Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews

Accelerometer-derived "weekend warrior" physical activity, genetic susceptibility, and risk of depression and anxiety: The UK Biobank study

IMPORTANCE

Guidelines recommend 150 min per week (min/wk) or more of moderate to vigorous physical activity (MVPA) for mental health benefits. However, the relative effects of concentrated against more evenly distributed activity patterns remain unclear.

OBJECTIVE

We aimed to examine associations of the accelerometer-derived "weekend warrior (WW)" pattern (MVPA concentrated within 1 to 2 days) vs MVPA spread more evenly with risk of depression and anxiety.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study included 84,570 participants with accelerometer data identified from the UK Biobank.

EXPOSURES

Three MVPA patterns were compared: active WW (MVPA ≥150 min/wk and ≥50 % of total MVPA within 1 to 2 days), active regular (MVPA ≥150 min/wk but not active WW), and inactive (MVPA <150 min/wk).

MAIN OUTCOMES AND MEASURES

Cox regression was used to assess the association of MVPA patterns with depression and anxiety, and whether the association differed by different levels of sedentary time (≤6, 7-12, ≥13 h/day) and light physical activity (≤60, 61-150, ≥151 min/day). We also evaluated the combined impact of MVPA patterns and genetic susceptibility on depression and anxiety.

RESULTS

During the follow-up of up to 9.40 years, 2098 and 2699 cases of depression and anxiety were identified, respectively. Compared with inactive group, active regular and active WW groups exhibited similarly reduced risks of depression (active regular: HR, 0.74 [95 % CI, 0.66-0.84]; active WW: 0.72 [0.65-0.80]) and anxiety (active regular: 0.77 [0.69-0.86]; active WW: 0.72 [0.66-0.79]). The impact of active regular and active WW groups on depression and anxiety was more pronounced among individuals with excessive sedentary time (≥13 h/day) and insufficient light physical activity (≤60 min/day). Individuals with low genetic risk and active regular (depression: 0.64 [0.48-0.87]; anxiety: 0.62 [0.49-0.79]), as well as low genetic risk and active WW groups (depression: 0.60 [0.47-0.77]; anxiety: 0.59 [0.48-0.72]) exhibited the lowest risks of depression and anxiety compared to those with high genetic risk and inactive group.

CONCLUSIONS AND RELEVANCE

Adherence to active physical activity, regardless of physical activity concentrated within 1 to 2 days or more evenly distributed, may help reduce depression and anxiety risks across a population with different genetic risk profiles.

Interplay of Physical Activity, Muscle Strength, and Depression in Cognitive Impairment among Korean Older Adults: A Cross-sectional Study

Objective

The present study was to investigate the association of physical activity (PA), relative-handgrip strength (RHGS), depressive symptoms, and cognitive impairment in Korean older adults.

Methods

This study included 512 community-dwelling Korean older adults (417 female, 95 male) aged ≥ 65 years (74.8 ± 5.4 years). PA and RHGS were assessed using an accelerometer and dynamometer, respectively. Depressive symptoms were evaluated by the Korean form of the Center for Epidemiologic Studies Depression (CES-D) Scale. Cognitive impairment was assessed through the Mini-Mental State Examination for Dementia Screening (MMSE-DS).

Results

Multiple logistic regression analysis revealed that depressive symptoms (odds ratio [OR] = 2.676, 95% confidence interval [CI]: 1.594-4.492, p < 0.001) showed a significant association with increased odds of cognitive impairment compared with normal depression status (OR = 1). Depressive symptoms had both direct and indirect effects on cognitive impairment. Both PA and RHGS partially mediated the relationship between depressive symptoms and cognitive impairment (PA: effect [B] = -0.017, 95% CI: -0.028 to -0.009, p < 0.001; RHGS: B = -0.005, 95% CI: -0.007 to -0.003, p < 0.001). Serial mediation analysis further indicated that the association between depressive symptoms and cognitive impairment was sequentially mediated by PA and RHGS (B = -0.004, 95% CI: -0.006 to -0.002, p < 0.001).

Conclusion

Promoting PA among older adults may be crucial, as this helps improve and maintain muscular strength and mitigates the negative impact of depressive symptoms on cognitive impairment.

Changes in Leisure-Time Physical Activity and Sedentary Time and Their Associations With Psychological Distress: An Occupational Cohort Study

BACKGROUND

Physical inactivity and sedentary behavior are associated with mental ill-health. We examined changes in leisure-time physical activity (LTPA) and sedentary time, and their associations with psychological distress in an occupational cohort.

METHODS

We used phase 1 survey data, collected among the employees of the City of Helsinki, Finland, aged 19-39 years in 2017, and phase 2 follow-up survey from 2022 (n = 1914 participants, 75% women). A 4-category variable (High→High, Low→High, High→Low, and Low→Low) was constructed for both LTPA and sedentary time to reflect the change over time. The 21-item Depression, Anxiety and Stress Scale was used to measure psychological distress. Logistic regression analysis estimated odds ratios (ORs) and their 95% CIs, adjusting for sociodemographic factors, working conditions, health-related factors, and physician-diagnosed mental disorders at phase 1.

RESULTS

Repeated low LTPA was associated with anxiety (OR = 2.03; 95% CI, 1.44-2.85), depressive (OR = 1.69; 95% CI, 1.22-2.36), and stress (OR = 2.22; 95% CI, 1.58-3.12) symptoms after adjusting for gender and age, compared with repeated high LTPA. The associations remained after full adjustments in anxiety (OR = 1.57; 95% CI, 1.08-2.30) and stress (OR = 1.92; 95% CI, 1.32-2.78) symptoms. Additionally, a change from high to low LTPA was associated with anxiety (OR = 1.47; 95% CI, 1.05-2.04) symptoms after full adjustments.

CONCLUSION

Repeated low levels of LTPA are associated with anxiety and stress symptoms. No consistent associations between sitting time and psychological distress could be confirmed. Considering the increasing levels of psychological distress in recent years, particularly among younger adults, it is essential to explore effective countermeasures through large interventions or prospective study designs.

Accelerometer-Derived Physical Activity, Sedentary Behavior, and the Risk of Depression and Anxiety in Middle-aged and Older Adults: A Prospective Cohort Study of 71,556 UK Biobank Participants

OBJECTIVES

To investigate the associations between accelerometer-measured physical activity and sedentary behavior with depression and anxiety.

METHODS

We used accelerometer data from the UK biobank. Time spent in moderate-to-vigorous physical activity (MVPA) was classified into four categories: very-low (0-74.9 min/week), low (75-149.9 min/week), moderate (150-299.9 min/week), and high (≥300 min/week). Associations were examined using Cox proportional hazard regression models. Restricted cubic splines were used to evaluate dose-response associations.

RESULTS

A total of 71556 adults (mean [SD] age, 62.11 [7.83] years; 54.5% were female) were included. When stratified by MVPA, 10562 participants were in the very-low group (14.8%), 11578 were in the low group (16.2%), 20700 were in the moderate group (28.9%), and 28716 were in the high group (40.1%). Both MVPA and total physical activity showed nonlinear associations with the risk of depression and anxiety. Compared with very-low level MVPA, moderate MVPA might reduce the risk of depression (HR, 0.71; 95% CI, 0.63-0.79) and anxiety (HR, 0.80; 95% CI, 0.71-0.90). High MVPA was associated with a 30% lower risk of depression (HR, 0.70; 95% CI, 0.62-0.78) and anxiety (HR, 0.70; 95% CI, 0.62-0.79). For sedentary behavior, quartile 4 (≥10.60 h/d) was associated with a 19% higher risk of depression (HR, 1.19; 95% CI, 1.05-1.35) compared to quartile 1 (<8.21 h/d).

CONCLUSION

The WHO guideline of 150-300 min/week of MVPA may reduce the risk of depression by 29% and anxiety by 20% compared to less than 75 min/week. Prolonged sedentary behavior was associated with a higher risk of depression.

Physical activity, health, and life satisfaction: Four panel studies demonstrate reciprocal effects

We examined the between-person correlations and within-person reciprocal effects of physical activity, long-standing health issues, self-rated health, and life satisfaction across four panels using random intercept cross-lagged panel models. Data were analyzed from the Household, Income and Labour Dynamics in Australia Survey (HILDA, N = 32,913, 21 waves, 1-year intervals), the German Socio-Economic Panel (SOEP, N = 83,844, 14 waves, 2-year intervals), the Dutch Longitudinal Internet Studies for the Social Sciences Panel (LISS, N = 14,778, 11 waves, 1-year intervals), and the United Kingdom Household Longitudinal Study (UKHLS, N = 50,032, 4 waves, 2-year intervals). The analysis of the first two panels focused on moderate-to-vigorous physical activity and sports participation in leisure time, whereas the latter two examined physical activity intensities (light, moderate, and vigorous). Across all panels, physical activity and its intensities were positively correlated with long-standing health issues, self-rated health, and life satisfaction. Within-person analyses revealed primarily positive bidirectional effects between physical activity and self-rated health and between physical activity and life satisfaction, with self-rated health effects more pronounced at higher physical activity intensities and life satisfaction at lower intensities. Effects between physical activity and long-standing health issues were less consistent, appearing mainly for moderate-to-vigorous physical activity intensities in 1-year intervals. Physical activity intensities had different effects on self-rated health and life satisfaction, and the effects were bidirectional in nature. These results suggest that physical activity interventions should be tailored to intensity: Light activity may enhance more effective life satisfaction, while higher intensities better support health. The existing bidirectional effects may further trigger an upward spiral, reinforcing improvements in both health and well-being.

