The Power of Physical Activity for Mental Health with Dr Charlotte Marriott

The third episode, hosted by Suzy focuses on the power of physical activity for our mental health. In conversation with  Dr. Charlotte Marriott, an NHS psychiatrist, lifestyle medicine physician, and chair of the BSLM mental health special interest group. We delve deep into the myriad of benefits of physical activity on mental health both in terms of prevention, treatment of common mental health disorders, highlighting the biochemical effects of physical activity. We also discuss how being more active, often as part of a group programme, can begin to bridge the shocking mortality gap between people with severe mental illness and the general population, and ask if this is the most important pillar of health (or is it the gateway to others?). 

In this episode we highlight inspiring programs like Mind's Moving Towards Better Health, Park Run, and the SHAPE programme (Supporting Health and Promoting Exercise) and outline some interesting resources for clinicians wanting to know more (see also key resources and further reading below). We also touch on two of Suzy’s favourite topics, green prescribing and wild swimming. 

Don't miss this informative episode that will change your perspective on physical activity and its vital role in mental health. Listen, learn, and let's move towards better health together!

Produced using funding from NHS Tayside Educational Fund and the British Society of Lifestyle Medicine.

Find us at https://themovementprescription.co.uk/

Transcript

0:00:00 - Suzy
Hello and welcome to this week's episode. I will be interviewing Dr Charlotte Marriott, who's an NHS psychiatrist specialising in early intervention psychosis. She has an intercalated degree in neuroscience from UCL and a postgraduate certificate in medical education. She's a certified lifestyle medicine physician and she chairs the BSLM mental health special interest group for the last three years. She's also a retired yoga instructor and juggles all this with bringing up her family. Charlotte, how do you fit it all in? 

0:00:30 - Charlotte
Thank you, susie. Well, the truth is that I don't fit it all in, which is why I'm a retired yoga teacher and no longer teaching. I can't do everything, i'm afraid, so some things have to go. I do what I can, but yeah, i can't do everything. 

0:00:44 - Suzy
And I know you, like me, prioritised getting in the great outdoors, don't you? 

0:00:48 - Charlotte
Yeah, it's absolutely my favourite thing to do, definitely. 

0:00:52 - Suzy
And hopefully we'll be talking a little bit later about the impact of physical activity in nature, and I'm really looking forward to discussing with you the latest evidence around physical activity, its benefits on mental health, touching on green prescribing, a little bit about national guidance, and I think most of all, what clinicians need to know is how can they put this into practice. 

0:01:14 - Charlotte
Brilliant, that sounds great. 

0:01:16 - Suzy
So I'm going to ask you a few questions. I'm going to go in there with a big one. Is it true that people with severe mental illness, such as severe depression and schizophrenia, have a significantly lower life expectancy than the general population? 

0:01:31 - Charlotte
Wow, yes, unfortunately, susie, that is true. So we know from data for a long time now that patients with what we call SMI serious mental illness like schizophrenia and bipolar affective disorder are likely to die. Well, different estimates vary, but between 10 and 25 years younger than the general population. So it's a huge mortality gap. Yeah, and this is a travesty and a tragedy really and something that we really need to address, and I think there are various different things that need to be done, but certainly I think that looking at lifestyle medicine interventions can be part of that, part of reducing that mortality gap. 

0:02:13 - Suzy
I think that's really important for us to realise how big this problem can get, because you and I, both, as lifestyle medics, i think we all know that prevention is better than cure, don't we? 

0:02:26 - Charlotte
Yeah, absolutely, and it's so multifactorial with my patients with SMI, if you think about their independent risk factors for chronic disease. We've got the socioeconomic deprivation. We've got the impact of their mental illness on things like sedentaryness and motivation and enjoyment. We've got the difficulties they have accessing things in the community, the impact of discrimination and stigma and prejudice, for example. We've got things like you know how difficult it might be for them to buy healthy food options and access things like exercise classes or gyms. And then we've got also the impact of their illness directly and we know that people with schizophrenia, for example, are more likely to develop cardiometabolic syndrome and that's independently of the medications we prescribe that further increase that risk. So it's hugely multifactorial and I think there are various things that we can do to help and maybe we can get into that a bit today. 

0:03:31 - Suzy
I really hope so. So I mean so much to cover here today, and I could probably talk to you all day, charlotte, about the issues between mental health and physical activity. I'm going to ask you a slightly difficult question do you think that physical activity is the most important pillar of lifestyle medicine for mental health? 

