Exercise Interventions for Mental Health: A Quantitative and Qualitative Review

The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review

Introduction:

Physical exercise has been proven to benefit the general population in terms of mental health and wellbeing. However, there is little research investigating the impact of exercise on mental health and quality of life for people who experience a severe and enduring mental illness.

Method:

This review aims to describe the effect of physical exercise intervention on the mental health and quality of life of people with severe mental illness. Quantitative and qualitative articles published between 1998–2009 were sourced using electronic databases. Articles were included if the study intervention involved exercise and the outcome measure included mental health or quality of life. Sixteen articles were analysed for common themes and appraised critically.

Findings:

The findings show that exercise can contribute to improvements in symptoms, including mood, alertness, concentration, sleep patterns and psychotic symptoms. Exercise can also contribute to improved quality of life through social interaction, meaningful use of time, purposeful activity and empowerment.

Implications:

Future research is warranted to describe the way exercise can meet the unique needs of this population. Studies with a focus on psychological outcome measures would provide greater evidence for its use in therapy.

Physical activity advertisements that feature daily well-being improve autonomy and body image in overweight women but not men

The reasons for exercising that are featured in health communications brand exercise and socialize individuals about why they should be physically active. Discovering which reasons for exercising are associated with high-quality motivation and behavioral regulation is essential to promoting physical activity and weight control that can be sustained over time. This study investigates whether framing physical activity in advertisements featuring distinct types of goals differentially influences body image and behavioral regulations based on self-determination theory among overweight and obese individuals. Using a three-arm randomized trial, overweight and obese women and men (aged 40-60 yr, n = 1690) read one of three ads framing physical activity as a way to achieve (1) better health, (2) weight loss, or (3) daily well-being. Framing effects were estimated in an ANOVA model with pairwise comparisons using the Bonferroni correction. This study showed that there are immediate framing effects on physical activity behavioral regulations and body image from reading a one-page advertisement about physical activity and that gender and BMI moderate these effects. Framing physical activity as a way to enhance daily well-being positively influenced participants' perceptions about the experience of being physically active and enhanced body image among overweight women, but not men. The experiment had less impact among the obese study participants compared to those who were overweight. These findings support a growing body of research suggesting that, compared to weight loss, framing physical activity for daily well-being is a better gain-frame message for overweight women in midlife.

Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis

BACKGROUND

Depression is a distressing side effect of cancer and its treatment. In the general population, exercise is an effective antidepressant.

OBJECTIVE

We conducted a systematic review and meta-analysis to determine the antidepressant effect of exercise in cancer survivors.

DATA SOURCES

In May 2011, we searched MEDLINE, PsycInfo, EMBASE, CINAHL, CDSR, CENTRAL, AMED, Biosis Previews, and Sport Discus and citations from relevant articles and reviews.

STUDY ELIGIBILITY CRITERIA

We included randomized controlled trials (RCT) comparing exercise interventions with usual care in cancer survivors, using a self-report inventory or clinician rating to assess depressive symptoms, and reporting symptoms pre- and postintervention.

STUDY APPRAISAL

Around 7,042 study titles were identified and screened, with 15 RCTs included.

SYNTHESIS METHODS

Effect sizes (ES) were reported as mean change scores. The Q test was conducted to evaluate heterogeneity of ES. Potential moderator variables were evaluated with examination of scatter plots and Wilcoxon rank-sum or Kruskal-Wallis tests.

RESULTS

The overall ES, under a random-effects model, was -0.22 (confidence interval, -0.43 to -0.09; P = 0.04). Significant moderating variables (ps < 0.05) were exercise location, exercise supervision, and exercise duration.

LIMITATIONS

Only one study identified depression as the primary endpoint.

CONCLUSIONS

Exercise has modest positive effects on depressive symptoms with larger effects for programs that were supervised or partially supervised, not conducted at home, and at least 30 minutes in duration.

IMPACT

Our results complement other studies showing that exercise is associated with reduced pain and fatigue and with improvements in quality of life among cancer survivors.

