Longitudinal associations between physical activity and depression scores in Swedish women followed 32 years

Longitudinal association between consecutive moderate-to-vigorous physical activity and the risk of depression among depressed and non-depressed participants: A nationally representative cohort study

The association between moderate-to-vigorous physical activity (MVPA) with depression are clear but needs to be investigated considering dynamic changes in MVPA. We investigated the association of longitudinal changes in MVPA with depression-related outcomes among depressed and non-depressed participants. From 209,095 depressed and 3,777,173 non-depressed participants of South Korea, MVPA was assessed from health screenings during period 1 (2014-15) and 2 (2016-17) using self-reported questionnaires. Participants were followed up from January 1, 2018 to 1-year and 3-year for any diagnosis of depression. Adjusted odds ratio (aOR) and 95 % confidence interval (CI) were calculated using multivariable-adjusted logistic regression analysis. From depressed participants, consistently highly active participants showed the lowest odds for incident depression (aOR 0.81; 95 % CI 0.70-0.95), while those who increased MVPA showed the lowest odds for depressive symptom (aOR 0.77; 95 % CI 0.72-0.82). When combining MVPA status during period 0 (2012-13) for the longitudinal analysis, the participant with depression at period 1 showed a lower odds if they maintained to be physically active before and after depression diagnosis (from period 0 to period 2). We found epidemiologic evidence that longitudinal evaluation for MVPA from pre-depression state may be important on analyzing depression-related risk.

Protective Role of Regular Physical Activity on Mental Health During the COVID-19 Pandemic

Understanding the impacts of lifestyle on mental health has become crucial. This study analyzed whether regular physical activity influences mental health indicators related to major depressive disorder, generalized anxiety, and COVID-19-related anxiety and obsession among Brazilian adults during the pandemic. Additionally, social adjustment and health and disability were assessed to measure broader impacts of physical activity on daily functioning and quality of life during the COVID-19 pandemic, an anxiogenic period. Participants completed sociodemographic, physical activity, and clinical surveys, along with standardized mental health scales: the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the Brazilian version of the Coronavirus Anxiety Scale (CAS-BR), the COVID-19 Obsession Scale (PB-OCS), the Work and Social Adjustment Scale (WSAS), and the WHO Disability Assessment Schedule (WHODAS 2.0). Descriptive analysis characterized the sample, while univariate, bivariate, and multivariate analyses of variance were conducted to explore the influence of physical activity and sex on mental health outcomes. The results indicated that women exhibited poorer mental health outcomes than men across most measures. Engaging in regular physical activity significantly reduced the risk of major depressive disorder in both women and men. Additionally, physically active women-but not men-had a lower likelihood of generalized anxiety and social adjustment impairments. Furthermore, individuals with longer engagement in physical activity (> 5 years) experienced greater mental health benefits compared to those with shorter engagement (< 5 years), particularly for depressive symptoms and generalized anxiety. This study highlights the protective effects of regular physical activity on mental health, with sex-specific differences in its impact. Long-term engagement in physical activity provides greater mental health benefits, reinforcing the importance of promoting sustained participation rather than short-term engagement.

Physical inactivity, depressive symptoms, and progression to sarcopenia in older adults: a 4-year longitudinal study

OBJECTIVES

To examine the combined association of physical inactivity and depressive symptoms with the progression to sarcopenia in community-dwelling older adults.

DESIGN

A 4-year follow-up longitudinal study.

SETTING

Community-dwelling older adults living in Japan, who were not sarcopenic at baseline.

PARTICIPANTS

The participants were 2,538 community-dwelling older adults and with a mean age of 70.9 ± 4.6 years, of whom 1,327 (52.3%) were women.

MEASUREMENTS

Sarcopenia, defined according to the European Working Group on Sarcopenia in Older People 2, was assessed at baseline and at the 4-year follow-up. Participants were divided into four groups according to their inactivity and depressive symptoms. Physical inactivity was assessed using two face-to-face questions regarding the frequency of regular exercise, sports, and light exercise per week. Depressive symptoms were defined as a score of six or higher on the Geriatric Depression Scale 15-item version. Logistic regression analysis was used to determine whether inactivity and depressive symptoms were associated with progression to sarcopenia 4 years later. For participants who could not be followed and participants with missing data in the follow-up assessment, the data at the follow-up assessment were imputed using the multiple imputations.

RESULTS

After 4 years, 518 participants (20.4%) with complete data progressed to sarcopenia. The rate of progression to sarcopenia after multiple imputations was 23.4%. Logistic regression analysis after multiple imputations showed that the group with both factors was significantly associated with the progression to sarcopenia [Odds ratio, 1.64 (95% Confidence interval 1.11-2.44), p = 0.014]. By contrast, no significant association was found for either inactivity or depressive symptoms alone.

CONCLUSION

This study indicates that the coexistence of physical inactivity and depressive symptoms may contribute to the progression of sarcopenia. Addressing both physical and mental factors, rather than limiting the problem to a single factor, may be essential for preventing sarcopenia.

The longitudinal relationship between leisure activities and depressive symptoms among older Chinese adults: an autoregressive cross-lagged analysis approach

BACKGROUND

Existing studies have shown a correlation between leisure activities and depressive symptoms in older adults, but the direction of the longitudinal relationship is inconsistent. This study used an autoregressive cross-lagged model to examine the longitudinal relationship between leisure activity participation and geriatric depression.

METHODS

A total of 7,138 participants aged 60 years or older from the 2nd to the 4th wave of the China Health and Retirement Longitudinal Study (CHARLS) were analysed.

