Association of perceived stress with changes in physical activity and sitting time before and during COVID-19 pandemic among college students

OBJECTIVE

To examine the association of perceived stress [PS] with physical activity [PA] and sitting time [ST], before and during COVID-19 among US college students. Participants: 592 students from a large Western university (19.08 ± 4.62 years, 76.69% female, 79.39% White) were recruited. Methods: Self-reported online survey was completed in June-December 2020. Analysis included paired T-tests for continuous variables, Pearson Correlation the relationship between PSS, PA, and sitting time before and during COVID-19, and linear mixed models examined the association of outcome variables with PSS, time, and PSS × time. Results. Vigorous, moderate, and light PA decreased by 40%, 35% and 19%, sitting time increased by 52%, and PSS increase by 42% from before to during COVID-19. Conclusions: The perceived stress during COVID-19 may have influenced physical activity and sitting time. Effective health promotion programs and coping strategies are needed to protect college students as campuses reopen during COVID.

Effect of Exercise on Mental Health and Health-related Quality of Life in Adults With Spinal Cord Injury: A Systematic Review and Meta-Analysis

OBJECTIVES

To determine the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with SCI.

DATA SOURCES

We searched Embase, CINAHL, Medline, PsychINFO, and SPORTDiscus from inception to September 2023.

STUDY SELECTION

We included randomized controlled trials that (1) involved participants ≥18 years old with a SCI; (2) administered an exercise intervention; and (3) measured subjective well-being, psychological well-being, social well-being, and/or HRQoL as outcomes. We reported standardized means differences (d) with a 95% confidence interval (CI), assessed the risk of bias by using the Revised Cochrane Risk-of-bias Tool for Randomized Trials (RoB 2), and the certainty of the evidence using GRADE.

DATA SYNTHESIS

Nineteen studies (797 participants, mean age <65 years in every study) were included. Exercise improved overall well-being (d=0.494; 95% CI 0.268, 0.720; low certainty evidence), subjective well-being (d=0.543; 95% CI 0.270, 0.816; low certainty evidence), psychological well-being (d=0.499; 95% CI 0.193, 0.805; low certainty evidence), social well-being (d=0.452; 95% CI 0.151, 0.752; low certainty evidence), and HRQoL (d=0.323; 95% CI 0.072, 0.574; low certainty evidence). Four serious adverse events probably attributable to the interventions were reported in 3 studies.

CONCLUSIONS

Exercise interventions can improve well-being and HRQoL in adults with SCI <65 years of age. Additional research is needed to determine effectiveness in adults ≥65 years of age.

Research status and trends of physical activity on depression or anxiety: a bibliometric analysis

Background

Anxiety and depression are prevalent mental disorders. As modern society continues to face mounting pressures, the incidence of anxiety and depression is on the rise. In recent years, there has been an increasing breadth of research exploring the relationship between anxiety, depression, and physical activity (PA). However, the current research progress and future development trends are unclear. The purpose of this study is to explore the research hotspots and development trends in this field, and to provide guidance for future studies and to provide some reference for clinicians.

Methods

We searched the relevant literature of Web of Science Core Collection from the establishment of the database to August 15, 2023. CiteSpace, VOSviewer and Bibliometrix Packages based on the R language were used to analyze the number of publications, countries, institutions, journals, authors, references, and keywords.

Results

A total of 1,591 studies were included in the analysis, and the research in the field of PA on anxiety or depression has consistently expanded. The USA (304 publications), Harvard University (93 publications), and the journal of affective disorders (97 publications) were the countries, institutions, and journals that published the highest number of articles, respectively. According to the keywords, students and pregnant women, adult neurogenesis, and Tai Chi were the groups of concern, physiological and pathological mechanisms, and the type of PA of interest, respectively.

Conclusion

The study of PA on anxiety or depression is experiencing ongoing expansion. Clinicians can consider advising patients to take mind-body exercise to improve mood. In addition, future researchers can explore the mind-body exercise and its impact on anxiety or depression, PA and anxiety or depression in specific populations, and adult neurogenesis of various exercise in anxiety or depression.

Elder abuse victimization, mental health, and protective factors

OBJECTIVES

This study investigated the association between elder abuse and depressive symptoms, as well as protective factors against adverse mental health outcomes from elder abuse.

METHODS

Participants were drawn from the 5928 graduates of the WLS, Wave 3 study (age range 70-73) who completed both in-person and telephone interviews. From this large group, 975 (16.4%) participants reported having experienced elder abuse and were included in the sample. Path analysis using Mplus was employed.

RESULTS

Elder abuse victimization was significantly associated with depressive symptoms, and those who had suffered multiple types of elder abuse experienced more severe mental health outcomes. However, both light physical activity conducted alone and having a friend as a confidant were negatively associated with depressive symptoms among older adults who had experienced elder abuse.

CONCLUSION

Given the significant association between elder abuse and negative mental health outcomes among older survivors, screening and prevention programs are recommended. Older adults who have experienced elder abuse may benefit from programs designed to increase physical activity and help older adults build and maintain close relationships with friends and confidants.

Analysis of the Effect of Different Physical Exercise Protocols on Depression in Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Physical exercise (PE) is an effective treatment for depression, alone or as an adjunct.

OBJECTIVE

There is a lack of indicators regarding the frequency, intensity, duration, and type of physical exercise (PE). This study aims to synthesize and analyze the dose-effect of different PE protocols in adult subjects in the treatment of depression, based on the analysis of randomized controlled trials (RCTs).

DATA SOURCES

The search was conducted using Web of Science, PubMed, and Cochrane Library electronic databases.

STUDY SELECTION

Studies with an exercise-based intervention published by December 31, 2021 were identified. RCTs and meta-analyses involving adults with depression were also included; 10 studies were selected, including a total of 956 subjects.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

RESULTS

Effect sizes were summarized using standardized mean differences (95% confidence interval) by effected randomized models. The results reinforce that exercise appears to be beneficial in improving depression among adults aged 18 to 65 years. Interventions lasting above 150 minutes per week of moderate intensity and group interventions seem to have a more significant effect on reducing depression. Studies have revealed that aerobic exercise, compared with resistance or flexibility, has a more positive effect on depression.