Exercise and physical activity in mental disorders

Exercise (EX) and physical activity (PA) have been shown to prevent or delay the onset of several mental disorders and to have therapeutic effects in different groups of psychiatric disorders. This review focuses on studies investigating EX as therapeutic intervention in anxiety disorders, affective disorders, eating disorders, schizophrenia, and substance use disorders. Despite EX being discussed as a potential therapy for several decades, adequately powered randomized, controlled trials are sparse in most disorder groups. Nevertheless, evidence points toward disorder-specific benefits that can be induced by EX/PA. Mechanisms of the therapeutic effects of EX/PA are summarized, including metabolic and physiological as well as psychological aspects. Finally, implications for research and therapeutic practice are illustrated.

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.

Sleep disturbances and suicidality: a common association to look for in clinical practise and preventive care

Suicidality and suicide has been associated with many risk factors, while recent clinical and epidemiological studies increasingly point to a potential link between sleep loss or sleep disturbances and suicidality. This review on studies of sleep disturbances associated with suicidality, i.e., suicidal ideation, suicide attempt and completed suicide suggests a frequent association especially with insomnia and nightmares but also hypersomnia and sleep panic attacks. In suicidal insomniacs with comorbid psychiatric disorders, there is some evidence for an even independent predictive nature of sleep problems for suicidality. Considerations on the shared neurobiology, risk assessment and treatment options complement the overview. Thus, sleep disturbances may qualify as an individual treatable target of personalised medicine in the clinical routine as well as in suicide prevention programmes. A more detailed assessment of sleep problems and identification of specific risk domains in primary or secondary prevention of suicidality seem to be a future area of high importance.

Environmental enrichment has antidepressant-like action without improving learning and memory deficits in olfactory bulbectomized rats

Depression, especially in the elderly, is associated with poor cognitive functioning. Exercise has received much attention in the treatment for depression and also dementia. Here we studied the effect of an enriched environment combined with voluntary exercise (EE/VE) on the olfactory bulbectomized (OBX) rat. The OBX rat is hyperactive in an open field, which is normalized by chronic antidepressant treatment, and suffers from learning and memory impairments. Neurotrophic factors are thought to be involved in the antidepressant action of EE/VE. Hyperactivity and cognitive functioning (both hippocampal dependent and independent tasks) were investigated before and after EE/VE. We quantified hippocampal mRNA levels of the neurotrophic factors BDNF, VGF and VEGF. VEGF receptor (FLK-1) inhibition was achieved by i.c.v administration of the antagonist SU5416 during the period of EE/VE. OBX almost completely blocked fear memory acquired either 48 h or 28 days before surgery. EE/EV normalized OBX-induced hyperactivity in open field, while having no effect on the decrease in hippocampal dependent learning and memory. VEGF mRNA levels in hippocampus were significantly increased both in OBX and control rats following EE/VE. OBX reduced BDNF mRNA levels, but EE did not reverse this. Inhibition of the FLK-1 receptor did not suppress EE/VE induced normalization of the hyperactivity of the OBX rat. The lack of effect of EE/VE on cognitive parameters, while normalizing hyperactivity, suggests different neuronal mechanisms underlying OBX-induced behavioral changes. Since EE/VE still normalizes the OBX-induced hyperactivity while the FLK-1 receptor was blocked, we assume that VEGF is not obligatory for the antidepressant effect of EE/VE. This article is part of a Special Issue entitled 'Anxiety and Depression'.

The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health study

OBJECTIVE

Recent evidence suggests a role for diet quality in the common mental disorders depression and anxiety. We aimed to investigate the association between diet quality, dietary patterns, and the common mental disorders in Norwegian adults.

METHODS

This cross-sectional study included 5731 population-based men and women aged 46 to 49 and 70 to 74 years. Habitual diet was assessed using a validated food frequency questionnaire, and mental health was measured using the Hospital Anxiety and Depression Scale.

RESULTS

After adjustments for variables including age, education, income, physical activity, smoking, and alcohol consumption, an a priori healthy diet quality score was inversely related to depression (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.59-0.84) and anxiety (OR = 0.77, 95% CI = 0.68-0.87) in women and to depression (OR = 0.83, 95% CI = 0.70-0.99) in men. Women scoring higher on a healthy dietary pattern were less likely to be depressed (OR = 0.68, 95% CI = 0.57-0.82) or anxious (OR = 0.87, 95% CI = 0.77-0.98), whereas men were more likely to be anxious (OR = 1.19, 95% CI = 1.03-1.38). A traditional Norwegian dietary pattern was also associated with reduced depression in women (OR = 0.77, 95% CI = 0.64-0.92) and anxiety in men (OR = 0.77, 95% CI = 0.61-0.96). A western-type diet was associated with increased anxiety in men (OR = 1.27, 95% CI = 1.14-1.42) and women (OR = 1.29, 95% CI = 1.17-1.43) before final adjustment for energy intake.