Impact of different exercise types on depression and anxiety in individuals with cancer: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVE

Various exercise modalities have been demonstrated to be effective in alleviating anxiety and depression among individuals with cancer. However, it remains unclear which specific exercise intervention is the optimal choice. This study aimed to systematically evaluate the impact of different exercise intervention types on anxiety and depression in individuals with cancer.

METHODS

Eligible randomized controlled trials were identified through searches of PubMed, Web of Science, and EBSCOHost, with the search period up to December 2024. Two researchers independently conducted the literature screening, data extraction, and assessment. Statistical analyses and visualizations were performed using Stata 15.0 software and RevMan5.4 software.

RESULTS

A total of 26 randomized controlled trials (involving 2118 individuals with cancer) examining three types of exercise interventions were included. Compared to usual care, mind-body exercise (SMD = -0.58, 95 % CI (-0.99, -0.17)), followed by resistance training (SMD = -0.52, 95 % CI (-1.12, 0.09)), and aerobic exercise (SMD = -0.51, 95 % CI (-0.89, -0.13)) significantly decreased depression levels among individuals with cancer. Additionally, resistance training (SMD = -0.66, 95 % CI (-1.59, 0.27)), followed by aerobic exercise (SMD = -0.59, 95 % CI (-1.08, -0.10)), and mind-body exercise (SMD = -0.48, 95 % CI (-0.96, 0.00)) significantly decreased anxiety levels among individuals with cancer compared to usual care.

CONCLUSION

The findings of this network meta-analysis suggest that mind-body exercise, resistance training, and aerobic exercise are all effective interventions for reducing anxiety and depression among individuals with cancer.

Peer Violence in Youth Sport: Do Age, Year of Training, and Type of Sport Affect Outcomes?

BACKGROUND

In sports and physical activities, destructive behaviors such as aggression and violence are not uncommon. Although sports and physical activities have many benefits, they can also have negative consequences. This study aimed to investigate the factors that can contribute to the manifestation of aggression and interpersonal violence (IV). The variables incorporated were the athletes' age, sports experience (training years), and type of sport.

METHODS

This study included n = 2091 youth athletes (aged between 11 and 18 years) from Serbia, with a cross-sectional study design. The data were collected through a questionnaire and analyzed using the Chi-square and Mann-Whitney U tests in IBM SPSS.

RESULTS

The athletes' ages and the types of sports (collective and contact) in which they participated are associated with aggression and IV manifestation. In addition, physical violence tends to be more common among older athletes in collective and contact sports, while psychological violence is more prevalent among older athletes who train for five or more years and participate in collective and non-contact sports.

CONCLUSIONS

Identifying some of the correlated factors in aggression and IV manifestation among youth athletes could help in the development of strategies to reduce these destructive behaviors in youth sports.

Effects of an additional multimodal intervention (MultiMove) during inpatient rehabilitation on clinical and functional outcomes in patients with chronic low back pain- a pilot trial

BACKGROUND

As a leading cause of disability, chronic low back pain (CLBP) is a musculoskeletal condition often associated with impaired physical and cognitive functions. Due to its multi-factorial facets, the application of multimodal interventions is recommended. MultiMove is a multimodal intervention designed for CLBP patients, which combines motor-cognitive and dancing exercises. This study aimed to assess the effects of an additional MultiMove intervention to a standard inpatient rehabilitation on clinical and functional outcomes in CLBP patients.

METHODS

For this prospective, two-arm, controlled pilot trial, 27 CLBP patients (17 females, 10 males) undergoing a 3-week inpatient rehabilitation, in a rehabilitation clinic in Germany, were recruited. The intervention group (IG, n = 15, 61.6 ± 1.8 years) received a daily MultiMove session in addition to the standard rehabilitation, while the control group (CG, n = 12, 63.8 ± 2.2 years) followed the standard rehabilitation. Physical (Timed Up and Go (TUG) [primary outcome], Five-Repetition Sit-to-Stand (FRSTS), and Six-Minute Walk Test (6MWT), trunk range of motion, single and dual task walking)), clinical (acute/chronic pain intensity, Oswestry Disability Index, EQ-5D-5 L), cognitive (Stroop Color Word Test, Trail Making Test), and psychosocial outcomes (Tampa Scale of Kinesiophobia, Beck Depression Inventory-II, Coping Strategies Questionnaire) were assessed during the first (pre-test) and last day (post-test) of the inpatient rehabilitation.

RESULTS

The statistical analyses revealed improvements in trunk range of motion (sagittal plane: p = 0.018, d = 1.00; transversal plane: p = 0.006, d = 1.18) and 6MWT performance (p = 0.003, d = 1.30) in the IG compared to the CG. Moreover, lower dual task costs for a gait variability measure (p = 0.034, d = 0.97) as well as reduced chronic pain intensity (p = 0.004, d = 1.33), kinesiophobia (p = 0.035, d = 1.15), and depression (p = 0.034, d = 1.08) were found in favour of the IG.

CONCLUSION

Data indicate that the multimodal intervention MultiMove improved clinical and functional outcomes in CLBP patients during inpatient rehabilitation. Therefore, conducting a randomized controlled trial with a large sample size is recommended to verify and extent these results.

TRIAL REGISTRATION

MultiMove project (German Clinical Trial Register, ID: DRKS00021696 / 10.07.2020, https://drks.de/drks_web/navigate.do?navigationId=trial.HTML26TRIAL_ID=DRKS00021696 ) and was carried out in the rehabilitation clinic Bad Salzelmen (Schönebeck, Germany).

Compositional associations of 24-h physical activities, sedentary time and sleep with depressive symptoms in urban and rural residents: a cross-sectional study

BACKGROUND

Studies investigating the associations of 24-h movement behaviours (including moderate-to-vigorous-intensity physical activity (MVPA), light-intensity PA (LPA), sedentary time (ST) and sleep) with depressive symptoms are scarce. It is also unclear whether possible associations differ between urban and rural residents. Hence, we aimed to investigate these associations in a population-based sample of middle-aged Finnish adults.

METHODS

The study population consisted of 4295 adults, aged 46 years, from the Northern Finland Birth Cohort 1966. The participants wore a hip-worn accelerometer for 14 days. Time spent in sedentary, LPA and MVPA was obtained from accelerometer data and then combined with self-reported sleep duration to obtain the 24-h composition. The residential environment was classified as urban or rural based on the participants' home addresses. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Multivariable adjusted regression analysis using a compositional data analysis approach based on isometric log-ratio transformation was used to determine the associations between movement behaviours and depressive symptoms in urban and rural residential environments.

RESULTS

The 24-h movement behaviour composition was significantly associated with the BDI-II score both in urban and rural residential environment. More time spent in sleep relative to other behaviours was associated with lower BDI-II score in rural residential environments. More time spent in ST among urban residents and in LPA among rural residents was associated with higher BDI-II scores. When modelling pairwise reallocations of time, more MVPA or more sleep at the expense of LPA or ST was associated with lower BDI-II score among rural residents. For urban residents, reallocating time from ST to any other behaviour was associated with lower BDI-II score.

CONCLUSIONS

Our findings showed that more relative time spent in MVPA and sleep was associated with lower levels of depressive symptoms among rural residents, and more relative time spent in any other behaviour at the expense of ST was associated with lower levels of depressive symptoms among urban residents. These differences should be considered in the prevention and treatment of depressive symptoms. Due to the cross-sectional design of this study, causality cannot be inferred, and further research exploring the mechanisms underlying these associations in diverse populations and longitudinal study settings are needed.

Clusters of healthy lifestyle behaviours are associated with symptoms of depression, anxiety, and psychological distress: A systematic review and meta-analysis of observational studies

Engagement in healthy and unhealthy lifestyle behaviours are related to a range of mental health outcomes. Most existing research has focussed on individual lifestyle behaviours, so it is not clear the extent to which clusters of healthy lifestyle behaviours relate to mental health outcomes. Therefore, this study aimed to systematically review and quantitatively synthesise research which have examined the association between clusters of lifestyle behaviours with symptoms of depression, anxiety, and psychological distress. A systematic search of five electronic databases were conducted to identify studies which used person-centred approaches (e.g., cluster analysis, latent class analysis) to identify subgroups of participants based on at least two unique lifestyle behaviours (i.e., physical activity/sedentary behaviours, diet, sleep, alcohol/tobacco/drug use) and examined differences in symptoms of depression, anxiety, or psychological distress between clusters. A correlated and hierarchical random effects meta-analysis was used to synthesise the results. A total of 81 studies reporting on nearly one-million individual participants were included in the review. Results demonstrated that participants who engaged in the healthiest clusters of lifestyle behaviours reported significantly fewer symptoms of depression (SMD = -0.41), anxiety (SMD = -0.43) and psychological distress (SMD = -0.34) compared to participants engaging in less healthy combinations of lifestyle behaviours, and a dose response relationship was observed across outcomes. These results demonstrate that there is a moderate-to-strong relationship between engaging in clusters of healthy lifestyle behaviours and mental health outcomes and demonstrate the importance of considering healthy lifestyle as a whole instead of as individual parts.

Systematic Umbrella Review and Meta-Meta Analysis: Effectiveness of Physical Activity in Improving Depression and Anxiety in Children and Adolescents

OBJECTIVE

Depression and anxiety are prevalent and rising in children and adolescents, prompting interest in exercise as a potential therapeutic intervention. The aim of this systematic umbrella review and meta-meta-analysis was to evaluate the effects of exercise on depression and anxiety symptoms in children and adolescents and identify the most promising exercise-based approaches.