RESULTS

First, present depressive symptoms were significantly associated with future depressive symptoms (β2013-2015 = .893, p < .001; β2015-2018 = .946, p < .001), and the same rule applied to leisure activities (β2013-2015 = .402, p < .001; β2015-2018 = .404, p < .001). Second, current depressive symptoms negatively predicted future leisure activities (β2013-2015 = -.071, p < .001; β2015-2018 = -.085, p < .001), but the inverse relationship was not statistically significant (β2013-2015 = -.003, p > .05; β2015-2018 = -.003, p > .05).

CONCLUSION

These findings underscore the importance of interventions targeting depressive symptoms to potentially enhance engagement in leisure activities among older adults. The results contribute to the understanding of the complex dynamics between mental health and lifestyle choices in older populations, highlighting the potential of proactive mental health interventions to improve overall well-being.

Exercise for the Prevention and Treatment of Depression

Depression is among the world's leading causes of disability and accounts for a significant loss of life. Despite large investments in research for antidepressants and psychotherapies, non-response, partial response, and small effects remain significant problems. Exercise and physical activity are two lifestyle behaviors that have been studied for well over half a century for the prevention and treatment of depression. The aim of this chapter is to summarize the current evidence base supporting the efficacy of exercise and physical activity in the prevention and treatment of depression, including evidence supporting exercise as a monotherapy and adjunct to antidepressant medication and psychotherapies. We conclude the chapter by outlining challenges to prescribing exercise for depression and general recommendations for encouraging behavioral adoption for individuals suffering from depression.

The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth

BACKGROUND

Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data.

OBJECTIVE

This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement.

METHODS

Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA's relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations.

RESULTS

Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40).

CONCLUSIONS

This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions.

TRIAL REGISTRATION

Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/11591.

Investigating the Relationship Between Physical Activity Disparities and Health-Related Quality of Life Among Black People With Knee Osteoarthritis

INTRODUCTION

Knee osteoarthritis (OA) is the most common form of arthritis, which is a leading cause of disability. Although no cure exists for knee OA, physical activity has been shown to improve functionality, which can improve an individual's health-related quality of life (HR-QOL). However, racial disparities exist in participating in physical activity, which can result in Black people with knee OA experiencing lower HR-QOL compared with their White counterparts. The purpose of this study was to investigate disparities of physical activity and related determinants, specifically pain and depression, and how these constructs explain why Black people with knee OA experience low HR-QOL.

METHODS

Data were from the Osteoarthritis Initiative, a multicenter longitudinal study that collected data from people with knee OA. The study used a serial mediation model to test whether a change in scores for pain, depression, and physical activity over 96 months mediated the effects between race and HR-QOL.

RESULTS

Analysis of variance models found Black race to be associated with high pain, depression, and lower physical activity and HR-QOL at baseline and month 96. The findings supported the prospective multi-mediation model, which found pain, depression, and physical activity to mediate between race and HR-QOL (β = -0.11, SE = 0.047; 95% CI, -0.203 to -0.016).

CONCLUSION

Disparities in pain, depression, and physical activity could explain why Black people with knee OA experience lower HR-QOL compared with their White counterparts. Future interventions should address sources of pain and depression disparities by improving health care delivery. Additionally, designing race- and culture-appropriate community physical activity programs would help to achieve physical activity equity.

Persons with rheumatoid arthritis have higher barriers to physical activity than controls: a cross-sectional study using the Facilitators and Barriers to Physical Activity Questionnaire (FasBarPAQ)

Facilitators and barriers to performing physical activity (PA) may vary among persons with rheumatoid arthritis (RA) as well as between RA patients and healthy individuals. Primary objective: To investigate associations of presence of RA and levels of stress and depression with scores for facilitators and barriers to PA, using a new questionnaire (FasBarPAQ). Secondary objectives: investigate inter-individual score differences in persons with RA, and associations with RA disease-specific variables. Persons with RA from two outpatient clinics (n = 203) and blood donor controls (n = 293) filled in the new 14-item FasBarPAQ questionnaire, the Hospital Anxiety and Depression Scale depression scale (HADS-D), Cohen's perceived stress scale, and questions regarding PA. Clinical data, and self-reported disease activity and physical function were collected for the persons with RA. Data were analyzed using linear and logistic regression. RA was associated with lower Facilitators scores (coefficient = - 1.30, p = 0.015), higher Barriers scores (coefficient = 2.36, p < 0.001) and lower Total Facilitators-Barriers scores (coefficient = - 3.67, p < 0.001). HADS-D ≥ 8 was associated with lower Total scores (coefficient = - 3.32, p = 0.022), and the two higher stress score tertiles were associated with higher Barriers and lower Total scores (p = 0.023 to p < 0.001). Persons with RA reported greatly varying facilitators and barriers profiles. Seropositivity and higher patient global assessment were associated with higher Barriers scores (coefficients = 1.79, p = 0.011; 0.60, p < 0.001) and lower Total scores (coefficients = - 3.60, p = 0.003; - 0.98, p < 0.001). Persons with RA had higher barriers and lower facilitators for PA, with varying individual profiles. The new FasBarPAQ questionnaire may be a useful screening tool for healthcare providers treating persons with RA.