CONCLUSIONS

In this study, those with better quality diets were less likely to be depressed, whereas a higher intake of processed and unhealthy foods was associated with increased anxiety.

Role of physical and sedentary activities in the development of depressive symptoms in early adolescence

OBJECTIVE

To examine whether levels of physical activity or sedentary activity are risk factors for the development of depressive symptoms in early adolescence.

METHODS

A representative sample of 2,464 12- to 15-year-old adolescents living in the middle of Norway was assessed twice, during the years 1998 (T1) and 1999/2000 (T2). The attrition rate was 4.3%. We assessed depressive symptoms (using the Mood and Feelings Questionnaire, MFQ) and levels of physical and sedentary activities at baseline and follow-up. Various potentially confounding factors, including demographic factors, were assessed at baseline.

RESULTS

The MFQ scores at T1 were cross-sectionally associated with low levels of vigorous exercise. A possible buffering effect of vigorous exercise on the relationship between stressful life events and depression was demonstrated. In longitudinal analysis low levels of vigorous exercise and high levels of sedentary activities (boys only) predicted a high score (MFQ ≥ 25) at T2.

CONCLUSIONS

Low levels of vigorous exercise and high levels of sedentary activities (boys only) constituted independent risk factors for the development of a high level of depressive symptoms in a 1-year study of young adolescents. This knowledge should be considered by policy makers, preventative services, and health-care professionals.

Physiological and health implications of a sedentary lifestyle

Sedentary behaviour is associated with deleterious health outcomes, which differ from those that can be attributed to a lack of moderate to vigorous physical activity. This has led to the field of "sedentary physiology", which may be considered as separate and distinct from exercise physiology. This paper gives an overview of this emerging area of research and highlights the ways that it differs from traditional exercise physiology. Definitions of key terms associated with the field of sedentary physiology and a review of the self-report and objective methods for assessing sedentary behaviour are provided. Proposed mechanisms of sedentary physiology are examined, and how they differ from those linking physical activity and health are highlighted. Evidence relating to associations of sedentary behaviours with major health outcomes and the population prevalence and correlates of sedentary behaviours are reviewed. Recommendations for future research are proposed.

Tinnitus-related distress: A review of recent findings

This article reviews recent articles relevant to tinnitus-related distress (TRD). Recent studies provide evidence that 1) chronic tinnitus, which occurs in a significant percentage of adults, has stress-inducing effects similar to those of other chronic health problems; 2) the effects of tinnitus on distress are worse in individuals who have certain personality characteristics, such as type D personality and anxiety sensitivity; 3) neural activity in TRD is similar to that for pain and depression; 4) tinnitus leads to less distress in individuals who accept their condition; and 5) cognitive-behavioral treatments, including relaxation training, attention-control training, and acceptance activities, tend to reduce TRD. The recent findings suggest that it would be good practice for mental health professionals to ask patients, especially older patients, about tinnitus and to offer psychological treatment for TRD in appropriate cases. Future research on TRD might explore the extent to which the problem is genetic and the possibility of preventing TRD in individuals who have recently developed persistent tinnitus.

Anxiety, Health Risk Factors, and Chronic Disease

Anxiety disorders are the most common mental health condition and frequently co-occur with a variety of health risk factors, such as physical inactivity, cigarette smoking, and alcohol consumption. As such, untreated anxiety and increased risk for engagement in these health risk habits can further increase risk for later-onset chronic disease and complications in disease management. Contemporary studies have identified unique temporal relationships between the onset of specific anxiety disorders with smoking and alcohol use disorders. Incorporating exercise with evidence-based treatments for anxiety is emerging and promising in enhancing treatments for anxiety-related conditions. Likewise, substance use treatment programs may benefit from the detection and management of anxiety. Collaborative care models for anxiety may provide the needed systems-based approach for treating anxiety more effectively in primary and specialty care medical settings. Based on a qualitative review of the literature, this article summarizes the current research on the associations between anxiety, health risk factors, and the risk for chronic diseases. The authors also offer suggestions for future research that would help in better understanding the complex relationships between the role anxiety plays in the vulnerability for and management of physical inactivity and substance use.