METHOD

This systematic umbrella review was preregistered (PROSPERO ID: CRD42024533558) and followed PRISMA and PRIOR guidelines. A search of 11 databases identified systematic reviews and meta-analyses of randomised controlled trials (RCTs) evaluating the effects of exercise (aerobic, resistance, mind-body exercise) on depression and anxiety symptoms in children and adolescents. Risk of bias was assessed using the AMSTAR-2 tool and certainty of evidence was assessed using GRADE. Meta-analyses were conducted to combine effect sizes, using random effects models. Subgroup analyses were performed to examine participant and intervention characteristics.

RESULTS

Twenty-one systematic reviews (n=375 RCTs, n=38,117 participants aged 5-18 years) were included. Participants had various clinical conditions including depression, psychosocial disorders, obesity, cancer, as well as healthy individuals. The pooled analysis found moderate effect sizes favouring exercise for symptoms of depression (SMD = -0.45 [95% CI, -0.59 to -0.31], I2 = 71.37%, p<0.01, 180 RCTs, n=34,490 participants) and anxiety (SMD = -0.39 [95% CI, -0.61 to -0.17], I2 = 68.1%, p<0.01, n=55 RCTs, n=24,797 participants). Mixed exercise modes and moderate-intensity exercise had the largest effects on depression, while resistance exercise was most effective for symptoms of anxiety. Interventions that were <12 weeks were more effective for depression compared with ≥12-week interventions. Benefits were generally consistent across populations. The certainty of evidence was moderate for depression and low to moderate for anxiety.

CONCLUSION

This meta-meta-analysis finds that exercise reduces depression and anxiety symptoms in children and adolescents. These results suggest that structured exercise programs should be considered as part of comprehensive care approaches.

The efficacy of an online exercise intervention for improving depressive symptoms among patients with subthreshold depression in primary care: protocol for a randomized controlled trial

BACKGROUND

Subthreshold depression is common in primary care and is associated with significant healthcare burden. There is emerging evidence for the benefits of Exercise can reduce depressive symptoms among people with diagnosed depression, but there is limited evidence for subthreshold depression in primary care setting. This study aims to examine the efficacy of a 12-week online instructor-led exercise intervention in reducing depressive symptoms among people with subthreshold depression in primary care, when compared to usual care control.

METHODS

This 1:1 randomised controlled trial will enrol 260 participants with subthreshold depression randomizing into 2 groups (online exercise intervention versus usual care control). The intervention consists of twice-weekly 1-h exercise online classes over 12 weeks, which will be led by certified instructors. Data will be collected at baseline (T0), immediate post intervention (T1), 3-month post intervention (T2) and 9-month post intervention (T3). The primary outcome is depressive symptoms measured by the Chinese version of Beck Depression Inventory-II (BDI-II) at T1. Secondary outcomes include anxiety symptoms, quality of life, physical activity levels, feasibility and acceptability, medication use and health service utilization, and cost assessment. Intention-to-treat analysis will be performed.

DISCUSSION

The proposed study will assess the efficacy of online exercise intervention in improving subthreshold depressive symptoms in primary care. The findings will inform clinicians and policy makers concerning prevention of depression in primary care, and may lead to changes in the respective current guidelines and public policies.

TRIAL REGISTRATION

This trial has been registered in the Chinese Clinical Trial Registry, with the registration number: ChiCTR2400087923. The date of registration is 2024-08-07.

Direct and indirect associations between mental health and motivational indicators with physical activity among Lithuanian adolescents

Background

Considering the low engagement of contemporary adolescents in physical activity (PA), apparently, PA still has a low priority for adolescents, who are the only ones making decisions and performing behavior. So, analysis of more proximal factors that lay on the personal and interpersonal levels as well as psychological mechanisms forming PA behavior is important.

Methods

The population-based cross-sectional study included 4,924 5th to 12th-grade school students. Among them, 50.9% were girls. The mean age of study participants varied from 11 to 19 years [mean 14.08 (2.21)]. Moderate-to-vigorous physical activity was measured by four items out of the IPAQ-SF questionnaire. Psychological well-being was assessed using The World Health Organization Five Well-Being Index (WHO-5) 5-item questionnaire. Psychological distress has been assessed by Kessler's six-item scale. Social support in terms of family and friends social support has been assessed by a 13-item subscale of Sallis' Support for Exercise Survey. Body mass index (BMI) was calculated by dividing body mass (kg) by height-squared (m2).

Results

Higher motivation for MVPA was predicted by higher family (β = 0.653) but not friends'support and both mental health indicators - higher psychological well-being (β = 0.049) and lower psychological distress (β = -0.078) were linked to higher motivation for physical activity, regardless the covariates. Higher motivation (β = 0.137), greater psychological well-being (β = 0.580) with the greatest magnitude, and lower psychological distress (β = -0.293) contributed to the greater MVPA.

Conclusion

Family but not friends' support for physical activity, greater psychological well-being, and lower psychological distress have direct and indirect effects on greater moderate-to-vigorous physical activity in adolescents.

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.

Yeast hydrolysate and exercise ameliorate high-fat diet-induced obesity in C57BL/6 mice

BACKGROUND

Yeast hydrolysate (YH) has been shown to be effective in inhibiting fat accumulation. This study aimed to investigate the effects of YH and exercise on high-fat diet-induced obesity and their underlying mechanisms in C57BL/6J mice.

METHODS

In this study, 6-week-old C57BL/6 mice were divided into 7 groups; a normal group fed a normal chow diet, an HFD group (CON) fed ad libitum, an exercise group (15m/min, 30min), an HFD supplemented with low dose of YH (100 mg/kg, YHL), an HFD supplemented with high dose of YH (200 mg/kg, YHH), and a combination of exercise and YHH group. After 12 weeks of HFD and YH administration, white adipocytes and liver tissue were analyzed.

RESULTS

Both YH and exercise significantly reduced the weight of the body and adipose tissues; however, the greatest effect was observed when YH and exercise were combined. Similarly, most reduction in adipocyte size and fat formation in the liver was notable following the combination of YH and exercise. Furthermore, both YH and exercise effectively downregulated lipid synthesis genes, namely fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), and HMG-CoA reductase (HMGCR), and SREBP1 and SREBP2 proteins. YH and/or exercise also significantly increased the mRNA levels of hormone sensitive lipase (HSL) and carnitine palmitoyltransferase 1 (CPT1), both of which are related to fatty acid oxidation. In addition, pAMPKα and PPARα levels were significantly increased by YH and exercise, with the greatest increase noted following the combination of YH and exercise. Additionally, YH and exercise combined caused the most significant increase in the antioxidant response, as evidenced by nuclear factor erythroid 2-related factor 2 (Nrf2) and superoxide dismutase 1 (SOD1) upregulation at protein and mRNA levels. Their combination also exhibited strongest suppression of inflammatory responses via the downregulation of NF-κB, TNF-α, and IL-1β at protein and mRNA levels. Collectively, YH and exercise combination showed an inhibitory effect on obesity, leading to decreased lipogenesis and increased lipolysis, with favorable regulation of antioxidant and inflammatory responses.

CONCLUSION

This study suggests the potential use of a combination of physical activity and YH supplementation to control obesity and related metabolic diseases.

Association of accelerometer-derived physical activity pattern with depression: Weekend warrior or regular activity?

BACKGROUND

The relationships between the weekend warrior (WW) and other physical activity (PA) patterns with depression remain inadequately examined. This study aimed to elucidate these associations using objective PA data obtained through accelerometer.

METHODS

Data of 6080 adults from NHANES 2011-2014 were used. Based on PA data collected by the ActiGraph GT3X+ wrist-worn triaxial accelerometer, participants were categorized into four patterns: inactive, insufficiently active (IA), WW, and regularly active (RA) pattern. Depression was assessed by the Patient Health Questionnaire-9. Multivariate logistic regression models with adjustment for covariates were used to explore the associations between PA patterns and depression.

RESULTS

IA, WW, and RA adults had 60.5 % (OR: 0.395, 95 % CI: 0.237-0.658), 59.4 % (OR: 0.406, 95 % CI: 0.240-0.687), and 71.0 % (OR: 0.290, 95 % CI: 0.173-0.486) lower prevalence of depression compared with inactive adults, respectively. When compared with RA adults, inactive (OR: 3.450, 95 % CI: 2.057-5.786), IA (OR: 1.364, 95 % CI: 1.011-1.839), and WW (OR: 1.399, 95 % CI: 1.120-1.748) adults all had elevated prevalence of depression. Age moderated such association, with no significant difference found between WW and RA among older adults (OR: 1.299, 95 % CI: 0.700-2.411).

CONCLUSION

Engagement in PA, regardless of pattern, is associated with a lower prevalence of depression, such association is most pronounced in the RA pattern, which appears to be the most desirable pattern for reducing risk of developing depression. The WW pattern also showed certain antidepressant effects and may be more feasible for individuals with demanding schedules.

Exploring the evolution of evidence synthesis: a bibliometric analysis of umbrella reviews in medicine

Background

Umbrella review studies have become increasingly vital in evidence synthesis, offering a comprehensive overview by analyzing multiple systematic reviews and meta-analyses. This bibliometric study aimed to delineate the growth and thematic evolution of umbrella reviews within evidence-based medicine, illuminating their integral role in synthesizing high-level evidence.