CONCLUSION

PE can be a way to reduce depression and can be used as a possible adjunctive tool for pharmacological and/or alternative treatments. Considering the findings of this study, it is important that health professionals (eg, exercise physiologists, physicians, nurses, psychologists) promote the practice of PE as a complementary alternative and act early to prevent the worsening of depression.

PROSPERO REGISTRATION NUMBER

CRD42020188909.

Effects of internet-based exercise intervention on depression and anxiety: A systematic review and meta-analysis

BACKGROUND

While exercise is acknowledged for its positive effects on depression and anxiety symptoms, the benefits of internet-based exercise on mental health have not been extensively examined. This study seeks to systematically review and quantify the outcomes of high-quality randomized controlled trials (RCTs) that investigate the impact of internet-based exercise on depression and anxiety symptoms.

METHODS

Following the PRISMA 2020 guidelines, we conducted a comprehensive meta-analysis of RCTs. Databases, including Web of Science Core Collection, PubMed, PsycINFO, Medline, BIOSIS Previews, SPORTDiscus, and Education Source, were scoured through in September 2023. After quality assessment and data extraction, the analysis was performed using R. Using random effects models, effect sizes were determined and subsequently represented as standardized mean differences (SMD).

RESULTS

Our analysis incorporated data from 11 RCTs, involving a cohort of 1009 participants. We observed a modest yet significant reduction in depression and anxiety symptoms, with an SMD of -0.44 [95% confidence interval (CI) (-0.63, -0.26), I^2 = 79.3%, P < .01]. Interestingly, the effects were more pronounced in individuals diagnosed with depression, as indicated by an SMD of -0.96 [95% CI (-1.55, -0.37), I^2 = 82%, P < .01]. Furthermore, participants utilizing smartphone applications as part of their intervention reported a meaningful reduction in their symptoms, evidenced by an SMD of -0.52 [95% CI (-0.90, -0.14), I^2 = 87%, P < .01]. Additionally, short-term interventions, specifically those lasting <12 weeks, indicated a notable alleviation in depression symptoms, with an SMD of -0.76 [95% CI (-1.38, -0.14), I^2 = 86%, P < .01].

CONCLUSION

Internet-based exercise interventions yield significant amelioration in depression and anxiety symptoms, with heightened efficacy observed among individuals with depression. Notably, short-term interventions, specifically those under 12 weeks, demonstrate enhanced benefits for depression relief.

Running exercise alleviates hippocampal neuroinflammation and shifts the balance of microglial M1/M2 polarization through adiponectin/AdipoR1 pathway activation in mice exposed to chronic unpredictable stress

Running exercise has been shown to alleviate depressive symptoms. However, the mechanism underlying the antidepressant effects of running exercise is not fully understood. The imbalance of M1/M2 microglia phenotype/polarization and concomitant dysregulation of neuroinflammation play crucial roles in the pathogenesis of depression. Running exercise increases circulating levels of adiponectin which is known to cross the blood‒brain barrier and suppress inflammatory responses. AdipoR1 is an adiponectin receptor that is involved in regulating microglial phenotypes and activation states. However, whether running exercise regulates hippocampal microglial phenotypes and neuroinflammation through adiponectin/AdipoR1 to exert its antidepressant effects remains unclear. In the current study, 4 weeks of running exercise significantly alleviated the depressive-like behaviors of chronic unpredictable stress (CUS)-exposed mice. Moreover, running exercise decreased the microglial numbers and altered microglial morphology in three subregions of the hippocampus to restore the M1/M2 balance; these effects were accompanied by regulation of pro-/anti-inflammatory cytokine production and secretion in CUS-exposed mice. These effects may involve elevation of peripheral tissue (adipose tissue and muscle) and plasma adiponectin levels, and hippocampal AdipoR1 levels as well as activation of the AMPK-NF-κB/STAT3 signaling pathway by running exercise. When an adeno-associated virus was used to knock down hippocampal AdipoR1, mice showed depressive-like behaviors and alterations in microglia and inflammatory factor expression in the hippocampus that were similar to those observed in CUS-exposed mice. Together, these results suggest that running exercise maintains the M1/M2 balance and inhibits neuroinflammation in the hippocampus of CUS-exposed mice. These effects might occur via adiponectin/AdipoR1-mediated activation of the AMPK-NF-κB/STAT3 signaling pathway.

Whether weekend warrior activity and other leisure-time physical activity pattern reduce the risk of depression symptom in the representative adults? A population-based analysis of NHANES 2007-2020

BACKGROUND

The rapid pace of life nowadays has seen a gradual increase in public involvement in weekend warrior (WW), a physical activity (PA) pattern that allows people to exercise once or twice a week, the recommended moderate-to-vigorous PA per week, since regular PA takes much time. We aim at exploring the effect of WW activity and other PA patterns on depression symptoms in U.S adults.

METHODS

The level of PA was measured by self-reporting activity patterns, (inactive, insufficiently active, WW and regularly active). Participants with Patient Health Questionnaire-9 (PHQ-9) scores above 10 are considered to have depression symptoms.

RESULTS

A weighted sample of 23,258 participants representing 1049.8 million non-institutionalized U.S adults aged from 20 to 80. Compared with the inactive group, general adults who met the PA guidelines with PA once or twice per week [WW, adjusted odds ratio (AOR) = 0.790, 95%CI: 0.638, 0.987] or more frequent PA [Regularly active, (AOR = 0.761, 95%CI: 0.671, 0.864)], were inversely associated with depression symptoms, while the association has not been observed in adults with insufficiently active PA (AOR = 0.892, 95%CI: 0.783, 1.017). Increase in minutes, sessions and intensity of PA in regularly active and WW groups brought additional benefits for depression symptoms.

CONCLUSION

WW and other equivalent PA intensities patterns may be sufficient to reduce the risk of depression symptom. With the same recommended levels of PA, whether spread over the week or done in fewer days, adults may achieve the same benefits.

Cardiorespiratory fitness and incident use of anxiolytics and antidepressants in adults. A linkage study between HUNT and the Norwegian Prescription Database

BACKGROUND

We investigated the association between cardiorespiratory fitness (CRF) and incident use of antidepressants or anxiolytics in the general adult population.

