As a medical student rotating through a psychiatry unit in South Korea, one of the most important tasks of my day was to play ping pong with my patients. It served not only to entertain patients throughout the lazy days on the unit, but also to foster valuable relationships with the patients.
When you think about it, it makes sense that ping pong is an ideal sport in a psychiatric unit. Its compact nature, coupled with the use of harmless small balls and paddles, renders it minimally intrusive to the unit. Participants receive a moderate level of physical activity with minimal spatial movement.
As I transitioned to psychiatric units in the United States, I observed an absence of physical activities. In many psychiatric units, merely taking a walk is often perceived as pacing. Patients who are running raise concerns about possible escapes. Shadowboxing indicates agitation, and dancing is construed as a manic behavior. A 22-year-old male patient whose hobby was to shadowbox told me that he needed to shout, run, or shadowbox to release energy that had been bottling up over the course of his hospital days. Each time he did any of these activities, he was sedated because he was perceived as a threat to the safety of staff and other patients.
I did not need to learn the profound impact of prolonged physical inactivity through research studies; an 18-hour flight from Seoul to New York was enough to demonstrate the link between inactivity and irritability. By around the 15th hour of my flight, I was restless and experiencing chest discomfort, and my breathing was getting heavy. I began to worry that I was having a pulmonary embolism. I decided to go to the back of the plane and do yoga stretching that I’ve learned over the course of eight years. People stared at me as I did splits and raised my legs over my head, but thankfully, nobody approached me with needles to calm me.
Nevertheless, for those who have not experienced an 18-hour flight to Seoul, I provide a quick review of literature:
Imaging studies have found that aerobic exercise improves
inhibitory control both acutely and
chronically. Implications are that acute exercise on psychiatric units would contribute to increasing patients’ inhibitory control, which leads to fewer agitation episodes. Numerous studies have demonstrated significant reduction in lability and agitation in patients with
dementia and
cognitive impairment.
During my three months on a psychiatric unit in Seoul, I did not see a single case of agitation. By comparison, I saw more than enough agitation cases by the end of my first month in United States. Where is this difference coming from? What if the answer to this profound question was as simple as a ping pong table? ■