Methods

Utilizing the Web of Science Core Collection, we performed a search for publications on umbrella reviews, identifying relevant articles through a refined strategy. Analytical tools including VOS Viewer and CiteSpace were employed to visualize connections and trends among the gathered data, converting intricate bibliometric information into comprehensible visual maps.

Results

Our search yielded 2965 pertinent publications, highlighting a marked growth in research output, particularly from 2010 to 2023. The United States, United Kingdom, and China were predominant in this field, with leading institutions like King's College London and the University of Toronto at the forefront. The analysis identified major journals such as BMJ Open and PLOS One as key publishers. Co-citation and keyword analysis revealed current research focuses, with recent trends emphasizing COVID-19 and mental health. The study also uncovered a robust international collaboration network, underscoring the global impact of umbrella reviews.

Conclusion

This bibliometric analysis confirms the expanding influence and utility of umbrella reviews in medical research and decision-making. By charting the evolution and current trends in this field, our study not only showcases the geographical and institutional distribution of research but also guides future scholarly efforts to advance evidence synthesis methodologies.

Running Reverses Chronic Stress-Induced Changes in Serotonergic Modulation of Hippocampal Granule Cells and Altered Behavioural Responses

Chronic stress increases susceptibility to anxiety and depression disorders, recurrent and common psychiatric conditions. Current antidepressant medications have varying degrees of efficacy and often have multiple side effects limiting treatment adherence. Physical exercise has beneficial effects on stress-related mental disorders. However, the underlying mechanisms are unclear. Dentate gyrus granule cells (GCs) excitability may mediate stress resilience. Here, we expose young adult C57Bl6 mice to chronic restraint stress (CRS) for 14 days followed by 30 days of running treatment. Behavioural evaluation before and after treatment showed that the behavioural alterations elicited by CRS were mitigated by running. Next, we evaluated serotonergic modulation of GC excitability, as a potential mechanism underlying running-induced stress resilience. Electrophysiological recordings indicate that CRS alters serotonergic modulation of GC excitability. Utilising (S)-WAY 100135 and Tropisetron, antagonists of 5-HT1A and 5-HT3 receptors respectively, we show that running recovers 5-HT1A receptor activity lost by CRS. Additionally, running promotes the indirect modulation of GCs through 5-HT3 receptor activation. Thus, 5-HT1A and 5-HT3 receptors may be potential targets for the treatment of stress-related psychiatric disorders.

Adaptive neural activation patterns in basketball athletes: insights from emotional processing using fMRI

The impact of long-term exercise training on emotional processing remains unclear. This study investigated the neural activation patterns during emotional processing in collegiate basketball athletes compared to non-athletes. We utilized functional magnetic resonance imaging (fMRI) to examine 37 basketball athletes and 38 age- and gender-matched non-athletes while they performed the Emotional Faces Task and Intense Emotion Task. Participants' emotional states were assessed using various psychological questionnaires. In the Emotional Faces Task, athletes exhibited decreased activation in the left medial frontal gyrus, left paracentral lobule, and left cingulate gyrus when viewing neutral faces and increased activation in the right parahippocampal gyrus and right temporal lobe when viewing happy faces. In the Intense Emotion Task, the athletes exhibited increased activation in the left inferior frontal gyrus, left precentral gyrus, and right middle temporal gyrus when viewing fearful pictures. Conversely, they showed decreased activation in the bilateral medial frontal gyri, anterior cingulate cortex, bilateral rectus gyri, right middle occipital gyrus, right cuneus, and right cerebellum posterior lobe when viewing fearful pictures minus neutral pictures. Basketball athletes demonstrated distinct neural adaptations in emotional processing, suggesting a potential enhancement in performance and well-being under competitive stress. These findings contribute to understanding how long-term athletic training may influence brain function and emotional regulation.

Physical activity targeting patients admitted to a psychiatric hospital- a mixed method feasibility study

BACKGROUND

Physical activity (PA) shows positive effects on mental illness. PA and the use of municipal rehabilitation after discharge from psychiatric hospitalisation are inconsistent. The aim of this study was to evaluate the feasibility and acceptability of an intervention consisting of structured PA during hospitalisation and the use of a personalised physical activity plan and referral for municipal rehabilitation after discharge.

METHODS

A mixed-method design was used to explore the feasibility and acceptability of the intervention. Changes in health-related quality of life and physical function were measured using a six-minute walk test, a 30-second sit-to-stand test, handgrip strength, and patient reported outcomes (SF-36 and the Patient Specific Functional Scale [PSFS]). Qualitative results were further explored through semi-structured telephone interviews with twelve participants three weeks after discharge.

RESULTS

Twenty-six participants completed the intervention (median age: 46 years old; female: 57.7%). Improvements were seen in the PSFS. For SF-36, overall improvements were observed in the subscales physical function, well-being, and social function. Participants adhered to 61.5% of the scheduled physical activity sessions, 88% received a personalised physical activity plan, and 57% received municipal rehabilitation. The clinical provider played an important role in terms of motivation, structure, and knowledge about physical activity.

CONCLUSION

Physical activity during hospitalisation, a personalised physical activity plan, and municipal rehabilitation was feasible for persons with mental illness. Positive changes were observed in the following self-reported outcomes: Quality of life, physical function, and social function, and participants reported moderate to good acceptance of the intervention.

Depressive symptoms among middle-aged and older adults in China: The interaction of physical activity and sleep duration

BACKGROUND

Previous research on the interaction of physical activity and sleep on depressive symptoms was mostly cross-sectional or conducted with children or young adults. This study examines the main and interactive associations of physical activity and sleep duration with depressive symptoms over a 3-year period among middle-aged and older Chinese adults.

METHODS

Data from 4269 Chinese adults aged 45 or older from the China Health and Retirement Longitudinal Study (CHARLS) were used. Physical activity was categorized as inadequate (<600 MET), adequate (600-8000 MET), and extremely high (>8000 MET). Sleep was classified as inadequate (<6 hours), adequate (6-9 hours), and excessive (>9 hours). The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms.

RESULTS

Inadequate sleep was linked to greater increases in depressive symptoms over 3years. A significant interaction between baseline physical activity and sleep duration in predicting depressive symptoms at the 3-year follow-up showed that inadequate sleep, when combined with either inadequate or extremely high physical activity, was associated with higher depressive symptoms at the 3-year follow-up. In middle-aged subgroups, for people with either inadequate physical activity or an extremely high level of physical activity, inadequate sleep was associated with higher CES-D score compared to adequate sleep; for older adults, only inadequate sleep was associated with a higher follow-up CES-D score.

CONCLUSION

Physical activity and sleep interactively impacted depressive symptoms, suggesting future personalized interventions that simultaneously target physical activity and sleep. Adequate sleep was associated with lower levels of future depressive symptoms in people with inadequate or extremely high physical activity.

Associations of comorbid headache disorders and depression with leisure-time physical activity among 14,088 adults in The Brazilian Longitudinal Study of Adult Health

BACKGROUND

While headache disorders are linked to low physical activity levels, the impact of depression on this relationship is unclear.

OBJECTIVE

To assess how single and comorbid diagnoses of migraine and tension-type headache (TTH) interact with depression and leisure-time physical activity (LTPA) levels in The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

In this cross-sectional analysis based on the ELSA-Brasil baseline data, the relationship of migraine, TTH (both assessed with the International Classification of Headache Disorders, Second Edition), and depression (assessed with the Clinical Interview Schedule-Revised) with LTPA levels (International Physical Activity Questionnaire) was investigated by employing linear regression models. Models were adjusted for sociodemographic, lifestyle, and clinical covariates, and interaction terms were created to examine additive effects of comorbid conditions.

RESULTS

Among 14,088 participants, 54.4% (7668/14,088) were female, prevalence rates were: TTH = 39.6% (5573/14,088), migraine = 27.0% (3806/14,088), depression = 0.7% (94/14,088), depression + TTH = 1.1% (148/14,088), and depression + migraine = 2.5% (356/14,088). The mean (standard deviation) LTPA levels across the groups were: no headache + no depression = 148.7 (183.0) min/week, TTH = 133.5 (170.1) min/week, migraine = 110.3 (154.8) min/week, depression = 76.5 (146.3) min/week, depression + TTH = 84.5 (127.7) min/week, and depression + migraine = 64.3 (123.2) min/week. Negative associations were found for depression (β = -55.1, 95% confidence interval [CI] -93.6 to -17.0; p = 0.005), migraine (β = -24.7, 95% CI -33.2 to -15.4; p < 0.001), and TTH (β = -15.5, 95% CI -23.1 to -7.6; p < 0.001) with LTPA. No interaction effect was observed for depression + TTH (β = 36.0, 95% CI -12.6 to 84.6; p = 0.147) and depression + migraine (β = 31.7, 95% CI -11.3 to 74.7; p = 0.149), indicating no additive effect of comorbid conditions on LTPA levels. After adjusting for headache attack frequency, only depression + migraine remained negatively associated with LTPA (β = -38.7, 95% CI -71.6 to -5.8; p = 0.021).

CONCLUSIONS

Headache disorders and depression were independently and inversely associated with LTPA, with the strongest effects seen in depression alone or comorbid with migraine.