METHODS

A non-exercise prediction model was used to estimate CRF in 32,603 participants in the third wave of the Trøndelag Health Study (HUNT3; 2006-08). Data on first purchase of antidepressants and anxiolytics were obtained from the Norwegian Prescription Database. Cox regression was used to estimate hazard ratios (HRs).

RESULTS

Each 1- metabolic equivalent of task (MET) increase in CRF was associated with 4 % reduced risk of purchasing antidepressant or anxiolytic medication during follow-up (HR 0.96, 95 % Confidence interval [CI] 0.94-0.98). Compared to the low CRF tertile, participants in intermediate (HR 0.93, 95 % CI 0.87-0.98) and high (HR 0.92, 95 % CI 0.86-0.98) CRF tertiles had reduced risk of medication purchase. Men in intermediate and high CRF tertile had lower risk of medication purchase (intermediate HR 0.87, 95 % CI 0.79-0.96; high HR 0.87, 95 % CI 0.78-0.96). Intermediate and high CRF tertiles were associated with reduced risk of medication use for younger adults (20 to <30 years old; intermediate HR 0.74, 95 % CI 0.61-0.91, high HR 0.78, 95 % CI 0.64-0.95) and middle-aged adults (30 to <65 years old; intermediate HR 0.90, 95 % CI 0.83-0.97, high HR 0.90, 95 % CI 0.84-0.98), but not in older adults (≥65 years old).

LIMITATIONS

Only information about medication purchase and not actual use was available.

CONCLUSION

Increased CRF is associated with reduced risk of anxiolytics and antidepressants purchase, with stronger effects for men and younger adults.

High-intensity interval training ameliorates chronic unpredictable mild stress-induced depressive behaviors via HDAC2-BDNF signaling in the ventral hippocampus

Major depressive disorder (MDD) is a devastating psychiatric disease, and current therapies could not well meet the demand for MDD treatment. Exercise benefits mental illness, and notably, exercise has been recommended as an alternative option for MDD treatment in some countries. However, the paradigm and intensity of exercise for MDD treatment has yet to be determined. High-intensity interval training (HIIT) is a potent and time-efficient type of exercise training and has gained popularity in recent years. In this study, we exposed the mice to chronic unpredictable mild stress (CUMS) and found HIIT exerted substantial antidepressant effect. Moreover, HIIT further enhanced the antidepressant effect of fluoxetine, a classic antidepressant in the clinic, confirming the antidepressant role of HIIT. HIIT significantly reversed the CUMS-induced upregulations in HDAC2 mRNA and protein level in the ventral hippocampus. We also found HIIT rescued the CUMS-induced downregulation in the expression of brain-derived neurotrophic factor (BDNF) and HDAC2 overexpression counteracted the HIIT-induced increase in BDNF level. More importantly, both virus-mediated HDAC2 overexpression and microinfusion of TrkB-Fc, a BDNF scavenger, in the ventral hippocampus abolished the antidepressant effect of HIIT. Together, our results strongly demonstrate that HIIT attenuates depressive behaviors, probably via HDAC2-BDNF signaling pathway and reveal that HIIT may serve as an alternative option for MDD treatment.

Efficacy of non-pharmacological interventions on improving sleep quality in depressed patients: A systematic review and network meta-analysis

OBJECTIVE

Depression and sleep are closely related and tend to affect each other. To improve the sleep quality in depressed patients and the depression severity, there is an urgent need to find safer and more effective treatments - non-pharmacological interventions. This network meta-analysis aimed to investigate the effects of non-pharmacological interventions on improving sleep quality of patients with depression.

METHODS

All published literature were searched from four databases (Pubmed, Embase, Cochrane, Web of Science) as of November 2022. The risk of bias of the included studies was assessed using the Cochrane Systematic Review Manual 2.0 bias risk assessment tool. The primary outcome was sleep quality and, the secondary outcome was depression severity.

RESULTS

This study included 26 randomized controlled trials, involving 11 interventions and 3748 depressed patients. Cognitive-behavioral therapy (CBT) (SMD: 2.80; 95% CI: 1.63,3.96), aromatherapy (SMD: 3.95; 95% CI: 0.71,7.19), and acupuncture (SMD:3.49; 95% CI: 0.88,6.10) statistically and significantly improved sleep quality, compared to education only. CBT and acupuncture both were significantly more effective than education in depression severity. The cluster analysis showed that acupuncture, exercise, and cognitive-behavioral therapy were considered to be more effective non-pharmacological interventions.

CONCLUSION

Non-pharmacological interventions are promising in the daily care of depressed patients. In future research, we should value the need for psychological and social aspects of psychiatric care and make better use of nonpharmacological interventions through the biopsychosocial model. (PROSPERO registration number: CRD42023402316).

"Students Moving Together", Tailored Exercise for Students Facing Mental Health Challenges-A Pilot Feasibility Study

An increasing number of university students are facing mental health challenges. The primary aim of this study was to determine the feasibility of 10 weeks of supervised tailored group exercise for 60 min twice a week delivered by the student health service for students facing mental health challenges. Secondary aims were to explore changes in mental health and physical fitness from pre- to post-test. Feasibility was assessed in terms of recruitment, drop-outs, attendance, and adverse events. The secondary outcomes included symptoms of depression and anxiety, wellbeing, satisfaction with life, cardiorespiratory fitness, and muscular endurance/strength. A total of 13 university students with self-reported mental health challenges, aged 20-39 years, were recruited during a four-week period. Ten (77%) of these completed the intervention and post-test as planned, and no adverse events occurred. There was a significant average reduction of 20% in symptoms of depression and anxiety (p = 0.008), and non-significant improvements of 21% in well-being and 16% in satisfaction with life were found. On average, cardiorespiratory fitness (p = 0.01) and muscular strength (push-ups test, p = 0.01, and sit-ups test, p = 0.02) increased. In conclusion, a 10-week tailored exercise intervention delivered by the student mental health service was found to be feasible, and beneficial for mental health and physical fitness in students facing mental health challenges.

