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Is Exercise as Effective as Medications or Talk Therapy?

A large meta-review suggests it is.

In the United States, when someone is experiencing a chronic health condition or persistent negative mood states, medications or talk therapy tend to be first to the rescue. Exercise is sometimes relegated to the category of “complementary and alternative medicine” for those who have tried medications and therapy and found them to be “ineffective” based on either provider opinion or a patient’s experience of subjective relief. However, this is not the case everywhere. In countries like Australia, behavioral approaches coined “lifestyle management,” which include exercise, is considered a front-line approach.
A new meta-review by a group of behavioral scientists from the University of South Australia highlighted the equivalence of physical activity to medications and psychotherapy in the treatment of depression, anxiety, various chronic diseases, and maintenance of overall health. The current findings, published in the British Journal of Sports Medicine, showed that physical activity has a medium effect size on depression, anxiety, and chronic disease, which is larger than the typical small effect sizes found in behavioral health research. This association improved with increased intensity of movement compared to treatment as usual. Critically, the effect size for physical activity on depression (median effect size = -0.43) and on anxiety (median effect size = -0.42) was comparable, though slightly greater, than medication or therapy (median effect size ranges = -0.22 to -0.37).
Though there have been dozens of randomized controlled trials or meta-analytic studies exploring the positive health impacts of exercise, they are typically limited due to examining very narrow demographics at a time, which may not generalize well to the larger population. The authors of the newest study attempted to include as many forms of physical activity as possible without focusing on specific subgroups of any one population to see what patterns emerged from data, which included over 128,000 participants across 1,039 clinical trials.
Any adult 18 years or older who participated in a research trial that aimed to increase physical activity was included in the analysis. Physical activity was defined as “any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase in caloric requirements over resting energy expenditure.” The physical activity intervention had to occur across time (versus a single physical activity event, like a one-time marathon). Studies which included confounding variables in their intervention such as dietary changes, medications, or psychotherapy were excluded to be able to highlight the impact of physical activity alone on health outcomes. Participants included in the study ranged from 29 to 86 years old, with a median age of 55 years old.
Results showed depression and depressive symptoms were significantly reduced with a medium effect size as a result of physical activity in over 62,000 participants across 875 randomized controlled trials (RCTs) from 72 meta-analyses. Anxiety symptoms were significantly reduced with a medium effect size as a result of physical activity in over 10,000 participants across 171 RCTs from 28 meta-analyses. Psychological distress significantly reduced with a medium effect size in more than 500 participants across six RCTs from one systematic review. Importantly, effect sizes varied highly by the assessment instrument used, highlighting the importance of measurement-based care, utilizing validated screening tools to assess symptomology in patients and research participants.
Perhaps even more promising than the massive number of participants for whom these impacts of physical activity on mood symptoms held true is the finding that all modes of exercise were effective in reducing depression and anxiety symptoms. Regardless of strength-based movement, mind-body practices like yoga and tai chi, aerobic exercise, or mixed-mode exercises which include both aerobic and resistance training, exercise was shown to be effective in improving negative emotions and health distress. Higher intensity exercises were found to be more effective in ameliorating depression symptoms than lower or moderate-intensity exercises, while both moderate and higher intensity physical activity was found to be effective for reducing anxiety symptoms.
As the overall physical activity treatment was extended beyond 12 weeks, the amount of reduction in mood symptoms paradoxically diminished. This highlights the importance of structuring physical activity interventions for discrete periods of time, consistent with how individuals set effective behavioral goals, compared to giving patients open-ended guidance on physical activity which is not time-bound. Limiting physical activity interventions to a “sweet spot” of roughly three months is also more effective for patients, medical systems, and payers alike, reducing the burden of healthcare costs while maximizing health outcomes.
Weekly physical activity close to or under 150 minutes each week is ideal, compared to exercise beyond 150 minutes weekly which showed diminishing health impacts. Exercising a moderate amount, of 4-5 times per week, was found to be more closely tied to better mood than exercising at higher frequency like daily or at lower frequency like only 1-2 times each week. For anyone wondering what the optimal length of an exercise session may be, the authors found 30-60 minute exercise sessions are most effective. Given the potential benefits of physical activity as an intervention and the minimal negative side effects, it stands to reason that exercise should be considered a front-line approach for mood and chronic health problems when possible. Or at least, exercise should be given equal consideration as medications and psychotherapy for improving health outcomes.

psychology today

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The Secret Behaviors That Make People Likable

How to impress others in initial encounters.

We meet someone — a stranger – and we immediately form an impression of that person. Often, we make a snap decision: “I like that person,” or “I really don’t care for them.” This important initial judgment can affect not only how we feel about the person, but whether we continue to interact with them, whether we want to develop a friendship or dating relationship, or, in the case of a hiring interview, whether the person gets the job.
Social psychological research suggests that there are certain behaviors that can strongly affect our initial impressions of strangers. In one study (Dufner & Krause, 2023), unacquainted young adults met in small groups and then spent a short amount of time interacting with each group member one-on-one. After each meeting, they rated how likable they found each stranger — whether they would like to get to know them and become friends with them. Trained observers watched each interaction and coded them for “agentic” and “communal” behaviors. Agentic behaviors are those that show confidence, dominance, and are slightly boastful. Communal behaviors include being polite, warm, friendly, and benevolent.
As far as initial likability, strangers who displayed high levels of both agentic and communal behaviors were better liked. However, when it came to establishing a deeper connection, it was only the communal behavior that predicted whether people wanted to form a friendship with the stranger. This makes sense. In an initial encounter, we may be impressed with people who are confident and proud/boastful. An air of confidence can increase liking. On the other hand, communal behavior – being warm, friendly, and polite – is strongly appealing and we want to get to know people better if they are warm, friendly, and seem to care.
Nonverbal Cues of Likability
In our own research, we found that in initial encounters with strangers, expressive body language led to greater liking. However, we also found a sex difference, such that men who were expressive with their bodies via posture and head movements were better liked, while women who were expressive with their facial expressions were most liked (Riggio & Friedman, 1986). We also found that nonverbally expressive people were better liked, and perceived as more attractive potential dating partners (Riggio, Widaman, Tucker, & Salinas, 1991).
So, what should someone do to increase their likability when meeting strangers? Try your best to appear warm and friendly, but it is also important to bring expressive energy to the encounter. Show that you are interested. Exude positive affect/emotions and a slight air of confidence. Demonstrate that you care about the other person by being a good listener. Let people know something about you, and show that you are proud of the positive things that you have accomplished.