A pilot randomized clinical trial of tDCS for increasing exercise engagement in individuals with elevated depressive symptoms: Rationale, design, and baseline characteristics

Regular exercise protects against overweight/obesity as well as numerous chronic diseases. Yet, less than half of Americans exercise sufficiently. Elevated levels of depressive symptoms have been identified as an important correlate of physical inactivity as well as poor adherence to exercise programs. Individuals with depression are less sensitive to rewards and demonstrate an attentional bias toward negative stimuli. These, and other features of depression, may place them at increased risk for effectively managing the affective experience of exercise. Lower baseline levels of activation of the left (vs right) frontal cortex, an area implicated in affect regulation, have also been found in depression, potentially pointing to this region as a potential target for intervening on affect regulation during exercise. Transcranial direct current stimulation (tDCS) has shown promise in impacting a variety of cognitive and affective processes in a large number of individuals, including people with depression. Some findings have suggested that tDCS targeting the left dorsolateral prefrontal cortex (DLPFC), specifically, may improve emotion regulation. Transcranial direct current stimulation could theoretically be a novel and potentially promising approach to improving the affective experience of exercise, thereby increasing exercise adherence among individuals with depressive symptoms. Here we present the rationale, design, and baseline characteristics of a pilot randomized controlled trial of tDCS versus sham delivered 3x/week for 8 weeks in the context of supervised aerobic exercise (AE) program among 51 low-active individuals with elevated depressive symptoms (86.3% female; mean age = 49.5). Follow-up assessments were conducted at end of treatment, and three and six months after enrollment to examine changes in levels of objectively-measured moderate-to-vigorous physical activity (MVPA). If effective, this approach could have high public health impact on preventing obesity and chronic diseases among these at-risk individuals.

Do the Self-Reported Changes in Physical Activity After the Emergence of the COVID-19 Pandemic Associate With Major Depression According to Moderate to Vigorous Physical Activity Status?

BACKGROUND

As the COVID-19 pandemic emerged, and social distancing increased, the physical activity (PA) of people decreased, which increased depression. The purpose of this study was to analyze the relationship between self-reported changes in PA with the COVID-19 pandemic and major depression according to moderate to vigorous physical activity (MVPA) status.

METHODS

This study included 228,457 adults and used data from the Korea Community Health Survey 2020. Multiple logistic regression analysis was performed to evaluate the relationship between self-reported changes in PA and major depression stratified by MVPA status.

RESULTS

The percentage of participants who reported decreases in PA was 39.5% in men and 44.7% in women compared with the pre-COVID-19 pandemic period. Those who reported decreases in PA after the onset of COVID-19 had major depression (men odds ratio = 1.28; 95% confidence interval, 1.15-1.43 and women odds ratio = 1.35; 95% confidence interval, 1.25-1.46). Women who were moderately or vigorously physically active had higher odds of major depression when they reported decreases in PA (odds ratio = 1.31; 95% confidence interval, 1.06-1.62).

CONCLUSIONS

People who reported decreases in PA were associated with major depression compared with the pre-COVID-19 pandemic period. Based on this, the government should encourage exercise to reduce major depression and provide guidelines for PA at home or outdoors.

Physical Activity and Risks of Cardiovascular Diseases: A Mendelian Randomization Study

Background: Although some observational studies have shown that physical activity may have a positive relationship with cardiovascular diseases, the causal effect remains uncertain. We conducted a Mendelian randomization (MR) study to identify the potential causal effect between physical activity and cardiovascular diseases.

Methods: Summary statistics of genome-wide association studies on four physical activity phenotypes and cardiovascular diseases were utilized. MR analysis was performed using inverse-variance weighted (IVW) and multivariable MR. Multiple sensitivity analysis was further conducted to identify the robustness of our results.

Results: Genetically predicted self-reported vigorous physical activity (VPA) was significantly associated with lower risk of myocardial infarction (IVW OR: 0.24, 95% CI: 0.08–0.68, p-value: 0.007). Additionally, the causal effect of VPA with myocardial infarction was robust after adjusting for several cardiovascular risk factors through using the multivariable MR. There were no apparent causal associations between physical activity with other cardiovascular diseases. Results were consistent with the sensitivity analysis.

Conclusion: The present study supports a protective role of self-reported vigorous physical activity in the initiation of myocardial infarction and highlights the importance of activity levels of physical activity. Further studies are required to elucidate the potential biological pathways of physical activity with cardiovascular diseases.

Bi-directional relationships between physical activity and mental health among a large sample of Canadian youth: a sex-stratified analysis of students in the COMPASS study

OBJECTIVE

The aim of this research was to examine the bidirectional association between self-reported symptoms of mental disorder and physical activity among a large sample of Canadian secondary school students over time.

METHODS

Linked survey data were obtained from 28,567 grade 9 to 12 students across Canada participating in two waves of the COMPASS Study (2017-18; 2018-19). Autoregressive cross-lagged models were run to examine the reciprocal relationships between self-reported moderate-to-vigorous physical activity (MVPA) and symptoms of depression (CESD-10) and anxiety (GAD-7). Models were stratified by gender, and accounted for grade, ethno-racial identity, and school-level clustering.

RESULTS

Autoregressive associations show that neither symptoms of anxiety nor depression, at baseline, were predictive of mean MVPA at follow-up - consistent for the full sample and among both males and females. Higher MVPA among males at baseline was associated with lower symptoms of both anxiety (β = - 0.03, p = 0.002) and depression (β = - 0.05, p < 0.001) at follow-up. However, among females, higher MVPA at baseline was associated with greater symptoms of anxiety (β = 0.03, p < 0.001), but not symptoms of depression (β = 0.01, p = 0.073), at follow-up.

CONCLUSION

In our large sample of Canadian secondary school students, associations between physical activity and symptoms of mental disorder were not bi-directional, and these relationships differed in males and females. This study illustrates the complex nature of the relationship between physical activity and symptoms of mental disorder among youth. While results support the benefits of promoting physical activity among males to prevent or manage internalizing symptoms, the relationship among females warrants further investigation.

When Much Is Too Much-Compared to Light Exercisers, Heavy Exercisers Report More Mental Health Issues and Stress, but Less Sleep Complaints

BACKGROUND

Physical inactivity has become a global somatic and mental health issue. To counterbalance, promoting regular physical activity appears plausible, above all among adults, where physical inactivity is particularly high. However, some, but sparse, research also indicates that excessive exercising might be associated with unfavorable mental health dimensions. Here, we tested the hypothesis that excessive exercising was associated with more mental health issues. To this end, we assessed mental health issues, stress, mental toughness, and sleep disturbances among heavy and light adult exercisers.

