Depressive symptoms and cardiorespiratory fitness in obese adolescents

Quantitative scale validation of the Dimensional Anhedonia Rating Scale in the treatment of Chinese patients with major depressive disorder

Background

The patient-reported Dimensional Anhedonia Rating Scale (DARS) has been adapted into Chinese, so there is a need to evaluate its measurement properties in a Chinese population.

Aims

To evaluate the reliability and validity of the DARS among Chinese individuals with major depressive disorder (MDD) and its treatment sensitivity in a prospective clinical study.

Methods

Data were from a multicentre, prospective clinical study (NCT03294525), which recruited both patients with MDD, who were followed for 8 weeks, and healthy controls (HCs), assessed at baseline only. The analysis included confirmatory factor analysis, validity and sensitivity to change.

Results

Patients' mean (standard deviation (SD)) age was 34.8 (11.0) years, with 68.7% being female. 75.2% of patients with MDD had melancholic features, followed by 63.8% with anxious distress. Patients had experienced MDD for a mean (SD) of 9.2 (18) months. DARS scores covered the full range of severity with no major floor or ceiling effects. Confirmatory factor analysis showed adequate fit statistics (comparative fit index 0.976, goodness-of-fit index 0.935 and root mean square error of approximation 0.055). Convergent validity with anhedonia-related measures was confirmed. While the correlation between the DARS and the Hamilton Depression Rating Scale was not strong (r=0.31, baseline), the DARS was found to differentiate between levels of depression. Greater improvements in DARS scores were seen with the Hamilton Rating Scale for Depression responder group (effect size 1.16) compared with the non-responder group (effect size 0.46).

Conclusions

This study comprehensively evaluated the measurement properties of the DARS using a Chinese population with MDD. Overall, the Chinese version of DARS demonstrates good psychometric properties and has been found to be responsive to change during antidepressant treatment. The DARS is a suitable scale for assessing patient-reported anhedonia in future clinical trials.

Association between sports participation and resilience in school-attending students: a cross-sectional study

Aim

This research sought to identify the association between sports participation and resilience in children and adolescents as a means to enhance mental health.

Methods

A comprehensive survey was carried out, encompassing primary, middle, and high school students from chosen educational institutions. The analytical sample comprised 67,281 students of school age. Sports participation and resilience were evaluated using validated assessment tools, while relevant covariates, such as sex and school grade, were assessed through self-reported questionnaires. Generalized Linear Models were applied to ascertain the association between sports participation and resilience for the entire sample, and separately for subgroups divided by gender or school grade, after controlling for covariates.

Results

Among the 67,281 school students, males constituted 51.9% of the sample. Approximately 47.1% of the entire sample reported no sports participation, and the average resilience score was 24.7. The regression model analysis revealed that, in the entire sample, increased in sports participation was linked to higher resilience scores (odds ratio [OR] for 1-3 times per month: 1.20, 95%CI: 1.16-1.24; OR for 1-2 times per week: 1.38, 95%CI: 1.33-1.43; OR for 3 times or more per week: 1.72, 95%CI: 1.65-1.79). Analyses stratified by gender and school grade indicated that sports participation was consistently associated with greater resilience.

Conclusion

This study provides cross-sectional evidence supporting the positive association between sports participation and the resilience of children and adolescents, underscoring the potential of encouraging sports participation as a strategy for promoting mental health resilience. The findings presented herein should be subject to further confirmation or refutation in future research endeavors.

Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth

The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.

Cognitive-behavioral therapy and exercise training in adolescent females with elevated depression symptoms and at-risk for type 2 diabetes: Protocol for a randomized controlled trial

BACKGROUND

Adolescent-onset type 2 diabetes (T2D) is a major public health concern of growing proportions. Prevention, therefore, is critical. Unfortunately, standard-of-care treatment for T2D prevention (e.g., exercise training) show insufficient effectiveness and do not address key modifiable barriers (e.g., depression symptoms) to exercise engagement. Depression symptoms are associated with both poorer physical fitness and greater insulin resistance, the key risk factor in adolescent-onset T2D. Thus, a targeted prevention approach that addresses depression symptoms in combination with exercise training may offer a novel approach to mitigating T2D risk.

METHODS

This manuscript describes the design and study protocol for a multi-site, four-arm randomized controlled trial comparing the efficacy of group cognitive-behavioral therapy, group exercise training, and their combinations for the targeted prevention of worsening insulin resistance in N = 300 adolescent females at-risk for T2D with BMI ≥85th percentile and elevated depression symptoms. All four intervention arms will run in parallel and meet weekly for 1 h per week for 6-week to 6-week segments (12 weeks total). Outcomes are assessed at baseline, 6-week mid-treatment, 12-week follow-up, and 1-year follow-up.

RESULTS

The primary outcome is insulin resistance. Key secondary outcomes include insulin sensitivity, cardiorespiratory fitness, physical activity, depression symptoms, and body measurements.

CONCLUSION

Study findings will guide the ideal sequencing of two brief T2D prevention interventions for ameliorating the course of insulin resistance and lessening T2D risk in vulnerable adolescents. These interventions will likely be cost-effective and scalable for dissemination, having the potential for significant public health impact on communities at risk for T2D.

