Physical exercise and psychological well being: a critical review

Expert Guidelines for the Treatment of Severe PMS, PMDD, and Comorbidities: The Role of SSRIs

The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains. Several treatment modalities are beneficial in PMDD and severe PMS, but the selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy. The SSRIs can be administered continuously throughout the entire month, intermittently from ovulation to the onset of menstruation, or semi-intermittently with dosage increases during the late luteal phase. These guidelines present practical treatment algorithms for the use of SSRIs in women with pure PMDD or severe PMS, PMDD and underlying subsyndromal clinical features of mood or anxiety, or premenstrual exacerbation of a mood/anxiety disorder.

A renaissance in trace amines inspired by a novel GPCR family

Trace amines (TAs) are endogenous compounds that are related to biogenic amine neurotransmitters and are present in the mammalian nervous system in trace amounts. Although their pronounced pharmacological effects and tight link to major human disorders such as depression and schizophrenia have been studied for decades, the understanding of their molecular mode of action remained incomplete because of the apparent absence of specialized receptors. However, the recent discovery of a novel family of G-protein-coupled receptors (GPCRs) that includes individual members that are highly specific for TAs indicates a potential role for TAs as vertebrate neurotransmitters or neuromodulators, although the majority of these GPCRs so far have not been demonstrated to be activated by TAs. The unique pharmacology and expression pattern of these receptors make them prime candidates for targets in drug development in the context of several neurological diseases. Current research focuses on dissecting their molecular pharmacology and on the identification of endogenous ligands for the apparently TA-insensitive members of this receptor family.

The exercise-induced expression of BDNF within the hippocampus varies across life-span

Voluntary exercise increases hippocampal brain-derived neurotrophic factor (BDNF) expression in young animals. In this investigation we examined the induction of BDNF protein in the hippocampus of young (2 months), late middle-aged (15 months) and old (24 months) animals over 4 weeks of exercise. Average running distances decreased with age, with the old animals also maintaining a constant level of activity over time, whereas the other groups tended to increase their average running distance. All animals demonstrated a biphasic profile of BDNF protein induction, with a significant (P<0.05) increase after 1 week of exercise followed by a decrease to near sedentary levels at 2 weeks. After this, BDNF protein levels increased significantly (P<0.05), as compared to baseline, primarily only in the young animals. In whole hippocampal homogenates, only particular BDNF mRNA exons were significantly (P<0.05) changed as a result of exercise, with the largest induction occurring in young animals. BDNF protein induction may, therefore, not be directly correlated with significant mRNA changes. Exercise may represent a therapeutic tool for disorders which involve a decrease in BDNF.

Stress and life dissatisfaction are inversely associated with jogging and other types of physical activity in leisure time-The Copenhagen City Heart Study

The associations between physical activity in leisure time with special focus on jogging and the level of mental stress and life dissatisfaction were studied in 12 028 randomly selected men and women aged 20-79 years. The associations were similar in men and women; thus, results are given for pooled data. The odds ratios (ORs) are presented as adjusted for sex, age, body mass index, smoking, alcohol consumption, education and income. With increasing physical activity in leisure time, there was a decrease in high level of stress, between sedentary persons and joggers, OR=0.30 (95% confidence interval (CI) from 0.16 to 0.56). With increasing physical activity there was also a decrease in life dissatisfaction, between sedentary persons and joggers, OR=0.30 (95% CI from 0.18 to 0.52). Although there was a dose-response effect between physical activity and psychosocial well-being the most pronounced difference with regard to the level of stress and dissatisfaction was seen between the group with low and the group with moderate physical activity, e.g., 2-4 h of walking per week. In conclusion, we recommend that increased well-being should be a key argument in future campaigns for increased leisure-time physical activity.

Endocannabinoids and exercise

Exercise induces changes in mental status, particularly analgesia, sedation, anxiolysis, and a sense of wellbeing. The mechanisms underlying these changes remain unknown. Recent findings show that exercise increases serum concentrations of endocannabinoids, suggesting a possible explanation for a number of these changes. This article provides an overview of this emerging field.

Wheel running alters serotonin (5-HT) transporter, 5-HT1A, 5-HT1B, and alpha 1b-adrenergic receptor mRNA in the rat raphe nuclei

BACKGROUND

Altered serotonergic (5-HT) neurotransmission is implicated in the antidepressant and anxiolytic properties of physical activity. In the current study, we investigated whether physical activity alters factors involved in the regulation of central 5-HT neural activity.

METHODS

In situ hybridization was used to quantify levels of 5-HT transporter (5-HTT), 5-HT(1A), 5-HT(1B), and alpha(1b)-adrenergic receptor (alpha(1b) ADR) messenger ribonucleic acids (mRNAs) in the dorsal (DRN) and median raphe (MR) nuclei of male Fischer rats after either sedentary housing or 3 days, 3 weeks, or 6 weeks of wheel running.