METHODS

A total of 200 adults (mean age: 35 years; 62% females) took part in the study. Of those, 100 were heavy exercisers (18-22 h/week), and 100 were light exercisers (1-6 h/week). Participants completed questionnaires covering sociodemographic information, mental health issues, perceived stress, mental toughness, and sleep disturbances.

RESULTS

Compared with light exercisers, heavy exercisers reported higher mental health issues, more stress, but also higher mental toughness scores and less sleep disturbances. Higher age, lower mental toughness scores, heavy exerciser-status, and more sleep disturbances predicted higher mental health complaints.

CONCLUSIONS

Compared with light exercising, heavy exercising might be associated with more mental health issues. As such, it appears that the association between exercise frequency, intensity, and duration and psychological well-being might be related to an optimum point, but not to a maximum point. In a similar vein, heavily exercising athletes, their coaches, parents, and representatives of sports associations should get sensitized to possible adverse psychological effects of excessive physical activity patterns.

Towards an understanding of how stress and resources affect the nonmedical use of prescription drugs for performance enhancement among employees

Based on assumptions of the Job Demands-Resources model, we investigated employees’ willingness to use prescription drugs such as methylphenidate and modafinil for nonmedical purposes to enhance their cognitive functioning as a response to strain (i.e., perceived stress) that is induced by job demands (e.g., overtime, emotional demands, shift work, leadership responsibility). We also examined the direct and moderating effects of resources (e.g., emotional stability, social and instrumental social support) in this process. We utilized data from a representative survey of employees in Germany (N = 6454) encompassing various job demands and resources, levels of perceived stress, and willingness to use nonmedical drugs for performance enhancement purposes. By using Structural Equation Models, we found that job demands (such as overtime and emotional demands) and a scarcity of resources (such as emotional stability) increased strain, consequently directly and indirectly increasing the willingness to use prescription drugs for cognitive enhancement. Moreover, emotional stability reduced the effect of certain demands on strain. These results delivered new insights into mechanisms behind nonmedical prescription drug use that can be used to prevent such behaviour and potential negative health consequences.

Towards an active and happy retirement? Changes in leisure activity and depressive symptoms during the retirement transition

Objectives: Retirement is a major life transition in the second half of life, and it can be associated with changes in leisure activity engagement. Although theories of retirement adjustment have emphasized the need to find meaningful activities in retirement, little is known about the nature of changes in leisure activity during the retirement transition and their association with mental health.Methods: Based on four annual waves of the 'Health, Aging and Retirement Transitions in Sweden' study, we investigated the longitudinal association of leisure activity engagement and depressive symptoms using bivariate dual change score models. We distinguished intellectual, social, and physical activity engagement.Results: We found increases in all three domains of activity engagement after retirement. Although level and change of activity and depressive symptoms were negatively associated, the coupling parameters were not significant, thus the direction of effects remains unclear.Conclusion: The results highlight the need to consider the role of lifestyle changes for retirement adjustment and mental health.

Disease prevalence and number of health care visits among members of a nationwide sports organization compared to matched controls

Background

Physical activity has positive effects on several diseases and may reduce the risk of morbidity and the mortality rate. Whether the prevalence of disease and health care consumption differ between the members of sports organizations and the general population has not been established. Hence, this pilot study aimed to compare the prevalence of diseases known to be associated with physical inactivity and health care consumption in members of a large non-profit sports organization and an age-, sex- and geographically matched random sample from the general population.

Methods

Subjects in two Swedish cities who exercised at least once a week and had been members for at least two years in the non-profit sports organization Friskis&Svettis were invited. A randomized age-, sex- and geographically matched sample was drawn from the general population. Data on disease prevalence (by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes) and health care consumption were retrieved using the members’ personal identification numbers through a regional health care database. Between-group differences in the prevalence of disease were compared using chi²-tests and logistic regression between members and controls. Health care consumption was defined as the number of visits, stratified by primary and hospital care, and was compared using chi²-tests and Mann-Whitney U-tests.

Results

In total, 3015 subjects were included in each group (response rate 11%). Controls had higher prevalence rates of musculoskeletal diseases (13.3% vs. 11.6%, p = 0.047), metabolic disease (10.4% vs. 5.4%, p < 0.001), hypertension (16.6% vs. 11.7%, p < 0.001), psychiatric diseases (8.9% vs. 7.1%, p = 0.012) and lung cancer (0.4% vs. 0%, p = 0.001) than the members. The total number of health care contacts was 22% higher in the controls than in the members, whereas the proportion of subjects with at least one health care visit was larger in the members (89% vs. 79%, p < 0.001).

Conclusions

The prevalence rates of lifestyle diseases related to musculoskeletal, metabolic and psychiatric diseases, hypertension and lung cancer, and the overall health care consumption, were lower among members of a sports organization than among controls. However, longitudinal studies are needed to establish a cause-effect relationship between membership and disease development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10466-9.

Objective measures of physical performance associated with depression and/or anxiety in midlife Singaporean women

OBJECTIVES

The aim of this study was to identify correlates of depression and anxiety in midlife Asian women, with a special focus on the potential role of objectively measured physical performance.