0:03:54 - Charlotte
Oh, that is a good question. Is it the most important? I would say yes and no. So, yes, we know there's huge evidence based for the benefits of regular physical activity for our mental health, for our mental well-being as well as for our physical health, and we know as well that our mental health and our physical health are absolutely one and the same thing. So what's good for the body is good for the mind. 

But I also think that physical activity is a really good entry point into making other sustainable lifestyle changes. So, for example, if you start to exercise a little bit, you might start to feel a bit more motivated to make other changes. It might make you feel that you want to do things that support your new exercise habits. So you know, prioritizing sleep, so you've got the energy you need. Improving your nutrition, so you're giving your body what it needs to exercise. You might find that it makes you realize, when you're getting fitter, that you need to get rid of other habits that are not so healthy, such as smoking or drinking too much. So I think it can be a really good entry point and I think it can improve our health overall and our take up of healthy habits overall. 

0:05:09 - Suzy
Yeah, I see this day and day out because I work in a very deprived practice actually, and you know, when you're having these conversations with people, you know you want to talk about nutrition and dietary pattern, but it's inaccessible to so many of my population. You want to talk about sleep, but they're working three jobs and you know the neighbors are noisy so they don't want to talk about that. But you can. You can, as you say, it's a low-hanging fruit, isn't it? you can talk about physical activity and I, very specifically and I think the nuances of language are so important on this as well talk about physical activity and movement, and you know one better would be re-discovering the joy of movement. I think that's a really, really important phrase I use a lot actually. 

0:05:53 - Charlotte
Oh yes, same here. Absolutely, joy is absolutely key. And I was having a conversation with a patient just the other day about this. Actually, she was saying things like I know I should do weight training and I know I should be doing this because it will be good for me, and I said, but do you enjoy that? and she was like not really. I said what do you enjoy? she said I love cycling and walking. I said do that? do that? I mean, enjoyment is absolutely key. Why do we need to make ourselves do things that are punishing or that we don't enjoy? that's not going to be helpful for us or sustainable, because you're not going to be able to keep it up. If it requires too much effort and motivation, it's just not going to work. But if it's something that brings you joy and makes you feel good, it doesn't require very much motivation to make it a habit. 

0:06:38 - Suzy
It's funny. One of my favourite vignettes that I sometimes talk about in my teaching to medical students and GP trainees is a patient who was so resistant to any form of change and who was on multiple medications for his blood pressure, and we just weren't willing. I just said to him listen, we need to do something different. I want to get you moving a bit more. You know your wife, who was also sitting in the room giving him a hard time about sitting watching the telly all day, and I asked him that same question. I said what is it you actually love doing? Can you think of one thing that you do when you're moving your body that you love? 

And he completely surprised me because he came out with the fact that he and his wife like to dance around the kitchen to 60s music. I said do that. That is your prescription today. Please can you do that? Just turn on some music, a couple of songs every other day. And he came back with a big smile on his face and his wife had a big smile on her face too And he said oh, dr Scarlett, thank you, that was the best advice you've ever given me. 

0:07:37 - Charlotte
Yeah, fantastic, and it just goes to show how easy it can be to. Because I think the narrative from if you think about all the health magazines that are covers with like six packs and people with weights and whatever it makes exercise really inaccessible and it makes it look like it has to be expensive, like you have to join a gym, you have to use equipment, and it makes it well, it sort of perpetuates that no pain, no gain narrative, doesn't it that it's a workout, it's something you've got to effort through, even if you hate it. You've got to do it, you've got to sweat and it's going to be grim, but you know, it makes it really really hard to get started, i think, with those messages. So, yeah, i give those sort of ideas as well all the time. So usually, like just dancing your kitchen, you know, go for a walk in nature and your lunch break, whatever you can do that you enjoy, fit it in And don't worry too much about what people say you should be doing. Enjoyment is key. 

0:08:36 - Suzy
And Hippocrates was onto this, wasn't he? a long time ago? What was it He said? if you're in a bad mood, go for a walk. If you're still in a bad mood, go for another walk. 

0:08:45 - Charlotte
Yeah, yeah, and that certainly works for me. That's how I manage stress day to day. 