RESULTS

Wheel running produced a rapid and lasting reduction of 5-HT(1B) mRNA in the ventral DRN. Three weeks of wheel running decreased 5-HTT mRNA in the DRN and MR and increased alpha(1b) ADR mRNA in the DRN. After 6 weeks of wheel running, 5-HTT mRNA remained reduced, but alpha(1b) ADR mRNA returned to sedentary levels. Serotonin(1A) mRNA was increased in the MR and certain DRN subregions after 6 weeks only.

CONCLUSIONS

Data suggest that the central 5-HT system is sensitive to wheel running in a time-dependent manner. The observed changes in mRNA regulation in a subset of raphe nuclei might contribute to the stress resistance produced by wheel running and the antidepressant and anxiolytic effects of physical activity.

Effect of vacation on health: moderating factors of vacation outcome

BACKGROUND

Vacation has recently become a topic of interest in health research as both beneficial and adverse health effects have been documented. The present study was aimed at identifying vacation characteristics predicting health-related vacation outcome.

METHODS

One hundred ninety-one predominantly white-collar employees (109 female, 82 males; mean age 37.8 yr, range 16-62 yr) received a questionnaire in the week after vacation assessing subject characteristics, physical vacation characteristics, the individual structuring of the day, health and social behavior, and stress during vacation as well as the perceived change of recuperation and exhaustion from before to after a vacation. Regression analysis was used to identify variables predicting vacation outcome.

RESULTS

Twenty-seven percent of the variance of the change of recuperation and 15% of the change of exhaustion could be explained. Recuperation was facilitated by free time for one's self, warmer (and sunnier) vacation locations, exercise during vacation, good sleep, and making new acquaintances, especially among vacationers reporting higher levels of prevacation work strain. Exhaustion was increased by vacation-related health problems and a greater time-zone difference to home, and was reduced by warmer vacation locations.

CONCLUSION

Health-related vacation outcome is significantly affected by the way an individual organizes his or her vacation.

Exercise-induced gene expression changes in the rat spinal cord

There is growing evidence that exercise benefits recovery of neuromuscular function from spinal cord injury (SCI). However, the effect of exercise on gene expression in the spinal cord is poorly understood. We used oligonucleotide microarrays to compare thoracic and lumbar regions of spinal cord of either exercising (voluntary wheel running for 21 days) or sedentary rats. The expression data were filtered using statistical tests for significance, and K-means clustering was then used to segregate lists of significantly changed genes into sets based upon expression patterns across all experimental groups. Levels of brain-derived neurotrophic factor (BDNF) protein were also measured after voluntary exercise, across different regions of the spinal cord. BDNF mRNA increased with voluntary exercise, as has been previously shown for other forms of exercise, contributed to by increases in both exon I and exon III. The exercise-induced gene expression changes identified by microarray analysis are consistent with increases in pathways promoting neuronal health, signaling, remodeling, cellular transport, and development of oligodendrocytes. Taken together these data suggest cellular pathways through which exercise may promote recovery in the SCI population.

Mood changes after maximal exercise testing in subjects with symptoms of exercise dependence

Considering exercise has positive and negative reinforcing properties, the mood states of sedentary, nonexercise-dependent and exercise-dependent volunteers were compared after maximal exercise testing. Mood status was evaluated by the Beck Depression Inventory, Trait-State Anxiety Inventory, and Profile of Mood States (POMS). No differences were detected before the test or after it, indicating little possibility of positive reinforcement. However, a significant reduction in the POMS Tension-Anxiety scores was observed in both exerciser groups (greater in the exercise-dependent group) but not in the sedentary group. Only in the exercise-dependent group were significant reductions in Anger and Total Mood Disorders scores observed compared with their pre-exercise scores. These data suggest that exercising has stronger negative reinforcement properties for exercise-dependent volunteers and is a factor which could increase the odds of their becoming dependent on exercise.

Relations among exercise, coping, disordered eating, and psychological health among college students

Researchers have long been interested in the coping styles of individuals who display disordered eating characteristics. Recently, exercise has been recognized as both a behavior and coping strategy that might be present among individuals with disordered eating. The present study evaluates the role of exercise as both a coping mechanism and as a health behavior in relation to eating pathology and other measures of psychological health in a nonclinical university population. Female (n=235) and male (n=86) undergraduate students completed questionnaires that assessed exercise behavior, coping strategies, eating attitudes, self-esteem, life satisfaction, affect, depression, and anxiety. The results indicate that the relations among exercise, coping, and eating pathology is complex. Exercise was related to positive psychological health in males, whereas exercise in females was associated with both positive and negative psychological health. For women with high Eating Attitudes Test (EAT-26) scores, exercise was significantly associated with negative affect, and a trend existed in this group such that exercise was associated with higher levels of depression and anxiety. Conversely, for women with low EAT scores, exercise was associated with positive affect. This suggests that exercise might be differentially associated with mental health based on the presence or absence of eating pathology.

