once we incur more data and get more information about the impacts of exercise and physical activity on mental health , I think that opens the door for our mental health professionals to have something to grab on to to say All right , and so for my person that comes in with depression , I'm going to regularly integrate exercise as a standard
of care for this type of individual .
I'd like to take a quick break from today's episode to tell you a little bit more about one of our strategic partners as a podcast .
As many of you know , the Wellness Paradox is all about closing off the trust , interaction and communication gap between fitness professionals and the medical community , and no organization does that better than the Medical Fitness Association . They are the professional member association for the medical fitness industry .
This is the industry that integrates directly with healthcare in many facilities throughout the entire country . The MFA is your go-to source for all things medical fitness . They provide newsletters , webinars . They even have standards and guidelines for medical fitness facilities .
They do events around the entire country and , most importantly , they are one of the more engaging networks in the entire fitness industry . I personally have benefited from the network that I've developed through the Medical Fitness Association and I highly recommend that all of you that are interested in solving the Wellness Paradox engage with the MFA .
To find out more about the Medical Fitness Association , you can go to their website , medicalfitnessorg . That's medicalfitnessorg . Now back to today's episode . Yeah , great answer .
And so , in saying all of that , which is a lot , it doesn't sound like it's a lot different than what we need to do to just integrate in exercise professionals with healthcare more broadly . This just has a mental health lens that we're filtering things through .
Absolutely yeah , and it is a tremendous amount of work and there are a lot of groups out there that are working hard . You mentioned ACLM . We'll link up to them in the show notes . Physical Activity Alliance that I'm very closely involved with .
I mean they are has the goal of making physical activity assessment , prescription and referral the standard of care and healthcare in America and they're making strides on that .
So there's a lot of good stuff that is happening and people like you doing amazing research that can inform some of the policy and systems change work that's happening , but we know that that's slow , certainly slower than what we want .
So in the meantime , I do think there's a role for the frontline exercise professional to play in this to possibly develop relationships with mental health providers in their community . So , from your perspective , is there , do you have any advice for fitness professionals that are listening to this going ?
Yeah , this is something I've never really thought of getting referrals from a mental health provider . I thought of it from a primary care physician . How would you suggest that they go about approaching maybe a mental health provider on this ?
You actually hit the nail on the head in your question . It's all going to be about personal relationships . When I was directing our exercises medicine on campus program , our largest referral source actually came from our counseling department , and that's because I personally had relationships with these professionals . I went to their in services once a year .
I talked with them about what programs we were doing , how we were implementing them and how it was going to impact their work . Mental health professionals are seeing an increase in services . They're seeing an increase in clients and individual needs , and the demand is far surpassing what they can accommodate .
And what I was able to communicate to my partners was hey , there's some low hanging fruit here that we can help to triage a little bit .
When we talk about lifestyle medicine , nutrition , physical activity , sleep , stress management , social support , when we're able to show them how what we're doing can impact their work , they're more likely to jump on board , and so it was my personal relationships with them that was really beneficial .
The other thing that I would say is to it's you'll have to do a little bit of digging , but there are resources out there educational , specialist resources , certifications that you can participate in . That will really help you understand how to talk with someone who is dealing with a mental health issue .
There are lots of nuances and caveats there that someone , without those those challenges or barriers , might not experience . For example , the same thing that causes someone not to want to exercise , such as like fatigue , low self esteem , are the actual byproducts of some of the mental health issues .
And so how do you help someone navigate those barriers and challenges when the same thing that you're trying to alleviate with physical activity is what's being caused by their mental health issues ? And so education on the part of the exercise professionals going to be really key in helping to develop those those relationships .
Yeah , I think that's such an important point because I mean , just like if you were working with somebody who had heart disease or diabetes , you would understand the condition , you would understand the medications that they're taking , but certainly the medications that address depression and anxiety , they have their own host to side effects , you being an educated
professional . We just can't go out there and say , hey , we know exercise is great for mental health , it's great for many people . There has to be some sort of an established relationship that exists and I like how you pointed out it was , you know you developing the relationship with those individuals . So I think that that's such a great point .
Resources do you have any suggestion as to what some of the resources that are out there that people can look at if they want to familiarize themselves a little bit more with this ?