The Developing Brain: Considering the Multifactorial Effects of Obesity, Physical Activity & Mental Wellbeing in Childhood and Adolescence

Obesity during childhood has been associated with many important physiological and neurological health considerations. Specifically concerning are the associations between youth obesity and declines in mental health, as shown with increasing rates of adolescent depression and anxiety worldwide. The emergence of mental health disorders commonly arises during adolescent development, and approximately half the global population satisfy the criteria for at least one psychiatric disorder in their lifetime, suggesting a need for early intervention. Adolescence is critical time whereby brain structure and functions are not only negatively associated with obesity and declines in mental health, while also coinciding with significant declines in rates of physical activity among individuals in this age group. Physical activity is thus a prime candidate to address the intersection of obesity and mental health crises occurring globally. This review addresses the important considerations between physiological health (obesity, aerobic fitness, physical activity), brain health (structure and function), and mental wellbeing symptomology. Lastly, we pose a theoretical framework which asks important questions regarding the influence of physiological health on the association between brain health and the development of depression and anxiety symptoms in adolescence. Specifically, we hypothesize that obesity is a mediating risk factor on the associations between brain health and psychopathology, whereas physical activity is a mediating protective factor. We conclude with recommendations for promoting physical activity and reducing sedentary time.

Comparisons between Bioelectrical Impedance Variables, Functional Tests and Blood Markers Based on BMI in Older Women and Their Association with Phase Angle

The aim of the present study was to compare electrical bioimpedance variables, blood markers and functional tests based on Body Mass Index (BMI) in older women. Associations between Phase Angle (PhA) with functional tests and blood markers were also analyzed. A total of 46 independent elderly people participated in the study, and they were divided into four groups according to BMI values: Group 1 (G1, BMI < 25 kg/m2); Group 2 (G2, BMI > 25−30 kg/m2); Group 3 (G3, BMI > 30−35 kg/m2); Group 4 (G4, BMI > 35 kg/m2). In addition to the weight and height used to calculate the BMI, the following body composition variables were collected: fat mass (FM), fat-free mass, intracellular water (ICW), extracellular water (ECW), total body water (TBW) and PhA (50 kHz) through InBody S10 equipment. Functional capacity was assessed using the Fullerton battery of tests: arm-curl; chair-stand; 6 min walking test (6MWT); time up-and-go test (TUG); standing on one leg (SOOL) and take 10 foot-lines (10FL). The main results showed differences between groups in the tests: 6MWT, SOOL and 10FL between G1 vs. G3 and G2 vs. G3 (p < 0.05); ACT, AIC and AEC between G1 vs. G4 (p < 0.05); FM among all groups (p < 0.05). Negative correlations were found between PhA and the agility test in G1 (r = −0.848; p = 0.008) and G4 (r = −0.909; p = 0.005); PhA and chair-stand in G3 (r = 0.527; p = 0.044); PhA and forearm flexion in G3 (r = 0.641; p = 0.010) and G4 (r = 0.943; p = 0.001); PhA and 6MWT in G4 (r = 0.771; p = 0.042). This study found that there is a clear trend towards better functional capacities with better parameters of body composition. Although there were no differences between groups in PhA, associations were found between different functional tests with PhA, which reveals the importance of this variable as a marker of health status.

A comparison of negative affect and disinhibited eating between children with and without parents with type 2 diabetes

BACKGROUND

Children whose parents have type 2 diabetes (T2D) are at high-risk for developing T2D. In youth, negative affect has been shown to predict insulin resistance (IR), and disinhibited-eating behaviors have been linked to IR. It is unknown if youth with a parent with T2D (P-T2D) report greater psychological and behavioral symptoms than those without a P-T2D.

OBJECTIVE

To compare youth with and without a P-T2D on symptoms of negative affect and disinhibited-eating.

METHODS

Nine-hundred thirty-two youth (13.3 ± 2.6 years; BMIz 1.06 ± 1.06; 67.8% female; 53.6% people of color; 10.7% with a P-T2D) completed questionnaires of anxiety and depressive symptoms, eating in the absence of hunger, and emotional-eating. Loss-of-control (LOC)-eating was assessed by interview. In two separate subsamples, energy intake was explored using laboratory test meals simulating eating in the absence of hunger and LOC-eating, respectively. Analyses were adjusted for age, sex, race/ethnicity. In follow-up analyses, fat mass (kg) and height, and IR were included as covariates, respectively.

RESULTS

Adjusting for all covariates including adiposity and IR, compared to youth without a P-T2D, youth with a P-T2D reported more anxiety and depression symptoms, greater eating in the absence of hunger, and emotional-eating (ps < 0.05). No significant differences were found for LOC-eating, or in exploratory analyses of energy intake for either test meal (ps > 0.16).

CONCLUSIONS

Self-reported negative affect and disinhibited-eating may be higher among youth with P-T2D compared to those without P-T2D. Prospective studies should examine, among those with a P-T2D, what role such symptoms may play for their subsequent risk for T2D.

Potential Predictors of Psychological Wellbeing in Elementary School Students

BACKGROUND

This study aimed to investigate the association of elementary school students' manipulative skill competency, cardiorespiratory fitness, and cognitive function with psychological wellbeing (PWB), as well as whether the association had gender differences.