Endurance exercise selectively impairs prefrontal-dependent cognition

Two experiments are reported that examine the possibility that exercise selectively influences different types of cognition. To our knowledge, these experiments represent the first attempt to study higher-cognitive processes during exercise. Theoretical thinking was guided by the transient hypofrontality hypothesis. In both experiments, athletes who exercised at a sustained, moderate pace were compared to sedentary controls on two neuropsychological tests, one that is generally regarded as heavily dependent on prefrontal cognition and one that is relatively insensitive to prefrontal operation. Results showed that during exercise performance on tests demanding prefrontal-dependent cognition was impaired, while at the same time, cognitive processes requiring little prefrontal activity were unaffected.

Vacation at moderate and low altitude improves perceived health in individuals with metabolic syndrome

BACKGROUND

Recent data suggest that vacation may improve cardiovascular health, an effect possibly moderated by altitude. The aim of the present study was to study the effect of a 3-week vacation at moderate and low altitude on perceived health in individuals with increased cardiovascular risk.

METHODS

Seventy-two overweight males, both occupationally active and retired (mean age=56.6 +/- 7.2 years), with signs of metabolic syndrome were randomly assigned to identical sojourns at either moderate (1,700 m) or low (300 m) altitude and engaged in four 3- to 4-h heart-rate-controlled hiking tours per week. Perceived health was measured 2 weeks before vacation, at the beginning and end of vacation, and 7 weeks after vacation.

RESULTS

Fitness, recreational ability, positive and negative mood and social activities improved during vacation, independent of altitude and occupational status, although the day-to-day improvement in quality of sleep was delayed at moderate altitude. During the follow-up examinations, improvements in all reported aspects of health except for social activities were maintained. In comparison to retired individuals, active individuals showed a greater long-term improvement in social activities.

CONCLUSION

Vacation positively affects perceived health independent of altitude or occupational status in generally inactive overweight males.

A Biopsychosocial Model of Disordered Eating and the Pursuit of Muscularity in Adolescent Boys

This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed.

Acute psychological benefits of exercise performed at self-selected workloads: implications for theory and practice

Given that most studies to date examined the connection between exercise and affect without considering the participants' preferred exercise workload, in this research the affective-benefits of jogging or running at a participant-selected pace were investigated in a pilot field and a laboratory experiment. Ninety-six male and female students (19.5 yrs) took part in the pilot field experiment whereas 32 women (20.3 yrs) completed the laboratory experiment. In both experiments, the participants ran/jogged for 20 minutes at a self-selected pace. They completed an abbreviated version of a 'right now form' of the Profile of Mood States (POMS - Grove and Prapavessis, 1992) inventory before and after exercise. In both experiments all dependent measures changed significantly from pre- to post-exercise, except 'fatigue' and 'vigor' that did not change in the laboratory. Total mood disturbance (TMD) decreased significantly in both experiments (68% and 89%). No significant correlations were found between exercise intensity (expressed as percent (%) of maximal heart rate reserve) and the magnitude of changes seen in the dependent measures. It is concluded that exercising at a self-selected workload yields positive changes in affect that are unrelated to exercise intensity. These results suggest that the physiological theories linking exercise with positive changes in affect, in which exercise intensity is instrumental, could not account for the acute affective benefits of exercise. It is proposed that a 'cognitive appraisal hypothesis' may be more appropriate in explaining the acute affective benefits of exercise.

Exercise dependence and attitudes toward eating among young adults

Few community-based studies of exercise dependence have been conducted. This investigation examined the prevalence of exercise-dependence symptoms among 237 college undergraduates and the relationship of exercise-dependence symptoms to atypical and disordered attitudes toward eating. Women scored significantly higher than men on the Exercise Dependence Questionnaire's (EDQ) Exercise for Weight Control and Exercise for Health Reasons subscales, and the Dieting and Bulimia and Food Preoccupation subscales of the Eating Attitudes Test (EAT), and exhibited significantly more symptoms of exercise dependence than men. Number of exercise-dependence symptoms was significantly positively correlated with problematic attitudes toward eating. Dysphoric mood states, cognitive problems, craving for exercise, and other symptoms associated with abstinence from exercise were relatively common among women and significantly more prevalent than among men. Study findings suggest that women with clinical and subclinical eating disorders are at high risk for the development of exercise-dependence symptoms. Findings also supported the existence of primary and secondary exercise dependence.

Wheel access duration in rats: II. Day-night and within-session changes

Time of day and duration of wheel access were manipulated to see how running changed over days. Young male rats were given 2 hr of wheel access, during either the light or dark phase. Over 24 days, running increased 4-fold in the dark group but remained low and stable in the light group. With rats given either 1 or 4 hr of dark phase wheel access, running increased much more in the 4-hr group (even in Hour 1) than in the 1-hr group. The within-session running pattern for high runners changed from a habituation to a sensitization profile. Running and cocaine self-administration (S. H. Ahmed & G. F. Koob, 1998, 1999) are affected similarly by session length, suggesting running as an interesting addiction model.