METHODS

Sociodemographic characteristics, reproductive health, menopause status, medical history, lifestyle choices, physical activity, and physical performance of healthy women aged 45 to 69 attending routine gynecologic care were collected. Depressive symptoms were assessed utilizing the Center for Epidemiologic Studies for Depression Scale (CES-D) and anxiety symptoms by the General Anxiety Disorder Scale (GAD-7). Upper body physical performance was assessed by handgrip strength, and lower body physical performance was assessed by the Short Physical Performance Battery. Chi-square tests and multivariable models were used to assess the crude and adjusted associations, respectively, between the studied risk factors and depression and/or anxiety. The main outcome measures were elevated depressive symptoms ≥16 on the CES-D, and/or elevated anxiety symptoms >10 on the GAD-7 score.

RESULTS

Of 1,159 women (mean age 56.3 ± 6.2), 181 (15.9%) were identified as having depressive and/or anxiety symptoms. Weak upper body (handgrip strength) and poor lower body strength (longer duration to complete the repeated chair stand test) were associated with elevated depressive and/or anxiety symptoms (adjusted odds ratio [aOR], 1.68; 95% CI, 1.18-2.40) and (aOR, 1.33; 95% CI, 1.09-1.63), respectively.

CONCLUSIONS

Weak upper and lower body physical performances were associated with depressive and anxiety symptoms in midlife Singaporean women. Future trials are required to determine whether strengthening exercises that improve physical performance could help reduce depressive and anxiety symptoms in midlife women. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A419.

Impact of physical activity and sport on social outcomes among Aboriginal and Torres Strait Islander people: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify and describe existing research on the impact of sport and physical activity programs on social outcomes among Aboriginal and Torres Strait Islander people in Australia.

INTRODUCTION

Physical activity can be particularly beneficial for groups such as Indigenous populations, who have increased rates of chronic disease. Systematic reviews have demonstrated the positive impact of physical activity on a range of health indicators, and there is also support for the positive impact of physical activity on wider social outcomes. However, there is a lack of evidence for the benefits of physical activity for broader social outcomes among Aboriginal and Torres Strait Islander people.

INCLUSION CRITERIA

This scoping review will consider studies that include Aboriginal and Torres Strait Islander people of any age from any setting or region of Australia. Studies will be considered if they report on programs or activities that use physical activity and sport participation as a component or tool to improve one or more of six social and community outcomes: education, employment, culture, social wellbeing, life skills and crime prevention.

METHODS

Nine databases will be searched, as well as a selection of websites containing resources related to physical activity, sport and social outcomes for Aboriginal and Torres Strait Islander people. Studies published in English will be included. No date limits will be set. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. Data extraction will be presented in a table with accompanying narrative.

Physical activity as prognostic factor for bipolar disorder: An 18-month prospective study

INTRODUCTION

Exercise is an adjuvant therapy indicated for various psychiatric disorders. However, prospective studies in patients with bipolar disorder (BD) are scarce and with uncertain conclusions. This study aims to evaluate physical activity as a prognostic factor for BD, analyzing relationship with levels of anxiety, functionality, sleep, mood episodes and hospitalizations.

METHODS

Three psychiatrists interviewed 80 BD outpatients in euthymia, referred from four different institutions in Brazil. In this moment, they evaluated the intensity of physical activities using the International Physical Activity Questionnaire (IPAQ) - short form. They reevaluated patients and reviewed medical records monthly for 18 months to identify mood episodes and psychiatric hospitalizations.

RESULTS

Thirty-eight patients (47.5%) were physically inactive (or sedentary) and 42 (52.5%) active. Physically active patients had lower Body Mass Index (p = 0.006), waist circumference (p = 0.002), lower levels of anxiety (p = 0.032) and less insomnia (p = 0.001). Sedentary individuals revealed poorer global functioning (p < 0.001) and in all domains: autonomy (p < 0.001), occupational functioning (p = 0.008), cognitive functioning (p = 0.013), capacity of managing the finances (p = 0.012), interpersonal relationships (p = 0.011) and leisure time (p = 0.001). Less activity was associated with more mood episodes (p = 0.042) and psychiatric hospitalizations (p = 0.043) over 18 months.

CONCLUSION

This study suggested physical activity as a good prognostic factor for BD during euthymia. This reinforces the need to encourage this practice in clinical settings. Future prospective surveys with longer duration using objective instruments are proposed.

Mental health disorders and physical risk factors in children with cerebral palsy: a cross-sectional study

AIM

To examine the prevalence of mental health disorders among children with and without cerebral palsy (CP), and to examine how physical risk factors in children with CP might mitigate any elevated risk of mental health disorders in this population.

METHOD

Children from 6 years to 17 years of age with (n=111) and without (n=29 909) CP from the 2016 National Survey of Children's Health were included in this cross-sectional study. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention deficit disorder/attention-deficit/hyperactivity disorder (ADHD). Physical risk factors included physical activity (number of active days ≥60min), sleep duration, and pain.

RESULTS

Adjusting for sociodemographics, children with CP had higher odds of mental health disorders (odds ratio [OR]=2.7-7.1, p<0.05) except for attention deficit disorder/ADHD (OR=2.5; 95% confidence interval [CI]=0.9-7.1). Further adjusting for physical factors, the odds of depression were no longer increased (i.e. attenuated) in children with CP (OR=1.0; 95% CI=0.3-3.3); however, the odds of anxiety (OR=3.8; 95% CI=1.9-7.8) and behavior/conduct problems (OR=3.8; 95% CI=1.3-11.1) remained elevated. Assessed individually, low physical activity and pain attenuated the odds of depression in children with CP (OR=1.9; 95% CI=0.7-5.3; OR=1.4; 95% CI=0.6-3.8 respectively).

INTERPRETATION

Children with CP have an elevated prevalence of mental health disorders even after accounting for physical risk factors. Low physical activity and pain partially accounts for the association between CP and depression.