Prevalence and factors associated with anxiety and depression among Chinese prison officers during the prolonged COVID-19 pandemic

Objective

This study examined the prevalence of anxiety and depression-along with the potential risk and protective factors-among Chinese prison officers during the prolonged COVID-19 pandemic.

Method

A cross-sectional survey of 1,268 officers from five prisons in western and southern China was administered between June and July 2022. The questionnaires comprised two sections. In the first section, the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate the prevalence of anxiety and depression, respectively, among prison officers. In the second section, the potential influencing factors were examined. Categorical data were compared using χ2 tests and t-tests; binary logistic regression analysis was performed to identify factors associated with anxiety and depression.

Results

The prevalence rates of anxiety and depression among the prison officers were 72.6% and 69.8%, respectively. Risk factors for anxiety were older age, being unmarried, work-family conflicts, job demands, and COVID-19 burnout; protective factors were exercise, positive family relationships, and group cohesion. Work-family conflicts, job demands, intolerance of uncertainty regarding COVID-19, and COVID-19 burnout were risk factors for depression, whereas annual income >150,000 RMB, exercise, positive family relationships, group cohesion, and job autonomy were protective factors against depression.

Conclusion

The prevalence of anxiety and depression among Chinese prison officers was relatively high during the prolonged COVID-19 pandemic, and more targeted measures should be implemented to improve their mental health. This study offers a reference for improving prison officers' mental health in response to similar public health emergencies in the future.

New Perspectives on Treatment of Depression in Coronary Heart Disease

ABSTRACT

It has been 35 years since we published a study in Psychosomatic Medicine showing that patients with coronary heart disease (CHD) and major depression were at twice the risk of having a cardiac event as were nondepressed patients (Carney et al. Psychosom Med. 1988;50:627-33). This small study was followed a few years later by a larger, more convincing report from Frasure-Smith et al. (JAMA. 1993;270:1819-25) showing that depression increased the rate of mortality in patients with a recent acute myocardial infarction. Since the 1990s, there have been many more studies of depression as a risk factor for cardiac events and cardiac-related mortality from all over the world, and many clinical trials designed to determine whether treating depression improves medical outcomes in these patients. Unfortunately, the effects of depression treatment in patients with CHD remain unclear. This article considers why it has been difficult to determine whether treatment of depression improves survival in these patients. It also proposes several lines of research to address this question, with the goal of definitively establishing whether treating depression can extend cardiac event-free survival and enhance quality of life in patients with CHD.

Adaption of tele-behavioral activation to increase physical activity in depression: Protocol for iterative development and evaluation

Background

Poor treatment outcomes, disease recurrence, and medical co-morbidities contribute to the significant burden caused by depressive disorders. Increasing physical activity in persons with depression has the potential to improve both depression treatment outcomes and physical health. However, evidence for physical activity interventions that can be delivered as part of depression treatment remains limited. This study will examine a Behavioral Activation teletherapy intervention adapted to include a specific focus on increasing physical activity.

Methods

The two-phase study will include a preliminary pilot study (n = 15) to evaluate and refine the manualized intervention using a mixed-methods approach followed by a single-arm study to evaluate feasibility and preliminary efficacy of the adapted BA teletherapy. Participants will be adults, age 18-64, with moderate to severe depressive symptoms (defined as a PHQ-9 score ≥10) and who currently engage in 90 min or less of moderate-to-vigorous physical activity. Individuals will be excluded if they have a current or past manic or hypomanic episode, psychosis, schizophrenia or schizophreniform disorder, or active suicidal ideation, or if not medically-cleared to exercise. The BA intervention will consist of 8 weekly sessions, followed by 2 bi-weekly booster sessions. Feasibility outcomes will include metrics of screening, enrollment, intervention adherence and fidelity, and participant retention. Intervention preliminary efficacy will be evaluated through assessment of changes in depressive symptoms and moderate-to-vigorous physical activity.

Conclusion

Data from this trial will be used to support the conduct of a randomized controlled trial to evaluate the efficacy of the adapted BA intervention.

Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders

BACKGROUND

Antidepressant medication and running therapy are both effective treatments for patients with depressive and anxiety disorders. However, they may work through different pathophysiological mechanisms and could differ in their impact on physical health. This study examined effects of antidepressants versus running therapy on both mental and physical health.

METHODS

According to a partially randomized patient preference design, 141 patients with depression and/or anxiety disorder were randomized or offered preferred 16-week treatment: antidepressant medication (escitalopram or sertraline) or group-based running therapy ≥2 per week. Baseline (T0) and post-treatment assessment at week 16 (T16) included mental (diagnosis status and symptom severity) and physical health indicators (metabolic and immune indicators, heart rate (variability), weight, lung function, hand grip strength, fitness).

RESULTS

Of the 141 participants (mean age 38.2 years; 58.2 % female), 45 participants received antidepressant medication and 96 underwent running therapy. Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881). However, the groups differed significantly on various changes in physical health: weight (d = 0.57; p = .001), waist circumference (d = 0.44; p = .011), systolic (d = 0.45; p = .011) and diastolic (d = 0.53; p = .002) blood pressure, heart rate (d = 0.36; p = .033) and heart rate variability (d = 0.48; p = .006).

LIMITATIONS

A minority of the participants was willing to be randomized; the running therapy was larger due to greater preference for this intervention.

CONCLUSIONS

While the interventions had comparable effects on mental health, running therapy outperformed antidepressants on physical health, due to both larger improvements in the running therapy group as well as larger deterioration in the antidepressant group.

TRIAL REGISTRATION

Trialregister.nl Number of identification: NTR3460.

Considering depression as a secondary outcome in the optimization of physical activity interventions for breast cancer survivors in the PACES trial: a factorial randomized controlled trial

BACKGROUND

Depressive symptoms result in considerable burden for breast cancer survivors. Increased physical activity may reduce these burdens but existing evidence from physical activity interventions in equivocal. Furthermore, physical activity intervention strategies may differentially impact depressive symptoms, which should be considered in designing and optimizing behavioral interventions for breast cancer survivors.