A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease

OBJECTIVE

To assess the effect of psychotherapy on the anxiety and depression levels of patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A blind, randomized, controlled trial.

SETTING

Outpatient university pulmonary rehabilitation program in Brazil.

PARTICIPANTS

Thirty patients with COPD (mean age, 60.33y; 22 men) attending a pulmonary rehabilitation program were randomized into 2 groups: experimental group (G1) and control group (G2). Both groups underwent a 12-week treatment program.

INTERVENTIONS

Group 1 (n=14) participated in 24 sessions of physical exercise, 24 sessions of physiotherapy, 12 psychologic sessions, and 3 educational sessions. Group 2 did not participate in psychotherapy sessions.

MAIN OUTCOME MEASURES

All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program by using 3 instruments: the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and 6-minute walk distance (6MWD).

RESULTS

Both groups showed statistically significant improvements on the 6MWD (G1, P<.001; G2, P=.03). Only G1 had a significant reduction in anxiety and depression levels (G1: BAI, P<.001; BDI, P<.001; G2: BAI, P=.156; BDI, P=.142). Statistically significant differences existed between G1 and G2 for BAI (P<.001) and BDI (P=.02).

CONCLUSIONS

Including psychotherapy in a pulmonary rehabilitation program for COPD reduced patients' anxiety and depression levels but did not modify 6MWD performance.

No “Old Fool”: 88 Years Old and Still Running

In the sport, physical activity, and aging literature, much attention has been given to the importance of physical activity and sport involvement for the elderly. Most of the literature, however, has focused on the continuity of physical activity among older adults. The purpose of this study was to extend the understanding of older sport participants by conducting a case study of Max Springer, a male, White master runner (88 years old). We assumed that continuity in sport would represent a primary adaptive strategy for coping with the aging process. In addition to two in-depth interviews with Max, the authors interviewed various other “participants” regarding their perceptions of Max as an older runner. From deductive analysis of the interview material, the following themes emerged as figural to Max’s experience as an older runner: tradition of always being physically active, I’m not an athlete, being of senior age, meaning and philosophy of running, and significance of social support.

Self-reported leisure-time physical activity during pregnancy and relationship to psychological well-being

The psychological benefits of physical exercise have been reported in numerous populations. While studies have found elevated stress and depressed mood during pregnancy and no adverse birth effects associated with low to moderate intensity exercise, few have examined exercise in relation to psychosocial outcomes during pregnancy. The present study examined leisure-time physical activity (LTPA) patterns during pregnancy and its association to psychological well-being. In each trimester of pregnancy 180 women self-reported on frequency, form and duration of LTPA through structured interviews. Beginning in the third month of pregnancy, data was collected monthly on depressed mood (Lubin depression adjective checklist), state-anxiety, pregnancy-specific stress (pregnancy experiences questionnaire) and Hassles Scale. Independent samples t-tests comparing exercisers and non-exercisers in each trimester showed exercisers reported significantly less depressed mood, daily hassles, state-anxiety and pregnancy-specific stress in the first and second trimester. Women who exercised in the third trimester reported less state-anxiety in that trimester compared to non-exercisers. The results indicate a consistent association between enhanced psychological well-being, as measured by a variety of psychosocial inventories, and LTPA participation particularly during the first and second trimesters of pregnancy. In healthy pregnant women, even low-intensity regular exercise may be a potentially effective low-cost method of enhancing psychological well-being.

Functional neuroanatomy of altered states of consciousness: the transient hypofrontality hypothesis

It is the central hypothesis of this paper that the mental states commonly referred to as altered states of consciousness are principally due to transient prefrontal cortex deregulation. Supportive evidence from psychological and neuroscientific studies of dreaming, endurance running, meditation, daydreaming, hypnosis, and various drug-induced states is presented and integrated. It is proposed that transient hypofrontality is the unifying feature of all altered states and that the phenomenological uniqueness of each state is the result of the differential viability of various frontal circuits. Using an evolutionary approach, consciousness is conceptualized as hierarchically ordered cognitive function. Higher-order structures perform increasingly integrative functions and thus contribute more sophisticated content. Although this implies a holistic approach to consciousness, such a functional hierarchy localizes the most sophisticated layers of consciousness in the zenithal higher-order structure: the prefrontal cortex. The hallmark of altered states of consciousness is the subtle modification of behavioral and cognitive functions that are typically ascribed to the prefrontal cortex. The theoretical framework presented yields a number of testable hypotheses.

