The Road To Happiness

How to outrun anxiety

Most Tuesdays, I run early in the morning with Meredith. For such close friends, we’re quite different. Meredith is a talkative social worker who draws energy from crowds. I’m an introverted writer who works from home. Meredith runs best in large races and loves training with big groups. I’ve set PBS in solo time trials and bail out when a run’s headcount gets above five. Meredith is a worrier, beset by regrets and anticipated outcomes, and has been treated for anxiety. I have dysthymia, or chronic low-grade depression. We like to joke that Meredith will stay up late as a way of avoiding the next day, whereas I prefer to go to bed early to speed the arrival of a better tomorrow. We do have one key thing in common: we run to bolster our mental health. Like all runners, we relish the short-term experience of finishing a run feeling like we’ve hit reset and can better handle the rest of the day. What’s not universal is our recognition that, without regular running, the underlying fabric of our lives – our friendships, marriages, careers, odds of being something other than miserable most of the time – will fray. Running is our medicine.

Meredith and I discovered this decades ago, and now researchers and doctors are catching up. Studies show that aerobic exercise can be as effective as antidepressants in treating mild-to-moderate depression (and with side effects such as improved health and weight management rather than the bloating and sexual dysfunction associated with medication). Official guidelines now include exercise as a first-line treatment for depression in the UK, as in other countries such as Australia and the Netherlands.

How does moving the body change the mind? A wealth of work – both in the lab and with patients – shows that there’s more to it than endorphins, the opioid the body produces during certain activities, including exercise. The emerging – considerably more sophisticated – view of running’s ability to improve mental health also takes into account long-term structural changes in the brain as well as subjective states such as mood and cognition. Scientists continue to work to try to explain the theory behind what we runners already know from practice.

Unlike many with the condition, I’ve never been hugely incapacitated by depression. Most people would consider me productive, even energetic, given a lifetime running odometer of 110,000-plus miles. My dysthymia has two main components: weltschmerz (a German word meaning sadness about how reality doesn’t live up to one’s hopes) and anhedonia, a diminished ability to experience pleasure. Life often feels like a series of not-horrible, not-fun obligations. Sometimes things seem so pointless that I watch myself not caring that I don’t care.

RUNNING CHANGES HOW YOU THINK That it’s possible to be outwardly active but internally askew can mask just how common depression and anxiety are. It is estimated that about 10 per cent of the population would meet the diagnostic criteria for depression, and about 20 per cent for anxiety. (The two often coexist.) And the incidence of these conditions in runners is probably similar; a 2017 review of research published in the Britishjournal of Sportsmedicine found no difference in depressive symptoms between what the researchers called ‘high-performance athletes’ and non-athletes. Runners at all levels are affected, with elites such as double Olympic gold medallist Kelly Holmes, former Team GB middle distance runner Andy Baddeley and Western States 100-mile champion Rob Krar having spoken publicly about their depression.

Of course, everybody gets sad and worried at times. What distinguishes those feelings from clinical depression and anxiety? In the short term, therapists often look for striking changes in emotions, behaviour and psychological functioning. They also focus on how symptoms such as feeling agitated, threatened and uncomfortable (for anxiety) or joyless, lethargic and apathetic (for depression) interfere with people’s everyday functioning. ‘ I look at how these things affect activities of daily living, like sleeping, going to work and interpersonal relationships,’ says clinical social worker Dr Franklin Brooks. ‘There’s a profound difference between “I’m having a bad day at work” and “I’m having a bad day at work and I’m not getting out of bed tomorrow because of it.”’

That classic depiction of depression sounds like what 34-year-old marathon runner Amelia Gapin has experienced. ‘ I’ve had episodes where, for six weeks, two months, I couldn’t even get myself out of bed,’ she says. ‘At weekends I’d wake up and take a couple of hours to move myself to the sofa.’

The sentiment is echoed by 22-year-old Ian Kellogg. ‘ When I fall into depression, more often than not, I don’t run. I can’t find the energy or willpower to get out the door, even though I know my training is suffering and that just half an hour will make me feel better.’

Others have found a way to use running as a solution to overcome this form of depression. In June 2015, Pati Haaz had a miscarriage while two months pregnant. She became severely depressed and started missing work. ‘ I didn’t want to get out of bed, I didn’t want to go out of my house,’ she says. ‘ It was that feeling that there’s no point in continuing. I had no motivation to do anything other than take care of my kids, which was more an automatic duty.’ Guilt over being depressed – ‘feeling like I’m the worst mother in the world’ – compounded the situation.