METHODS

The Physical Activity for Cancer Survivors (PACES) trial enrolled 336 participants breast cancer survivors, who were 3 months to 10 years post-treatment, and insufficiently active (< 150 min of moderate-to-vigorous physical activity per week). Participants were randomly assigned to a combination of 4 intervention strategies in a full-factorial design: 1) supervised exercise sessions, 2) facility access, 3) Active Living Every Day, and 4) Fitbit self-monitoring. Depressive symptoms were assessed at baseline, mid-intervention (3 months), and post-intervention (6 months) using the Quick Inventory for Depressive Symptoms. Change in depressive symptoms were analyzed using a linear mixed-effects model.

RESULTS

Results from the linear mixed-effects model indicated that depressive symptoms decreased significantly across the entire study sample over the 6-month intervention (F = 4.09, p = 0.044). A significant ALED x time interaction indicated participants who received the ALED intervention experienced greater reductions in depressive symptoms (F = 5.29, p = 0.022). No other intervention strategy significantly impacted depressive symptoms.

CONCLUSIONS

The ALED intervention consists of strategies (i.e., goal setting, social support) that may have a beneficial impact on depressive symptoms above and beyond the effect of increased physical activity. Our findings highlight the need to consider secondary outcomes when designing and optimizing physical activity interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03060941. Posted February 23, 2017.

Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to patients with post-covid-19 condition? A systematic review and meta-analysis

The Coronavirus Disease 2019 (Covid-19) pandemic had dramatic effect on mental health, causing long-term psychiatricmorbidity. At present, there are no randomized trials reporting the effect of physical exercise on individuals with post- Covid-19 condition are available. The aim of this review was to summarize the evidence regarding the evidence on exercise as a treatment for anxiety and depression symptoms secondary to chronic diseases, which may be generalized to individuals suffering from the post- Covid-19 condition. Trials were included if they reported the effects of physical exercise programs on anxiety or depression symptoms in adults, either healthy or affected by chronic diseases. Outcomes were changes of anxiety or depression severity after an exercise-based intervention. Of the 2161 RCTs identified, eight out of 15 studies were included. Exercise was associated with greater improvements of depressive (SMD = -0.169; 95 % CI -0.302 at -0.003; p = 0.013) and anxiety symptoms (SMD = -0.263, 95 % CI -0.418 at -0.109; p = 0.001), compared with control interventions. Supervised exercise programs were effective against symptoms of anxiety or depression among individuals with chronich illnesses. Pending specific clinical trials, exercise may be considered for adoption among patients with the post Covid-19 condition.

Undergraduate student perceptions of cognitive behavioral therapy, aerobic exercise, and their combination for depression

OBJECTIVE

Both aerobic exercise and Cognitive Behavioral Therapy (CBT) improve depression, but perceptions of their credibility and efficacy are underexplored. These perceptions can contribute to treatment seeking and outcome. A previous online sample ranging in age and education rated a combined treatment higher than individual components and underestimated their efficacy. The current study is a replication exclusively focused on college students.

PARTICIPANTS

Undergraduates (N = 260) participated during the 2021-2022 school year.

METHODS

Students reported impressions of each treatment's credibility, efficacy, difficulty, and recovery rate.

RESULTS

Students viewed combined therapy as potentially better, but also more difficult, and underestimated recovery rates, replicating previous work. Their efficacy ratings significantly underestimated both meta-analytic estimates and the previous sample's perceptions.

CONCLUSIONS

Consistent underestimation of treatment effectiveness suggests that realistic education could prove especially beneficial. Students might be more willing than the broader population to accept exercise as a treatment or adjunct for depression.

An examination of bidirectional associations between physical activity and mood symptoms among individuals diagnosed and at risk for bipolar spectrum disorders

OBJECTIVES

Activation, a construct including energy and activity, is a central feature of Bipolar Spectrum Disorders (BSDs). Prior research found motor activity is associated with affect, and this relationship may be stronger for individuals with BSDs. The aims of this study were to investigate bidirectional relationships between physical activity and mood and evaluate whether bipolar risk status moderated potential associations.

METHODS

Young adults at low-risk, high-risk, and diagnosed with BSD participated in a 20-day EMA study in which they wore an actiwatch to measure physical activity and sleep/wake cycles. They also reported depressive and hypo/manic symptoms three times daily. Multilevel linear models were estimated to examine how bipolar risk group moderated bidirectional relationships between physical activity and mood symptoms at within-day and between-day timescales.

RESULTS

Physical activity was significantly associated with subsequent mood symptoms at the within-day level. The relationship between physical activity and depressive symptoms was moderated by BSD risk group. An increase in physical activity resulted in a greater reduction of depressive symptoms for the BSD group compared to the low-risk and high-risk groups.

CONCLUSIONS

Interventions targeting activity like behavioral activation may improve residual inter-episode mood symptoms.

The impact of physical activity intervention on perinatal depression: A systematic review and meta-analysis

BACKGROUND

No meta-analysis has analyzed the effect of physical activity level, period of physical activity intervention, and duration of intervention, on perinatal depression. This study was to evaluate the impact of physical activity intensity, dose, period, and duration on perinatal depression.

METHODS

The literature was searched via the PubMed, Embase, Cochrane Library, and Web of Science databases. Weighted mean difference (WMD) or the risk ratio (RR) was used as the effect indicator, and the effect size was represented by the 95 % confidence interval (CI). Subgroup analysis based on the perinatal stage, physical activity intensity, physical activity equivalent, and intervention duration was performed.

RESULTS

Totally, 35 studies including 5084 women were included. Physical activity could reduce the incidence and severity of depression in perinatal women. Among depressed women with prenatal depression, low-intensity physical activity, with metabolic equivalents (METs)-min/week being <450, was associated with lower levels of depression. In the general population, the risk of postpartum depression was lower in the physical activity group when the duration of intervention was ≥12 weeks, being II, III stage, and ≥450 METs-min/week. Both low and moderate-intensity physical activity were beneficial to an improved depression severity among depressed women with postpartum depression, and moderate exercise intervention could decrease the risk of postpartum depression in general pregnant women.

LIMITATIONS

Different types of physical activities may affect the effectiveness of interventions.

CONCLUSION

Our study indicated physical activity specifically targeted at pregnant women could reduce depression risk and severity.