Involvement of glutamate neurotransmission in the development of excessive wheel running in Lewis rats

Physical activities such as long-distance running can form a habit and might be related to drug-induced addictive behaviors. We investigated possible modulations of N-methyl-D-aspartate (NMDA) receptor subunits during voluntary wheel running in brain regions implicated in reward and addiction. It was observed that Lewis rats progressively increased their amount of daily running, reaching maximum levels of 4-6 km/day. After 3 weeks of running, mRNA levels coding for NR2A and NR2B subunits were increased in the ventral tegmental area, while only NR2A mRNA levels were found to be elevated in the frontal cortex. Long-term wheel running was also associated with increased binding of specific NMDA receptor antagonist [3H]CGP39653 in the frontal cortex. Moreover, pharmacological inhibition of glutamate release by repeated administration of phenytoin (20 mg/kg IP for 21 days) significantly suppressed daily running. These results suggest that glutamatergic neurotransmission might be related to neurobiological mechanisms underlying the compulsive character of voluntary wheel running.

Effects of acute bouts of exercise on cognition

A review was conducted of studies that assessed the effects of acute bouts of physical activity on adults' cognitive performance. Three groups of studies were constituted on the basis of the type of exercise protocol employed. Each group was then evaluated in terms of information-processing theory. It was concluded that submaximal aerobic exercise performed for periods up to 60 min facilitate specific aspects of information processing; however, extended exercise that leads to dehydration compromises both information processing and memory functions. The selective effects of exercise on cognitive performance are explained in terms of Sanders' [Acta Psychol. 53 (1983) 61] cognitive-energetic model.

Stroll your way to well-being: a survey of the perceived benefits, barriers, community support, and stigma associated with pram walking groups designed for new mothers, Sydney, Australia

In our survey of 500 mothers with children 0-5 years involving telephone interviews (n = 450) and focus groups (n = 50), we showed that 87% of mothers telephone surveyed used a pram for incidental activities, whilst 47% used the pram specifically for exercise. Factors preventing mothers exercising more included poor weather, lack of time, and poor quality paths. Ninety-two percent of mothers believed that pram walking would increase mental well-being, and 87% felt that it would help to reduce postnatal depression (PND). However, feedback from focus groups expressed less confidence in the program's ability to potentially benefit mothers with PND. Programs will have to be marketed carefully to avoid the stigma associated with PND and successfully target mothers at risk.

Contribution of individual spa therapies in the treatment of chronic pain

OBJECTIVES

The aim of the present study was to evaluate the contribution of individual spa therapies administered during a period of 3 weeks on measures of well being and pain in a sample of patients with chronic back pain.

DESIGN

One hundred fifty-three patients with chronic back pain undergoing inpatient spa therapy in Bad Tatzmannsdorf, Austria, participated in the study. According to the prescription of their spa physician, patients underwent two or more of the following treatments: mud packs, carbon dioxide baths, massages, exercise therapies, spinal traction, and electrotherapy. The outcome measures were general pain, back pain, negative mood, and health satisfaction. Regression analyses were conducted to predict the 4 outcome measures at the end of spa therapy and at 6 weeks' follow-up for all therapies applied. The pretreatment outcome measure, age, and sex were controlled for by entering them into the analysis.

RESULTS

Patients showed significant improvements in all 4 outcome measures. The prediction of improvement was generally small: only 1% to 11% of the change of the outcome measures could be explained by the type and number of therapies received. On a short-term basis, mud packs and exercise were found to be associated with a greater improvement in mood, whereas a greater frequency of massage therapy and carbon dioxide baths was associated with a smaller improvement in health satisfaction. On a long-term basis, exercise therapy and spinal traction were associated with a greater reduction in back pain.

CONCLUSIONS

The results indicate that, in addition to the individual therapies, other factors relating to spa therapy as a whole must contribute to overall treatment outcome. In addition, the results support the efficacy of exercise therapy for chronic back pain.

The relationships between physical activity, health status and psychological well-being of fertility-aged women

The purpose of this investigation was to measure the association between leisure time physical activity and health status, mental health and depression. The participants were women aged 18-45. The data were collected using questionnaires that were mailed to 1200 women. The response rate was 55%. The questionnaire contained three instruments: the General Health Questionnaire (GHQ), the Health Questionnaire for Adults, and the Beck Depression Inventory (BDI). The results showed that 52.8% of the sample were physically inactive. Physically active women experienced better mental health (P < 0.05), less depression (P < 0.05) and they had better general health status (P < 0.005). Differences in the emotional state (GHQ score) and depression (BDI score) between active (participating in exercise 3 or 1-2 times a week) and inactive women were significant (P < 0.05). Even a low level of physical activity (1-2 times per week) was positively related to women's mental health (P < 0.05).

Exercise for treating fibromyalgia syndrome

BACKGROUND

Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment.

OBJECTIVES

The objective of this systematic review was to examine the efficacy of exercise training as an treatment for FMS.