Yeah , I would say two resources that come to mind . One that I actually just finished authoring a section on is through the JW Brick Foundation . They just developed a mental health and fitness specialist certification , if you will , and I wrote the section on exercise and movement .
And then there's also a sub , a section of the exercises medicine resources on the ACSM website . That I think is phenomenal . That really speaks to how exercise is integrated into mental health care , and I think those are two great places to start .
I'm glad you said that about the Brick Foundation because I got to look this up on my computer , because I the very next podcast we'll be having actually will be with Victor and Lynn Brick to talk about that exact certification .
So they are amazing .
That's serendipity , folks . I had no idea that you were involved in their work whatsoever .
But yeah , they've developed this mental well-being certification for fitness professionals , which , to my knowledge , I believe it's the only certification right now that's dedicated specifically to that , I think , and that speaks volumes to the probably the lack of education and evidence that is out there in a structured fashion for this . But so we will .
That will drop on the 6th of March , just for everyone who's listening . So that is our very next episode . And then you mentioned the EIM resources as well , and certainly your research and other people that are doing research in the area .
I think that this seems like it's an emerging area , and that's the last question that I want to really ask you about what excites you most with the research you're doing and the research you're seeing right now ?
I think it's that it the broad impact that it can have . I mean , unfortunately , mental illness is becoming one of the biggest public health issues out there . I mean , at this point it's right up there when we talk about the global disease burden .
It's right up there with things like obesity , with things like diabetes , with cancers , and so the number of people that can be impacted through exercise and physical activity is tremendous , and that excites me a lot . The second thing is , I think that there are so many other purposes from physical activity and mental health .
From a social standpoint , we see people developing relationships that they would have never had from participating in sports , from joining a gym , from being a part of a group fitness class , and I think that is also something that is under estimated when we talk about the purposes of physical activity and exercise .
Yeah , absolutely . The community aspect is so , so big and , as your working people go if they want to find out more about you and all the great work you're doing .
So I spend a lot of time on Instagram . Right now that's at Anajia Newsome , phd , and I also do coaching health coaching , behavior change coaching , as well as nutritional coaching via OptiMyshtrengthco . So those are the two places that you can connect with me .
I share a lot of free resources just like this for people , because I think that accessibility is important and good information , good resources , shouldn't be behind a paywall .
Amen to that , and we will link up to all of that on the show notes page so our audience has a chance to check that out . The last question I'm gonna ask you is we kind of previewed this a little bit earlier , but I'll see if I can get you to dig a little deeper here . And it's the question I always end the podcast on , which is the wellness .
Paradox for me is this gap that exists between exercise professionals and the medical community , and my goal , which also sounds like it's your goal , is to close off that gap . You mentioned relationships earlier as being an important part of closing off that gap , but I wanna open up the space to maybe have you drill down a little bit more .
And is there one single piece of advice you can give the exercise professionals that are listening If they wanted to start to develop those relationships with healthcare ? What would that one piece of advice be ?
Well , that's a really great question , and the thing that comes to mind for me is that , as exercise professionals , we have to treat the whole person . We have to look at the entire person if we really want to build relationships and understand what the medical community is trying to do and what our goals are as exercise professionals .
I just wrote a piece on this about developing the whole athlete , and I think the same thing is true . People don't exist as just exercisers . It's about their lifestyle , it's about their mindset , it's about their wellness and it's about their financial resources .
And I think that , as exercise professionals , the more that we can dig down , the more that we can learn how those things influence and are influenced by exercise , then I think that we have a real opening to understand what's happening in the medical community .
When we talk about health disparities , when we talk about the way people seek medical care , or the reasons that they do or don't seek medical care , and the reasons that they choose lifestyle medicine versus not , I think those are really important things . So I would say treat the whole person .
Treat the whole person . That is the topic of this whole podcast to a great degree . Dr Adajah Newsom , thank you so much for joining us on the Wellness Paradox .
Thank you so much for having me . It was a blast .
Well , I hope you enjoyed that conversation with Dr Newsom as much as I did . If you found it insightful and informative , please share with your friends and colleagues . Those shares make a big difference for us . Any information we'd like to share with you from today's episode can be found on the show notes page , that's by going to wellnessparadoxpodcom .
Forward slash episode 116 . Please be on the lookout for our next episode when it drops in two weeks , and don't forget to subscribe through your favorite podcast platform . Until we chat again next , please be well .