Mood enhancement persists for up to 12 hours following aerobic exercise: a pilot study

The objective was to estimate the duration of the effects of aerobic exercise on mood. Healthy men (n = 13) and women (n = 35) ages 18 to 25 years (M = 20.2, SD = 3.4) were randomly assigned to either a control or exercise group. Participants completed the Profile of Mood States before, after, and at 1, 2, 4, 8, 12, and 24 hours following either exercise at 60% VO2 peak or quiet rest. Repeated-measures analysis of covariance was utilized with VO2 peak entered as a covariate. The exercise group showed significantly lower total mood disturbance immediately after and at 4, 8, and 12 hours following exercise.

The Role of Exercise in Treating Postpartum Depression: A Review of the Literature

There is now evidence to support the antidepressant effects of exercise in general and in clinical populations. This article reviews the evidence regarding the potential role of exercise, particularly pram walking, as an adjunctive treatment for postpartum depression. Database searches revealed two small randomised controlled trials conducted in Australia which support exercise as a useful treatment for women with postpartum depression. In addition, uncontrolled studies and observational evidence suggest that postpartum women, some of whom were depressed, report benefit from participation in exercise programmes. There are plausible mechanisms by which exercise could have such an effect. Limited evidence supports a relationship between participation in exercise and reduction in postpartum depression. Given the reluctance by some women to use antidepressant medication postpartum and the limited availability of psychological therapies, exercise as a therapeutic possibility deserves further exploration. Further research using well-designed randomised controlled trial methodologies are warranted.

Therapeutic armamentarium for treating depression

Depressive disorders are highly prevalent and are a leading cause of disability, morbidity, and mortality worldwide; however, they often remain undertreated or untreated. This article provides a broad overview of the many strategies for treating depression. More than 24 antidepressant medications and depression-focused psychotherapies are available as first-choice options for treating depression. When patients have not had a satisfactory treatment response, the 2 main strategies are switching to an alternative antidepressant therapy or adding a second antidepressant therapy. A large number of medication combinations have been reported in the literature, and some have been shown to be effective in controlled studies. Nonstandard alternatives to conventional antidepressant treatments include exercise, light therapy, sleep deprivation, and various complementary and alternative therapies. For more chronic and refractory forms of depression, various neuromodulation therapies are available or are being investigated. Because depressive disorders are common in primary care and other medical settings, medical practitioners should be aware of the therapeutic armamentarium available for treating depression.

Depressive symptom outcomes of physical activity interventions: meta-analysis findings

BACKGROUND

Physical activity (PA) is consistently linked to mental health outcomes.

PURPOSE

This meta-analysis synthesized depressive symptom outcomes of supervised and unsupervised PA interventions among healthy adults.

METHODS

Comprehensive searching and coding were applied to PA interventions among adults without clinical depression. Analyses included random-effects standardized means, Q, and moderator analysis using analysis of variance and regression meta-analytic analogues.

RESULTS

Treatment versus control comparisons yielded a standardized mean effect size of 0.372 among 38 supervised PA studies and 0.522 among 22 unsupervised PA studies. Preliminary moderator analyses suggested that supervised PA interventions may be more effective when they include flexibility/resistance and low-intensity exercise. Unsupervised PA interventions may be more effective when they recommend center-based PA. Methodological moderators (random assignment, control group management) were identified.

CONCLUSIONS

These findings document that PA interventions reduce depressive symptoms even in adults without clinical depression. Moderator analyses suggest directions for future research as well as practice.

Exercise as a Treatment to Enhance Sleep

The prevalence of sleep-related complaints and the limited efficacy of pharmacological treatments make nonpharmacological alternatives essential. Physical exercise is one such alternative that is inexpensive and affects numerous health systems simultaneously. This article reviews putative mechanisms that have guided exercise and sleep research, including exercise’s antidepressant effects, restorative functions, and circadian effects, and concludes that a number of mechanisms are plausible and likely active in explaining the effects of exercise on sleep. The empirical literature is reviewed, with special emphasis given to randomized controlled trials and experimental studies that help to inform for whom (eg, age, fitness characteristics), under what conditions (eg, light exposure, time of day), and by what means (eg, type, intensity, duration) exercise optimally affects sleep. The review also includes the emerging research using exercise as a treatment of obstructive sleep apnea and restless legs syndrome. The current literature indicates that moderate amounts of exercise, which can be obtained through a variety of means such as brisk walking and resistance training, are sufficient to improve sleep quality. Additional research is warranted in this area, particularly randomized controlled trials that target subgroups at risk for poor sleep such as older adults and persons with sleep disorders.

