Family aspects, physical fitness, and physical activity associated with mental-health indicators in adolescents

Physical Fitness and Risk of Mental Disorders in Children and Adolescents

Importance

With the rising prevalence of mental disorders among children and adolescents, identifying modifiable associations is critical.

Objective

To examine the association between physical fitness and mental disorder risks.

Design, Setting, and Participants

This nationwide cohort study used data from the Taiwan National Student Fitness Tests and National Health Insurance Research Databases from January 1, 2009 to December 31, 2019. Participants were divided into 2 cohorts targeting anxiety and depression (1 996 633 participants) and attention-deficit/hyperactivity disorder (ADHD; 1 920 596 participants). Participants were aged 10 to 11 years at study entry and followed up for at least 3 years, had a nearly equal gender distribution, and an average follow-up of 6 years. Data were analyzed from October 2022 to February 2024.

Exposures

Assessments of physical fitness included cardiorespiratory fitness (CF), muscular endurance (ME), muscular power (MP), and flexibility, measured through an 800-m run time, bent-leg curl-ups, standing broad jump, and sit-and-reach test, respectively.

Main Outcomes and Measures

Kaplan-Meier method calculated the cumulative incidence of anxiety, depression, and ADHD across fitness quartiles. Additionally, multivariable Cox proportional hazards models were used that included all 4 fitness components and explored sex and income as modifiers.

Results

The anxiety and depression cohort had 1 996 633 participants (1 035 411 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years), while the ADHD cohort had 1 920 596 (975 568 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years). Cumulative incidence of mental disorders was lower among participants in better-performing fitness quartiles, suggesting a dose-dependent association. Gender-specific analyses, controlling for confounders, revealed that improved CF, indicated by a 30-second decrease in run times, was associated with reduced risks of anxiety, depression, and ADHD in female participants, and lower risks of anxiety and ADHD in male participants (adjusted hazard ratio [aHR] for ADHD risk for female participants, 0.92; 95% CI, 0.90-0.94; P < .001; for male participants, 0.93; 95% CI, 0.92-0.94; P < .001). Enhanced ME, marked by an increase of 5 curl-ups per minute, was associated with decreased risks of depression and ADHD in female participants, and lower anxiety and ADHD risks in male participants (aHR for ADHD risk for female participants, 0.94; 95% CI, 0.92-0.97; P < .001; for male participants, 0.96; 95% CI, 0.95-0.97; P < .001). Improved MP, reflected by a 20-cm increase in jump distance, was associated with reduced risks of anxiety and ADHD in female participants and reduced anxiety, depression, and ADHD in male participants (aHR for ADHD risk for female participants, 0.95; 95% CI, 0.91-1.00; P = .04; for male participants, 0.96; 95% CI, 0.94-0.99; P = .001).

Conclusions and Relevance

This study highlights the potential protective role of cardiorespiratory fitness, muscular endurance, and muscular power in preventing the onset of mental disorders. It warrants further investigation of the effectiveness of physical fitness programs as a preventive measure for mental disorders among children and adolescents.

Chinese college students' mental health during the first three months of the COVID-19 pandemic: the protective role of family functioning

Background

Various psychological theories suggest that a supportive family environment protects the mental health of young adults during stressful life events. However, evidence is limited regarding the protective role of family support during a major public health crisis.

Objective

To examine the role of family functioning on mental health among Chinese college students during first stage of the COVID-19 pandemic.

Methods

Between January-March 2020, 1,555 college students (44% female, on average 19 years old) from five Chinese universities participated. Participants rated their family functioning on the Family APGAR Index and their mental health on the Psychological Questionnaires for Emergent Events of Public Health, measuring depression, neurasthenia, fear, obsessive-anxiety and hypochondriasis.

Results

Better family functioning was associated with having fewer psychological symptoms. In addition, we identified three mental health profiles related to the severity across the psychological symptoms: Low-level, medium-level and high-level symptom clusters. Latent profile analysis showed that as family function improved, students were, respectively, 16 to 24% more likely to be in the low-level symptom group, compared to being in the medium symptom group or the high-level symptom group.

Conclusion

These results support the notion that family support may act as a psychological buffer for young adults during a large-scale public health crisis like the COVID-19 pandemic.

A cross-sectional study on the analysis of the current situation of depression and anxiety among primary and secondary school students in Urumqi City in 2021: A case study of S district

BACKGROUND

Depression and anxiety in children and adolescents have become one of the major public health threats. This study aimed to provide a comprehensive and accurate understanding of the current status of depression and anxiety in primary and secondary school students in Urumqi and to provide a basis for early intervention in depressed and anxious individuals.