Heart rate variability in mental disorders: an umbrella review of meta-analyses

Heart rate variability (HRV) monitoring is increasingly applied in the realm of mental disorders; however, it remains a subject of controversy. This umbrella review summarizes HRV differences between individuals with mental disorders and healthy controls (HCs), as well as changes in HRV before and after treatment in patients with mental disorders. A literature search was conducted using Medline, PubMed, Embase, and the Cochrane Database. Meta-analyses on HRV changes in patients with mental disorders, as well as meta-analyses comparing HCs and patients with mental disorders were included. We computed the summary effect size using random effects models, along with 95% confidence and prediction intervals. We assessed heterogeneity, p value of the largest study, excess significance bias, and small-study effects. Evidence levels were classified as convincing, highly suggestive, suggestive, weak, or not significant. Twenty-one systematic reviews on HRV, covering 19 mental disorders (53 meta-analyses) and 8 treatment modalities (18 meta-analyses), included 442 primary studies and 34,625. For differences between mental disorders and HCs, evidence was suggestive for 7 (13.2%) pooled analyses, indicating decreased HRV in dementia, PTSD, somatic symptom disorders, functional somatic syndromes, and schizophrenia. For other disorders, including autism spectrum disorder, alcohol use disorder, bipolar disorder, generalized anxiety disorder, insomnia, and major depressive disorder, the evidence was weaker and below the suggestive level. For treatment effects, 5 pooled analyses (27.8%) had weak evidence, indicating altered HRV before and after antipsychotic treatment, repetitive transcranial magnetic stimulation treatment, physiotherapy, and psychotherapy. The credibility of HRV evidence in mental disorders varied across HRV variables and diseases. No two diseases exhibited identical altered HRV patterns, highlighting the potential significance of overall HRV profiles in delineating distinct disorders.

Epigenetic Echoes: Bridging Nature, Nurture, and Healing Across Generations

Trauma can impact individuals within a generation (intragenerational) and future generations (transgenerational) through a complex interplay of biological and environmental factors. This review explores the epigenetic mechanisms that have been correlated with the effects of trauma across generations, including DNA methylation, histone modifications, and non-coding RNAs. These mechanisms can regulate the expression of stress-related genes (such as the glucocorticoid receptor (NR3C1) and FK506 binding protein 5 (FKBP5) gene), linking trauma to biological pathways that may affect long-term stress regulation and health outcomes. Although research using model organisms has elucidated potential epigenetic mechanisms underlying the intergenerational effects of trauma, applying these findings to human populations remains challenging due to confounding variables, methodological limitations, and ethical considerations. This complexity is compounded by difficulties in establishing causality and in disentangling epigenetic influences from shared environmental factors. Emerging therapies, such as psychedelic-assisted treatments and mind-body interventions, offer promising avenues to address both the psychological and potential epigenetic aspects of trauma. However, translating these findings into effective interventions will require interdisciplinary methods and culturally sensitive approaches. Enriched environments, cultural reconnection, and psychosocial interventions have shown the potential to mitigate trauma's impacts within and across generations. By integrating biological, social, and cultural perspectives, this review highlights the critical importance of interdisciplinary frameworks in breaking cycles of trauma, fostering resilience, and advancing comprehensive healing across generations.

Feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer: a systematic review

PURPOSE

This systematic review aims to evaluate the feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer. The primary research question is: Are home-based exercise interventions safe and feasible for people diagnosed with cancer?

METHODS

A comprehensive search of databases including PubMed, EMBASE, and Cochrane Library was conducted in January 2025, focusing on randomized controlled trials (RCTs) that involved home-based exercise interventions people diagnosed with cancer. Studies were included if they reported on safety, feasibility, and health-related outcomes. The Physiotherapy Evidence Database (PEDro) scale was used to assess study quality and risk of bias. Adverse events were categorized by severity, and feasibility which was determined based on recruitment, withdrawal, and adherence rates.

RESULTS

From 127 eligible studies involving 10,562 participants, the review found that home-based exercise interventions are generally safe, with less than 3.2% of participants experiencing exercise-related adverse events, most of which were minor. Feasibility was supported by an average recruitment rate of 50.1%, which was calculated as the proportion of eligible participants who consented to participate across the included studies. Additionally, the review found a withdrawal rate of 13.7%, and an adherence rate of 76.2%. However, significant variability in these rates were observed across the studies, highlighting the challenges in maintaining participant engagement.

CONCLUSIONS

Home-based exercise interventions are feasible and safe for people diagnosed with cancer, with minor adverse events being the most common. However, there is a need for standardized protocols in reporting adverse events and better strategies to improve recruitment and adherence.

IMPLICATIONS FOR CANCER SURVIVORS

These findings support the integration of home-based exercise into standard cancer care, offering a practical and safe option for enhancing the health and well-being of cancer survivors. However, the successful implementation of these programs may require additional support from exercise professionals within primary care or community settings to ensure appropriate guidance and adherence. Personalized exercise programs, developed by qualified exercise professionals such as physiotherapists or clinical exercise physiologists, and improved reporting standards are essential to optimizing these interventions.

Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis

BACKGROUND

There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior.

OBJECTIVE

The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes.

METHODS

A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics.

RESULTS

Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] -0.37; P<.001), a small effect on anxiety (SMD -0.29; P<.001) and stress (SMD -0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted.

CONCLUSIONS

Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity.

TRIAL REGISTRATION

PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908.

Objectively measured physical activity and mental health among asylum seekers residing in a camp

Physical activity has been linked to better mental health in the general population but also migrants and displaced populations. Studies on the latter populations have been almost exclusively based on self-reported physical activity, thus providing a limited perspective. The purpose of this study was to explore the associations between objectively measured physical activity and mental health indices, in asylum seekers residing in a camp. Participants were asked to wear the accelerometers for a period of seven days, after which they were administered questionnaires assessing depression, anxiety, and well-being in their spoken language. Out of a total of 116 participants, 79 (49 women) accomplished the criteria for valid accelerometer wear days and wear hours and completed the questionnaires. The results showed that participants accumulated adequate, according to the recommendations of the World Health Organization, levels of moderate-to-vigorous physical activity, reported mild to moderate anxiety and depression symptoms, and were marginally above the threshold of poor well-being. Physical activity and sedentary time predicted depression (adjusted R2 = .11) and anxiety (adjusted R2 = .08) symptoms, and levels of well-being (adjusted R2 = .15). In particular, moderate-to-vigorous physical activity was linked to lower depression and anxiety, and better well-being, while sedentary time was linked with poorer well-being. The findings provide valuable evidence regarding the links between physical activity and mental health in displaced populations and highlight the need for a multimethod examination of physical activity in such populations.

Effect of physical exercise training on neural activity during working memory in major depressive disorder

BACKGROUND

Deficits in working memory (WM) are common in patients with Major Depression Disorder (MDD). Previous research mainly in healthy adults indicated that physical exercise training may improve cognitive functions by stimulating neuronal plasticity particularly in hippocampal structures. Thus, the goal of this functional Magnetic Resonance Imaging (fMRI) study was to examine alterations in neuronal activity during a WM task and to investigate changes in brain volume and functioning following a physical exercise training in patients with MDD with a specific focus on hippocampal structures.

METHODS

86 (39 female) MDD outpatients (average age 37.3), diagnosed by clinical psychologists, were randomly assigned to one of three groups for a 12-week intervention: High intensity exercise training (HEX), low intensity exercise training (LEX) or waiting list control group (WL). An n-back task (with WM loads of 0, 1, 2, and 3) during fMRI was conducted before and after interventions/waiting period.

RESULTS

Both exercise groups showed better performance and shorter reaction times at higher WM loads after 12-weeks of physical exercise training. Specifically in the HEX, we found an improvement in physical fitness and an increase in neural activation in the left hippocampus as compared to the WL following the exercise training. Training-related structural volume changes in gray matter or hippocampus were not detected.

CONCLUSIONS

Our results partly support the hypothesis that physical exercise training positively affects WM functions by improving neuronal plasticity in hippocampal regions. Exercise training seems to be a promising intervention to improve deficient WM performance in patients with MDD.

CLINICAL TRIALS REGISTRATION NAME

Neurobiological correlates and mechanisms of the augmentation of psychotherapy with endurance exercise in mild to moderate depression - SPeED, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00008869, DRKS00008869.

Efficacy of a Multicomponent Physical Activity Intervention for Teachers With or At Risk of Type 2 Diabetes: The Support, Motivation, and Physical Activity Research for Teachers Health Randomized Controlled Trial

BACKGROUND

Type 2 diabetes is a major cause of illness and disability and physical activity reduces these risks. The SMART Health study aim was to compare the efficacy of a multicomponent intervention to promote aerobic physical activity and resistance training in schoolteachers at risk of or diagnosed with type 2 diabetes, with and without a technology-based behavior change package.

METHODS

We randomized participants (N = 104) into 3 groups: "wait-list" control group, 5 face-to-face visits with a psychologist and exercise specialist (SH group), or 5 face-to-face visits over a 3-month period with a psychologist and exercise specialist, plus a technology-based behavior change package for an additional 6 months (SH+ group). Physical activity was the primary outcome (daily steps measured by pedometers). Systolic and diastolic blood pressure, waist circumference, body mass index, fasting blood glucose, glycosylated hemoglobin, plasma lipids, self-reported resistance training, anxiety and depression were also assessed at 3 and 9 months (primary time point). Linear mixed models were used to assess the intervention efficacy of SH and SH+ compared with wait-list control.