A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation

Background

The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial.

Methods/Design

The randomised controlled trial, with nested economic and process evaluations, recruited 2,104 inactive men and women aged 16+ with coronary heart disease (CHD) risk factors and/or mild to moderate depression, anxiety or stress. Participants were recruited from 12 local health boards in Wales and referred directly by health professionals working in a range of health care settings. Consenting participants were randomised to either a 16 week tailored exercise programme run by qualified exercise professionals at community sports centres (intervention), or received an information booklet on physical activity (control). A range of validated measures assessing physical activity, mental health, psycho-social processes and health economics were administered at 6 and 12 months, with the primary 12 month outcome measure being 7 day Physical Activity Recall. The process evaluation explored factors determining the effectiveness or otherwise of the scheme, whilst the economic evaluation determined the relative cost-effectiveness of the scheme in terms of public spending.

Discussion

Evaluation of such a large scale national public health intervention presents methodological challenges in terms of trial design and implementation. This study was facilitated by early collaboration with social research and policy colleagues to develop a rigorous design which included an innovative approach to patient referral and trial recruitment, a comprehensive process evaluation examining intervention delivery and an integrated economic evaluation. This will allow a unique insight into the feasibility, effectiveness and cost effectiveness of a national exercise referral scheme for participants with CHD risk factors or mild to moderate anxiety, depression, or stress and provides a potential model for future policy evaluations.

Trial registration

Current Controlled Trials ISRCTN47680448

Negative affect as a mediator of the relationship between vigorous-intensity exercise and smoking

The present cross-sectional study evaluated whether people who engage in vigorous-intensity exercise are better able to regulate negative affective states, thereby changing core maintenance factors of smoking. Participants were a community sample of adults (n = 270) who completed self-report measures of physical activity, cigarette smoking, anxiety sensitivity, and negative affect. Consistent with hypothesis, vigorous-intensity exercise was related to lower levels of cigarette smoking, accounting for 10% of the variance in smoking. Additionally, negative affect mediated the relationship between vigorous-intensity physical activity and cigarette smoking, accounting for about 12% of this relation. Furthermore, these relationships were stronger for individuals with high anxiety sensitivity than for those with low anxiety sensitivity; including anxiety sensitivity as a moderator of the mediated relationship increased the amount of variance accounted for by negative affect to 17%. The findings are discussed in relation to developing further scientific insight into the mechanisms and pathways relevant to understanding the association among vigorous-intensity exercise, smoking, and emotional vulnerability.

A Pilot Study of Aerobic Exercise as an Adjunctive Treatment for Drug Dependence

Intervention to increase exercise in drug dependent patients represents a potentially useful yet unexplored strategy for preventing relapse. However, there are currently no established exercise interventions for use with this population. The purpose of this pilot study was to examine the feasibility of aerobic exercise as an adjunct to substance abuse treatment among drug dependent patients. Participants included 16 (31% female, 38.3 years old) drug dependent patients who participated in a 12-week, moderate-intensity aerobic exercise intervention. Participants attended a mean of 8.6 sessions (out of 12). Participants demonstrated a significant increase in percent days abstinent for both alcohol and drugs at the end of treatment, and those who attended at least 75% of the exercise sessions had significantly better substance use outcomes than those who did not. In addition, participants showed a significant increase in their cardiorespiratory fitness by the end of treatment. While preliminary, this study is one of the first to demonstrate the feasibility of incorporating aerobic exercise during drug abuse treatment. Future randomized control trials are a necessary next step to test the efficacy of a moderate-intensity aerobic exercise intervention as an adjunct to drug abuse treatment in this patient population.

Successful Aging: Focus on Cognitive and Emotional Health

We review the definitions, predictors, and biobehavioral determinants of successful aging, as well as the evidence for and mechanisms of underlying selected interventions to enhance cognitive and emotional health in older adults. Defining successful aging has proven difficult, with discrepancies seen among biomedical, psychological, and lay perspectives. Although consensus is lacking, a number of studies have examined the genetic, lifestyle, and social determinants of operationalized determinants of successful aging; qualitative examinations of the meaning of the construct have also been conducted. The determinants coincide with fundamental aspects of aging. Recent clinical trials suggest that caloric restriction, physical activity, cognitive intervention, stress reduction, and social programs may enhance cognitive and emotional health in older people.

Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art

The purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders.

Evaluating the effectiveness of psychosocial resilience training for heart health, and the added value of promoting physical activity: a cluster randomized trial of the READY program

BACKGROUND

Depression and poor social support are significant risk factors for coronary heart disease (CHD), and stress and anxiety can trigger coronary events. People experiencing such psychosocial difficulties are more likely to be physically inactive, which is also an independent risk factor for CHD. Resilience training can target these risk factors, but there is little research evaluating the effectiveness of such programs. This paper describes the design and measures of a study to evaluate a resilience training program (READY) to promote psychosocial well-being for heart health, and the added value of integrating physical activity promotion.

METHODS/DESIGN

In a cluster randomized trial, 95 participants will be allocated to either a waitlist or one of two intervention conditions. Both intervention conditions will receive a 10 x 2.5 hour group resilience training program (READY) over 13 weeks. The program targets five protective factors identified from empirical evidence and analyzed as mediating variables: positive emotions, cognitive flexibility, social support, life meaning, and active coping. Resilience enhancement strategies reflect the six core Acceptance and Commitment Therapy processes (values, mindfulness, defusion, acceptance, self-as-context, committed action) and Cognitive Behavior Therapy strategies such as relaxation training and social support building skills. Sessions include psychoeducation, discussions, experiential exercises, and home assignments. One intervention condition will include an additional session and ongoing content promoting physical activity. Measurement will occur at baseline, two weeks post intervention, and at eight weeks follow-up, and will include questionnaires, pedometer step logs, and physical and hematological measures. Primary outcome measures will include self-reported indicators of psychosocial well-being and depression. Secondary outcome measures will include self-reported indicators of stress, anxiety and physical activity, and objective indicators of CHD risk (blood glucose, cholesterol [mmol.L-1], triglycerides, blood pressure). Process measures of attendance, engagement and fidelity will also be conducted. Linear analyses will be used to examine group differences in the outcome measures, and the product of coefficients method will be used to examine mediated effects.

DISCUSSION

If successful, this program will provide an innovative means by which to promote psychosocial well-being for heart health in the general population. The program could also be adapted to promote well-being in other at risk population subgroups.

TRIAL REGISTRATION

ACTRN12608000017325.

Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder

Aerobic exercise can acutely influence anxious and depressive mood in both clinical and nonclinical populations. However, there are no existing studies that have examined the acute effect of exercise on mood, anxiety, obsessions, and compulsions in patients with OCD. The primary aim of this study was to examine acute changes in these symptoms after engaging in single exercise sessions during a 12-week exercise intervention for 15 (53% female; mean age=41.9 years) patients with OCD. Participants reported reductions in negative mood, anxiety, and OCD symptoms at the end of each exercise session relative to the beginning. Changes in the magnitude of the effect of exercise in reducing negative mood and anxiety remained fairly stable while levels of self-reported obsessions and compulsions decreased over the duration of the intervention. Results of this study point toward the promising effect of exercise for acute symptom reduction in patients with OCD.

Exercise for depression

BACKGROUND

Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychotherapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression.

OBJECTIVES

To determine the effectiveness of exercise in the treatment of depression.

SEARCH STRATEGY

We searched Medline, Embase, Sports Discus, PsycINFO, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews for eligible studies in March 2007. In addition, we hand-searched several relevant journals, contacted experts in the field, searched bibliographies of retrieved articles, and performed citation searches of identified studies. We also searched www.controlled-trials.com in May 2008.

SELECTION CRITERIA

Randomised controlled trials in which exercise was compared to standard treatment, no treatment or a placebo treatment in adults (aged 18 and over) with depression, as defined by trial authors. We excluded trials of post-natal depression.

DATA COLLECTION AND ANALYSIS

We calculated effect sizes for each trial using Cohen's method and a standardised mean difference (SMD) for the overall pooled effect, using a random effects model. Where trials used a number of different tools to assess depression, we included the main outcome measure only in the meta-analysis.