WHAT THIS PAPER ADDS

Children with cerebral palsy (CP) have an elevated risk of developing mental health disorders. Physical factors do not fully account for higher mental health disorder prevalence. Physical activity partially accounts for the relationship between CP and depression. Pain partially accounts for the relationship between CP and depression.

Factors associated with depression and anxiety in children with intellectual disabilities

BACKGROUND

Individuals with intellectual disabilities (ID) are at increased risk for depression and anxiety disorders; however, there is a paucity of research that pertains to associative factors for these mental health disorders in this population. The objective of this investigation was to determine factors associated with depression and anxiety problems in children with ID.

METHODS

Children 6-17 years with ID (n = 423; 63% male) from the 2016 National Survey of Children's Health were included in this cross-sectional study. Outcome measures included depression and anxiety problems. Predictor variables included sociodemographics, ID severity, co-morbid conditions (autism spectrum disorders, epilepsy, cerebral palsy, Down syndrome and attention-deficit/hyperactivity disorder), physical factors (i.e. physical activity, sleep duration and pain) and social factors (e.g. participation in activities and bully victimisation). Multivariable logistic regression was performed to determine the association between all factors and depression and/or anxiety problems among children with ID.

RESULTS

The prevalence of depression and/or anxiety problems was 35.4%. After adjusting for sociodemographics, Hispanic race was associated with lower odds [odds ratio (OR), 0.3; 95% confidence interval (CI), 0.1-0.8] of depression and/or anxiety problems. After adjusting for race, co-morbid conditions, and physical and social factors, autism spectrum disorders (OR, 4.4; 95% CI, 1.1-10.1), Down syndrome (OR, 0.2; 95% CI, 0.1-0.8), attention-deficit/hyperactivity disorder (OR, 5.9; 95% CI, 2.5-14.3), pain (OR, 7.0; 95% CI, 2.9-17.1) and bully victimisation (OR 2.3; 95% CI, 1.0-5.3) were each associated with depression and/or anxiety problems.

CONCLUSIONS

The present study identified both treatable and modifiable, as well as unmodifiable, factors associated with depression and/or anxiety problems in children with ID.

Leisure time physical activity and incident use of prescription tranquilizers: A longitudinal population-based study

OBJECTIVE

Physical inactivity is a major public health problem associated with an increased risk of several psychiatric and physical conditions. This study investigated the association between leisure time physical activity (PA) and incident use of prescription tranquilizers in a regionally representative and prospective cohort.

METHODS

A total of 4043 men and women (mean age: 61.3 years; 57% women) from the Tromsø Study were followed for six years. Leisure time PA was captured at baseline. Psychiatric morbidity was measured by use of prescription tranquilizers, captured at both baseline and follow-up. Leisure time PA at baseline was used as a predictor of subsequent (incident) use of prescription tranquilizers. We used multinomial regression models and Poisson regression models to estimate relative risk-ratios (RRRs), and relative risks (RRs), respectively, and their corresponding 95% confidence intervals (CIs).

RESULTS

In the fully-adjusted model, accounting for socio-demographic factors, parental history of psychopathology, years of education, smoking, respondent's psychopathology at baseline, and occupational PA, a lower leisure time PA conferred a 41% increased risk of incident use of prescription tranquilizers at follow-up (RR = 1.41, 95% CI: 1.09, 1.83; p = 0.010).

CONCLUSIONS

These findings suggest that physical inactivity increases the risk of psychiatric morbidity (albeit, measured via use of prescription tranquilizers). Future regionally representative and longitudinal research is required to confirm/refute our findings and explore underlying mechanisms.

Leisure time physical activity and future psychological distress: A thirteen year longitudinal population-based study

A number of cross-sectional studies have suggested that physical activity (PA) is negatively associated with psychological distress in adulthood. A paucity of regionally representative and longitudinal studies has considered this relationship. This study investigated the association between leisure time light and moderate-vigorous PA (MVPA) and psychological distress over 13 years in a regionally representative sample. A total of 4754 men (mean age: 47.2 years) and 5571 women from (mean age: 46.9 years) the Tromsø Study were followed for 13 years. Light PA and MVPA was captured at baseline and psychological distress was captured using the Hopkins Symptom Check List-10 scale. Ordinary least square and Poisson regression models were used, adjusting for multiple confounders to investigate the relationship between light PA/MVPA and psychological distress. In the fully-adjusted model, accounting sociodemographics, history of parental psychopathology, socioeconomic status, marital status, smoking, social support and risk factors, we found evidence that both light PA (β 0.11, 95% CI: 0.03, 0.19; p < 0.01) and MVPA (β 0.19, 95% CI: 0.12, 0.26; p < 0.001) confered protection against psychological distress at follow-up. Among men, a lower MVPA was associated with 14% (RR = 1.14, 95% CI: 1.01, 1.28) increased risk of clinically significant psychological distress; while among women, the risk was 15% (RR = 1.15, 95% CI: 1.06, 1.26; p < 0.001). In this regionally representative cohort, our study suggests that both higher levels of light PA and MVPA confer protection against future psychological distress. However, a key limitation of this study is that psychological distress at baseline was not controlled-for.

Discrimination against Obese Exercise Clients: An Experimental Study of Personal Trainers

The aim of the study was to compare exercise recommendations, attitudes, and behaviors of personal trainers toward clients of different weight statuses. Fifty-two personal trainers participated in the study. The data collection was organized into two phases. In phase one, trainers read a profile and watched the video displaying an interview of either an obese or an average-weight client. Profiles and video interviews were identical except for weight status. Then, trainers provided exercise recommendations and rated their attitude toward the client. In phase two, trainers personally met an obese or an average-weight mock client. Measures were duration and number of advices provided by the trainer to a question posed by the client and sitting distance between trainer and client. There were no significant differences in exercise intensity (p = .94), duration of first session (p = .65), and total exercise duration of first week (p = .76) prescribed to the obese and average-weight clients. The attitude of the personal trainers toward the obese client were not significantly different from the attitude of personal trainers toward the average-weight client (p = .58). The number of advices provided (p = .49), the duration of the answer (p = .55), and the distance personal trainers sat from the obese client (p = .68) were not significantly different from the behaviors displayed toward the average-weight client. Personal trainers did not discriminate against obese clients in professional settings.

