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Exercise Is Medicine? a Critical Examination of the Promotion of Exercise for Mental Healthcare

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Exercise Is Medicine? a Critical Examination of the Promotion of Exercise for Mental Healthcare ABSTRACT Title of Dissertation: EXERCISE IS MEDICINE? A CRITICAL EXAMINATION OF THE PROMOTION OF EXERCISE FOR MENTAL HEALTHCARE Julie M. Maier Doctor of Philosophy, 2018 Dissertation directed by: Associate Professor Shannon L. Jette Department of Kinesiology Increasingly, physical activity is being promoted as a way to prevent or treat a range of chronic health conditions, including mental illness. In this dissertation, I utilize an ecological framework and draw upon feminist theories to explore why it is that physical activity is being used as a form of (mental health) therapy in this current moment, as well as the benefits and shortcomings of physical activity in preventing or treating mental illness. In particular, I focus on the ways in which gendered discourses and norms shape the physical activity experiences of women with mental illness. The project entails three separate, yet related, phases: 1) Extensive review of popular and academic literature to contextualize the “exercise is medicine” movement; 2) Assessment of the American College of Sports Medicine and American Medical Association’s “Exercise is Medicine” initiative; and 3) In-depth qualitative interviews with women with obsessive compulsive disorder (OCD). The results of my three empirical examinations suggest that physical activity can be a beneficial form of mental health treatment, or a valued part of one’s life and identity more generally. However, too often the limits to physical activity’s effectiveness in treating particular mental illnesses is downplayed, as is attention to the potential harms that can come from being physically active. At times, exercise is even positioned as a “cure”, or superior to psychopharmaceuticals in treating mental illnesses, such as depression. Such enthusiasm toward exercise’s potential therapeutic value can be seen to be, in part, the result of the current neoliberal, healthist moment in which individual responsibility, hard work, and natural remedies are valued over that which is considered easy, quick, or synthetic (Crawford, 1980, Lupton, 1995, Fullagar, 2017). This is not to suggest that physical activity cannot play a vital role in helping people with mental illness, but better messages and more resources are needed to make it accessible, safe, and meaningful to this population. I conclude the dissertation by providing suggestions as to how this can be accomplished. EXERCISE IS MEDICINE? A CRITICAL EXAMINATION OF THE PROMOTION OF EXERCISE FOR MENTAL HEALTHCARE by Julie M. Maier Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, College Park, in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2018 Advisory Committee: Dr. Shannon L. Jette, Chair Dr. David L. Andrews Dr. Beth Douthirt Cohen Dr. Alyssa N. Zucker Dr. Kerry M. Green, Dean’s Rep. © Copyright by Julie M. Maier 2018 Dedication To Grandma Bendavine: While you could not stay to see this project to completion, your love and support laid the foundation that made it possible. ii Acknowledgements Writing the acknowledgement page is, surprisingly, just as anxiety-provoking as writing other parts of the dissertation. Perhaps more so. I want to get it right so people know how truly appreciative I am of their support. Completing this dissertation would not be possible without the guidance, help, time, effort, insights, care, patience, companionship, love, and commitment from countless people in my life. While a sentence or two of thanks to each of you is woefully insufficient, I hope you know how grateful I am for all you have done for me. Laina Bay-Cheng: I would never have thought that I could start, let alone complete, a dissertation without your faith in me as a researcher. Your unwavering mentorship the past nine years has helped to grow as a scholar and person in innumerable ways. I consider myself so incredibly lucky to have such a brilliant, generous, and kind role model. I can never thank you enough. Carrie James and Project Zero colleagues: Thank you for helping me become a stronger qualitative researcher and being such smart, supportive, and fun colleagues. Carrie, your care and encouragement as a supervisor and person is truly a rare gift. Shannon Jette: I know it’s cliché to say, but I could not ask for a better advisor. At every turn, you have gone above and beyond in providing me with all of the guidance and support I could ask for. From connecting me with research assistantships and opportunities to co-author publications, to going out of your way to meet with me or provide valuable insights on a paper draft, you were always there for me. Even in my worst moments, you did not give up on me or my abilities to complete this PhD. I am forever grateful to have you as my advisor. iii David Andrews, Beth Douthirt Cohen, Kerry Green, and Alyssa Zucker: I consider myself incredibly fortunate to have such an intelligent, caring, and supportive committee. Your classes provided me with the groundwork to begin this dissertation, and your continued guidance have helped to see it through. I cannot thank you enough for all of your time, energy, and faith in me. Research participants: This project would not be possible without the willingness of the 14 women I interviewed to bravely share their stories with me. When framed as “data”, the human experience that you are sharing is trivialized. Hearing your narratives helped me to learn and grow. I can only hope I did justice to your experiences in my representation. Kinesiology faculty, past and present, especially Jennifer Roberts, Adam Beissel, Damion Thomas, Jo Zimmerman, Andy Grainger, and Mike Friedman: Your insightful feedback on earlier drafts of my dissertation and other projects and presentations through the years has helped to make me a stronger scholar. Kinesiology Administration, especially Polly Sebastian Schurer, Jessica Duque, Bianca Garcia, Regina Clary, and Blessing Awe: I would not have been able to make it through this program without your tireless assistance. Your patience and competence is remarkable. Linda Macri: The dissertation writing retreats were an invaluable help in staying focused, motivated, caffeinated, and making substantial progress. Thank you for organizing them and being so accommodating and helpful. Kinesiology grad students, past and present, especially my PCS cohort, Sam Clevenger, Shaun Edmonds, Stephanie Cork (honorary member), and Amber Wiest iv (honorary member): From the very first day of this program, you have been a rock that has helped me make it through. From happy hours and silliness in the office, to serious conversations about research and praxis, having you as comrades on this dissertation journey has made it so much more special. My friends, especially Katie and Nate Luna, Nick Cerami, Jamie Gullen, Nate Vogel, Emily Kaplan, April Sizemore-Barber, Christine Velez, as well as my bandmates: The value of friendship cannot be overstated. Your companionship through the years is invaluable. Thank you for contributing ideas, advice, and lots of food and drinks, picking me up when I stumbled, and being some of my loudest cheerleaders. Lissa Mantell: Your empathy, combined with your insistence that I develop self-compassion and prioritize self-care, has helped to sustain me through this program. Joe and Dave Maier: From the start, I was following in big footsteps. Being Joe and Dave’s little sister meant I had to live up a high standard. This shaped me in intangible ways. Your example, as well as your continued support, have helped to make this possible. Dusty Maier: One of the biggest fans of exercise I have ever known. Any stress I was feeling dissipated when I saw your wagging tail. I only wish you could have stayed on this planet longer. Mom, Dad, and Grandma B.: For as long as I can remember, you advocated the benefits of education. (Grandma, while in your upper 70s, I can remember you saying that you wish you were still in school.) Not only did you instill in me the value v of education, but you did everything you could throughout my life to make it possible for me to excel academically—and in all realms. Your unconditional love and guidance is something I will never take for granted. It has helped me complete this dissertation, but, more importantly, made me who I am. vi Table of Contents Dedication ..................................................................................................................... ii Acknowledgements ...................................................................................................... iii Table of Contents ........................................................................................................ vii List of Figures .............................................................................................................. ix Chapter 1: Introduction ................................................................................................. 1 My Research Journey ................................................................................................ 1 Research Aims and Significance .............................................................................. 4 Research Questions ................................................................................................... 6 Overview of Dissertation .......................................................................................... 7 Chapter 2: Review of Literature ................................................................................. 10 Theoretical
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