Hybrid and Traditional Cardiac Rehabilitation in a Rural Area: A RETROSPECTIVE STUDY

PURPOSE

Cardiac rehabilitation is a prescribed exercise intervention that reduces cardiovascular mortality, secondary events, and hospitalizations. Hybrid cardiac rehabilitation (HBCR) is an alternative method that overcomes barriers to participation, such as travel distance and transportation issues. To date, comparisons of HBCR and traditional cardiac rehabilitation (TCR) are limited to randomized controlled trials, which may influence outcomes due to supervision associated with clinical research. Coincidental to the COVID-19 pandemic, we investigated HBCR effectiveness (peak metabolic equivalents [peak METs]), resting heart rate (RHR), resting systolic (SBP) and diastolic blood pressure (DBP), body mass index (BMI), and depression outcomes (Patient Health Questionnaire-9 [PHQ-9]).

METHODS

Via retrospective analysis, TCR and HBCR were examined during the COVID-19 pandemic (October 1, 2020, and March 31, 2022). Key dependent variables were quantified at baseline (pre) and discharge (post). Completion was determined by participation in 18 monitored TCR exercise sessions and four monitored HBCR exercise sessions.

RESULTS

Peak METs increased at post-TCR and HBCR (P < .001); however, TCR resulted in greater improvements (P = .034). The PHQ-9 scores were decreased in all groups (P < .001), while post-SBP and BMI did not improve (SBP: P = .185, BMI: P = .355). Post-DBP and RHR increased (DBP: P = .003, RHR: P = .032), although associations between intervention and program completion were not observed (P = .172).

CONCLUSIONS

Peak METs and depression metric outcomes (PHQ-9) improved with TCR and HBCR. Improvements in exercise capacity were greater with TCR; however, HBCR did not produce inferior results by comparison, an outcome that may have been essential during the first 18 mo of the COVID-19 pandemic.

Physical exercise training as preceding treatment to cognitive behavioral therapy in mild to moderate major depressive disorder: A randomized controlled trial

BACKGROUND

Many patients with major depressive disorder (MDD) remain untreated or do not respond to cognitive behavioral therapy (CBT). Physical exercise shows antidepressive effects and may serve as an effective augmentation treatment. However, research on combining exercise with CBT is sparse in MDD and underlying mechanisms of exercise are not well understood to date.

METHODS

120 outpatients with MDD were randomized to either a high intensity exercise group (HEX), a low intensity exercise group (LEX), or a waiting list control group (WL). After 12 weeks of exercise training or waiting period, all patients received a manualized CBT.

RESULTS

Seventy-five patients with MDD completed both the exercise program/ waiting period and the CBT. While physical fitness improved in HEX after the exercise program, it did not change in LEX and WL. Depressive symptoms improved in all three groups from baseline to post-CBT and the group by time interaction was not significant. Regression analyses revealed that the amount of fitness improvement during exercise predicted the subsequent CBT response.

LIMITATIONS

The dropout rate was relatively high, preparatory CBT sessions during exercise / waiting period may have influenced depressive symptoms, and no patients with severe MDD were included.

CONCLUSIONS

High intense physical exercise did not lead to a general enhancement of CBT outcome, but higher increases in physical fitness seem to improve symptom change during CBT. Our results suggest that the implementation of more individually tailored exercise programs could be a promising approach for future research and clinical practice.

The Effects of Physical Activity on Positive Emotions in Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Positive emotions help children and adolescents develop good personalities and interpersonal relationships. Evidence shows that participation in physical activity is associated with positive emotions in young people. However, there is still a lack of studies on the effects of physical activity on positive emotions in children and adolescents.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to examine the effects of physical activity on positive emotions in children and adolescents.

METHODS

Online databases (Scopus, PubMed, Web of Science, EBSCOhost, and APA PsycInfo) were searched from inception to August 2022.

RESULT

A total of 24 articles were eventually included representing 3907 participants from 14 different countries. Overall, the effect of physical activity interventions on positive emotions was significant. The studies revealed that positive emotions were statistically better in the physical activity participation group than in the control group without physical activity (SMD = 0.62, 95% CI: (0.24, 1.01), (p < 0.01). Based on subgroup analyses, we found that participation in aerobic exercise for 30-60 min in adolescents aged ≥12 years had a more significant intervention effect on positive emotions.

CONCLUSION

These findings indicate that the moods of children and adolescents who participate in physical activity significantly improved compared with the moods of those who do not participate in physical activity. The age, exercise type, and exercise duration of adolescents are important factors influencing the positive emotions resulting from physical activity interventions.

Computational markers of experience- but not description-based decision-making are associated with future depressive symptoms in young adults

BACKGROUND

Early prediction of high depressive symptoms is crucial for selective intervention and the minimization of functional impairment. Recent cross-sectional studies indicated decision-making deficits in depression, which may be an important contributor to the disorder. Our goal was to test whether description- and experience-based decision making, two major neuroeconomic paradigms of decision-making under uncertainty, predict future depressive symptoms in young adults.

METHODS

One hundred young adults performed two decision-making tasks, one description-based, in which subjects chose between two gambling options given explicitly stated rewards and their probabilities, and the other experience-based, in which subjects were shown rewards but had to learn the probability of those rewards (or cue-outcome contingencies) via trial-and-error experience. We evaluated subjects' depressive symptoms with BDI-II at baseline (T1) and half a year later (T2).

RESULTS

Comparing subjects with low versus high levels of depressive symptoms at T2 showed that the latter performed worse on the experience- but not description-based task at T1. Computational modeling of the decision-making process suggested that subjects with high levels of depressive symptoms had a more concave utility function, indicating enhanced risk aversion. Furthermore, a more concave utility function at T1 increased the odds of high depressive symptoms at T2, even after controlling depressive symptoms at T1, perceived stress at T2, and several covariates (OR = 0.251, 95% CI [0.085, 0.741]).

CONCLUSIONS

This is the first study to demonstrate a prospective link between experience-based decision-making and depressive symptoms. Our results suggest that enhanced risk aversion in experience-based decision-making may be an important contributor to the development of depressive symptoms.