METHODS

All primary and secondary school students in 13 schools in the Urumqi S district were surveyed from March 2021 to November 2021, and depression and anxiety were screened using the Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS).

RESULTS

Overall, 17,086 students participated, with 16,462 valid questionnaires and an effective rate of 96.3%; the numbers of primary, middle, and high school students were 3351, 10,469, and 2642, respectively, with 8493 male students and 7969 female students. The overall depression and anxiety detection rates of primary and secondary school students were 10.74 % and 14.85 %, respectively; the depression detection rates were 5.97 %, 12.05 %, and 11.62 % in elementary, middle, and high schools, respectively=114.8, P < 0.001), while that of anxiety were 9.16 %, 16.75 %, and 14.53 %, respectively (x2=127.5, P < 0.001); the overall depression combined with anxiety detection rate was 8.61 %, and the depression combined with anxiety detection rates in elementary, middle, and high school were 0.95 %, 6.27 %, and 1.39 %, respectively=86.34, P < 0.001). SDS scores in elementary, middle, and high school were (33.21 ± 10.16), (36.66 ± 12.83), and (36.90 ± 11.97), respectively, and SAS scores were (39.64 ± 8.41), (41.88 ± 10.03), (40.71 ± 9.26), respectively. The depression and anxiety scores of primary and secondary school students in Urumqi were lower than those of domestic norm; female students in the middle school group had the highest depression and anxiety scores among all school periods. The SDS and SAS individual scores showed differences in the frequency of specific symptoms and subjective feelings of depression and anxiety among students of different sex and school periods. Depression and anxiety detection rates were highest in secondary school and lowest in primary school; the detection rates of depression and anxiety were significantly higher in female students than in male students. Depression and anxiety scores were significantly lower in the primary school group than in the middle and high school groups, and depression and anxiety levels were significantly higher in female than in male students in each academic period. Female students were 2.045 (95 % confidence interval [CI]: 1.845-2.267) and 2.006 (95 % CI: 1.835-2.193) times more likely to have symptoms of depression and anxiety than male students, respectively. Middle school students were 7.112 (95 % CI: 3.639-13.898) and 5.499 (95 % CI: 3.302-9.155) times and high school students were 7.504(95 % CI: 3.740-15.058) and 5.093 (95 % CI: 2.966-8.744) times more likely to have symptoms of depression and anxiety than elementary school students, respectively.

LIMITATIONS

The pandemic may have impacted the results of the study, and this study did not explore the influencing factors of anxiety and depression.

CONCLUSION

Depression and anxiety symptoms exist in some primary and secondary school students in S District, Urumqi.

Health indicators in Brazil and Spain: strategies for health promoting universities

AIMS

The study aims to identify and compare health indicators collected by national research in Spain and in Brazil that can generate action strategies for health promoting universities.

METHODS

This is an epidemiological, descriptive, cross-sectional study that uses the database of the Secretariat of Health Surveillance of the Brazilian Ministry of Health and the database of the National Statistics Institute of Spain. Based on the National Health Promotion Policy, the analyzer axis prioritizes defined themes; percentage of physical exercise, daily smokers, sedentary lifestyle, obesity and self-perception of health status were evaluated. The data were collected from 2014 to 2020.

RESULTS

In Brazil, physical exercise is the highest percentage indicator, whereas in Spain, sedentary lifestyle is the highest. Regarding the age group, Brazil presented the lowest prevalence of daily smokers in the age group from 18 to 24, with little increase in older age groups; in Spain, older age groups presented the highest rates of sedentary lifestyle and obesity. In 2020, 4.5% of Brazilians reported a negative self-perception of health and in Spain 6.6%.

CONCLUSION

The indicators 'physical exercise', 'daily smokers' and 'sedentary lifestyle' presented better results in Brazil than in Spain. Brazil presents a better perspective on health when compared with Spain, as the results showed that older ages present higher rates of sedentary lifestyle and obesity. Our study results also show that Brazilians report better self-perception in health, which can be interpreted by health promotion strategies.

Perceived Quality of Life Is Related to a Healthy Lifestyle and Related Outcomes in Spanish Children and Adolescents: The Physical Activity, Sedentarism, and Obesity in Spanish Study

BACKGROUND

Maintaining a healthy lifestyle is crucial for safeguarding the well-being and quality of life perception, appropriate growth, and development of children and adolescents, while also mitigating the risk of future adult-onset diseases.

