September 30, 2021

Is there a role for physical activity in reducing suicide risk?

by Rachael Troughton, MSc, MBA

In 2019, nearly 48,000 people died by suicide. Research reports that up to 25% of American adults have considered or attempted suicide. While 90% of people who die by suicide showed symptoms of a mental health condition, according to those close to them, only 46% were formally diagnosed. This means interventions that improve the outcomes for those with mental health concerns are potentially important and helpful in reducing suicide risk. 

In addition, interventions that reduce other known risk factors for suicide, such as sleep disturbances, chronic pain, social isolation, and low self-esteem, are also necessary.

Mental health concerns can be chronic, episodic, or triggered by life experiences. These are increasingly challenging times for everyone as the Covid-19 pandemic has had a significant adverse effect on mental health. Disrupted routines, anxiety, and growing social isolation caused by quarantine restrictions could cause distress that becomes a strong contributor to suicide risk.

In response, people are actively taking steps to improve their resilience, with 41% choosing exercise as a way to support their mental health.

In this article, we’ll look at how physical activity affects mental well-being and focus on the emerging current research around a role for physical activity in lowering suicide risk. Finally, we’ll cover practical tips to increase physical activity in your life.

How physical activity can affect mental health

Supporting people with their mental health challenges may involve several options depending on individual needs and preferences. While psychological and pharmacological interventions may be appropriate, alternative, adjunctive, and complementary approaches can offer accessible, lower-cost, different, and/or additive benefits to therapy and medications. 

As this piece on the American Psychological Association website describes, exercise is an often-overlooked intervention with valuable effects on mood and cognition. 

The benefits of exercise on mental health have been well known for some time, and physical activity became a hot topic as newscasters and health experts shared tips on how to get through quarantine. Patient-facing newsletters, such as the Mayo Clinic newsletter, suggest exercise, even just walking, as a way to promote relaxation and manage stress. 

In fact, recent research of home-based exercise during the pandemic suggests physical activity has significant benefits in supporting mental well-being, improving stress resilience, and lowering the risk of anxiety, depression. The mechanisms may vary by individual, but  likely a combination of biological and psychosocial factors, including:

  • Reduction in stress hormones
  • Improved sleep
  • Greater social connection
  • Positive health behaviors

Stress reduction

Through exercise, there is a reduction in the body’s levels of stress hormones, such as adrenaline and cortisol. In one study examining aerobic exercise, people with depressive and anxiety disorders had significantly decreased anxiety after only 20 minutes of cycling.

Research reveals an increase in the neurotransmitter serotonin, which contributes to feelings of well-being and happiness. Low levels of serotonin increase vulnerability to stress.

There is also some evidence showing a link between sedentary behaviors (not exercising) and increased risk of anxiety. A systematic review showed that physical activity used alongside antidepressants could be highly effective in the treatment of major depressive disorder.

Improved sleep

Research suggests that regular physical activity can help you fall asleep more easily and sleep better overall. This may be due to exercise’s effects on the central and autonomic nervous systems and on endocrine and somatic function. This is important as sleep disturbance can contribute to mood disorders, increased stress and pain response, physiological concerns, cognitive function and emotional distress, all of which can be risk factors in suicidal thoughts and behaviors.

Source of social support

Loneliness stems from not having our need for connection met, and has effects on our physiological as well as emotional and mental states. Loneliness during the pandemic was associated with mental health challenges, including anxiety and depression and may also contribute to increased drug and alcohol use.

Sports clubs, group classes, and team activities offer a good opportunity for social interaction and becoming part of a community and many of these are available outdoors.

Noting a role for group rather than repetitive individual activity, one review found direct biopsychosocial benefits as a consequence of sports participation for adults with severe mental illness. These benefits included a sense of meaning, purpose, and identity, plus a feeling of belonging and achievement, in addition to the biological effects of exercise.

Better physical health

Chronic pain can contribute to anxiety, depression, sleep disturbances, and suicidal behaviors. People in better physical health have reduced musculoskeletal pain and decreased likelihood of illness. A 2017 review concluded that physical activity might contribute to a reduction in pain severity, consequently improving quality of life.

One study showed that young adults who engaged in a 15-week exercise program also began to make healthier food choices, and we know that diet may have some influence on mental health and suicide resilience.

Calms and distracts from negative thoughts 

There is limited evidence to suggest that exercise may act to distract people from negative thoughts. Some people describe a ‘flow state’ that occurs when they exercise, which helps them concentrate on being in the moment.

Physical activities which also promote mindfulness and breathwork, such as Tai Chi and yoga, may have a positive effect on mental well-being and the sympathetic – parasympathetic response. A systematic review of pregnant women found some evidence that integrated mindfulness and yoga practices reduced perinatal anxiety and depressive symptoms.

Physical activity may directly impact suicide risk

Physical activity benefits mental health in several ways, including the mood effects described above. We know that suicide risk factors are complex and varied. People who die by suicide do not always present with diagnosed or chronic mental health conditions, however engaging in physical activity may offer multiple benefits beyond those we usually consider. 