METHODS

Participants were 291 fourth-grade students (166 boys vs. 125 girls; mean age = 9.770 years old; SD = 0.584) at two elementary schools from the province of Henan in China. The students' soccer skills in manipulative skill competency were assessed using the PE Metric Assessment Rubric, cardiorespiratory fitness was assessed by means of the PACER 15 m test, and cognitive function and PWB were assessed using the d2 test of attention and Warwick-Edinburgh Mental Wellbeing Scale, respectively. Data were analyzed with descriptive statistics and multiple linear regression models.

RESULTS

The result of linear regression models showed that soccer skills, cardiorespiratory fitness, and cognitive function were collectively associated with PWB for the total sample (F (5, 285) = 3.097, p < 0.01), boys (F (5, 160) = 1.355, p < 0.01), and girls (F (5, 119) = 2.132, p < 0.01). Furthermore, the standardized regression coefficients (β) indicated that cardiorespiratory fitness was the only significant contributor to PWB for the total sample (β = 0.119, t = 2.021, p < 0.05), but not for boys and girls. Soccer skills and cognitive function were not individual significant contributors to PWB for the total sample, boys, and girls.

CONCLUSIONS

Cardiorespiratory fitness was significantly associated with PWB, and there were no gender differences in the relationship of manipulative skill competency, cardiorespiratory fitness, and cognitive function with PWB in elementary school students. This study provides empirical evidence that improving cardiorespiratory fitness is an important intervention strategy to promote elementary school students' PWB.

Association between cardiorespiratory fitness and depressive symptoms in children and adolescents: A systematic review and meta-analysis

Background Higher cardiorespiratory fitness (CRF) is associated with lower depressive symptoms in adults. However, no systematic review with meta-analysis assessed the cross-sectional associations between CRF and depressive symptoms in children and adolescents. Therefore, this meta-analysis assessed the relationship between CRF and depressive symptom in these populations. Methods Cross-sectional data evaluating the correlation between CRF and depression were searched, from database inception through 21/05/2020, on PubMed, PsycINFO, Web of Science, and SPORTDiscus. Age, sex, CRF and depression assessments, and correlations were extracted. A random-effects meta-analysis was conducted, and the potential sources of heterogeneity were also explored through meta-regression analysis. Results Across 14 effects of 11 unique studies, including a total of 7,095 participants (median age=12.49) with nearly equal sex distribution (median=53% females), it was found that higher CRF was associated with lower depressive symptoms in children and adolescents (r =-0.174, 95%CI -0.221 to -0.126, p<0.001, I²=75.09, Q value=52.19). No moderators were identified. Conclusion Available evidence supports the notion that higher CRF is inversely associated with depressive symptoms in children and adolescents. Physical activity and exercise interventions targeting improving CRF should be promoted for these populations. Further studies, including clinical populations, should be conducted to assess objective measures of aerobic fitness and body composition, while controlling for puberty status, to better characterize this association.

The Relationship between Body Mass Index and Physical Fitness among Chinese University Students: Results of a Longitudinal Study

Over the past few decades, a gradual increase in sedentary lifestyles along with the increased consumption of a modern, hypercaloric diet has resulted in a substantial increase in the number of those classified as overweight or obese in China. The prevalence of overweight and obesity has become a key public health issue. However, it is important to be cautious when interpreting the literature as the majority of studies apply cross-sectional data to assess and subjectively compare the relationship between physical fitness and being overweight and obese. In the present study, longitudinal data were collected from 3066 students (enrolled in 2014) at a university in China at the beginning of each academic year throughout their four-year university program. The aim of this study was to analyze the various associations between BMI, explosive power, flexibility, and cardiorespiratory endurance, and a random-intercept panel model (RIPM) was separately employed on male and female participants to identify between- and within-person variations. In this way, the associations for between-person physical fitness and normal/overweight/obese weight ranges, and for within-person physical fitness and normal/overweight/obese weight ranges could be observed. The results of this study revealed that every physical fitness test chosen for evaluation (such as the standing long jump for explosive power or the distance run for cardiorespiratory endurance) was negatively related to the BMI results, irrespective of sex, with the notable exception of the flexibility results. In addition, this study showed that both males and females exhibited positively correlated results in both between-person BMI and flexibility as well as within-person BMI and flexibility. Furthermore, the relationships between and within persons of cardiorespiratory endurance, explosive power, and flexibility all showed positive correlations across both sexes. The dynamics between physical fitness and BMI identified in this study could prove useful to practitioners and researchers investigating such relationships in the future.

The Roles of Physical Activity, Exercise, and Fitness in Promoting Resilience During Adolescence: Effects on Mental Well-Being and Brain Development

Adolescence is a critical yet vulnerable period for developing behaviors important for mental well-being. The existing literature suggests that physical activity (PA), exercise, and aerobic fitness promote well-being and reduce risk of mental health problems. In this review, we focus on PA, exercise, and fitness as modifiable resilience factors that may help promote self-regulation via strengthening of top-down control of bottom-up processes in the brain, thereby acting as a buffer against mental health problems during this period of vulnerability. First, we briefly review the link between PA, exercise, and aerobic fitness with mental well-being and reduced mental health problems in adolescence. Then we present how impairments in self-regulation, which involves top-down control to modulate bottom-up processes, are common across a wide range of mental health disorders. Finally, we use the extant neuroimaging literature to highlight how neural systems underlying top-down control continue to develop across adolescence, and propose that PA, exercise, and aerobic fitness may facilitate resilience through strengthening individual brain regions as well as large-scale neural circuits to improve emotional and behavioral regulation. Future neuroimaging studies assessing the effects of PA, exercise, and aerobic fitness at various developmental stages in each sex and studies considering the characteristics (e.g., frequency, intensity, type) and social context of PA and exercise are vital to better understand both macro- and microscale mechanisms by which these behaviors and attributes may facilitate mental health resilience during adolescent development.