0:08:50 - Suzy
Yes, yes, absolutely One of my stress in my stress toolkit. Definitely, for sure, brilliant, okay. We know that physical activity can prevent depression. Can it be used for treatment? 

0:09:05 - Charlotte
Well, this is another good question. So yes, yes is the simple answer And I'll tell you. I'll tell you a little bit more about what the research shows. So there's been a huge amount of research done in this topic on both both sides of that coin, zuzi, And one of the leading researchers in this area is Brendan Stubbs, who I'm sure you've heard about, and also with his colleagues Simon Rosenbaum and Joseph Firth. 

They've done a lot of work looking at prevention and treatment of depression and other mental illnesses with physical activity. And yes, absolutely, it can reduce your prospective risk of developing depression. Even if you have a genetic propensity, like a family history, a strong family history of developing depression, exercise reduces your risk of it becoming true in yourself and also effective as a treatment, and some research has shown that physical activity is as effective for mild to moderate depression as antidepressant medication and psychotherapy, like cognitive behavioral therapy, combined. So it's effective for treatment. Recent research by Brendan Stubbs and colleagues show that there are some key things that make the physical activity successful as a treatment, and those are that it's group based, that it's led by an instructor or supervisor, and also that it's of moderate intensity, and those are the key things that make it effective for depression. 

0:10:29 - Suzy
That's interesting. So group based, and what do you think the reason for the need for a group? what do you think is the reason for group based therapy? 

0:10:39 - Charlotte
I think it's probably multifactorial. I think part of it is the social connection that it forges when you do it with a group, and also the motivation as well, because when you're doing it with other people, you will go even if you don't feel like it, because you don't want to let everybody else down. But it's also motivating to do things with other people And if you're all moving and breathing together, you're creating this lovely, lovely connection with others and getting a lot of reward from that, the kind of oxytocin and dolphin feeling that makes you feel good. Yeah, so I think it's probably a bit of that. For example, that's why things like Park Runner are so effective, because it's a community that you're part of. It's not just you running alone, which, not to say that, doesn't have benefits, but there's added benefits from doing things with other people. 

0:11:31 - Suzy
And I know that, mind the charity, they as well have plowed a lot of money into researching physical activity and depressive symptoms over years, really didn't they? And they've produced this moving towards better health. I was having a look at the executive summary this morning and it mentioned lots of the things you've just mentioned there And also targeting groups such as young people, people living in poverty, which, again, is an area very close to my heart for sure. Yeah, absolutely. Do you know much about that? I? 

0:12:07 - Charlotte
haven't read about that in particular. No, it sounds very interesting. But what I do know, though, is that the National Institute for Health and Clinical Excellence, nice, updated their depression guidance and it was published in June 2022. And for the first time, this includes group physical activity with a supervisor as being part of the first stages of treating a multi-moderate depressive illness. Yeah, so this is exciting. The research evidence is now informing national guidance. It's been slow, but it's getting there. 

0:12:44 - Suzy
And that's brilliant, isn't it? And I think more and more we are seeing a nod to lifestyle intervention And this word lifestyle. I know lots of people don't like the word lifestyle and I think it's very important that we don't trigger, we don't cause unintended harms, we don't make people feel excluded by using this word lifestyle. But I know, local to us, we've got some fantastic physical activity programs. I have the opportunity with Edinburgh Leisure to refer to a program called Healthy, active Minds, which is a 12-week program locally. I don't know what you have on your doorstep, charlotte. 

0:13:22 - Charlotte
Oh yeah, that's great. What you do sounds very exciting Locally to me. We have well in the trust I work for, we have something called the SHAPE program, which stands for Supporting Health and Promoting Exercise, and it was developed by our trust. It's been the research on it, as the service evaluation was published a couple of years ago and it showed it was really effective. And it's for patients in the trust who are treated with antipsychotic medications. It's a 12-week nutrition and exercise program that introduces people to a whole range of different things to try. So things like boxing, yoga, running, walking, gym-based equipment work a whole range of things And one of the findings of the evaluation study was not just that it improved people's physical health parameters, but also that people formed these social connections and bonds and people carried on meeting after the groups had finished to work out together or to spend time together. 

