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The 10-minute project
The 10-minute project
The 10-minute project is a push to bring this sports medicine treatment to college campuses. The 10-minute project is an extremely cost effective and very effective at treating anxiety/depression.. In college the actual percentage of students who have mental health is many times higher than the national average. For example in 2018 the American College Health Association found over 60% of college students had major anxiety and 42% had major depression (1). As a comparison the regular US population has 18% for anxiety and 6.1% for depression (2). Meaning that college students had around a 3x increase in having these issues. We are starting to see an increase in the number of students seeking counseling rise around 30% from the years 2009-2010 through 2014-2015.(3), even though enrollment rose just 5%, However there is a sizeable increase, on average only 10-15% of college students seek counseling (Francis and Horn 20106) This still means that 85-90% of those students received no treatment of any kind. Obviously it would be a major undertaking to have all of those students receive counseling sessions, as well is extremely expensive.
What are some possible reasons college students are more prone to mental health issues?
What are some possible reasons college students are more prone to mental health issues?
It is fairly common knowledge that chronic stress is not good for us. College students tend to have somewhat chronic stress due to homework, classes, studying, etc. Physical and emotional stress would cause a sympathetic nervous system response, ultimately increasing cortisol, epinipherine/norepiniphrine, glucose, and insulin to name a few. The increase in both glucose and insulin causes the body to ultimately use more glucose for energy. The change to glucose from fat for energy then decreases the amount triglycerides going to the brain to ultimately become serotonin. Additionally if this glucose insulin response keeps reoccuring it could decrease insulin sensitivity and predispose them to having diabetes as well as having decreased cerebral blood flow. Diabetics are at a much higher risk of having depression and anxiety partly due to this. Chronic levels of high glucose is associated with a smaller hippocampus and lowered cerebral blood flow. Excess storage of fat also has been shown to cause depression as well as decreased cerebral blood flow. Lower cerebral blood flow has been linked to depression and anxiety.
We've established that chronic stress is bad overall, now let's talk specifically about the change in the brain. I'll bypass the basics of the Monoamine hypothesis and how exercise helps regulates, after all this is college. Increased stress physical/mental ultimately induces our stress response we know, epinephrine/norepinephrine, and cortisol. During the early stages of the body's response to stress we see both an increase in the precursors of both norepinephrine and cortisol. The precourses of cortisols (c-Fos) helps kick off the neural activation of the locus coeruleus, ultimately mass producing norepinephrine. Aerobic exercise reduces both the effect of this c-Fos on the locus coeruleus as well as reducing the secretion of norepinephrine via hyperpolarized neurons.These reductions can occur even after a short bout of exercise, including an endorphin explosion. The overall reduction is somewhat significant even without a recent bout of exercise! We also see a reduction in overall cortisol production, which if the higher levels were left unchecked could damage the hippocampus significantly. Also with the elevated cortisol levels it tends to alter both serotonin and dopamine levels causing a greater risk of depression/anxiety.This also leads to what some studies report, generally those suffering from chronic stress, and anxiety/depression would receive a greater reduction in symptoms via exercise.
*Diving into how exercise effects chronic stress has started to grow in research in both pharmacology and neurology. Some more recent research established that a neuropeptide, galanin, seems to be responsible for how we adapt to greater levels of stress. Not to nerd out too much but exercise has been shown to increase this peptide, thus having one theory as to why exercise helps with stress. Within the past couple of years some research has gone directly into combining galanin inducing chemicals with standard SSRI's with patients who were regularly resistant to the SSRI's. The combination treatment showed great promise in reducing symptoms. Aerobic exercise helps produce galanin and helps serotonin regulation, just saying.
What does mental health cost colleges?
What does mental health cost colleges?
The actual amount of money that a college loses through mental health depends upon a few things. The main things are if a school has a counseling/therapy center for students, cost per hour, that schools dropout rate, and how many students actually attend. About 70% of of Americans will actually go to college but only less than 2/3 will graduate with a 4-year degree (4). Also 30% of college freshman dropout before their sophomore year. The National Alliance on Mental Illness found that 64% of students dropped out directly due to their mental illness (5), Even within this group only 50% used counseling services. Let's plug in some numbers to let this hit home; a conservative estimate is around $400 per credit hour. If a freshman drops out then effectively they are missing out on at least 90 credit hours, $400 times 90 equals $36,000 lost. If a university gets around 5,000 freshman a year, 19.2%% will drop out due to mental health issues that year, loss of $36,000 per, overall loss of $34.6 million dollars. Exercise intervention costs next to nothing per student as most have recreation centers but will still have a massive effect on mental health.
How can we get these students to exercise?
How can we get these students to exercise?
Getting students who have anxiety and depression to exercise poses some problems in itself. Most people know that exercise can improve most things in their life including their mental health. The key to it 2 fold, raise the motivation of the student to exercise, while also making it as easy for them to exercise as possible. As part of the motivation providing information like your anxiety symptoms can by reduced by up to 41% (6) and depression symptoms by 80% (7).. This by itself could likely motivate the student to start an exercise program. After they start we need to find a way to actually keep them to keep doing it. Most studies have people leaving the study but the majority don't progress from lower to the actual test protocol. Usually having a progressive exercise program can mentally and physically prepare someone for that level of exercise. The American College of Sports Medicine has a simple acronym for exercise, FITTE; Frequency, Intensity, Time, Type, and Enjoyment. The first 3 are somewhat simple but the last 2, type and enjoyment refer to running, stairmaster, elliptical, and the enjoyment for each. Just saying exercise can be somewhat overwhelming but providing examples, stairmaster, stationary bicycle, running outside, then challenging them to find one they actually enjoy doing. For example I don't enjoy running on a treadmill but can run all day on a track outside. An effective addition would be doing temptation bundling, Neflix, Hulu, streaming services combined with exercise. One study using college students and audio books found those with the audio books visited the gym 28% more than the control group (8). A literature review found other nudging techniques, planning and reminders, also had a significant impact on increasing exercise adherence (9).Taking a note from psychology but having a higher frequency activity tied with a lower frequency one would also increase the frequency of the lower activity. An example is watching your favorite show after studying for an hour.
References:
References:
FALL 2018 - American College Health Association. (n.d.). Retrieved from https://www.acha.org/documents/ncha/NCHA-II_Fall_2018_Reference_Group_Executive_Summary.pdf
Products - Data Briefs - Number 303 - February 2018. (2018, February 13). Retrieved from https://www.cdc.gov/nchs/products/databriefs/db303.htm
Winnerman, L. (2017, September). By the numbers: Stress on campus. Retrieved from https://www.apa.org/monitor/2017/09/numbers
Atlas, C. (2018, June 29). U.S. College Dropout Rate: College Statistics. Retrieved from https://www.collegeatlas.org/college-dropout.html#:~:text=College Dropout Rate and Other Statistics&text=70% of Americans will study,year than a college graduate.
Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1). doi: 10.1186/s12913-018-3313-5
Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014). Physical activity interventions for people with mental illness: a systematic review and meta-analysis. The Journal of clinical psychiatry, 75(9), 964–974. https://doi.org/10.4088/JCP.13r08765
Milkman, K., Minson, J., & Volpp, K. (2013). Holding the Hunger Games Hostage at the Gym: An Evaluation of Temptation Bundling. PsycEXTRA Dataset. doi:10.1037/e513702014-057
Möllenkamp, M., Zeppernick, M., & Schreyögg, J. (2019). The effectiveness of nudges in improving the self-management of patients with chronic diseases: A systematic literature review. Health Policy, 123(12), 1199-1209. doi:10.1016/j.healthpol.2019.09.008
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