Ansiedade, Depressão, Dor e Fadiga em Pacientes com Câncer de Mama que Realizaram Treinamento Combinado

Introdução: Apesar do aumento na sobrevida de pacientes com neoplasias de mama, muitas persistem com ansiedade, depressão, fadiga e dor mesmo após o tratamento anticancerígeno, fatores associados a uma pior qualidade de vida. Objetivo: Avaliar a influencia do treinamento combinado na ansiedade, depressão, dor e fadiga em pacientes com câncer de mama. Método: Ensaio controlado randomizado com 26 pacientes em quimioterapia, radioterapia ou acompanhamento clinico em um centro de referência em tratamento de câncer, com idade 30 a 59 anos, não praticantes de treinamento físico nos últimos três meses. O grupo experimental (GE) (n=13) foi submetido a três sessões por semana de treinamento aeróbico e resistido em 12 semanas, com duração de 60 minutos, e duas sessões de treinamento de flexibilidade por semana com duração de 20 segundos em três series. O grupo controle (GC) (n=13) realizou somente o tratamento hospitalar convencional. Todas as avaliações foram realizadas no tempo basal e após 12 semanas. Resultados: As pacientes do GE apresentaram redução significativa da ansiedade (p=0,0242), intensidade da dor (p=0,0290) e dimensão comportamental da fadiga (0,0033). Não foram observadas diferenças na depressão (p=0,0803), interferência da dor nas atividades habituais (p=0,0933) e dimensões afetiva (p=0,0583) e sensorial/cognitiva/emocional (p=0,5525) da fadiga. O GC permaneceu inalterado em todas as variáveis. Conclusão: O treinamento combinado, envolvendo exercícios aeróbios, de resistência e de flexibilidade durante 12 semanas, apresenta efeitos benéficos na ansiedade, fadiga e dor em pacientes com câncer de mama.

Associations between depression, domain-specific physical activity, and BMI among US adults: NHANES 2011-2014 cross-sectional data

Background

Physical activity is associated with depression. However, benefits of physical activity on depression may differ for specific domains of physical activity (i.e., leisure-time, work, and travel). Moreover, the relationship between physical activity and depression could also differ for people in different Body Mass Index (BMI) categories. This study investigated the relationship between domain-specific physical activity and BMI with depression, and the moderation effects of BMI on the relationship between domain physical activity and depression.

Methods

Complex survey data from the NHANES 2011-2014 was used (N=10,047). Depression was measured using the Patient Health Questionnaire (PHQ-9). Participants reported physical activity minutes in each domain using the Global Physical Activity Questionnaire. Demographic characteristics were self-reported. Weight and height were objectively measured and used for calculating BMI. Survey procedures were used to account for complex survey design. As two survey cycles were used, sampling weights were re-calculated and used for analyses. Taylor series linearisation was chosen as a variance estimation method.

Results

Participants who engaged in ≥150 minutes/week of total moderate-vigorous physical activity (MVPA) (adjusted B = 0.83, 95% CI [0.50, 1.16]) and leisure-time MVPA (adjusted B = 0.84, 95% CI [0.57, 1.11]) experienced lower levels of depression compared to those engaging in <150 MVPA minutes/week. Work and travel-related physical activity were not associated with depression. Overweight (adjusted B = -0.40, 95% CI [-0.76, -0.04]) and underweight/normal weight participants (adjusted B = -0.60, 95%CI [-0.96, -0.25]) experienced less depressive symptoms compared to obese participants. BMI did not moderate the relationship between domain-specific physical activity and depression.

Conclusions

Interventions that focus on leisure-time physical activity appear to be best suited to improve depression, however, this needs to be confirmed in purposefully designed intervention studies. Future studies may also examine ways to improve the effectiveness of work and travel physical activity for reducing depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14037-4.

A Comparison of Acute Effects of Climbing Therapy with Nordic Walking for Inpatient Adults with Mental Health Disorder: A Clinical Pilot Trial

As climbing therapy is increasingly used for mental health disorders, the present study aimed to compare acute effects of a therapeutic climbing intervention (CT) on affective responses, anxiety, and self-efficacy with those of Nordic walking (NW) and a sedentary control condition (SC) in an inpatient setting with persons with depression, anxiety, or obsessive−compulsive disorders. A total of 21 inpatients (32 ± 12.2 years) participated in a clinical trial in all interventions using an experimental within-subject design. Anxiety and self-efficacy were assessed preintervention (t0) and postintervention (t2) using the State-Trait Anxiety Inventory and the General Self-Efficacy Scale, and affective responses were additionally evaluated during (t1) and 180 min after the intervention (t3) using the Feeling Scale, Felt Arousal Scale, and Positive and Negative Affect Schedule. Statistical evaluation was performed with a 3 × 2 or 3 × 4 repeated measures ANOVA. Significant interaction effects were found for affective responses regarding positive affect, affective valence, and perceived activation (p < 0.015) favoring CT over NW and SC. For anxiety, a significant interaction effect was found (F(2.40) = 6.603; p = 0.003; η2 = 0.248), and also perceived self-efficacy increased significantly (F(2.40) = 6.046; p = 0.005; η2 = 0.232). Single CT sessions may enhance affective responses and self-efficacy and reduce anxiety in inpatients with mental health disorders to a higher extent than NW. CT as part of an inpatient therapy program may help to improve key affective mechanisms and should be further studied in comparison with other exercise interventions with comparable intensity.

Maternal vitamin D supplementation and treadmill exercise attenuated vitamin D deficiency-induced anxiety-and depressive-like behaviors in adult male offspring rats

BACKGROUND

Vitamin D is a vital neuroactive steroid for brain development and function. Vitamin D deficiency is a worldwide health problem, particularly in children and women. Gestational or developmental vitamin D deficiency is associated with an increased risk of neurodevelopmental and neuropsychiatric disorders. This study examined the effect of maternal vitamin D dietary manipulations and treadmill exercise on anxiety-and depressive-related behaviors, pro-inflammatory cytokines, and prefrontal cortex (PFC) protein levels of brain-derived neurotrophic factor (BDNF) and vitamin D receptor (VDR) in adult male offspring born to vitamin D-deficient diet (VDD)-fed dams.