So, yeah, that's really good. And in my team we run a walking group, we're starting a badminton group, we've taken patients on adventure therapy to the local outward bound centre to do archery and zip wires and things like that. We're looking at the possibility of taking our patients for wild swimming and stand-up paddleboarding on a local lake sometime in the future. So, yeah, we try and do that as much as we can. And one thing I noticed through the pandemic was that because we couldn't go into people's homes to sit with them and they couldn't come to clinic to see us and we found there's such a disconnect, seeing people over screens, that we would meet people outdoors and go for walks And I was doing a lot of my patient consultations outdoors during the pandemic and that was really great. It made a big difference to the kind of information sharing that was happening and our working relationships. So as a team we try and incorporate that as much as possible. 

0:15:21 - Suzy
Are you still managing to do those walking consultations, starting even out with the pandemic? Is that state? 

0:15:28 - Charlotte
Not so much. It's been difficult to keep it going because workloads have increased and the capacity just isn't there at the moment. But there's something that we talk about doing more and more. I think various different team members manage it more often than I do because of schedules and things. 

0:15:46 - Suzy
There's lots of doctors up and down the country joining the movement for a walk and talk walk with a doc where you can meet up with your doctor and go for a walk on a regular basis and it's that slightly less formal environment. And I went on a couple of the walks with our in the end not successful walking group that we tried to set up at the practice And it was amazing what people shared when you're out walking with them. 

0:16:13 - Charlotte
Yeah, it makes a huge difference, i think. The different environment, walking side by side instead of locking eyes in a clinic room it takes away some of that pressure, i think, and then people can be more open and more natural in their conversation and you see a different side of them and they see a different side of you. So it's quite nice for breaking down those barriers. 

0:16:34 - Suzy
It can be very difficult to find the capacity within the working day to do these things. I think often people are doing this out with work. 

0:16:41 - Charlotte
Do you find that as? 

0:16:42 - Suzy
well when people are doing these sorts of interventions. 

0:16:46 - Charlotte
I think yes, I think probably it depends. I think there's walk with the doctor really good and somebody I know, Dr Linda Misen in the Sheffield area. Yeah, she's been really successful with those heroes for health. I think hers is called And, yes, it's a really important thing. If only we had more time to do that kind of thing would be great. 

0:17:12 - Suzy
But I think it's so important, isn't it, to practice what we preach as well? 

0:17:15 - Charlotte
Yeah, absolutely. 

0:17:16 - Suzy
I know that I work it into my work as a GP trainer and within the tutorials I do try and build in a section of our tutorial that we go for a walk and a talk, and often that's the part of our tutorial where we do all the stuff that comes with being a mentor. Often the trainees will explain issues they might be having out with the job, because it's all about work-life balance as well and looking after our trainees and our colleagues as well. 

0:17:46 - Charlotte
Yeah, definitely, and we spend so long sitting on chairs these days, don't we? So any opportunity to move is a good thing. 

0:17:54 - Suzy
I try and avoid it. I'm at my standing desk as we speak. Yes, same thing, Oh good. 

0:18:00 - Charlotte
Is yours a proper one? Yeah, we built it ourselves, actually from an old bit of kitchen cabinet, cupboard top, work top and some legs from the Hepin Leg Company. So yeah, we built one, because I hate sitting all day. It's the worst. 

0:18:16 - Suzy
Me too, i'm currently. Now anyone who's ever been to any of my talks will have seen a photograph which I title Are You Sitting Comfortably? and then I have a photograph of my sit-to-stand desk that I use at work and my favourite use for an ironing board, the Children's Paint Box and two large books, which is what I'm using at the moment. Make do. That's excellent, absolutely Yeah. So you touched on this very briefly. I've got another question here. Is low intensity exercise enough? 

0:18:45 - Charlotte
I suppose it depends what you mean by low intensity. Most of the research and the benefits and what the UK chief medical officer recommends is moderate physical activity, which is when you're moving at a pace where you wouldn't be able to sing but you can maintain a conversation. So it's moderate intensity And the chief medical officer says we should be getting 150 minutes of moderate intensity exercise a week plus, or including around 75 minutes of vigorous intensity a week, which is when you're working so hard or running or whatever, that you can't maintain a conversation anymore. Recent research has shown that light physical activity is really important for maintaining our health and wellbeing and can reduce all cause mortality, even if you've got cardiovascular risk factors. So I saw a recent paper that said that just 11 minutes of walking a day is sufficient to reduce all cause mortality. And then I suppose it would be how you define low intensity exercise. Is that light walking? Probably? Probably We're not making yourself hot and sweaty or out of breath. 