OBJECTIVE

To assess associations between perceived quality of life and healthy lifestyle and related outcomes in Spanish children and adolescents.

METHODS

Cross-sectional analysis of 8-16-year-old children and adolescents (n = 3534) were included in the nationwide study of Physical Activity, Sedentarism, and Obesity in Spanish Youth (PASOS). Data were collected through (1) questionnaires on health-related quality of life (HRQoL), healthy lifestyle outcomes (dietary intake, physical fitness, sleep, and screen time), and (2) anthropometric measurements for weight status assessment. Data were analysed by logistic regression, using the health-related quality of life (HRQoL) as the grouping variable.

RESULTS

Participants with a lower HRQoL were those with a lower adherence to the MedDiet and lower achievement of the recommended daily intake of fruit and vegetables. They were also less likely to follow the recommendations for screen time and sleep (with the exception of the weekend) compared to participants with a higher HRQoL. Participants with a lower HRQoL showed a lower healthy weight status and poorer physical fitness than those with a higher HRQoL.

CONCLUSIONS

Healthy eating habits, healthy weight status (normal weight), appropriate sleep time, physical fitness, and limited screen time play a crucial role in the perceived quality of life in children and adolescents.

The promoting effect of exercise motivation on physical fitness in college students: a mediation effect model

BACKGROUND

In recent years, the physical fitness situation of college students is worrying in China. Exercise motivation is of great importance for the physical activity and physical fitness. However, existing studies have paid limited attention to the specific effect between exercise motivation, physical activity and physical fitness, and even less to the different genders and exercise motivation dimensions. This study aimed to investigate the promoting effect of sport motivation on physical fitness with different gender and dimension in college students.

METHODS

Physical fitness levels of 2544 college students in Wuhan and Jingzhou city were measured. Exercise motivation and physical activity was assessed using the Chinese version of the motives for physical activities measure-revised scale and the physical activity survey scale, respectively. Correlation analysis and structural equation model were used to explore the relationship between exercise motivation, physical activity and physical fitness. Bootstrap method was used to test the mediating effect. Multilevel regression analysis was used to examine the effects of different dimensions of exercise motivation on PF.

RESULTS

The exercise motivation of college students was directly related to physical fitness (effect value: 0.307) or indirectly related through the mediating effect of physical activity (effect value: 0.092). The mediation effect percentage of physical activity on exercise motivation and physical fitness in male (51.20%) was greater than female (27.18%), and the standardized regression coefficient of the health dimension to PF was β = 0.151, P < 0.001, and the competence dimension to PF was β = 0.189, P < 0.001.

CONCLUSIONS

The exercise motivation of college students can directly influence PF or indirectly influence PF through the mediating effect of PA. The promoting effect of exercise motivation and PA on PF in college students is related to gender and dimensions of exercise motivation. Therefore, we can improve physical fitness levels of college students by promoting their exercise motivation (especially for health motivation and competence motivation) and increasing their participation in physical activity. This study provides new strategies for improving physical fitness in college students.

Comparative effectiveness of school-based exercise interventions on physical fitness in children and adolescents: a systematic review and network meta-analysis

Background

Schools provide a favorable setting for health education, however, the most effective school-based exercise mode for improving physical fitness remains unclear. This network meta-analysis was designed to assess and rank the comparative efficacy of six exercise modalities on physical fitness indicators in a school-based setting.

Methods

An online search of the Web of Science, PubMed, SPORTDiscus, and Scopus databases was conducted. Randomized and quasi-randomized controlled trials were considered. Outcomes included measures of anthropometry and body composition, muscular fitness, and cardiorespiratory fitness. Data were pooled with a random effects model using the frequentist framework.

Results

A total of 66 studies with 8,578 participants (48% girls) were included. High-intensity interval training was the most effective intervention reducing body mass index (mean difference (MD) = -0.60 kg·m^-2, 95% confidence interval (95%CI) = -1.04 to -0.15, p = 0.009), elevating VO_2max (MD = 3.59 mL·kg^-1·min^-1, 95% CI = 2.45 to 4.74, p < 0.001), and 20-meter sprint performance (MD = -0.35 s, 95% CI = -0.55 to -0.14, p = 0.001). Aerobic training had the highest probability of reducing waist circumference (standardized mean difference (SMD) = -0.60, 95% CI = -0.88 to -0.32, p < 0.001). Active video games emerged as a promising modality for improving countermovement jump (MD = 2.43 cm, 95% CI = 0.06 to 4.80, p = 0.041) and shuttle running performance (SMD = 0.86, 95% CI = 0.29 to 1.43, p = 0.003). Strength training was the best exercise mode for improving standing long jump performance (SMD = 1.03, 95% CI = 0.07 to 1.98, p = 0.035) while combined training was rated the first for decreasing body fat percent (MD = -2.56%, 95% CI = -4.73 to -0.40, p = 0.022) and increasing push-up repetitions (SMD = 3.59, 95% CI = 0.81 to 6.37, p = 0.012).