Haaz started seeing a therapist, who asked her about her pre-depression hobbies. The 42-year-old said that she was a runner who, before becoming pregnant, had planned to run her first marathon. The therapist encouraged her to resume running and Haaz liked the idea that she needed the goal of finishing a marathon to overcome the inertia that depression had introduced to her life.

‘ If I was running for the sake of running, I would have stopped with my normal six-mile run,’ says Haaz. ‘ But in marathon training, I was doing 16, 18, 20 miles, things I’d never done before. I was able to carry this sense of accomplishment into other areas of my life.’

Even her shortest runs helped her think differently. ‘ If I was driving or working or waking up in the middle of the night and thinking about the things that were making me sad, it would just make things worse – it would become like a spiral and there was no end to it. But when I was running, I would think about those same things and somehow I was able to process them differently. I would start my run with all these negative thoughts and after a mile or two, they were gone.’ Five months after her miscarriage, she crossed the finish line of her first marathon in 6:38.

Reframing ruminations – thinking differently about hashed-over topics – is one of the main appeals of running for those of us with mental health issues. Cecilia Bidwell, 42, who suffers from anxiety, puts it this way: ‘ When I’m running, the thoughts come in and out, and I’m not worried,’ she says. ‘ I can think about things objectively. I realise the things that I’m thinking are a huge deal aren’t a big deal in the scheme of things.’ The effect carries through Bidwell’s stressful workdays. ‘ When I’ve gone for a good run in the morning, if things are

‘I can’t find the energy to get out the door, even though I know my training is suffering and that just half an hour will make me feel better’

going haywire at 2pm, I handle them a lot better. I’m not creating crises and wondering, “Why am I here?”’

The more-immediate cognitive focus that’s involved in a typical run also helps. ‘ When we are overwhelmed with anxiety and depression, shifting from the big picture – all the frustrations, worst- case-scenario thinking – to the in-the-moment task of doing something that approaches a goal, such as running a four-mile loop with two hills, will kick off a positive feedback loop that continues throughout the run and takes our thinking and emotions out of the trench of negativity,’ says clinical psychologist Dr Laura Fredendall.

Research shows that these changes in mood and thinking are more accessible for runners. In a 2008 study published in the Archivesof Physicalmedicineandrehabilitation, ultramarathoners, moderate regular exercisers and non-exercisers walked or ran for 30 minutes at a self-selected pace that felt somewhat hard. After the workout, everyone’s mood had improved, but that of the ultramarathoners and moderate exercisers did so about twice as much as that of the sedentary people. Also, the ultrarunners and regular exercisers reported greater vigour and less fatigue after the workout than before, while the non- exercisers felt the same.

That’s because runners can hold a good pace for a long time without going anaerobic, allowing the physiological processes that lead to improved mood to take place, according to Dr Panteleimon Ekkekakis, a professor at Iowa State University, US, who is a world-leading figure in the field of exercise psychology. ‘ In sedentary people, their ventilatory threshold – the point where exercise is no longer purely aerobic – is very low,’ he says. ‘So they get up off the couch, they take a few steps, they’re already above their ventilatory threshold. If you’re a regular runner, you have the cardiorespiratory fitness to sustain an exercise intensity that’s associated with a feel-better effect.’

A CHEMICAL ROMANCE What causes that effect? The quick answer is usually endorphins, but the latest science is showing that focusing on the nebulous ‘runner’s high’ ignores crucial changes in brain structure and thinking patterns that running can induce.

Endorphins entered the runner’s lexicon in the 1970s, when it became known that these chemicals, which bind to neuron receptors in the brain, are released at higher levels during a run. Several studies found that higher blood levels of postrun endorphins correlated to improved mood. In 2008, German researchers scanned the brains of athletes as they ran for two hours. They found high levels of endorphins in the subjects’ prefrontal cortex and other parts of the brain associated with mood, and that these levels aligned with the athletes’ reports of euphoria.

But endorphins aren’t everything. As part of his research into human evolution, Dr David Raichlen, a professor of anthropology at the University of Arizona, US, has measured prerun and postrun endocannabinoid levels in runners, dogs and ferrets. Endocannabinoids are substances that bind to the same receptors in the brain as THC, the substance primarily responsible for a marijuana high.

According to Raichlen, there are two leading theories on why running causes increased levels of endorphins and endocannabinoids. First, when humans became hunter-gatherers, around two million years ago, they became more active; the release of these chemicals, which act as pain relievers, may have evolved to allow longer, faster movement. In this scenario, the feel-good aspect is a by-product. Second, higher levels of these chemicals while active could have motivated continued movement, which would lead to getting more food and, ultimately, higher survival rates. Raichlen says the two mechanisms might have worked in tandem.