0:20:01 - Suzy
One of the things with the Lifestyle Medicine approach for me is about meeting my patients where they are at, and if I look at the average patient that I see on a day to day basis, there are a lot of them who do not move very much in a standard day. 

So one of my favourite infographics is contained somewhere within the Every Move Counts World Health Organization guidelines on physical activity that were released during the pandemic 2022, i think And on that graph it shows the little chap sitting in the chair at one end of the graph and you've got your elite sports person at the other end of the graph And the person sitting in the red chair. If they just were to move a little bit, in terms of their physical health, they are the one who stand to get the most gains. I suppose what I was wondering is you know, does that translate into mental health gains as well? I don't know if there's an answer to that, but that is one of my favourite pictures and I've got it on my wall at work because I show patients that often. I say look, this is why I want you to get moving a little bit more in whatever way you can. Have you seen that infographic? 

0:21:06 - Charlotte
Yeah, yeah, i absolutely loved that too. And there's the slogan, isn't it that? what is it? Some is better than none and more is better than some, but we don't all we need to be aiming for a marathon or anything like that. 

We just need to do a little bit every day and we'll have the benefits. And yes, those benefits are true for our mental health, just as they are true for our physical health. And in fact they did some research I think this was Brendan Stubbs and colleagues, but I might have got that wrong but they did some research a few years back looking at sedentaryness and whether being sedentary impairs our mood. So they took people who were usually very active, doing around 10,000 steps a day, and they asked them to halve their physical activity. So they were not allowed to do more than 5,000 steps a day And over a week they measured all sorts of things, but including their moods and wellbeing scores, And in just a week of reducing their activity, their mood and wellbeing scores dropped off. 

So it's really important for our, not just for preventing depression or treating depression, but also for maintaining good mood, good wellbeing, you know, life satisfaction and all of those sorts of things. And they've even done studies on in schizophrenia that shows that regular physical activity can improve the negative symptoms of schizophrenia. So that's things like apathy, loss of motivation, social withdrawal and, you know, not wanting to do things, And it can improve those, but also improve quality of life scores as well in schizophrenia. So really important to get moving a little bit every day And, like you say, the people who do the least stand the most to gain just by doing a tiny bit here. 

0:22:40 - Suzy
And I suppose at the other end of the spectrum. you know, particularly because this is aimed at GPs, and you know, medics in general tend to be perfectionists. They tend to be highly driven, they tend to get quite hyper focused often. You know that's how we get where we are And you know, can you get addicted to exercise. 

0:23:01 - Charlotte
Yes, you can just like any behaviour. That can be addictive, and part of that is because when we exercise or move, we release feel good hormones, dopamine and so on, and these impact our reward pathways in our brains And we can become addicted to exercise. So the things to look out for would be tolerance. You know you want to do more and more and more to get those feel good benefits, when exercise is all you think about and it's taking over in your life so you're doing it to the exclusion of other hobbies and interests or social engagements. If you're craving it and having withdrawal symptoms, those things are indicators that maybe you've got a bit of a problem and your healthy habit is starting to become an unhealthy one. 

0:23:51 - Suzy
That's really interesting A healthy habit becoming an unhealthy one. I certainly see in, you know, one or two patients, maybe replacing one addiction with another. Have you seen that? 

0:24:04 - Charlotte
Yeah. 

0:24:04 - Suzy
But actually, you know, you see, recovering people who are recovering from substance misuse often find physical activity as a replacement, almost as a replacement addiction. And you know, where is that line between a healthy habit and an addiction? And I guess it's as you say, to the exclusion of other things. 

0:24:25 - Charlotte
Yeah, i think so. I think I'm not decrying that, though, because I think it can be a really good way of helping people replace a harmful habit. Certainly, i'm thinking of a yoga teacher in America who is a heroin addict and he's now an astanga yoga teacher, and he found that yoga was his path out of addiction. I don't know whether he's addicted to yoga I wouldn't like to comment on that but certainly it can be therapeutic to replace things with physical activity. 

0:24:56 - Suzy
Yeah, And that brings me nicely onto another question that I've got here is is yoga for mental health evidence based? 