Conclusion

School-based exercise interventions have multiple effects on physical fitness. The findings of this study will help to inform physical education teachers and coaches how best to deliver exercise programs in a school setting. Since the study was limited by the original research, the conclusions will require further verification using high-quality randomized controlled trials.

Systematic Review Registration

PROSPERO, Identifier: CRD42023401963.

Results from the China 2022 report card on physical activity for children and adolescents

Background/Objective

Regular physical activity (PA) is beneficial to young people's health and development. In order to provide nationally representative and internationally comparable evidence on youth PA, China has participated in Global Matrix 2.0 and 3.0. The purpose of this study is to report the updated results of China's Report Card on PA for Children and Adolescents.

Methods

The grades were assigned by results derived from the PA and Fitness in China––The Youth Study (PAFCTYS), conducted from October to December in 2020. The data from PAFCTYS 2020 included a nationally representative sample of Chinese school-aged children (n = 133,006, boys: 49.6%, aged 9–17 years). Self-report questionnaires were completed by the sampled students, their parents/guardians (n = 133,006), and physical education teachers (n = 1036) from each sampled school respectively.

Results

The grades of China 2022 Report Card are Overall PA (C), Organized Sport Participation (F), Active Play (C-), Active Transportation (C), Sedentary behaviors (C), Physical Fitness (INC), Family and Peers (C-), School (D), Community and Environment (D-), and Government (D).

Conclusion

Levels of PA among Chinese youth were low and most young people were below the recommended guidelines, although the grade of Overall PA has been improved since the modified benchmark. Prevalence of sedentary behaviors remained high. Interventions and policies at the community and environment level should be encouraged to promote PA and reduce sedentary behaviors. In addition, national policies on young people's PA should be advocated widely to ensure the policies can be transferred into action.

Helicopter Parenting and Emotional Problems in Chinese Emerging Adults: Are there Cross-lagged Effects and the Mediations of Autonomy?

Although evidence suggests that helicopter parenting causes emotional problems in emerging adults, how emotional problems in emerging adults affect helicopter parenting and the mediating role of autonomy in reciprocal relationships is little known. Therefore, this study collected data from 418 Chinese university students (80.1% female; M_age = 18.71, SD = 1.15) three times (in the second, fourth, and fourteenth months after enrollment) about perceived helicopter parenting, emotional issues (anxiety and depressive symptoms), and autonomy. The results of the cross-lagged panel models showed that emotional problems in emerging adults predicted the later assessment of helicopter parenting, the reverse relationship between the two variables was not the case. Emerging adults' emotional issues at Time 1 reduced their autonomy at Time 2, leading to increased helicopter parenting behaviors at Time 3. However, helicopter parenting at Time 1 did not affect emerging adults' autonomy at Time 2, which also had no relation to their emotional problems at Time 3. These findings suggest that helicopter parenting is more likely a reaction to maladjustment in emerging adults than an influencing factor. The research clarifies changes in parent-child interactions during the transition to adulthood and will help promote the adaptation of emerging adults in college.

The Importance of Healthy Habits to Compensate for Differences between Adolescent Males and Females in Anthropometric, Psychological and Physical Fitness Variables