MAIN RESULTS

Twenty-eight trials fulfilled our inclusion criteria, of which 25 provided data for meta-analyses. Randomisation was adequately concealed in a minority of studies, most did not use intention to treat analyses and most used self-reported symptoms as outcome measures. For the 23 trials (907 participants) comparing exercise with no treatment or a control intervention, the pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect. However, when we included only the three trials with adequate allocation concealment and intention to treat analysis and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88, 0.03) i.e. moderate, non-significant effect. The effect of exercise was not significantly different from that of cognitive therapy. There was insufficient data to determine risks and costs.

AUTHORS' CONCLUSIONS

Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant. Further, more methodologically robust trials should be performed to obtain more accurate estimates of effect sizes, and to determine risks and costs. Further systematic reviews could be performed to investigate the effect of exercise in people with dysthymia who do not fulfil diagnostic criteria for depression.

Sport participation and anxiety in children with ADHD

OBJECTIVE

Few studies have examined the psychological benefits of physical activity in children with ADHD who may be at higher risk for mood and anxiety problems. This study explores the relationship between participation in physical activity and emotional functioning in children with ADHD.

METHOD

Scores on parent-reported measures of mood and behavior were retrospectively compared among a group of 65 children (ages 6 to 14) diagnosed with ADHD based on their amount of sport participation. A total of 32 children diagnosed with a learning disorder (LD) were used as a comparison group.

RESULTS

Children with ADHD who participated in three or more sports displayed significantly fewer anxiety or depression symptoms than did those who participated in fewer than three sports. These differences were not evident among children with LDs.

CONCLUSION

Results suggest that active sport participation may be associated with a reduced expression of anxiety or depression symptoms in children with ADHD.

Reducing anxiety sensitivity with exercise

BACKGROUND

Exercise interventions repeatedly have been shown to be efficacious for the treatment of depression, and initial studies indicate similar efficacy for the treatment of anxiety conditions. To further study the potential beneficial role of prescriptive exercise for anxiety-related conditions, we examined the role of exercise in reducing fears of anxiety-related sensations (anxiety sensitivity).

METHODS

We randomly assigned 60 participants with elevated levels of anxiety sensitivity to a 2-week exercise intervention, a 2-week exercise plus cognitive restructuring intervention, or a waitlist control condition. Assessment of outcome was completed at pretreatment, midtreatment, 1-week posttreatment, and 3-week follow-up.

RESULTS

We found that both exercise conditions led to clinically significant changes in anxiety sensitivity that were superior to the waitlist condition, representing a large controlled effect size (d=2.15). Adding a cognitive component did not facilitate the effects of the exercise intervention. Consistent with hypotheses, changes in anxiety sensitivity mediated the beneficial effects of exercise on anxious and depressed mood.

CONCLUSIONS

We discuss these findings in terms of the potential role of exercise as an additional psychosocial intervention for conditions such as panic disorder, where anxiety sensitivity is a prominent component of pathology.

Physical activity and depression in young adults

BACKGROUND

Epidemiologic research suggests that physical activity is associated with decreased prevalence of depression. However, the relationship between physical activity accumulated in various domains and depression remains unclear. Further, previous population-based studies have predominantly utilized self-reported measures of physical activity and depression symptom subscales. Associations between physical activity in various domains (leisure, work, active commuting, yard/household) and depression were examined using both subjective and objective measures of physical activity and a diagnostic measure of depression.

METHODS

Analyses (conducted in 2007) included data from 1995 young adults participating in a national study (2004-2006). Physical activity was measured by self-report (International Physical Activity Questionnaire) and objectively as pedometer steps/day. Depression (DSM-IV 12-month diagnosis of major depression or dysthymic disorder) was assessed using the Composite International Diagnostic Interview.

RESULTS

For women, moderate levels of ambulatory activity (>or=7500 steps/day) were associated with approximately 50% lower prevalence of depression compared with being sedentary (<5000 steps/day) (p trend=0.005). Relatively low durations of leisure physical activity (>or=1.25 hours/week) were associated with approximately 45% lower prevalence compared with the sedentary group (0 hours/week) (p trend=0.003). In contrast, high durations of work physical activity (>or=10 hours/week) were associated with an approximate twofold higher prevalence of depression compared with being sedentary (0 hours/week) (p trend=0.005). No significant associations were observed for steps/day in men or for other types of self-reported activity including total physical activity in both men and women.

CONCLUSIONS

These findings indicate that the context in which physical activity is assessed and the measurement methods utilized are important considerations when investigating associations between physical activity and depression.