0:25:06 - Charlotte
There is increasing amounts now of evidence that the yoga has a beneficial impact on our brain health and our mental health. We're doing EEG studies and MRI studies and some of the research is on yoga itself. Some is on mindfulness, some of it is on meditation And whether you consider yoga a form of mindful meditation, then I think you can perhaps extrapolate some of the findings from one thing to another. But, yes, there is evidence and there are movements to use yoga to help with things like anxiety and depression. There's yoga in prisons, yoga in schools, and mental health benefits is seen in those groups as well. 

And when I was teaching yoga, i did 15 weeks of yoga sessions in a primary school, teaching all the whole age range from reception to a year, so six that would have been year six And at the end we didn't do a formal evaluation of it or anything like that, but the teachers reported that they'd noticed that their pupils seemed calmer, they were focusing better in lessons and even their handwriting had improved because their core strength had improved in just five weeks. So, yeah, it can have a lot of benefits in lots of different ways, and it's also really important if we think about things like balance and proprioception and reducing our risk of falls as we age and reducing our risk of fractures, therefore also our bone density and all of those sorts of things. So yoga can be really important exercise to incorporate into your routine. 

0:26:42 - Suzy
Fantastic. So we've spoken a little bit already about why physical activity is so good for mental health, but can you explain this to me on a sort of a biochemical level so we can explain it to patients? Any happiness, thanks. Thank you, letton. 

0:26:57 - Charlotte
Well, when we think about it, I think a lot of people would think of endorphins and feel good hormones that we release when we move. And to some extent that's true. You get that kind of buzz or high after you've been for a run, for example, makes you feel immediately good. But the longer term, more important benefits seem to be because we release BDNF, brain-derived neurotrophic factor, when we move, And BDNF is like fertilizer for the brain. 

Our studies have shown starting with mouse studies, but now in humans as well that BDNF increases angiogenesis, So we make new blood vessels in the brain. It increases synaptogenesis, making new neuronal connections and even, remarkably, neurogenesis, making new neurons. And they first noticed this in mice, the mice that were exercising on wheels. The more they exercised, the bigger their hippocampi got. And we didn't think this would extrapolate to humans, because I don't know if, like me, you were taught at medical school that your brain stops making new neurons from about the age of 25 onwards. But in actual fact, we now know that that's not true and that the hippocampus can continue to make new neurons as we age. And this is really important for mood, but also for things like focus and concentration, learning a memory and reducing our risk of neurodegenerative disorders and cognitive decline as we age. So research has shown that people who exercise regularly are less likely to develop Alzheimer's, dementia, Parkinson's disease and other neurodegenerative diseases. So part of the reason why exercise is good is because of the field that hormones, but also, more importantly, it's BDNF. 

0:28:41 - Suzy
That's absolutely fascinating, And something that I would like to understand is you know, so often we prescribe SSRIs for patients as first line therapy for depression. Does exercise have an impact on that axis? 

0:28:59 - Charlotte
On serotonin? Yeah, yes, but as you've seen in the news recently, there's been a lot of talk about the serotonin hypothesis for depression, And we've known always that it's never been as simple as that. People with depression have low serotonin. But yes, ssris are serotonin reuptake inhibitors, which increases the amount of serotonin in the brain, and this can improve symptoms of depression. It's not as simple as because of the serotonin. We're not. 

You know, there are a lot of other mechanisms by which it might be effective, but certainly physical activity does increase release of things like dopamine and serotonin and endorphins, and then there's also the oxidosin as well. So all of these things can help to make you feel good. But I think the human body, in the brain especially, a way more complex than we yet know, and I think there are various things that we're just starting to discover. For example, the gut brain axis and the impact of my gut microbiome on our mental health, and then the impact of our mental health on our gut microbiome and vice versa. We know now that physical activity can improve the health of the gut microbiome, improving microbial diversity, but also some research I was reading just this morning in preparation for meeting with you showed me that the health of your microbiome independently affects your motivation to exercise, and so your exercise affects your microbiome, your microbiome affects your exercise, and all of this affects your brain health and your mental health. So it's just phenomenal really. 

0:30:42 - Suzy
The rise and the rise of the microbiome, isn't it? 

0:30:46 - Charlotte
Absolutely, absolutely. 

0:30:47 - Suzy
Fascinated by the podcast that one of my colleagues and fellow diplomats, Sheena Langdon, along with Shabon McCormack, have done as well, which is some fascinating information in that podcast. 

0:30:59 - Charlotte
Yeah, it's really incredible. 