Adolescence is a crucial stage in human development, and differences in psychological, physical and body composition variables between males and females have been amply demonstrated. However, the role played by certain healthy habits, such as the practice of physical activity, adherence to the Mediterranean diet (AMD) or the maintenance of an adequate weight status, in compensating for the differences found between males and females in these variables, is not well known. For this reason, the study aimed to analyze whether the practice of physical activity, optimal AMD, and adequate weight status can compensate for the differences between adolescent males and females in anthropometric variables, psychological state, and physical fitness. The sample was composed of 791 adolescents (404 males and 387 females) aged twelve to sixteen years old, whose anthropometric, psychological (autonomy, competence, relatedness, and life satisfaction), and physical fitness variables (cardiorespiratory fitness, upper strength and explosive lower limb power, hamstring and lower back flexibility, and speed) were measured. All measurements were carried out in a single day using the sports pavilion of the four participating schools. The most novel results of this research show that the practice of physical activity was determinant mainly in females, as it reduced the differences found in comparison with males in psychological (p < 0.001−0.045) and anthropometric variables (p < 0.001). Regarding weight status and AMD, these were still relevant for the adolescent population, mainly the achievement of optimal AMD, but males continued to present higher values in physical fitness tests (p < 0.001) and lower values in fat accumulation (p < 0.001), regardless of weight status or AMD. Thus, physical activity seems to be the most determining factor that compensates for the differences between adolescent boys and girls.

Associations between socioeconomic status and physical activity: A cross-sectional analysis of Chinese children and adolescents

Objectives

Although socioeconomic status (SES) has been shown to be an important determinant of physical activity (PA) in adults, the association in children and adolescents remains less consistent based on evidence from western developed countries. The purpose of this study, therefore, is to investigate associations between SES and PA among Chinese children and adolescents.

Methods

A cross-sectional study was conducted with a self-reported questionnaire in China. The multi-stage stratified cluster sampling method was used, and 2,955 children and adolescents (8–17 years old, 53.4% girls) were enrolled in this study. SES was assessed by measuring parental education levels, perceived family wealth, and Family Affluence Scale II (FAS II). PA was assessed by reliable and valid items from the Health Behavior School-aged Children Surveillance questionnaires. Descriptive statistics were used to report sample characteristics, including demographic characteristics, levels of PA, and SES. The Chi-square test was applied to analyze the differences of PA in gender and school period. Binary logistic regression was used to analyze the association between SES and PA among children and adolescents.

Results

Overall, 10.4% of children and adolescents accumulated moderate-to-vigorous physical activity (MVPA) at least 60 min per day. Boys were more physically active than girls (14.1% vs. 7.2%, p &lt; 0.001). Higher socioeconomic status was positively associated with higher physical activity levels among children and adolescents, especially using FAS and mother education level as SES measures. The association between SES and PA varied by gender and grade group, and the effects of SES are also different on weekdays and weekends.

Conclusion

This study found socioeconomic disparities in PA among Chinese children and adolescents, and showed the importance of targeting children and adolescents with low SES intervention priority. Based on these research findings, it is suggested that SES, especially for FAS and mother education level, should be considered when designing and implementing the promotion of regular PA in children and adolescents. Health policymakers may use this information to develop interventions to reduce health inequalities among children and adolescents in the future.

Association between Physical Fitness Index and Psychological Symptoms in Chinese Children and Adolescents

The aim of this study was to determine the relationship between different physical fitness indices (PFIs) and psychological symptoms and each dimension (emotional symptoms, behavioral symptoms, social adaptation difficulties) of Chinese children and adolescents. Methods: A total of 7199 children and adolescents aged 13−18 in Jiangxi Province, China, were tested for grip strength, standing long jump, sit-ups, sit and reach, repeated straddling, 50 m run, 20 m shuttle run test (20 m SRT) items. The physical fitness indicators were standardized, converted to Z score and added up to obtain the PFI, and the self-assessment of the psychological section of the multidimensional sub-health questionnaire of adolescents (MSQA) to test the psychological symptoms, using the chi-square test to determine the psychological symptoms of different types of children and adolescents and binary logistic regression analysis to determine the association between psychological symptoms and different PFI grades. Results: The higher the PFI of Chinese children and adolescents, the lower the detection rate of psychological symptoms, emotional symptoms and social adaptation difficulties, from 25.0% to 18.4%, 31.3% to 25.7% and 20.1% to 14.4%, respectively. These results were statistically significant (χ2 = 14.073, 9.332, 12.183, p < 0.05). Taking the high-grade PFI as a reference, binary logistic regression analysis was performed. Generally, compared with the high-grade PFI, children and adolescents with a low-grade PFI (OR = 1.476, 95% CI: 1.200−1.814) or medium-grade PFI (OR = 1.195, 95% CI: 1.010−1.413) had a higher risk of psychological symptoms (p < 0.05). Conclusions: The lower the PFI of Chinese children and adolescents, the higher the detection rate of psychological symptoms, showing a negative correlation. In the future, measures should be taken to improve the physical fitness level of children and adolescents in order to reduce the incidence of psychological symptoms and promote the healthy development of children and adolescents.