RESULTS

There were no significant group-by-time effects for steps in the SH or SH+ groups compared to the wait-list control group. Self-reported participation in monthly minutes of resistance training significantly increased at 3-month postbaseline in both groups (SH: 136 min, P < .01, d = 0.33 and SH+: 145 min P < .001, d = 0.4) versus the control group. The improvements were maintained for the SH group at 9 months. There was also a meaningful effect (P < .06, d = -0.23) for reducing anxiety for SH group at 9 months.

CONCLUSIONS

SMART Health was a feasible, multicomponent intervention, which increased self-reported resistance training but no other secondary outcomes.

Effects of Activities on the Psychological Well-Being of Caregivers of Older Adults: A Systematic Review

Given that approximately 41.8 million Americans provide unpaid care to older adults and caregiving roles are often associated with decreased well-being, it is critical to identify strategies to maximize their well-being. The purpose of this review was to explore which activities significantly improve well-being among caregivers of older adults. A systematic literature review was conducted using PsycINFO and 24 research articles met inclusion criteria and were included in the final analysis. Eight cohesive activity categories were identified: Social (n = 5), Psychoeducation (n = 3), Arts/entertainment in the home (n = 2), Psychotherapy (n = 5), Religious/Spiritual (n = 4), Multimodal (n = 4), Physical (n = 5), and Arts/entertainment outside the home (n = 2). Findings suggest that caregivers of older adults should seek opportunities for engagement in meaningful activities, particularly social, psychoeducational activities, arts/entertainment activities in the home, which showed positive impacts, as well as psychotherapy, religious/spiritual, multimodal, and physical activities, which showed mixed impacts on caregivers' psychological well-being.

Why friendship and loneliness affect our health

Humans, like all monkeys and apes, have an intense desire to be social. The human social world, however, is extraordinarily complex, depends on sophisticated cognitive and neural processing, and is easily destabilized, with dramatic consequences for our mental and physical health. To show why, I first summarize descriptive aspects of human friendships and what they do for us, then discuss the cognitive and neurobiological processes that underpin them. I then summarize the growing body of evidence suggesting that our mental as well as our physical health and wellbeing are best predicted by the number and quality of close friend/family relationships we have, with five being the optimal number. Finally, I review neurobiological evidence that both number of friends and loneliness itself are correlated with the volume of certain key brain regions associated with the default mode neural network and its associated gray-matter processing units.

Effect of an Innovative Online Ayurveda Program for Detox and Lifestyle on Mental and Physical Health in Home-Based Adults: A Pilot Study

Background and Objective: Mental health complaints have significantly increased in Europe over recent years. This study evaluated the effects and safety of a 4-month online, multimodal, complementary intervention on the mental and physical health of home-based adults. Method: Ninety-eight home-based adults with mild to severe mental health and related physical symptoms were recruited across Europe through digital advertisements. This single-arm repeated-measures study utilized three individualized treatment groups to evaluate the impact of the Ayurveda Program for Detox and Lifestyle. The online program included a personalized Ayurveda diet, daily routine, yoga exercise, herbal detoxification procedures, and herbal preparations. Standardized online tests were administered monthly for 4 months to assess anxiety, depression, physical symptoms (Patient Health Questionnaire for Somatic, Anxiety, and Depressive Symptoms), fatigue (PROMIS), and body mass index (BMI). Results: The study population was predominantly female (85%), with a mean age of 58 years. By the end of the fourth month, primary outcomes indicated a significant decrease in anxiety (55%, p < 0.001) and depression symptoms (45%, p < 0.001). The secondary outcomes showed a significant reduction in physical symptoms, including musculoskeletal, neurological, and digestive issues (42%, p < 0.001); fatigue (31%, p < 0.001); and BMI (2%, p < 0.001). Improvements were consistent across all treatment groups, with no significant differences observed. The intervention was feasible and generally safe, with 91% retention, 70% compliance, and 6% adverse effects. Conclusion: The initial results suggest that the Ayurveda Program for Detox and Lifestyle is safe and is associated with significant improvements in the mental and physical health of participants. This trial highlights the potential benefits of integrating complementary lifestyle protocols into standard primary and mental health care practices. Future randomized controlled trials are recommended to control for confounding factors and validate these findings in larger clinical populations.

Effects of exergames on rehabilitation outcomes in patients with osteoarthritis. A systematic review

PURPOSE

To analyze the effects of exergames on rehabilitation outcomes in osteoarthritis (OA) patients.

MATERIALS AND METHODS

A systematic review was reported according to the PRISMA statement. Randomized controlled trials (RCTs) were searched in Pubmed, Scopus, WoS, CINAHL, and PEDro (inception to November 2023). Studies that applied non-immersive exergames and assessed physical, functional, cognitive, pain, and psychosocial outcomes were included. Comparisons were other exercise modalities and non-intervention. Methodological quality was assessed with PEDro scale, and risk of bias (RoB) was assessed with Cochrane RoB-2 tool.

RESULTS

Eight studies were included (total of participants = 401). The mean PEDro score was 6.1, and seven studies had high RoB. Seven studies involved knee OA and one cervical OA. The most frequent duration for interventions was four weeks. Exergames were more effective than controls in at least one outcome in all studies. The outcomes for which exergames were most effective were functional disability, postural balance, muscle strength, proprioception, gait, range of motion, pain, quality of life, depression, and kinesiophobia.

CONCLUSION

Non-immersive exergames constitute an effective strategy for optimizing several relevant outcomes in rehabilitation. However, more RCTs with high methodological quality are required to deepen the knowledge about the multidimensional effects of exergames in OA patients.

The Tormented Soul: Caring for Older Adults with Depression in Home Healthcare

This article explores depression in older adults, addressing types of depression, risk factors, signs and symptoms, prevention strategies, treatments, and the critical role of home care clinicians. It concludes with a discussion on the tragic issue of suicide among older adults, including its risk factors, prevention, and management.

The effects of exercise on anxiety symptoms in women with gestational diabetes mellitus: a pilot study

PURPOSE

Anxiety is a common mental health issue during pregnancy. Moreover, women with gestational diabetes mellitus (GDM) seem to have to cope with higher levels of anxiety, being at higher risk for several health and mental complications. Women with GDM are recommended to undertake regular physical exercise to improve metabolic and reproductive outcomes. However, there are no specific guidelines for exercise in women with GDM and data on its relationship with mental health are scarce. The aim of this study was to investigate the effect of exercise on anxiety symptoms in pregnant women with GDM.

METHODS

The present non-randomized, open-label clinical trial was a pilot study intended to provide initial data on the effect of exercise on anxiety symptoms of pregnant women with GDM. Forty-three women were assigned to three the following three study groups, (a) Advice Group (n = 17), Walking Group (n = 14), and Mixed Exercise Group (n = 12), from GDM diagnosis to delivery.

RESULTS

Based on the Beck Anxiety Inventory (BAI) scores, all groups showed normal anxiety changes or mild anxiety levels pre- and post-intervention, ranging between 9.00 (1.00-32.00) (pre-intervention) and 7.5 (1.00-26.00) (post-intervention), but none experienced severe anxiety.

CONCLUSION

In the present study, a trend of self-selected pace walking to reduce the BAI scores was identified since the Walking Groups had lower scores after the intervention. However, this trend did not reach statistical significance. Brisk walking (30-45 min) three times per week may produce positive changes in both the treatment plan and the anxiety state of women with GDM. Moreover, the study confirms that routine medical care, counseling, and support by an interdisciplinary team are protective against anxiety in women with GDM.

Circulating microRNAs and physical activity: Impact in diabetes

The term "ci-miRNAs," or "circulating microRNAs," refers to extracellular microRNAs (miRNAs) that exist outside of cells and can be detected in various bodily fluids, including blood, saliva, urine, and breast milk. These ci-miRNAs play a role in regulating gene expression and are mainly recognized for their functions beyond the cell, serving as signaling molecules in the blood. Researchers have thoroughly investigated the roles of these circulating miRNAs in various diseases. The capacity to detect and quantify ci-miRNAs in bodily fluids suggests their potential as biomarkers for monitoring several health conditions, including cancer, heart disease, brain disorders, and metabolic disorders, where fluctuations in miRNA levels may correlate with different physiological and pathological states. Current methods enable researchers to identify and measure miRNAs in these fluids, facilitating the exploration of their roles in health maintenance and disease resistance. Although research on ci-miRNAs is ongoing, recent studies focus on uncovering their significance, assessing their viability as biomarkers, and clarifying their functions. However, our understanding of how various types, intensities, and durations of exercise influence the levels of these miRNAs in the bloodstream is still limited. This section seeks to provide an overview of the changes in ci-miRNAs in response to exercise.

Physical activity alleviates mental health problems related to bullying through moderating rumination

BACKGROUND

Physical activity and experiencing bullying is a protective and risk factor for mental health, respectively. Adolescents who suffer from bullying tend to be trapped in rumination, leading to mental health problem. However, the interaction among them from the perspective of increasing protective factors and reducing risk factors is unclear. This study explored whether rumination mediated the association between experiencing bullying and mental health problems and the moderating role of physical activity.

METHOD

This study investigated 13,983 students from high school in Jiangxi Province, China, and assessed for experiencing bullying, rumination, mental health problems (depressive, anxiety, and insomnia symptoms), and physical activity. Moderated mediation analysis was conducted using R software (version 4.1.1).