0:31:01 - Suzy
Can you tell me, then? could you tell me as well, then, what about the effect of? you know, we're talking about the interconnectedness of all the pillars of health. How does physical activity impact sleep? 

0:31:16 - Charlotte
Yeah, good question. I don't well, i've never really looked into the mechanisms as such, but we know that when we are moving regularly we sleep better, and when we sleep better we've got more energy and motivation to move. And so there's certainly a connection there And, wise, it could be to do with metabolism, the impact on hormones, the impact on melatonin as well, and daylight, and you know, especially if you're working out outdoors or exercising or moving outdoors, you're experiencing daylight exposure which is suppressing melatonin and improving those the release of melatonin later in the evening. That eases you into sleep. So it's probably hugely multifactorial, something I'm an expert in. But, yeah, definitely physical activity improves sleep. 

0:32:07 - Suzy
I suppose the reason that I asked you that question was because I find so many of my patients who are suffering with anxiety are not sleeping. They get two, maybe three hours of sleep a night. We know that. You know why have we evolved as creatures that spend, you know, a third of our life asleep, essentially in a very vulnerable state, and the reason is is because it's so important for our physical and mental health, i think. Do you find that too? 

0:32:32 - Charlotte
Yeah, definitely, absolutely. Your sleep is when you restore, isn't it? You reform memories, you lay down new neural pathways, your muscles recover. Everything has a chance to rest and recover and recuperate and regenerate. So sleep is absolutely vital. And while we're sleeping, all sorts of things are happening that we don't know about to do with our hunger hormones, For example, the impact on grelin and leptin, which influences then what we want to eat during the day. So if you don't sleep well, you're more likely to crave a carbohydrate-rich foods or less healthy options you want to consume. It increases your insulin resistance. If you don't get enough sleep, you're more likely to develop diabetes in the future. It affects your weight, it affects your mood, your reaction times, your irritability, and all of these things have an impact on choices you make each day as well. It can become a real vicious circle. And then, if you don't sleep well at night, you're also more likely to want to nap in the daytime, which then makes it even harder to sleep the next night, and everything just goes out of kilter. 

0:33:44 - Suzy
And I think what you said earlier on during our conversation is that talking about physical activity is a great entry point into starting to make some of these changes. And I say starting to because so often you'll talk to someone and then suddenly something will click And they will want to overhaul their life. They will want to eat clean, they will want to sleep for eight hours a night, they will want to be off doing park run every week. But if they're starting from sitting in that chair like the chap at the left-hand side of that wonderful World Health Organization graph, i think sometimes and I often do this I say that's brilliant, but that's maybe the three-year plan. Let's just pick on one change today. 

What one thing do you think you could start with? that's probably quite an easy goal. We talk about smart goals, easy and achievable that over the next time-orientated, over the next four weeks, we could maybe suggest And I often do this on the right-hand side of somebody's prescription. I would either hand them the pen so they have to write it down, or, if I'm a bit short of time, i will paraphrase it for them Say right, this is your alternative prescription. Go put that on your fridge and I'll follow you up in four weeks' time. Do you find people doing that too? 

0:34:53 - Charlotte
Yeah, definitely, and I think part of the problem is, as human beings, we can be quite all or nothing in our thinking, can't we? And we see this every new year where it's New Year's resolution time. This year, i'm going to be fit, i'm going to be active, i'm going to eat well and all of those things, and then by the middle of February, all of those healthy habits are out the window. So I absolutely agree We need to make things small and easy and accessible, and then the ripple effect will happen And it will sort of evolve naturally, rather than people feeling easily demoralised and deflated and giving up on all of those good intentions really quickly. 

0:35:30 - Suzy
Yeah, always make it very small and easy, definitely, and I'm just going to make one more question before we wrap this up, so I'm very aware of the time. But swimming, cold water swimming and mental health I don't really know my question about it. I know that you love cold water swimming and I wonder what is it about cold water swimming and mental health that is so beneficial to people? 