SEARCH STRATEGY

We searched 6 electronic bibliographies for studies of exercise training in FMS: MEDLINE (1966-12/2000), CINAHL (1982-12/2000), HealthSTAR (1990-12/2000), Sports Discus (1975-05/2000), EMBASE (1974-05/2000) and the Cochrane Controlled Trials Register (2000, issue 4). We also reviewed the reference lists from identified articles including reviews and meta-analyses of treatment studies.

SELECTION CRITERIA

Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected.

DATA COLLECTION AND ANALYSIS

Two reviewers independently identified trials meeting inclusion criteria, rated the methodologic quality using 2 standardized validated instruments, evaluated the adequacy of the exercise training stimulus using the American College of Sports Medicine (ACSM) criteria and evaluated the results. Disagreements were resolved through active discussion and consensus. High quality training studies had scores of 50% or greater on van Tulder methodologic criteria and met the minimum training standards of ACSM. Outcome variables were grouped into 7 constructs: pain, tender points, physical function, global well being, self efficacy, fatigue & sleep, and psychological function. Two reviewers independently extracted data on study characteristics, results and point estimates for selected variables, and used consensus to address discrepancies.

MAIN RESULTS

Sixteen trials involving a total of 724 participants were assigned at random to: exercise intervention groups (n=379), control groups (n=277), or groups receiving an alternate treatment (n=68). Seven studies were high quality training studies: 4 aerobic training, 1 a mixture of aerobic, strength and flexibility training, 1 strength training and 2 with exercise training as part of a composite treatment. Flexibility protocols were never described in sufficient detail to allow evaluation. The four high quality aerobic training studies reported significantly greater improvements in the exercise groups versus control groups in aerobic performance (17.1% increase in aerobic performance with exercise versus 0.5% increase in the control groups), tender point pain pressure threshold (28.1% increase versus 7.0% decrease) and improvements in pain (11.4% decrease in pain versus 1.6% increase). Poor description of exercise protocols was common, with insufficient information on intensity, duration, frequency and mode of exercise. Adverse events were also poorly reported.

REVIEWER'S CONCLUSIONS

Supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed.

Mood change through physical exercise in nine- to ten-year-old children

The present study assessed the effect of two types of physical exercise on the self reported mood of 64 9 and 10-yr.-old children who responded to a self-report mood meassure after two different types of aerobic exercise of 15 min., and after a 15-min. video. Significant increases in positive mood and significant decreases in negative mood were found after each exercise treatment; however, positive mood decreased and negative mood increased following the video treatment. Interestingly, no significant difference in mean mood scores was found between the two exercise treatments. These data suggest that short bouts of physical exercise have psychological benefits for children.

Women's college physical activity and self-reports of physician-diagnosed depression and of current symptoms of psychiatric distress

It is believed that physical activity is protective against depression. This paper investigates the association between women's athletic activity in the college and precollege years and physician-diagnosed depression in postcollege years. College alumnae (n = 3940), former college athletes and nonathletes, completed a detailed self-administered questionnaire that sought information on health histories up to the present time, including questions on history of physician-diagnosed depression and current symptoms of psychiatric distress. A negative association between college athletic activity and self-reported physician-diagnosed depression in the last 10 years was observed (adjusted odds ratio [OR] = 0.664, with 95% confidence limits [CL] 0.545, 0.808, p < 0.0001). Other factors significantly associated with depression are living with a spouse, at time of reporting-protective; self-rated current health good to poor compared with very good or excellent; alcoholism; and having a doctoral degree-risk factors. Current state variables based on the Rand Mental Health Inventory-5 (RMHI-5) were also more favorable among athletes. This is the first study to report a long-term beneficial association between women's college athletic activity and self-reported physician-diagnosed depression in the postcollege years and current symptoms of psychiatric distress. The findings support the Surgeon General's promotion of the health benefits of physical activity.

The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials

OBJECTIVE

To determine the effectiveness of exercise as an intervention in the management of depression.

DESIGN

Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals.

MAIN OUTCOME MEASURES

Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy.

RESULTS

All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6); weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)).

CONCLUSIONS

The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up.

Influence of rugby injuries on players' subsequent health and lifestyle: beginning a long term follow up

OBJECTIVES

To describe the current rugby playing status of a cohort of 1,169 men who had previously participated in an epidemiological survey of rugby injuries during the 1993-1994 season, and assess the consequences of rugby injuries sustained.

METHODS

In May 1998, 911 (78%) men completed a questionnaire reporting their current involvement in rugby and the influence that the 324 (71%) injuries they had sustained four years earlier had since had on their health and wellbeing.

