Deborah Cerasoli always knew walking helped her work through her troubles.
The 54-year-old, who has severe depression, once walked from East to West Baltimore, "until I felt better."
Now there is growing evidence that she's onto something.
Studies going back to the 1970s have suggested that exercise may be beneficial in treating mental illness in the long term. But a recent study has gone further in showing exercise could be as effective as medication in treating depression in the short term.
And while few who treat mental illness are ready to ditch drugs or even say for sure there is an immediate mental-health benefit to exercising, there aren't many who dispute the long-term physical health benefits. Prescribing exercise is becoming more mainstream in many doctors' offices for everything from severe depression and anxiety to mild cases of the blues.
Cerasoli credits walking with helping her to lose weight, get control of her diabetes and keep her in a good mood.
She now lives in her own apartment in Baltimore and catches the bus to Mosaic Community Services Inc., the Timonium-based nonprofit mental-health treatment facility that has made her a co-leader of an exercise group.
"I don't force it," she said of those in her group. "I tell them I'm here when they're ready. I tell them they will feel better. And they do. I haven't lost anyone yet."
Mosaic formed the group after executive director Jeff Richardson read a report this year that said chronic mental illness can cut 25 years off people's lives and most of the causes of death are preventable.
Richardson knew many of Mosaic's 4,000 annual clients smoke, are overweight or have diabetes. But the report startled him. He became convinced exercise and nutritional counseling were needed to reverse the course. And maybe those people who improved wouldn't just live longer, they'd feel better, depend on services and medication less and contribute to society more.
His staff began putting many of Mosaic's clients into wellness programs.
It's too early to know if Richardson's clients will buck the statistics, but he already has positive anecdotal evidence of improved physical and mental health. And a growing collection of research by others seems to be backing up the stories with science.
"It's hard to separate the mind from the body," said Richardson, who took his own advice and recently lost 20 pounds. "Our goal is to help these people live longer lives but also more satisfying lives."
To get clients into the mood to move, Mosaic didn't lecture. The staff formed groups of people with severe depression, schizophrenia and bipolar disorder so they could encourage each other to take care of themselves, exercise and eat right. Their wellness became something within their control and something to take pride in.
Also, with an annual budget of just $18 million - about 85 percent of the nonprofit's clients are Medicare or Medicaid recipients - Mosaic staff found buying a little equipment and hiring a dietitian to be a good value for the returns.
Cerasoli, who has been going to Mosaic for about four years, says the best benefit hasn't been what it's done for her - it's what it helps her do for others. Still, her energy, positive outlook and leadership skills have landed her a position leading another group at the University of Maryland.
The improved sense of self-worth, and the physical benefits, have led many doctors to embrace exercise for their patients with depression and anxiety, even if the science isn't completely proven, said Philip R. Muskin, a Columbia University professor of clinical psychiatry and the former chairman of the American Psychiatric Association's Council on Psychosomatic Medicine.
But, he said, health care providers have to be careful about making promises because patients could be let down. And those with severe mental and physical conditions may need medication and therapy before they can even get out of their pajamas.
He said professionals also have to tailor their advice because some people may not want to run or lift weights and may dismiss the prescription. But they may be willing to take the stairs instead of the elevator or enjoy a bowling league but not a gym.
It's not known how often exercise is prescribed. But Muskin said he believes that not just psychiatrists and therapists are advising that people do something physical, but also primary care doctors who see patients feeling a little down.
"I think it's worked its way into the traditional from the complementary or alternative," Muskin said. "Everybody agrees that exercise appears to help because there really isn't data saying exercise does not help. And even if exercise isn't as good as drugs, maybe patients notice their abs are a little flatter, their arms a little more toned and they aren't fatigued all the time. And that makes them feel better. "
Meanwhile, studies of the short- and long-term benefits are continuing. One recent report shows evidence of an immediate return from exercising in clinically depressed patients.
A study from 2000 to 2005 at Duke University shows that those who were put on supervised or unsupervised exercise programs achieved nearly as significant a reduction in depressive symptoms as those on antidepressants.
Another study will look at the value of exercise in treating patients with depression and heart disease. Depression more than doubles the risk of further cardiac problems.
"We believe that these data provide more support for the value of exercise as an alternative to medication in treating patients with major depression," said James A. Blumenthal, lead author on the first exercise study and a professor of medical psychology at Duke University and an assistant professor of medicine at Duke University Medical Center.
"An increasing number of patients may want to consider exercise as a possible treatment for their depression."
meredith.cohn@baltsun.com
Lift your feet to lift your spirits
Exercising may improve symptoms of depression or anxiety.
How it works: The science isn't proven, but in the short term, exercising may increase mood-enhancing elements in the brain and may improve sleep and relax muscles in the same way antidepressants can. In the longer term, better physical health may reduce stress, increase coping skills and boost confidence.
How much: Thirty minutes at a time, three to five days a week, is recommended. But as little as 10 to 15 minutes at a time may improve mood. Set aside time, as if it's an appointment with a therapist.
What kind: Pick something enjoyable, such as playing with your kids, joining a sports league or gardening, and set reasonable goals. Ask for suggestions from a health care provider and test a few activities.
When to call a professional: People with physical health issues or those who have not exercised before should consult their doctor before starting a new exercise program. If feelings of hopelessness or anxiety do not go away with exercise or are interfering with daily life, therapy and medication may be needed.
Source: Duke University and Mayo Clinic research
Where to get help
Mosaic Community Services -- For more information, call 410-453-9553, e-mail info@mosaicinc.org or go to the Web site mosaicinc.org.
Maryland Mental Health Administration -- For more information about mental health services available, contact your health care provider or go to the state's Mental Health Administration Web site, dhmh.state.md.us
mha.