Bouldering psychotherapy reduces depressive symptoms even when general physical activity is controlled for: A randomized controlled trial

Background

Bouldering psychotherapy (BPT) combines psychotherapeutic elements with physical activity (PA). It might be effective for reducing symptoms of depression, but so far, no study has assessed individuals' levels of PA to control for whether positive effects on depression can also be found when adjusting for participants' levels of PA. This is important because PA itself has been proven effective in reducing depression and therefore might be an important variable to account for – especially in therapies using sport as one therapeutic mechanism.

Methods

Using a waitlist control group design, outpatients with depression were assessed at baseline and after eight, 16, and 24 weeks. The intervention group took part in an eight-week bouldering psychotherapy which met once a week for three hours. Self-report measures before and after the intervention included the Symptom Checklist-90-R (SCL-90-R), the Beck Depression Inventory (BDI-II), and the questionnaire on resources and self-management skills (FERUS). PA was assessed during the first 16-week period via FitBit Zip accelerometers.

Results

Altogether, 47 complete cases (20 men and 27 women) were included in the final analyses. Depression scores dropped by up to 6.74 (CI 2.80–10.67) points on the SCL-90-R depression scale and by up to 8.26 (CI 4.21–12.31) points on the BDI-II during the BPT intervention, the control group remained stable (SCL-90-R Cohen's d = 0.60; BDI-II: Cohen's d = .50). All Participants accrued an average of 6,515 steps per day, which is considered “low-active.” Participants of the BPT intervention were significantly more likely to reduce their depressive symptoms (p = .025) than participants of the control group, even when PA was controlled for in a regression analysis.

Limitations

Limitations of the study are the relatively small number of patients and the assessment of outcome scores via self-report.

Conclusions

This study provides evidence that short-term BPT can be effective for reducing symptoms of depression even if controlled for other therapeutically active confounders including antidepressant medication, psychotherapy and general level of PA.

Is the link between movement and mental health a two-way street? Prospective associations between physical activity, sedentary behaviour and depressive symptoms among women living in socioeconomically disadvantaged neighbourhoods

This study aimed to investigate the bi-directional relationship between different domains of physical activity (PA), sedentary behaviour (SB) and depressive symptoms among women living in socioeconomically disadvantaged neighbourhoods in Victoria, Australia. Women (n=1033), aged 18-46years at Wave 1 (2007/08), completed self-report measures of PA (leisure-time, transport, occupational, domestic), SB (TV viewing, computer use, overall sitting time) and depressive symptoms (CES-D 10) at each study time-point (Wave 2: 2010/11, Wave 3: 2012/13). Separate linear mixed models were fitted to examine if change in depressive symptoms differed dependent on each of the baseline PA or SB measures. Similarly, baseline depressive symptoms were used as a predictor of change in PA and SB. In secondary analyses, associations between baseline PA or SB and odds of becoming 'at risk' of depression among those not 'at risk' at baseline were examined using logistic regression. There was no evidence that change in depressive symptoms differed depending on PA or SB at baseline. In general, there was also no evidence that change in PA or SB differed depending on baseline depressive symptoms. One exception was change in leisure-time PA, which declined more among those with heightened depressive symptoms at baseline (Interaction: β=-0.003, 95% CI=-0.007, -0.0003). Transport-related PA (adjusted OR=1.06, 95% CI=1.013, 1.101) and domestic PA (adjusted OR=1.02, 95% CI=1.003, 1.040) were associated with greater odds of becoming at risk of depression at wave 3. There was limited evidence of a bi-directional relationship between PA, SB and depressive symptoms in women living in socioeconomically disadvantaged neighbourhoods.

Sit, step, sweat: longitudinal associations between physical activity patterns, anxiety and depression

BACKGROUND

Physical inactivity has been identified as a risk factor for depression and, less often, as a long-term consequence of depression. Underexplored is whether similar bi-directional longitudinal relationships are observed for anxiety disorders, particularly in relation to three distinct indicators of activity levels - sports participation, general physical activity and sedentary behavior.

METHOD

Participants were from the Netherlands Study of Depression and Anxiety (NESDA; N = 2932, 18-65 years old; 57% current anxiety or depressive disorder, 21% remitted disorder, 22% healthy controls). At baseline, 2, 4, and 6 years, participants completed a diagnostic interview and self-report questionnaires assessing psychopathology symptom severity, physical activity indicators, and sociodemographic and health covariates.

RESULTS

Consistently across assessment waves, people with anxiety and/or depressive disorders had lower sports participation and general physical activity compared to healthy controls. Greater anxiety or depressive symptoms were associated with lower activity according to all three indicators. Over time, a diagnosis or greater symptom severity at one assessment was associated with poorer sports participation and general physical activity 2 years later. In the opposite direction, only low sports participation was associated with greater symptom severity and increased odds of disorder onset 2 years later. Stronger effects were observed for chronicity, with lower activity according to all indicators increasing the odds of disorder chronicity after 2 years.

CONCLUSIONS

Over time, there seems to a mutually reinforcing, bidirectional relationship between psychopathology and lower physical activity, particularly low sports participation. People with anxiety are as adversely affected as those with depression.