RESULTS

The most common reasons given by the 390 (43%) ex-players for ceasing to play rugby were family (10%), employment (25%), and an injury sustained while playing rugby (26%), 80% of which were dislocations, strains, and sprains, mainly to the knee (35%), back (14%), and shoulder (9%). A significantly (chi2 test 21.7, df = 1, p<0.001) higher proportion of current players (90%) undertook (non-rugby) sporting activities compared with ex-players (78%). Few ex-players undertook coaching (12%) and refereeing (2%). Only 22 (9%) men reported significant negative effects to employment, family life, and health up to mid-1998 from injuries that occurred during the 1993-1994 season, although the impact on their lifestyle had been substantial in some cases.

CONCLUSIONS

With the recent increase in the incidence of dislocation, strain, and sprain injuries in rugby football, the findings of this follow up could have a great impact on the game in the future. Although this survey has shown that, so far, only a small proportion of players suffer significant effects of rugby injuries, four years is not long enough to assess the long term effects. This cohort of rugby players need to be followed up for at least a further 20 years to determine whether there is a higher incidence of subsequent degenerative joint disease or other long term sequelae to injuries sustained while playing rugby.

Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory

Until recently, claims for the psychological benefits of physical exercise have tended to precede supportive evidence. Acutely, emotional effects of exercise remain confusing, both positive and negative effects being reported. Results of cross-sectional and longitudinal studies are more consistent in indicating that aerobic exercise training has antidepressant and anxiolytic effects and protects against harmful consequences of stress. Details of each of these effects remain unclear. Antidepressant and anxiolytic effects have been demonstrated most clearly in subclinical disorder, and clinical applications remain to be exploited. Cross-sectional studies link exercise habits to protection from harmful effects of stress on physical and mental health, but causality is not clear. Nevertheless, the pattern of evidence suggests the theory that exercise training recruits a process which confers enduring resilience to stress. This view allows the effects of exercise to be understood in terms of existing psychobiological knowledge, and it can thereby provide the theoretical base that is needed to guide future research in this area. Clinically, exercise training continues to offer clinical psychologists a vehicle for nonspecific therapeutic social and psychological processes. It also offers a specific psychological treatment that may be particularly effective for patients for whom more conventional psychological interventions are less acceptable.

The relationship between physical exercise and distress in a national sample of Canadians

This paper presents an empirical examination of the relationship between physical exercise and generalized distress within a stress process framework by examining how chronic strains, self-esteem, mastery, and social support influence this relationship. The analysis employed the 1994 wave of the National Population Health Survey consisting of a sample of 12,636 Canadians between 20 and 64 years of age. Findings suggest that physical exercise is a significant predictor of generalized distress independent of chronic strain, self-esteem and social support. However, mastery mediated the association between physical exercise and distress. Moreover, mastery moderated the relationship indicating that it is a more important resource for people who are inactive.

Exercise and physical activity: an analysis of answers to an open-ended survey question

In this paper 708 comments made in response to an open-ended question at the end of a lifestyle survey are analysed in order to explore issues in exercise behaviour. Quantitative and qualitative techniques are used. Five areas are identified as important in shaping people's exercise behaviour: 1) Health-related factors; 2) Factors related to available facilities; 3) Issues of behavioural change; 4) Issues of health information and promotion; and 5) Miscellaneous issues. Each of the five areas of responses is discussed and related to current theory on exercise behaviour. Three substantive conclusions are drawn. Firstly, environmental change might be important to people but not necessarily in a personalized way. Secondly, health problems are an important barrier to exercising. Thirdly, health promotion possibly targets sedentary individuals too much. With regard to the methodology, the open-ended question proves to yield interesting information. However, a single powerful factor cannot be found in the data and the data seems to suffer from a problem of low-explained variance.

Physical activity and peptic ulcers. Does physical activity reduce the risk of developing peptic ulcers?

BACKGROUND

Although Helicobacter pylori has been identified as a major cause of chronic gastritis, not all infected patients develop ulcers, suggesting that other factors such as lifestyle may be critical to the development of ulcer disease.

OBJECTIVE

To investigate the role physical activity may play in the incidence of peptic ulcer disease.

METHODS

The participants were men (n = 8,529) and women (n = 2,884) who attended the Cooper Institute for Aerobics Research, Dallas, Texas, between 1970 and 1990. The presence of gastric or duodenal ulcer disease diagnosed by a physician was determined from a mail survey in 1990. Participants were classified into 3 physical activity groups according to information provided at the baseline clinic visit (before 1990): active, those who walked or ran 10 miles or more a week; moderately active, those who walked or ran less than 10 miles a week or did another regular activity; and the referent group consisting of those who reported no regular physical activity.

RESULTS

With the use of gender-specific proportional hazards regression models that could be adjusted for age, smoking, alcohol use, body mass index, and self-reported tension, active men had a significantly reduced risk for duodenal ulcers (relative hazard [95% confidence interval] for the active group, 0.38 [0.15-0.94], and 0.54 [0.30-0.96] for the moderately active group). No association was found between physical activity and gastric ulcers for men or for either type of ulcer for women.