Recurrent depression in childhood and adolescence and low childhood socioeconomic status predict low cardiorespiratory fitness in early adulthood

BACKGROUND

Cardiorespiratory fitness (CRF) strongly influences health, but very little is known about the childhood determinants of adult CRF. Our longitudinal study investigated whether childhood psychopathology and socioeconomic status (SES) were related to adult CRF in 1647 Finnish male military conscripts.

METHODS

Childhood psychopathology was assessed at the age of eight using the Rutter and Children's Depression Inventory questionnaires. Parental education and family structure were used to assess childhood SES. In late adolescence, depressive symptoms were assessed with the Beck Depression Inventory and smoking with a questionnaire. CRF in early adulthood was examined with the Cooper's 12-minute run test.

RESULTS

General linear models showed that low parental education (p=0.001), depressive symptoms in childhood (p=0.035) and late adolescence, smoking, underweight, and overweight/obesity (all p<0.001) independently predicted lower CRF. The interaction between depressive symptoms in childhood and adolescence was significant (p=0.003). In adolescents with depressive symptoms, childhood depressive symptoms (p=0.001) and overweight/obesity (p<0.001) predicted lower CRF. In adolescents without depressive symptoms, conduct problems in childhood predicted lower CRF in the initial models, but the effect disappeared after taking into account smoking and body mass index. Mediational analysis confirmed these results.

LIMITATIONS

We lacked data on physical activity and only studied males at three time-points.

CONCLUSIONS

Recurrent depression in childhood and adolescence and low SES in childhood predict lower adult CRF. Conduct problems in childhood predict lower CRF, but the effect is mediated by overweight/obesity and smoking. Psychiatric treatment for children and adolescents should promote physical activity, particularly for children with low SES.

SLEEP AND CHILDHOOD MENTAL HEALTH: ROLE OF PHYSICAL ACTIVITY AND CARDIORESPIRATORY FITNESS

ABSTRACT Introduction: Sleep is considered an important health indicator and plays a key role in brain development and plasticity. Objective: To ascertain whether there is a relationship between sleep quality and mental health indicators and whether organized physical activity (PA) or cardiorespiratory fitness (CRF) act as moderators of this association. Methods: This is a cross-sectional study with a quantitative approach. The sample consisted of 226 students between six and 11 years of age, male and female, in the early years of elementary education at a public school in Porto Alegre, Brazil, which was selected for convenience. CRF was measured by running test and six-minute walk. Sleep quality and organized physical activity outside of school were verified through an anamnesis, socioeconomic status through an adaptation of the ABEP (Brazilian Association of Research Companies) questionnaire, and mental health indicators with the assistance of the Strengths and Difficulties Questionnaire, all answered by parents. Frequencies, means, standard deviations and generalized linear models were used for the data analysis, while a 95% confidence interval was used for the analyses. Results: Sleep quality was associated with total difficulties (β=7.659, p<0.001), emotional symptoms (β= 1.754; p=0.001), hyperactivity/inattentiveness (β=3.054, p <0.001), conduct problems (β=1.619, p<0.001) and peer relationship problems (β=1.231; p=0.007) in boys. In girls it was related to total difficulties (β=3.421; p=0.006), and conduct problems (β=1.235; p=0.003). However, the interactions were not significant. Conclusion: Although they occur independently, stress is placed on the importance of sleeping well, engaging in organized PA and having good CRF levels for the improvement and maintenance of mental health. Level of evidence III; Case-control study.

Effort-based decision-making is affected by overweight/obesity in major depressive disorder

BACKGROUND

Anhedonia and abnormalities in reward behavior are core features of major depressive disorder (MDD). Convergent evidence indicates that overweight/obesity (OW), a highly prevalent condition in MDD, is independently associated with reward disturbances. We therefore aimed to investigate the moderating effect of OW on the willingness to expend efforts for reward in individuals with MDD and healthy controls (HC).

METHODS

Forty-one adults (HC n = 20, MDD n = 21) completed the Effort Expenditure for Rewards Task (EEfRT), clinical and cognitive measures. Anthropometric parameters were assessed in all participants, and an additional evaluation of laboratorial parameters were conducted solely on those with MDD. Individuals with MDD were all on vortioxetine monotherapy (10-20 mg/day).

RESULTS

Interactions between reward magnitude, group and OW were observed (χ² = 9.192, p = 0.010); the OW-MDD group chose the hard task significantly less than normal weight (NW)-HC (p = 0.033) and OW-HC (p = 0.034), whereas there were no differences between NW-MDD and HCs. Within individuals with MDD, the proportion of hard task choices was more strongly correlated with body mass index (BMI) (r = -0.456, p = 0.043) and insulin resistance (HOMA2-IR) (r = -0.467, p = 0.038), than with depressive symptoms (r = 0.290, p = 0.214).

CONCLUSIONS

OW significantly moderated the association between MDD and willingness to make efforts for rewards. These findings offer novel evidence on the potential role of metabolic factors on the basis of anhedonia, and for the heuristic models proposing a pathophysiological connection between mood and metabolic disorders.

