Counseling on exercise should become routine in psychiatry.

BOSTON -- Exercise counseling should be part of routine psychiatric practice, Dr. Alison C. Phillips advised at the American Psychiatric Association's Institute on Psychiatric Services.

Physical activity is particularly important for psychiatric patients. Not only do the vast majority of psychotropic medications potentially cause weight gain, but mood and anxiety disorders often are associated with low energy and decreased motivation to eat well. But despite a large body of literature suggesting improvements in depression and anxiety with regular aerobic exercise--above and beyond its vast general medical benefit--such counseling has not been incorporated into routine psychiatry practice, noted Dr. Phillips of the Hestia Institute, Wellesley, Mass.

"Psychiatrists should be involved in exercise counseling. We typically see patients more frequently and for longer periods of time than any other medical specialty, allowing for frequent reinforcement and monitoring. And we have special training in counseling people to change behavior. Moreover, not counseling the benefits of exercise may be perceived as condoning a sedentary lifestyle," she remarked.

Although most of the data on improvements in mental health from exercise are derived from nonclinical populations, the overall positive trend is consistent for both depression and anxiety, and also for both aerobic and strength/flexibility training. The few data that are available on patients with diagnosed depression and anxiety also demonstrate beneficial effects from exercise.

When counseling patients about exercise, don't emphasize thresholds. Instead, focus on moderate-intensity activity with realistic goals. Be a role model by being physically active yourself, and be familiar with what's available in your community. Ask patients about their exercise history, and what has been the most enjoyable for them in the past. Telling success stories of other patients is also a good motivational tool, Dr. Phillips said.

Writing an exercise recommendation on an official prescription pad will strengthen the message. Then, at each visit, ask patients about exercise just as you inquire about sleep, concentration, and other general health assessments.

When patients report having exercised, give them positive reinforcement, and document it all in the patient's chart, she advised.

BY MIRIAM E. TUCKER

Senior Writer