While exercise as a prescriptive treatment for suicidal behaviors has not been extensively studied, some studies highlight ways that physical activity may alter risks, such as the following: 

  • Reduce suicidal ideation
  • Improve stress response
  • Improve sleep 
  • Influence negative health behaviors, including substance abuse
  • Reduce chronic pain
  • Reduce social isolation
  • Improve low self-esteem

For example, a systematic review of recent research suggested that higher levels of physical activity are associated with lower suicidal ideation. Another study concluded that not engaging in physical activity significantly raised the level of suicidal behaviors in older men and women. In a study of high school students, researchers found increased physical activity reduced sadness, suicidal ideation, and suicide attempt. Physical activity had the most benefit for students who also reported being bullied. For those students, exercising more than four times a week reduced suicidal ideation and attempt by 23%.

Studies have shown that people using unhealthy measures to control weight may increase their risk for suicidal ideation, suicide attempt, and death by suicide. Introducing physical activity as a healthy way to maintain weight may reduce that risk. For adolescents with low self-esteem or a negative body image, participation in sport may protect against depression and suicidal ideation.

People who engage in physical activity are likely to make healthier choices overall, including a more nutritious diet and reduced alcohol or drug use. A meta-analysis showed that exercise may reduce alcohol consumption in individuals with alcohol use disorder. This is important because substance abuse is a risk factor for suicide ideation and behavior.

Chronic pain, a known risk factor for suicide, can often be improved through a variety of physical activities. Research suggests physical activity is effective in treating chronic pain when prescribed alone or alongside pharmacotherapy and cognitive behavioral therapy.

Tips for including physical activity in your life

  • Start small. Whenever you’re starting a new exercise routine, it’s wise to check in with your healthcare provider first to make sure you don’t have any underlying health issues. Start by setting a goal that’s just a bit more than you do at the moment. If you don’t currently do any exercise, a short walk outside might be a great first step. Once you achieve any exercise goal, make sure y
    ou take the time to celebrate your success before moving on to the next one.
  • Choose something you enjoy. Exercise is more likely to boost your mood if you choose an activity you look forward to doing. Forcing yourself to do something you’re not enthusiastic about may only add to your stress levels. And don’t feel you need to constantly push yourself to get the benefit. A study showed that exercisers who were able to self-select their exercise intensity reported positive effects on well-being not shown by participants who had the intensity chosen for them.
  • Build it into your routine. Try to build physical activity into your routine. While the positive effects of exercise can be felt after a single session, a meta-analysis of studies on the subject showed the greatest benefits were felt after 15–30minutes of low to moderate-intensity exercise at least three times a week.
  • Consider a social activity. Coupling your physical activity with an opportunity for positive social connection increases the likelihood of mental health benefits. Engaging in team activities and playing towards a shared goal can create feelings of inclusion and achievement. Group classes offer an opportunity to make new friends, and more traditionally solo activities, such as running, can be made more social by joining a local club or having a buddy.
  • Support your exercise with a healthful diet. Training for a specific exercise goal can provide a purpose that acts to improve your mental well-being. Whether you’re training for performance or simply to support your resilience it helps to fuel your body with appropriate nutrition. Healthy food choices can help your body sustain and recover well from physical activity by providing carbohydrates for energy and protein to repair your muscles. A diet full of fruits and vegetables also provides lots of fiber, which is crucial for gut health and may have additional positive implications for mental health. Drinking enough fluid is also important. If you’re well-hydrated when you exercise, your heart doesn’t have to work as hard and your muscles can work more efficiently. Around two liters of water a day is recommended, though you may need more if you’re exercising a lot or in warmer weather.
  • Get adequate rest. Exercise can help improve how you sleep. Ensure you get appropriate rest between training sessions and prioritize the sleep your mind and body need to repair, get stronger, and stay enthusiastic about your chosen activity to benefit this positive feedback loop. Consider the best time of the day for you to exercise, mindful of the fact that vigorous physical activity less than an hour before bed may interfere with your ability to fall asleep. If you need or prefer to exercise later in the day, make sure you take the time to cool down and hydrate properly after your session. A warm shower before bed can help prepare your body for sleep.

Physical activity may help to reduce suicide risk factors

Engaging in physical activity may decrease suicide risk by reducing or removing known risk factors, such as mental health challenges, stress, poor physical health or chronic pain, sleep challenges, and low social connection. While getting started can feel daunting, setting small goals and celebrating your successes will help you incorporate more exercise into your life, positively impacting both your physical and mental health.

You can use our tips above to guide you in getting moving and fuelling your body for activity. Why don’t you choose today to get started?

Rachael Troughton, MSc, MBA, is a freelance writer and editor, specializing in health & wellness and business writing. She has degrees in Natural Science, Sport and Exercise Science, and Business Administration.