The Relationships Between Weight Status and Physical Fitness Among Chinese Children and Youth

PURPOSE

This study examined the prevalence of different weight status and the relationships between weight status and physical fitness among Chinese children and youth.

METHODS

Participants were 107,206 Grade 4 children and 70,213 Grade 8 youth from the China National Assessment of Educational Quality - Physical Education & Health in 2015 (CNAEQ-PEH 2015). Using World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) criteria, weight status was divided into four groups (underweight, normal weight, overweight, and obese) according to Body Mass Index (BMI). The differences of physical fitness performances (15-m progressive aerobic cardiovascular endurance run [PACER], standing long jump, and 50-m sprint) among four weight status groups were compared. Data were analyzed using descriptive statistics, MANCOVA, and Cohen's d.

RESULTS

The prevalence of weight status varied by criteria (e.g., for Grade 4 boys, the prevalence of underweight by WHO and CDC were 5.9% and 10.5%; overweight were 14.5% and 11.4%, respectively). Compared with the normal weight group, the selected physical fitness performances in the overweight and obese groups were worse (p < .001) with small to large effect sizes.

CONCLUSION

The prevalence of underweight and overweight/obese was relatively high among Chinese children and youth. The prevalence of underweight, overweight, and obesity varied slightly depending on the criteria used for evaluating BMI. The overweight/obese participants tended to perform poorer in selected physical fitness tests. The performance disparities between the normal weight group and overweight/obese groups were larger in Grade 4 than in Grade 8 and among boys than among girls.

Insulin Sensitivity, Depression/Anxiety, and Physical Fitness in At-Risk Adolescents

Poor physical fitness contributes to the early progression of cardiometabolic disease, yet the physiological and psychological factors underpinning poor fitness in at-risk adolescents are not well understood. In this study, we sought to determine the relationship of physical fitness with two developmental phenomena of adolescence, insulin resistance and depression/anxiety symptoms among at-risk youth. We conducted secondary data analyses of 241 overweight or obese adolescents (12-17 years), drawn from two study cohorts. Insulin sensitivity index was derived from oral glucose tolerance tests. Adolescents self-reported depressive symptoms and anxiety symptoms on validated surveys. A walk/run test was administered to determine perceived exertion and physical fitness (distance traveled). Insulin sensitivity was positively associated with walk/run distance ( b =0.16, P< 0.01), even after accounting for all covariates. Anxiety symptoms were inversely related to perceived exertion ( b =-0.11, P< 0.05), adjusting for covariates. These findings suggest that insulin resistance and anxiety symptoms are associated with different dimensions of physical fitness in overweight or obese adolescents and could both potentially contribute to declining fitness and worsening metabolic outcomes in at-risk youth.

Low fitness is associated with abdominal adiposity and low-grade inflammation independent of BMI

OBJECTIVE

Up to 30% of obese individuals are metabolically healthy. Metabolically healthy obese (MHO) individuals are characterized by having low abdominal adiposity, low inflammation level and low risk of developing metabolic comorbidity. In this study, we hypothesize that cardiorespiratory fitness (fitness) is a determinant factor for the MHO individuals and aim to investigate the associations between fitness, abdominal adiposity and low-grade inflammation within different BMI categories.

METHOD

Data from 10,976 individuals from the general population, DANHES 2007-2008, on waist circumference, fitness and C-reactive protein (hsCRP) were analysed using multiple linear and median quantile regressions.

RESULTS

In men, an inverse association between fitness (+5 mL min-1 kg-1) and waist circumference (-1.45 cm; 95% CI: -1.55 to -1.35 cm; p<0.001), and an inverse association between fitness (+5 mL min-1 kg-1) and hsCRP (-0.22 mg/L; 95% CI: -0.255 to -0.185 mg/L; p<0.001) was found, all independent of BMI. Similarly in women, an inverse association between fitness (+5 mL min-1 kg-1) and waist circumference (-1.15 cm; 95% CI: -1.25 to -1.0 cm; p<0.001), and an inverse association between fitness (+5 mL min-1 kg-1) and hsCRP (-0.26 mg/L; 95% CI: -0.3 to -0.22 mg/L; p<0.001) was found, all independent of BMI. Additionally, significant positive associations between waist circumference and hsCRP were found for both men and women, independently of BMI.

CONCLUSION

Fitness was found to be inversely associated with both abdominal adiposity and low-grade inflammation independent of BMI. These data suggest that, in spite of BMI, high fitness levels lead to a reduction in abdominal fat mass and low-grade inflammation.

A Randomized Controlled Trial to Prevent Depression and Ameliorate Insulin Resistance in Adolescent Girls at Risk for Type 2 Diabetes

BACKGROUND

Prospective data suggest depressive symptoms worsen insulin resistance and accelerate type 2 diabetes (T2D) onset.

PURPOSE

We sought to determine whether reducing depressive symptoms in overweight/obese adolescents at risk for T2D would increase insulin sensitivity and mitigate T2D risk.