RESULTS

Significant differences were observed in rumination, physical activity and mental health problems between adolescents who have experienced bullying and those who have not (p < 0.001). Rumination mediated the relationship between experiencing bullying and depressive symptoms (β= 0.45, 95 % CI [0.42, 0.48]), anxiety symptoms (β= 0.37, 95 % CI [0.35, 0.39]), and insomnia symptoms (β= 0.36, 95 % CI [0.33, 0.38]). Moreover, physical activity moderated the relationship between rumination and depressive symptoms (coeff = -0.03, p < 0.001), anxiety symptoms (coeff = -0.02, p < 0.001), and insomnia symptoms (coeff = -0.01, p < 0.001).

CONCLUSIONS

Rumination and physical activity mediated and moderated, respectively, the relationship between experiencing bullying and adolescents' mental health problems. These findings indicate that schools and society should establish a campus bullying early warning system, pay attention to bullying incidents and promote physical activity.

Cardio-oncology rehabilitation and exercise: evidence, priorities, and research standards from the ICOS-CORE working group

The aim of this whitepaper is to review the current state of the literature on the effects of cardio-oncology rehabilitation and exercise (CORE) programmes and provide a roadmap for improving the evidence-based to support the implementation of CORE. There is an urgent need to reinforce and extend the evidence informing the cardiovascular care of cancer survivors. CORE is an attractive model that is potentially scalable to improve the cardiovascular health of cancer survivors as it leverages many of the existing frameworks developed through decades of delivery of cardiac rehabilitation. However, there are several challenges within this burgeoning field, including limited evidence of the efficacy of this approach in patients with cancer. In this paper, a multidisciplinary team of international experts highlights priorities for future research in this field and recommends standards for the conduct of research.

Depression, reduced physical activity and the risk of heart disease: a prospective cohort of European middle-aged and older adults

OBJECTIVE

To assess the impact of depression and physical activity (PA) of different intensities on the incidence of heart disease.

METHODS

A prospective cohort study with 20 645 European middle-aged and older adults (mean baseline age 63 years; 55.1% women; median follow-up 9.5 years) was conducted using data from the Survey of Health, Ageing and Retirement in Europe. The EURO-D 12-item scale assessed depression. Moderate-intensity and vigorous-intensity PA and heart disease diagnoses were self-reported. We classified participants into the following four groups: (1) depression plus low PA, (2) no depression plus low PA, (3) depression plus moderate/high PA, (4) no depression plus moderate/high PA. Hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models adjusted for confounders.

RESULTS

Compared with having depression and low PA levels, adjusted HR for heart disease similarly decreased for participants with depression and moderate/high PA (moderate-intensity PA: HR=0.63, 95% CI=0.50, 0.78; vigorous-intensity PA: HR=0.69, 95% CI=0.53, 0.89) and participants without depression and low PA (moderate-intensity PA: HR=0.64, 95% CI=0.50, 0.82; vigorous-intensity PA: HR=0.68, 95% CI=0.58, 0.80). The greatest risk reduction was found in participants without depression and moderate/high PA (moderate-intensity PA: HR=0.46, 95% CI=0.37, 0.55; vigorous-intensity PA: HR=0.48, 95% CI=0.40, 0.58).

CONCLUSION

Moderate-intensity and vigorous-intensity PA seems to counteract the increased risk for heart disease associated with depression. This highlights the importance of PA as a possible intervention strategy aiming to manage the risk of heart disease among people with depression.

CrossFit Beyond the Barbell: Exploring the Psychological Benefits for Individuals and Organizations

Branded as 'the sport of fitness', CrossFit is well known for its physical benefits, but the benefits may extend far beyond general fitness. Through the lens of positive psychology, we focused on a global CrossFit community to examine the potential psychological and workplace benefits behind this popular exercise program. Results showed that the frequency of CrossFit participation each week significantly predicted well-being and positive Psychological Capital (PsyCap). Additionally, both well-being and PsyCap mediated the relationship between weekly frequency and employee engagement. Our findings show support for benefits in frequent weekly CrossFit participation that reach far beyond physical health. This research underscores CrossFit's multifaceted benefits and encourages organizations to incorporate CrossFit into employee wellness initiatives. It also paves the way for further exploration into the complex impacts of physical fitness on psychological and organizational health.

The mediating role of behavioral systems in linking physical activity and anxiety symptoms in college students

Data show that the detection rate of anxiety symptoms among college students has risen from 16.6 to 34.8% over the past 10 years, and that college students are gradually becoming a high prevalence group for anxiety symptoms.This study aims to investigate the relationship between physical activity, behavioral inhibition and activation, and anxiety symptoms in college students. Specifically, it seeks to identify the mediating role of individual subcomponents of behavioral inhibition and activation in the association between physical activity and anxiety symptoms. A total of 5125 college students were recruited to participate in the study. Participants completed the Physical Activity Rating Scale-3, the Behavioral Inhibition/Activation System Scale, and the Generalized Anxiety Disorder-7 (GAD-7) scale. ANOVA, linear regression analysis and structural equation modelling were used to analyse the data and subcomponents of each variable (physical activity, anxiety symptoms, BIS/BAS) were analysed. Anxious college students demonstrated significantly lower scores in reward responsiveness, drive, and fun seeking, while exhibiting higher scores in behavioral inhibition. Additionally, these students engaged in physical activity at lower intensities, for shorter times, with reduced frequency, and overall less total exercise (all p < 0.001). Furthermore, a significant negative correlation was observed between levels of physical activity and anxiety (r= - 0.145, p < 0.001), while a weak correlation was identified between physical activity levels and the behavioral inhibition system (r= - 0.020, p = 0.156). Conversely, physical activity levels were significantly positively correlated with the behavioral activation subcomponents of reward responsiveness (r = 0.062, p < 0.001), drive (r = 0.122, p < 0.001), and fun seeking (r = 0.067, p < 0.001). Physical activity, behavioral inhibition, and behavioral activation were significant predictors of anxiety symptoms among university students. Among male students, exercise intensity (Beta= - 0.088, p = 0.001) and reward responsiveness (Beta= - 0.255, p < 0.001) showed the strongest correlations with anxiety levels, while among female students, exercise time (Beta = - 0.084, p < 0.001) and behavioral inhibition (Beta = 0.291, p < 0.001) were the most highly correlated. Physical activity levels had a direct effect of 84.37% on reducing anxiety symptoms (Beta= - 0.286, p < 0.001), with 15.63% of the effect mediated by the behavioral inhibition and activation system (Beta= - 0.053, p < 0.001). The mediating effects of the behavioral inhibition and activation system were stronger in females (29.92%, Beta= - 0.076, p = 0.001) compared to males (15.76%, Beta= - 0.061, p < 0.001). Factor loadings indicated that exercise time (male: 1.81, female: 2.71) and drive (male: 1.01, female: 1.04) were more effective in alleviating anxiety symptoms, particularly in the dimensions of uncontrollable worrying (1.07), worry too much (1.03), trouble relaxing (1.00), and nervousness (1.00). Physical activity exerts a direct influence on anxiety, with its anxiolytic effects partially mediated by the behavioral inhibition and activation system. This mediating effect is most pronounced in the female college student population.

The Role of Physical Activity on Quality of Life Among Breast Cancer Survivors in the Black Women's Health Study

PURPOSE

Black breast cancer survivors (BCS) are more likely to experience poor quality of life (QoL) compared to White BCS. Physical activity (PA) has been shown to improve QoL in cancer survivors. However, there is limited evidence demonstrating associations between PA and multiple QoL domains among Black BCS. This study examined the association between PA duration and intensity level (e.g., ≥ 150 min/week of moderate activity) and multiple QoL domains (e.g., physical health) among BCS in the Black Women's Health Study (BWHS).

METHODS

A total of 904 BWHS participants were eligible to participate in this study. The 2019 BWHS follow questionnaire, which assessed multiple QoL domains was used to address the primary aim. Adjusted multinomial logistic regression models were fit to estimate the odds ratios and 95% confidence intervals for the associations with each exposure variable (PA) and outcome variable (QoL). Multiple imputation was used to address missing data.

RESULTS

The average participant age was 66, and the average body mass index was 29 kg/m2 at the time of QoL assessment. There were significant and positive associations between PA duration and intensity level and multiple domains of QoL (p < 0.05). Participants who engaged in higher durations of moderate PA (e.g., ≥ 150 minutes/week) had increased odds of optimal social functioning (aOR = 2.67; 95% CI 1.40, 5.08) and functional wellbeing (aOR = 4.10; 95% CI 1.71, 9.83) than those who engaged in lower durations of moderate PA (e.g., < 150 minutes/week). Compared to participants who engaged in lower durations of vigorous PA (e.g., < 60 minutes/week), those who engaged in higher durations of vigorous PA (e.g., ≥ 60 minutes/week) had greater odds of optimal physical health (aOR = 4.27; 95% CI 2.04, 8.90), social functioning (aOR = 4.48; 95% CI 2.27, 8.86), and financial wellbeing (aOR = 1.64; 95% CI 1.03, 2.63).

CONCLUSIONS

Black BCS who engage in higher durations of moderate and vigorous PA tend to have better QoL. These findings may help to build upon the importance of PA and the relevance of PA in the context of supportive care for racial and ethnic minority BCS. Future longitudinal studies are needed to establish clear temporal associations between PA and QoL in this group.

The association between weekend warrior physical activity pattern and anxiety: evidence from a U.S. population-based study

OBJECTIVE

This study investigates the association between the Weekend Warrior (WW) pattern and the risk of anxiety among American adults, offering insights into a more flexible exercise strategy for individuals with limited time for regular exercise during weekdays.