CONCLUSION

Physical activity may provide a nonpharmacologic method of reducing the incidence of duodenal ulcers among men.

The relationship between physical exercise and distress in a national sample of Canadians

This paper presents an empirical examination of the relationship between physical exercise and generalized distress within a stress process framework by examining how chronic strains, self-esteem, mastery, and social support influence this relationship. The analysis employed the 1994 wave of the National Population Health Survey consisting of a sample of 12,636 Canadians between 20 and 64 years of age. Findings suggest that physical exercise is a significant predictor of generalized distress independent of chronic strain, self-esteem and social support. However, mastery mediated the association between physical exercise and distress. Moreover, mastery moderated the relationship indicating that it is a more important resource for people who are inactive.

Walking in (affective) circles: can short walks enhance affect?

Recent physical activity recommendations call for activities that are of moderate intensity and can be performed intermittently during the day, such as walking. These proclamations were based partly on the assumption that moderate activities are generally more enjoyable than physically demanding ones, and they are, therefore, also more likely to be continued over the long haul. However, little is actually known about the affective outcomes of short bouts of walking and extant findings are equivocal. Four experimental studies examined the affective responses associated with short (10- to 15-min) bouts of walking using a dimensional conceptual model of affect, namely, the circumplex. Results consistently showed that walking was associated with shifts toward increased activation and more positive affective valence. Recovery from walking for 10-15 min was associated with a return toward calmness and relaxation. This pattern, was robust across different self-report measures of the circumplex affective dimensions, across ecological settings (field and laboratory), across time, and across samples.

Does physical activity reduce the risk of developing peptic ulcers?

BACKGROUND

Although Helicobacter pylori has been identified as a major cause of chronic gastritis, not all infected patients develop ulcers, suggesting that other factors such as lifestyle may be critical to the development of ulcer disease.

AIM

To investigate the role physical activity may play in the incidence of peptic ulcer disease.

METHODS

The subjects were men (8529) and women (2884) who attended the Cooper Clinic in Dallas between 1970 and 1990. The presence of gastric or duodenal ulcer disease diagnosed by a doctor was determined from a mail survey in 1990. Subjects were classified into three physical activity groups according to information provided at the baseline clinic visit (before 1990): active, those who walked or ran 10 miles or more a week; moderately active, those who walked or ran less than 10 miles a week or did another regular activity; the referent group consisting of those who reported no regular physical activity.

RESULTS

With the use of gender specific proportional hazards regression models that could be adjusted for age, smoking, alcohol use, body mass index, and self reported tension, active men were found to have a significant reduction in risk for duodenal ulcers (relative hazard (95% confidence interval) for the active group was 0.38 (0.15 to 0.94) and 0.54 (0.30 to 0.96) for the moderately active group). No association was found between physical activity and gastric ulcers for men or for either type of ulcer for women.

CONCLUSIONS

Physical activity may provide a non-pharmacological method of reducing the incidence of duodenal ulcers among men.

Acute aerobic exercise and affect: current status, problems and prospects regarding dose-response

One of the assumptions underlying recent physical activity recommendations is that lower doses of activity (i.e. intensity and duration) are more enjoyable for the average person, thus leading to higher involvement and adherence rates. However, the veracity of this hypothesis can be questioned, since little is actually known regarding the association between activity doses and affective responses. The few preliminary attempts at the conceptual delineation of the dose-response relationship, all centred around an 'inverted-U' notion, are reviewed and criticised as lacking empirical foundation. Available meta-analyses, as well as the empirical literature on the role of exercise intensity and duration, are examined. Increased intensity appears to be associated with reduced positivity of affect during and immediately following an exercise bout. Intensity effects appear to be attenuated during recovery. Fitness and training status appear to become significant mediators of the exercise-affect relationship only at high intensities. With intensity being kept constant, different exercise bout durations have not been shown to have a differential impact on pre- to post-exercise affective changes. Recommendations for future research include: (i) a shift from categorical to dimensional conceptualisations and operationalisations of affect; (ii) the examination of psychological theories on the association between activation and affect (e.g. extraversion-introversion, sensation seeking, type A behaviour pattern and related self-evaluative tendencies, reversal theory, optimal stimulation theory, multidimensional activation theory and self-efficacy); (iii) the systematic and theory-based examination of in-task and post-exercise affective responses; (iv) the incorporation of the parameter of fitness and/or activity status in research designs; and (v) the re-evaluation of methods for selecting exercise intensity levels.

Premenstrual syndromes: closing the 20th century chapters

The need to re-evaluate premenstrual syndromes became apparent in 1997-1998 and early 1999. The success stories of some symptomatic treatment modalities and more sophisticated studies of pathobiology chart the pathways for future progress: the shift from a descriptive diagnosis to diagnoses based on etiology, the recognition of diversified vulnerabilities and their expression in particular situations, and specific treatment modalities.