METHOD

We conducted a parallel-group, randomized controlled trial comparing a 6-week cognitive-behavioral (CB) depression prevention group with a 6-week health education (HE) control group in 119 overweight/obese adolescent girls with mild-to-moderate depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D] ≥16) and T2D family history. Primary outcomes were baseline to post-intervention changes in CES-D and whole body insulin sensitivity index (WBISI), derived from 2-h oral glucose tolerance tests. Outcome changes were compared between groups using ANCOVA, adjusting for respective baseline outcome, puberty, race, facilitator, T2D family history degree, baseline age, adiposity, and adiposity change. Multiple imputation was used for missing data.

RESULTS

Depressive symptoms decreased (p < 0.001) in CB and HE from baseline to posttreatment, but did not differ between groups (ΔCESD = -12 vs. -11, 95 % CI difference = -4 to +1, p = 0.31). Insulin sensitivity was stable (p > 0.29) in CB and HE (ΔWBISI = 0.1 vs. 0.2, 95 % CI difference = -0.6 to +0.4, p = 0.63). Among all participants, reductions in depressive symptoms were associated with improvements in insulin sensitivity (p = 0.02).

CONCLUSIONS

Girls at risk for T2D displayed reduced depressive symptoms following 6 weeks of CB or HE. Decreases in depressive symptoms related to improvements in insulin sensitivity. Longer-term follow-up is needed to determine whether either program causes sustained decreases in depressive symptoms and improvements in insulin sensitivity.

TRIAL REGISTRATION NUMBER

The trial was registered with clinicaltrials.gov (NCT01425905).

Depressive symptomology in multiple sclerosis: Disability, cardiorespiratory fitness and heart rate variability

OBJECTIVES

This study aimed to investigate whether neurological disability status, heart rate variability (HRV), cardiorespiratory fitness (CRF) explained the variance in depressive symptoms in multiple sclerosis (MS).

METHODS

Associations between CRF (via maximal oxygen uptake; VO_2peak ), HRV indices of normalized ultra-low (nULF) and very low frequency domains (nVLF), neurological disability status and depressive symptoms (using the Depression subscale of the Hospital Anxiety Depression Scale; HADS-D) were assessed in 53 participants with MS and 17 matched controls. Hierarchical linear regression analysis was conducted within the MS subsample to examine the variance explained by neurological disability alone and CRF.

RESULTS

The groups were similar in mean age (MS=52.0 years, Control=51.1 years) and sex (MS=72% female, Control=77% female). Among individuals with MS, HADS-D scores significantly correlated with disability status (sample mean score=4) and VO_2peak (r=-.62, P<.001), whereas VO_2peak only correlated with nVLF (r=0.29, P<.05), but not nULF (r=0.26, P=.06). The hierarchical linear regression indicated that VO_2peak (P<.05) attenuated the effect of disability status on HADS-D scores such that disability was no longer a predictor of depressive symptomology at step 2 (P>.05).

CONCLUSION

Heart rate variability does not seem to significantly differ between individuals with MS and healthy controls. When accounting for CRF, disability status no longer explains significant variance in depressive symptoms in MS. Accordingly, targeting CRF might be an effective approach for effectively managing depressive symptoms in individuals with MS.

Physical fitness and psychological health in overweight/obese children: A cross-sectional study from the ActiveBrains project

OBJECTIVES

To examine the associations of physical fitness (i.e. cardiorespiratory fitness, muscular strength, and speed/agility) with psychological distress and psychological well-being in overweight/obese pre-adolescent children.

DESIGN

110 overweight/obese children (10.0±1.1years old, 61 boys) from the ActiveBrains project (http://profith.ugr.es/activebrains) participated in this cross-sectional study.

METHODS

Physical fitness was evaluated by the ALPHA battery test. Cardiorespiratory fitness was additionally evaluated by a maximal incremental treadmill. Stress was assessed by the Children's Daily Stress Inventory, anxiety by the State-Trait Anxiety Inventory, depression by the Children Depression Inventory, positive affect and negative affect by the Positive and Negative Affect Scale for Children, happiness by the Subjective Happiness Scale, optimism by the Life Orientation Test, and self-esteem by the Rosenberg Self-Esteem questionnaire. Linear regression adjusted for sex and peak height velocity was used to examine associations.

RESULTS

Absolute upper-body muscular strength was negatively associated with stress and negative affect (β=-0.246, p=0.047; β=-0.329, p=0.010, respectively). Furthermore, absolute lower-body muscular strength was negatively associated with negative affect (β=-0.301, p=0.029). Cardiorespiratory fitness, expressed by the last completed lap, and relative upper-body muscular strength were positively associated with optimism (β=0.220, p=0.042; β=0.240, p=0.017, respectively). Finally, absolute upper-body muscular strength was positively associated with self-esteem (β=0.362, p=0.003) independently of sex and weight status (p for interactions >0.3), and absolute lower-body muscular strength was also positively associated with self-esteem (β=0.352, p=0.008).

CONCLUSIONS

Muscular strength was associated with psychological distress (i.e. stress and negative affect) and psychological well-being (i.e. optimism and self-esteem) as well as cardiorespiratory fitness was associated with optimism. Therefore, increased levels of physical fitness, specifically muscular strength, could have significant benefits for overweight/obese children psychological health.

Perceived stress and anhedonia predict short-and long-term weight change, respectively, in healthy adults

OBJECTIVE

Perceived stress; emotional eating; anhedonia; depression and dietary restraint, hunger, and disinhibition have been studied as risk factors for obesity. However, the majority of studies have been cross-sectional and the directionality of these relationships remains unclear. In this longitudinal study, we assess their impact on future weight change.