psychology today


The Stigma of Being Overweight: 7 Core Themes

Research finds that overweight individuals internalize others’ negative views.

The prejudice against overweight people pervades many domains of life, including at school, work, in health care, in popular media, and especially in social relationships. It can also lead to “internalized weight stigma," in which overweight individuals essentially agree with negative stereotypes about having excess weight, and in turn devalue themselves. Put another way, it's when overweight individuals are biased against themselves for how they look.
What are the consequences of internalized weight stigma? This question was the focus of a new study led by Emma Davidsen and her colleagues at the Steno Diabetes Center and the University of Copenhagen, both in Denmark. To pursue this inquiry, Davidsen began by recruiting 10 participants who were overweight (as defined by BMI) through social media channels, including a “fat activist” group on social media and a Department of Bariatric Surgery. From there, the investigators conducted in-depth interviews about the participants’ lived experiences and administered questionnaires about weight-related self-devaluation and distress. The participants’ responses were then analyzed for themes.
What did Davidson and her colleagues find? The results yielded seven themes that reflected self-devaluation and struggle:

1. Devaluation of competencies. Two participants shared that they had doubted their competence and credibility because of stereotypes associated with overweight people. Jane, whose job involved physical activity, said she felt out of place or incompetent because of her weight: “It has definitely been my idea of not fitting in [at work] and my concerns about being skilled enough [at my job] that I could channel into some kind of insecurity about – well if I look like this, how can I stand here and present [my work]?”
2. Self-blame. Six participants blamed themselves for being overweight. They saw themselves as weak-willed for not sticking with diets and felt genetics was just an excuse for their excessive weight, and that overweight individuals should bear personal responsibility. Mary, a healthcare worker, remarked: “I definitely feel that saying overweight is in your genes is a poor excuse. I mean, you don’t get fat by not eating enough, or eating sensibly. I don’t believe in that, and I honestly have the philosophy that people who are using that excuse should be sent to a deserted island and then they wouldn’t stay fat very long.”
The participants also expressed judgment of other overweight people, and felt put off by overweight people who ate dessert or used public transportation rather than riding a bike.
3. Bodily devaluation. Nine of the ten participants devalued their bodies because of their weight; this was especially the case in the context of romantic relationships. One participant said she was trying to lose weight, and didn’t want to get involved romantically until she lost weight because she didn’t feel “at home” in her body. Another participant stayed with a verbally abusive boyfriend because she believed that she wouldn’t be able to attract someone else because of her weight. Yet another respondent said she didn’t feel sexually attractive to her husband.
4. Ambivalence. Six participants expressed concern with the way they perceived themselves, their bodies, and other overweight people. Mary, for example, expressed that despite feeling highly worthy and satisfied with life, she still found difficulty connecting to her body: “I also have some prejudices about being fat myself – that is, the fact that it is rarely upper-class people that are fat. After all, it is often social class 5 where they are. So sometimes I think about it myself. I'm a well-educated woman, and I have some healthy values and stuff like that, and I know what it takes to lose weight, but I still fall into that category, with the fat ones. And I can’t help but question myself. If I can’t even control my own weight, then what kind of human am I?”
5. Anticipated stigma. All participants experienced anticipated discrimination, which refers to the assumptions they made about how other people will think of and react to them because of their weight. Anticipated stigma emerged as an ongoing and deep concern. Simon equated this form of discrimination to his experience of being bullied as a youth: “If something goes wrong when I walk by, or something happens, then I can see them standing and pointing and telling each other about him over there, it's him who takes up two seats in the bus, or it's him who eats more, and it’s him that destroys the world. I can see that, and then I stuff music in my ears, so I do not have to listen to them.”
6. Coping strategies. All participants used avoidance to fend off feeling humiliated or degraded because of how others reacted to their weight. Take Kirsten, who didn’t want to wear short or revealing clothes during the summer: “I don’t find it super fun to change with other people by the public pools, or wear bathing suits, so in that way, I feel limited. [...] I don’t want to show my body, so it has been an extremely long and hot summer when one prefers wearing a lot of layers”
7. Mental well-being. Nine participants shared that “living with a stigmatized body” had a negative impact on their mental health, including anxiety, uneasiness, or anxiety in social situations, loneliness, disordered eating, violence, and reduced self-esteem. Consider Cecilia, who struggled with an intense fear of dying, or thanatophobia. She feared her death would create a scene and call attention to her excessive weight: “I have had quite a lot of anxiety about dying. For example, if I am in the cinema, I can get scared that I am dying [...] but I am not actually afraid of death, I am afraid of causing a scene. Then I think to myself – okay, if I am dying, I just have to die quietly, so no one will notice. Then they can carry me out after the movie.”
The authors conclude their study by noting its limitations, including its small sample size. Still, they maintain, this exploratory work demonstrates the harmful and damaging effects of internalized weight stigma.

psychology todady