Whatever the original mechanism for these evolutionary adaptations, they’re especially helpful for modern runners with mental health issues. It’s nice to run for an hour and go from being in a good-enough mood to a better one. It’s a fundamental shift to go from being miserable to content, thanks to an infusion of feel-good substances. ‘ I’ll finish a run and think, “Wow, this is how most people feel all the time,”’ says Bidwell.

A short-term mood boost from endorphins and endocannabinoids is one (very much appreciated) thing, but where running really helps with mental health is over time, thanks to a change in brain structure. A review of research, published in Clinicalpsychology Review, concluded ‘exercise training recruits a process which confers enduring resilience to stress’. This appears to occur because regular running produces the same two changes

that are thought to be responsible for the effectiveness of antidepressants: increased levels of the neurotransmitters serotonin and norepinephrine; and neurogenesis, the creation of new neurons.

Neurogenesis occurs primarily due to a protein called brain-derived neurotrophic factor (BDNF). ‘ It helps neurons fire and wire together,’ says Fredendall. Much of this happens in the hippocampus, an area of the brain that’s often shrunken in people with depression. ‘MRI scans have shown that even after a six-month exercise intervention, there’s a visible increase in the size of the hippocampus,’ says Ekkekakis.

As he points out, you have to be fit to really enjoy the daily benefits that can lead to those important structural changes. Of course, you also have to get yourself out the door, which can be especially difficult if you’re depressed. But success in running on an especially tough day makes it easier to get out the next time. And it can spur another key mental health benefit of running.

I THINK I CAN, I REALLY THINK I CAN

Levels of chemicals in the brain are only part of your mental state. There’s also cognition, or mental processes. Cognition includes not just straightforward thinking (‘ I should run long today because it’s raining tomorrow’) but also more involved phenomena, such as how you think about your thoughts.

A hallmark of depression is self-defeating, absolutist thinking – ‘everything is harder than it should be,’ ‘ there’s no pleasure in my life,’ ‘it’s always going to be like this.’ I’ve learned that lacing up and hitting the roads is my best way to break free from such thoughts. On a daily basis, running reminds me that I can overcome apathy and torpor. Seeing that small victory, I can convince myself that progress is possible on meeting professional goals, or not feeling lonely so often, or even figuring out how to afford retirement. ‘The subjective experience of seeing yourself do something can make you feel better,’ says Fredendall.

Ekkekakis says cognition is also key to understanding another aspect of running’s effectiveness. ‘ If you take antidepressants and they make you feel better, the psychological attribution is external – patients believe that the reason they get better is because of the drug,’ he says. ‘ With exercise, the attribution is internal – the reason I get better is that I’m doing this thing, I’m putting in the effort. That’s where, perhaps, the additional benefit of exercise compared with antidepressants lies – that sense of empowerment, that sense that I’m taking control of my situation.’ EVER HEARD OF THE GOLFER’S HIGH? Is there something uniquely effective about running for managing mental health? Or can any form of exercise provide similar relief?

There is no definitive research comparing the mood-boosting properties of various forms of exercise. However, it is safe to say that purposeful exercise is better than incidental physical activity. A study published in Medicine &Scienceinsports&exercise found improved mood in people after they worked out, but not after daily-living activities such as climbing stairs. Also, aerobic exercise seems more effective than something like lifting weights. In fact, a review of research, published in Preventivemedicine, found that people with low levels of cardiovascular fitness were at greater risk of developing depression.

Dr Raichlen offers a little more on why running might be the best tonic for mental health: ‘It’s much easier to get yourself into a reasonable intensity by running compared to a lot of other sports,’ he says. ‘ It’s not too difficult to get in the right zone and stay there. You have a lot more control over your speed than in something like cycling, where your effort level is more dictated by the topography or traffic lights.’

That’s been my experience over the last four decades. When I’ve been injured and switch to cycling or pool running, the workouts are like proverbial castor oil – I do them because I know I need them, not because they’re enjoyable in themselves. The net that keeps me from plummeting starts to fray and sag.

But when running is going well, the net is taut and strong. A few times a month, usually while cruising along a wooded trail speckled with morning light, I’m overcome with a sensation best articulated as ‘ yes’. Yes to the moment, yes to whatever is in store the rest of the day, yes to life. If I could bottle that feeling, I’d eventually forget what it’s like to be depressed.

‘If you’re a regular runner, you have the cardiorespiratory fitness to sustain an exercise intensity that’s associated with a feel-better effect’