METHODS

Psychological predictors of weight change in short- (6month) and long-term (>1year) periods were studied in 65 lean and obese individuals in two cohorts. Subjects participated in studies of food intake and metabolism that did not include any type of medication or weight loss interventions. They completed psychological questionnaires at baseline and weight change was monitored at follow-up visits.

RESULTS

At six months, perceived stress predicted weight gain (r(2)=0.23, P=0.02). There was a significant interaction (r(2)=.38, P=0.009) between perceived stress and positive emotional eating, such that higher scores in both predicted greater weight gain, while those with low stress but high emotional eating scores lost weight. For long-term, higher anhedonia scores predicted weight gain (r(2)=0.24, P=0.04). Depression moderated these effects such that higher scores in both predicted weight gain but higher depression and lower anhedonia scores predicted weight loss.

CONCLUSION

There are different behavioral determinants for short- and long-term weight change. Targeting perceived stress may help with short-term weight loss while depression and anhedonia may be better targets for long-term weight regulation.

Psychological distress leads to reduced physical activity and fitness in children: the Australian longitudinal LOOK study

Stress and depression can affect an individual's level of physical activity and fitness, which may place them at risk of developing cardiovascular disease. This study investigates the longitudinal effects of stress and depression on physical activity and cardiorespiratory fitness among youth. Six hundred and seventy-six children, initially aged 8 years, from the LOOK study completed a modified version of the Children's Depression Inventory, the Children's Stress Questionnaire, and objective physical activity and cardiorespiratory fitness assessments on three occasions, every 4 years. Depressive symptoms had a direct effect (longitudinal) on the cardiorespiratory fitness of girls, with a similar trend for boys. In cross-sectional analyses, a child who identified with more symptoms of depression and stress was likely to be less fit and less physically active, which in girls extended to less moderate-to-vigorous physical activity. Our findings, that both physical activity and fitness are impacted by depression and stress may contribute to strategies directed towards achieving enhanced physical activity and reductions in obesity.

The association between depressive symptoms and physical status including physical activity, aerobic and muscular fitness tests in children

OBJECTIVES

The aims of the study were to explore the association between depressive symptoms (DS), physical activity (PA), aerobic and muscular fitness in a sample of children.

METHODS

Four hundred and fifty-six schoolboys aged 7-11-year-old underwent standard anthropometry and various physical fitness tests (e.g., aerobic fitness, strength, speed, power, agility and flexibility). DS and PA were obtained by questionnaires.

RESULTS

After adjustment for potential confounders (e.g., age, socioeconomic status and adiposity), PA was significantly and negatively related to DS (P < 0.05). Among the physical fitness tests, just time in one-mile run/walk was significantly related to DS (P < 0.05).

CONCLUSION

Physical activity and aerobic fitness were significantly correlated with DS; however, no significant relationship was observed between DS and the muscular fitness tests in the children.

Cardiorespiratory Fitness May Help in Protecting Against Depression Among Middle School Adolescents

PURPOSE

Cross-sectional studies demonstrate a robust association between depression, physical activity, and cardiorespiratory fitness in adolescents, but longitudinal evidence that can better parse the direction of these effects is scarce and conflicting, and no such studies in adolescents have considered the importance of fitness (as opposed to physical activity per se) for preventing depression. Therefore, the present study sought to determine if cardiorespiratory fitness in the first year of middle school (sixth grade) would protect against developing depression a year later (seventh grade), even after controlling for other risk factors (i.e., preexisting depression levels and weight status).

METHODS

Participants (N = 437 with 54.9% female) were recruited from six different middle schools during their sixth-grade year and reassessed during the seventh grade. At each assessment, participants completed self-report measures of depression and fitness. Participants were also weighed and were asked to complete a shuttle-run at both points.

RESULTS

A cross-lagged panel model indicated that cardiorespiratory fitness in the sixth grade was associated with significantly less depression by the seventh grade in girls, even after controlling for preexisting depression and weight. The effect was in the same direction for boys, but was nonsignificant. In both cases, effects were modest to small.

CONCLUSIONS

Cardiorespiratory fitness had a small, but significant protective effect against developing depression in middle school girls, and may have a similar but smaller effect in boys. Promotion of cardiorespiratory fitness can be an important strategy for preventing depression in middle school adolescents, but needs to be coupled with interventions that more directly address symptom treatment.

Health-related fitness, body mass index, and risk of depression among adolescents

PURPOSE

The Centers for Disease Control and Prevention indicates that depression is a serious issue for teenagers, with 10% to 15% reporting some symptoms and 15% having considered attempting suicide in 2009.

PURPOSE

The objective of this study is to determine the relations between cardiorespiratory fitness and body mass index (BMI) and depressive symptoms among young adolescents.

METHODS

The sample included 531 females and 455 males in grades 6 to 8. The FITNESSGRAM physical fitness test battery was administered to the participants as part of required school activities. Two results from the test battery, cardiorespiratory fitness and BMI, were used to classify the students into meeting or not meeting the healthy fitness zones established for each test. The Center for Epidemiological Studies-Depression Scale for Children (CES-DC) was administered in the schools to assess behavioral and cognitive aspects of depression. Participants were classified as elevated depression (CES-DC ≥16, n = 295) or normal (<16, n = 691).