0:35:57 - Charlotte
Yeah, well, i think that's a big question. I do, i do, i do really love it And it makes you feel amazing. is the first thing that I would say? that's not evidence based, that's just my anecdote that when you get into the cold water, first of all you're thinking what am I doing? This is ridiculous. You're freezing. and then you start getting in and you're like, oh, and it makes you feel. that makes you feel like you're doing something kind of exciting and a bit, a bit oh, you're just a bit out there And then you're getting in the water and then all of a sudden you're in and you're swimming in the lake and you're feeling like free and at one with nature. 

and then you find the sense of bliss and the cold, your body gets used to the cold. then you start to feel warm and then you know it's time to get out. So as soon as you start to feel warm in the cold water, you need to get out. and you get out and you're getting dry and you're feeling exhilarated and invigorated and excited and happy And that's a sort of immediate effect, but longer term effects that it has for our mental health. it can help reduce anxiety and depression And there are studies looking into that right at the moment by Chill UK, which is an organisation headed up by by medics who love cold water swimming, and they're doing a lot of research And a lot of it is to do with cold adaptation and that has the physical health benefits. So as you adapt to the cold, you develop more brown fat around your organs which is highly metabolic and this increases your metabolic rate, improves your immune system function and so on, and improves your cardiovascular and respiratory function. And then a lot of the mental health benefits, particularly for things like our anxiety, are because of everything about what I described about getting in and that's your sympathetic nervous system. 

with the fight or flight, what am I doing? This is not the right. this is what am I doing Makes you very immediately fight or flight, and then you're breathing, which is starting to activate your parasympathetic nervous system. You take control of that fight or flight deep, slow, calm breaths as you enter the water And then that's increasing your vagal tone, which improves your parasympathetic potential, meaning that you're learning how to manage anxiety and stress in that one moment, which can then extrapolate to other difficult situations in your life, and I think that's part of it in a nutshell, but yeah, putting yourself into controlled stress can improve your ability to manage stress, and the similar thing happens in yoga. If you think about doing difficult, challenging postures in yoga, it can bring up a lot of fear. for example, back bends or a headstand, for example, can make you feel afraid. You get the fight or flight, but you're breathing deeply and slowly, so you're telling your brain this is okay, we can relax and you're learning to manage stress in a controlled environment, which has longer term benefits. 

0:38:53 - Suzy
That is absolutely fascinating, yeah, and I'm actually feeling now inspired. I want to go and have a Duke Charlotte listen, i could talk to you all day about the benefits of physical activity, green prescribing We barely touched on the guidelines, but you brought up some really important research there And, i think, lots and lots of food for thought for people who've maybe tuned into the podcast today. I don't know if you have some take home messages that you want to leave with people, but what I'm taking certainly from today is that physical activity is the low hanging fruit, isn't it? It's a great access point into behavior change for people. Specifically, today we're focusing on mental illness. It's an important pillar for health, but they're all actually interconnected And lifestyle intervention is making its way up on these national guidelines. Today we've discussed a little bit of not only the watch, but a little bit of the how of overcoming some of the barriers of those who find it more difficult to engage. What's your favorite resource that you would leave with people? 

0:39:58 - Charlotte
Oh well, for medics, I'd recommend the Moving Medicine website. It's got some really fantastic links on there for one minute, three minute, five minute conversations with patients to start to introduce the benefits and to get people motivated to start moving. I would say I like that one a lot. The NHS website has some really good apps. I think that EveryMind Matters app, which is very helpful, And there are a number of books and things I could recommend as well, but perhaps I could send you the links to those for the show notes. 

0:40:33 - Suzy
I think that would be brilliant. Was there anything else? you wanted any final thoughts you wanted to leave with the listeners today? Charlotte? 

0:40:42 - Charlotte
Final thoughts would be everybody can do something and it doesn't have to be a lot. So you know, we talk a lot about things like running and swimming and walking and this requires you to be able-bodied and for it to be possible for you. But it doesn't have to be any of those things. It can be accessible to everyone with the right knowledge and adaptations. And, for example, i'll tell you about David Swenson, a yoga teacher who I went on a week-end workshop with, and he and his wife teacher go to a local blind school where they live in Texas, and he met a girl who was in a wheelchair. She could raise her arms, she couldn't stand, but she'd never done yoga before. And he said to her inhale, lift your arms. And she went wow. And then he said, lean to the left. And she went wow. Lean to the right, wow. So just that tiny little bit of movement had an immediate benefit for her in terms of her capability to experience the joy of movement in her body with what she could do. So yeah, we can all do something. 

0:41:51 - Suzy
So start small, think big and embrace the joy of movement. Absolutely yes. Thank you, Charlotte. 

0:41:59 - Charlotte
Thank you, Suzy.