METHODS

We analyzed data from the 2007-2012 National Health and Nutrition Examination Survey (NHANES) to examine the relationship between different physical activity (PA) patterns and the risk of anxiety. Multivariate logistic regression, subgroup interaction, restricted cubic spline analysis (RCS), and sensitivity analyses were conducted to assess this association.

RESULTS

Compared to inactive individuals, those engaging in WW pattern (OR = 0.65, 95% CI: 0.48-0.90, p = 0.010), insufficiently active (OR = 0.71, 95% CI: 0.62-0.82, p < 0.001), or regularly active pattern (OR = 0.75, 95% CI: 0.65-0.87, p < 0.001) showed significantly lower risk of anxiety. Subgroup interaction analyses revealed significant effect modification in the poverty income ratio (PIR) and diabetes subgroups (P for interaction < 0.05), while no significant interactions were observed for other variables. RCS analysis showed a significant nonlinear relationship between recreational moderate to vigorous intensity physical activity and risk of anxiety (P for nonlinear < 0.001). Sensitivity analyses further confirmed the stability of the findings.

CONCLUSION

The WW pattern was associated with a lower risk of anxiety. For individuals unable to exercise consistently throughout the week, the WW pattern offers a practical alternative for reducing the risk of anxiety, particularly among those with lower income levels or diabetes.

Dose-dependent association between physical activity and mental health, and mitigation effects on risk behaviors

Understanding the dose-response effects of physical activity on mental health and risk behavior mitigation is crucial for mental health promotion. This study using restricted cubic spline and piecewise regression analyses based on a representative national sample of 30,054 Chinese adults, revealed reverse J-shaped (p for nonlinear <0.001) but monotonic beneficial associations between physical activity and depression, anxiety, and stress symptoms, with optimal thresholds identified at 2.15 METs-hour/day for depression and anxiety, and 3.25 METs-hour/day for stress. Engaging in 1-3 METs-hour/day of physical activity appeared to mitigate the adverse effects of unhealthy food intake on depression and anxiety, whereas 4-6 METs-hour/day could offset the impact of short sleep duration on depression, anxiety, and stress. The findings suggest that physical activity prescription could be effective in mitigating the adverse effects of certain risk behaviors on common mental symptoms, and excessive physical activity might not be necessary for mental health promotion.

Factors Influencing Frequency of Depressive Experiences Among Married Working Women in South Korea

Background/Objectives: This study aimed to identify the factors influencing and predicting the frequency of depressive experiences among married working women in South Korea in the post-COVID-19 period (2022-2023). It examines how alterations in circumstances and the complex difficulties encountered by this demographic group may have shaped their depressive experiences. Through a comparative analysis of the group reporting depressive experiences and the group reporting no depressive experiences, the study delineates the factors influencing depressive experiences within the former group and the predictive factors within the latter group. The findings offer a comprehensive understanding of the factors that may contribute to mental health outcomes within this population. Methods: This study utilized data from the ninth wave (2022-2023) of the Korean Longitudinal Survey of Women and Families, conducted by the Korean Women's Development Institute. The study included a total of 1735 participants. A zero-inflated negative binomial regression model was applied to analyze the frequency of depressive experiences and the influencing and predictive factors. Results: Among the participants, 38.9% reported no depressive experiences. The count model analysis revealed that subjective health status, physical activity, thoughts about husband, family decision-making, and work-family balance were significant factors associated with the frequency of depressive experiences. In the logistic model, key predictors for those without depression included the spouse's education, physical activity, satisfaction with the spouse's housework, and happiness with marital life. Conclusions: These findings provide essential empirical evidence for the development of targeted policies and interventions aimed at mitigating and preventing depression problem among married working women.

How does physical education influence university students' psychological health? An analysis from the dual perspectives of social support and exercise behavior

Objective

Physical education, as a central component of educational systems, plays a unique role in enhancing the psychological well-being of university students. This study investigates the impacts of physical education on students' mental health and examines the mediating roles of social support and exercise behavior.

Methodology

A cross-sectional survey was conducted using the Physical Education Satisfaction Scale, SCL-90, the Social Support Questionnaire, and the International Physical Activity Questionnaire. A total of 1,437 university students were assessed.

Results

The research found a positive correlation between physical education at universities and students' mental health, with a direct significant effect (β = 0.622, p < 0.001). Moreover, physical education positively influenced social support and exercise behavior (β = 0.523, p < 0.001; β = 0.473, p < 0.001). In turn, social support significantly fostered exercise behavior and improved mental health (β = 0.578, p < 0.001; β = 0.277, p < 0.001). Additionally, enhanced exercise behavior positively contributed to better mental health (β = 0.357, p < 0.001).

Conclusion

Physical education is a crucial influencing factor for university students' psychological health and also indirectly impacts mental well-being through improved social support and increased exercise behavior.

Sports Facility Use and Perceptions of Exercise Effectiveness: A Nationwide Survey of People with Disabilities in South Korea

Objectives: This study examined how the benefits of exercise vary across different dimensions, such as physical health, psychological well-being, and social interaction, for individuals with disabilities, focusing on their use of sports facilities. Methods: Based on the 2019 National Survey on Sports Participation among People with Disabilities in South Korea, 3726 participants were analyzed using stratified chi-square tests, one-way analysis of variance, analysis of covariance, and logistic regression methods, adjusting for covariates as appropriate. Results: This study's results indicate that sports facility users showed higher positive perceptions of exercise benefits compared to non-users. Notable differences in the perceived effectiveness of exercise benefits were observed in physical health and fitness (odds ratio (OR), 1.31; 95% CI, 1.07-1.62), stress relief and psychological stability (OR, 1.38; 95% CI, 1.11-1.71), daily vitality and motivation (OR, 1.62; 95% CI, 1.31-2.00), and a general sense of happiness from exercise participation (OR, 1.32; 95% CI, 1.12-1.57), whereas the perception of medical cost savings did not vary (OR, 1.08; 95% CI, 0.93-1.27). Conclusions: These findings underscore the importance of accessible sports facilities and the promotion of their active use to improve the quality of life for individuals with disabilities. Political and practical initiatives are essential for improving both physical and mental well-being among individuals with disabilities.

SleepNow - A combined cognitive behavioral therapy for insomnia and physical exercise intervention in men with metastatic prostate cancer: results from a feasibility randomized controlled trial

focused on patients living with metastatic cancer. We examined the feasibility of the SleepNow intervention combining cognitive behavioral therapy for insomnia (CBT-I) with physical exercise in men with metastatic prostate cancer (mPCa).

PATIENTS/MATERIAL AND METHODS

We conducted a feasibility randomized trial in patients under treatment for castration resistant mPCa with insomnia (Insomnia Severity Index [ISI] score ≥ 8). Patients were randomized 1:1 to either SleepNow or usual care. SleepNow is a manualized 12-week program consisting of bi-weekly sessions of physical exercise and four nurse-led sessions of CBT-I. Patients in usual care received no insomnia treatment. We assessed feasibility and measured objective and patient-reported outcomes at baseline and 3-months follow-up. Changes in both groups were compared using the Wilcoxon test.

RESULTS

We randomized 12 patients (5 intervention and 7 control; age range = 59-81 years, mean Gleason score = 7.75, mean time since diagnosis ≈ 7 years). Intervention patients reported high satisfaction, all attended at least three CBT-I sessions (75%) and four completed at least 20 of the 24 training sessions. The intervention group showed improvements in insomnia, sleep quality, fatigue, anxiety, depression and health-related quality-of-life but between-group differences were not statistically significant.

INTERPRETATION

The SleepNow intervention is the first to combine nurse-delivered CBT-I and physical exercise and was acceptable and potentially efficacious. Our results are important for targeting sleep interventions to the growing population of patients living long term with metastatic cancer.

Exploring Self-Reported Physical Activity Levels and Physical Fitness in Italian Children: A Mediation and Moderation Analysis

BACKGROUND/OBJECTIVES

Skill-related physical fitness is a crucial factor influencing health status during childhood. Starting from the lack of knowledge in the field of skill-related physical fitness and levels of physical activity in Southern Italy, this cross-sectional study aims to explore the mediating and moderating influence of PAL on the association between BMI and skill-related physical fitness.

METHODS

The sample (N = 387 students; male = 196, age = 12.2 ± 0.87 yrs; female = 191, age = 12.3 ± 0.93) was recruited from schools in the Apulia Region. The assessment included standing long jump (SLJ), 2 kg medicine ball throw (MBT) and 10 × 5 shuttle run (10 × 5) as indicators of physical fitness, and a self-report for measuring daily physical activity (PAL). A 2 (gender) × 3 (BMI cutoff)-factorial ANOVA was performed to highlight differences between groups for physical fitness components and PAL. Then, mediation and moderation models were created, establishing BMI as the independent variable, physical fitness tests as dependent variables, and PAL as the mediator and moderator variable.

RESULTS

The findings showed higher physical fitness and PAL in male and female normal-weight groups than in those who were overweight and obese. Mediation analysis revealed that higher PAL improved performance in SLJ (b = 0.091, p < 0.01, R2 = 17.16%), led to a modest understanding of the variation in MBT (ΔR2 = 0.026), and significantly reduced the time spent to perform 10 × 5 (p < 0.0, R2 = 10.72%).

CONCLUSIONS

Despite the obtained results, future research is needed to further understand the association between physical fitness and the sociocultural determinants of physical activity to guide institutional policies and interventions to prevent poor health habits.