RESULTS

Logistic regression was used to assess the relations of Health Fitness Zone status for cardiorespiratory fitness and BMI with depression while controlling for age, ethnicity, sex, economic status (school lunch support), and other fitness factors (cardiorespiratory fitness or BMI). Children classified as not in the Health Fitness Zone for cardiorespiratory fitness had significantly higher odds of elevated depression (odds ratio = 1.71 (95% CI = 1.03-2.84)). BMI was not significantly related to depression.

CONCLUSION

These findings indicate that a healthy level of cardiorespiratory fitness was associated with a lower level of depression as measured by the CES-DC. Because of the cross-sectional nature of this study, no cause and effect relations can be assumed.

The evaluation of a telephonic wellness coaching intervention for weight reduction and wellness improvement in a community-based cohort of persons with serious mental illness

Obesity and metabolic disturbances frequently occur in individuals with psychiatric disorders. This study evaluates a telephonically delivered lifestyle coaching intervention aimed at weight reduction and wellness improvement in psychiatric outpatients. A cohort of 761 participants was prospectively followed up for a period of 12 months. Lifestyle coaching was administered telephonically on a weekly basis for the first 3 months and monthly thereafter. During the study period, there was a significant reduction in weight and waist circumference as well as a significant increase in general health in the completer group. A total of 46% of the participants lost 5% or more of their baseline weight. Significant predictors of attrition at baseline were the presence of metabolic syndrome, younger age, chronic illness, and the diagnosis of a mood disorder. Dropout was significantly less in those participants who received support from a nominated caregiver. Telephonic lifestyle coaching is feasible in this population.

Musculoskeletal pain in overweight and obese children

This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain.

High cardiorespiratory fitness is inversely associated with incidence of overweight in adolescence: a longitudinal study

To assess the association of baseline cardiorespiratory fitness (CRF) with incidence of overweight over a 4.6-year period in adolescence. In a cohort of 4878 adolescents, we assessed body mass index in years 2001-2003 and 2007. CRF was assessed at baseline as maximal oxygen consumption (VO2max , mL/kg/min) using the 20-m shuttle run test and was examined against incidence of overweight at follow-up. Estimated VO2max at baseline was higher in males than in females, P < 0.001, and was lower in overweight and obese than in non-overweight subjects. The incidence of overweight at follow-up among non-overweight participants at baseline was 15.5% [95% confidence interval (CI) 13.7% to 17.3%] in males and 5.6% (95% CI 4.9% to 7.0%) in females, P < 0.001. Adjusted odds ratio for incidence of overweight in participants in the fourth quartile of VO2max was 0.40 (95%CI 0.26 to 0.61) in males and 0.57 (95% CI 0.33 to 0.99) in females in comparison with participants in the first quartiles of VO2max . Incidence of overweight was three times more frequent in males than in females. Among non-overweight at baseline, high fitness levels were inversely associated with incidence of overweight at follow-up, suggesting that interventions aiming to increase CRF in early childhood might help reverse increasing trends in obesity.

Mood disorders in youth: exercise, light therapy, and pharmacologic complementary and integrative approaches

The therapeutic value of physical exercise, bright light therapy and dawn simulation, and several pharmacologic treatments, including hypericum (St. John's wort), S-adenosylmethionine, and 5-hydroxytryptophan, are reviewed, with a focus on their use for treating major depressive disorder in children and adolescents and also for alleviating depressed mood in the general (nonclinical) population of youth. For each treatment discussed, all published randomized, double-blind, placebo-controlled trials are summarized, along with some additional selected studies. Nutritional psychopharmacology and several other approaches to treating depression will be presented in an upcoming volume in the Child and Adolescent Psychiatric Clinics of North America.

Anhedonia: a concept analysis

Anhedonia presents itself in a myriad of disease processes. To further develop our understanding of anhedonia and effective ways to manage it, the concept requires clear boundaries. This paper critically examined the current scientific literature and conducted a concept analysis of anhedonia to provide a more accurate and lucid understanding of the concept. As part of the concept analysis, this paper also provides model, borderline, related, and contrary examples of anhedonia.

Longitudinal study of depressive symptoms and progression of insulin resistance in youth at risk for adult obesity

OBJECTIVE The purpose of this study was to determine whether having childhood depressive symptoms is a risk factor that prospectively predicts impairment in glucose homeostasis. RESEARCH DESIGN AND METHODS A non-treatment-seeking sample of 115 children (aged 5-13 years), oversampled for being at risk for adult obesity, was assessed at baseline and again ~6 years later. Children self-reported depressive symptoms using the Children's Depression Inventory at baseline. Insulin resistance was assessed at baseline and follow-up with the homeostasis model assessment of insulin resistance index (HOMA-IR). RESULTS Children's depressive symptoms were a significant predictor of follow-up HOMA-IR, fasting insulin, and fasting glucose in models accounting for baseline HOMA-IR, insulin, or glucose values; sex; race; baseline age; baseline BMI; change in BMI at follow-up; family history of type 2 diabetes; and time in the study (P < 0.01). CONCLUSIONS In this study, depressive symptomatology at baseline predicted the progression of insulin resistance during child and adolescent development independent of changes in BMI. Research is needed to determine whether early intervention to decrease elevated depressive symptoms in youth ameliorates later development of insulin resistance and lessens the risk of type 2 diabetes.