Bidirectional longitudinal relationship between leisure-time physical activity and psychotropic medication usage: A register linked follow-up study

This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (≥14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007-10) psychotropic medication purchasing according to changes in physical activity (phases 1-2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1-2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage.

Longitudinal Mediation Modeling of Unhealthy Behaviors as Mediators between Workplace Demands/Support and Depressive Symptoms

Lifestyle has been regarded as a key pathway through which adverse psychosocial working characteristics can give rise to long-term health problems. The purpose of this study was to estimate the indirect/mediated effect of health behaviors in the longitudinal work characteristics-depression relationship. The analyses were based on the Swedish Longitudinal Occupational Survey of Health, including 3706 working participants with repeat survey measures on four occasions (2008, 2010, 2012 and 2014). Psychosocial work characteristics including demands and social support were analyzed in relation to depressive symptoms. Autoregressive longitudinal mediation models using structural equation modeling were used to estimate the intermediate effects of unhealthy behaviors including current smoking, excessive alcohol consumption, unhealthy diet and physical inactivity. Both workplace demands and social support were related to later depressive symptoms. In bivariate models we found no significant paths from workplace demands to health behaviors, but two out of three significant time-specific paths from workplace support to excessive drinking and from excessive drinking to depressive symptoms. Social support was also associated with subsequent unhealthy diet, and one path from unhealthy diet to depressive symptoms was found. However, despite indications of certain longitudinal relationships between psychosocial working conditions and health behaviors as well as between health behaviors and depressive symptoms, no significant intermediate effects were found (p>0.05). We conclude that changes in unhealthy behaviors over a period of two years are unlikely to act as strong intermediaries in the longitudinal relationship between job demands and depressive symptoms and between social support and depressive symptoms.

Examining acute bi-directional relationships between affect, physical feeling states, and physical activity in free-living situations using electronic ecological momentary assessment

Current knowledge about the relationship of physical activity with acute affective and physical feeling states is informed largely by lab-based studies, which have limited generalizability to the natural ecology. This study used ecological momentary assessment to assess subjective affective and physical feeling states in free-living settings across 4 days from 110 non-physically active adults (Age M = 40.4, SD = 9.7). Light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were measured objectively by an accelerometer. Multilevel modeling was used to test the bi-directional associations between affective and physical feeling states and LPA/MVPA minutes. Higher positive affect, lower negative affect and fatigue were associated with more MVPA over the subsequent 15 min, while higher negative affect and energy were associated with more LPA over the subsequent 15 and 30 min. Additionally, more LPA and MVPA were associated with feeling more energetic over the subsequent 15 and 30 min, and more LPA was additionally associated with feeling more negative and less tired over the subsequent 15 and 30 min. Positive and negative affective states might serve as antecedents to but not consequences of MVPA in adults' daily lives. Changes in LPA may be predicted and followed by negative affective states. Physical feeling states appear to lead up to and follow changes in both LPA and MVPA.

A Longitudinal Investigation of Anxiety and Depressive Symptomatology and Exercise Behaviour Among Adults With Type 2 Diabetes Mellitus

OBJECTIVES

Evidence suggests that symptoms of depression and anxiety predict lower exercise behaviour and, inversely, that less exercise predicts higher symptomatology. The present longitudinal study examined this reciprocal association in adults with type 2 diabetes mellitus. We predicted that symptoms of anxiety or depression would intensify over time as a consequence of lower exercise frequency and, similarly, that exercise frequency would decrease as a consequence of greater symptoms of anxiety or depression.

METHODS

We studied 1691 adults with type 2 diabetes who provided baseline measures in 2011 and 2 subsequent annual assessments (Follow-up 1 and Follow-up 2). Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. A single item assessed exercise frequency in the past month (in days).

RESULTS

Separate 3-wave cross-lagged path models for symptoms of anxiety and depression tested the reciprocal associations. Contrary to our hypotheses, the reciprocal associations were not supported and, by extension, the predicted secondary associations were not tested. In sum, only depressive symptoms negatively predicted subsequent exercise frequency (Follow-up 1 and Follow-up 2).

CONCLUSIONS

Symptoms of depression were prospectively associated with lower exercise frequency, which is consistent with evidence from population-based studies that identify depressive symptoms as a barrier to exercise participation.

Habitual physical activity levels predict treatment outcomes in depressed adults: A prospective cohort study

OBJECTIVE

Exercise is an efficacious stand-alone therapy for mild-to-moderate depression, but little is known about the influence of physical activity levels on responses to depression treatment. This study aimed to prospectively assess the association between self-reported habitual physical activity levels and depression severity following a 12-week intervention.

METHOD

629 adults (75% women; aged 18-71years) with mild-to-moderate depression were recruited from primary care centres across Sweden and treated for 12weeks. The interventions included internet-based cognitive behavioural therapy (ICBT) and 'usual care' (CBT or supportive counselling). One third of all participants were taking anti-depressant medication. The primary outcome was the change in depression severity assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Habitual physical activity levels were self-rated and based on the estimated frequency, duration and intensity of total physical activity, including planned exercise, 'during a typical week'. Prospective associations were explored using linear regression models (percentage change) with 95% confidence intervals (CI's).

RESULTS

Following adjustment for relevant covariates, high levels of habitual physical activity were associated with larger relative reductions in depression severity compared to low physical activity (β=-9.19, 95% CI=-18.46, -0.09, p=0.052) and moderate physical activity (β=-10.81, 95% CI=-21.09, -0.53, p<0.05), respectively.

CONCLUSION

Adults who routinely engage in high levels of physical activity respond more favourably to CBT-focused depression treatments than adults who engage in low-to-moderate levels of activity. The optimal level of physical activity associated with reductions in depression severity corresponds to consensus recommendations for maximizing general health. One limitation is the use of self-reported physical activity data.