METHODS AND RESULTS

Female rats were provided standard diet (SD) or VDD for six weeks and then were treated with SD (started a week before mating throughout gestation and lactation) and treadmill exercise (a week before mating until gestational day 20). Male offspring were separated on postnatal day (PND) 21 and fed SD chow until PND90. Our results demonstrated that maternal vitamin D deficiency increased anxiety and depression-related behaviors, increased levels of TNF-α and IL-1β in serum, and decreased prefrontal protein expressions of BDNF and VDR in adult male offspring. However, maternal vitamin D supplementation and treadmill exercise reversed these changes alone or in combination.

CONCLUSION

It seems that developmental vitamin D deficiency disrupts brain development and has a long-lasting effect on VDR and BDNF signaling in the rat brain resulting in neuropsychiatric disorders in offspring. Therefore, vitamin D supplementation and physical exercise are reasonable strategies to prevent these neurobehavioral impairments.

Being Hopeful and Mindful During Adversity: A Longitudinal Study on College Students’ Adjustment During COVID-19

Objectives

The current study examined whether hope and mindfulness were associated with changes in two maladjustment measures, internalizing and externalizing behaviors, during the COVID-19 pandemic and tested sense of coherence as a mediator. The salutogenic theory of health, which posits that sense of coherence is central to individuals’ well-being in stressful situations and that individuals derive their sense of coherence from their generalized resistance resources (GRRs), was used to guide the analyses.

Methods

On two occasions separated by about 6 months, 253 Hong Kong college students (mean age = 21.0 years at time 1; 86% of them were women) filled in online questionnaires during the COVID-19 outbreaks. Path analysis was conducted to examine the interrelationships among hope and mindfulness, sense of coherence, and internalizing and externalizing behaviors.

Results

Results indicated that hope and mindfulness at time 1 were associated with internalizing and externalizing behaviors at time 2, even after controlling for confounding variables and prior levels of internalizing and externalizing behaviors. Moreover, sense of coherence at time 1 significantly mediated these associations.

Conclusions

Findings pointed to the potential roles of hope, mindfulness, and sense of coherence in understanding Chinese college students’ adjustment during the COVID-19 pandemic. Future research is needed to test whether sense of coherence and behavioral adjustment can be promoted through hope- and mindfulness-based intervention programs. Future research is also needed to examine the interrelationships among health-promoting assets, sense of coherence, and individual adjustment in samples of diverse cultural backgrounds.

The Impact of Web-Based Physical Activity Interventions on Depression and Anxiety Among College Students: Randomized Experimental Trial

Background

Depression and anxiety are growing issues for college students, with both aerobic resistance training and mindfulness yoga exercises known to be effective in reducing symptoms and severity. However, no known research is available comparing these 2 depression and anxiety interventions simultaneously and in a web-based environment.

Objective

This study aims to determine the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness exercise intervention (WeMindful) on depression and anxiety symptoms in college students.

Methods

The participants were 77 college students who anonymously completed a Qualtrics survey, including the Generalized Anxiety Disorder Scale and the Major Depression Inventory at baseline and after the intervention. Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks.

Results

The results of analysis of covariance with repeated measures indicated that although not statistically significant, both groups showed a notable decrease in anxiety with a marginally significant main effect of time (F1=3.485; P=.07; η2=0.047) but no significant main effect of group and no significant interaction effect of time with group. The 2 intervention groups experienced a significant decrease in depression with the main effect of time (F=3.892; P=.05; η2=0.052). There was no significant main effect of group or interaction effect of time with group for depression.

Conclusions

College students in both WeActive and WeMindful groups experienced a significant decrease in depression symptoms and a decrease, although not significant, in anxiety as well. The study suggests that web-based WeActive and WeMindful interventions are effective approaches to managing US college students’ depression and anxiety during a pandemic.

Molecular Mechanisms of Exercise and Healthspan

Healthspan is the period of our life without major debilitating diseases. In the modern world where unhealthy lifestyle choices and chronic diseases taper the healthspan, which lead to an enormous economic burden, finding ways to promote healthspan becomes a pressing goal of the scientific community. Exercise, one of humanity's most ancient and effective lifestyle interventions, appears to be at the center of the solution since it can both treat and prevent the occurrence of many chronic diseases. Here, we will review the current evidence and opinions about regular exercise promoting healthspan through enhancing the functionality of our organ systems and preventing diseases.

Interaction Effect between Physical Activity and the BDNF Val66Met Polymorphism on Depression in Women from the PISMA-ep Study

The relationship between depression and the Val66Met polymorphism at the brain-derived neurotrophic factor gene (BDNF), has been largely studied. It has also been related to physical activity, although the results remain inconclusive. The aim of this study is to investigate the relationship between this polymorphism, depression and physical activity in a thoroughly characterised sample of community-based individuals from the PISMA-ep study. A total of 3123 participants from the PISMA-ep study were genotyped for the BDNF Val66Met polymorphism, of which 209 had depression. Our results are in line with previous studies reporting a protective effect of physical activity on depression, specifically in light intensity. Interestingly, we report a gene-environment interaction effect in which Met allele carriers of the BDNF Val66Met polymorphism who reported more hours of physical activity showed a decreased prevalence of depression. This effect was observed in the total sample (OR = 0.95, 95%CI = 0.90–0.99, p = 0.027) and was strengthened in women (OR = 0.93, 95%CI = 0.87–0.98, p = 0.019). These results highlight the potential role of physical activity as a promising therapeutic strategy for preventing and adjuvant treatment of depression and suggest molecular and genetic particularities of depression between sexes.

Impact of interventions targeting anxiety and depression in adults with asthma

OBJECTIVE

High rates of anxiety and depression exist among asthma patient populations. This scoping review will examine the existing interventional therapies that address depression and anxiety symptoms in patients with asthma.

DATA SOURCES

PubMed, Cochrane, Psychinfo, CINAHL, Google Scholar and EMBASE databases were searched using the following search terms: 'anxiety asthma', 'panic disorder asthma' and 'depression asthma' with a randomized clinical trial filter and additional filters to exclude exclusion criteria.

STUDY SELECTIONS

Study selections included only randomized control trials with anxiety and/or depression and/or panic disorder outcomes as primary or secondary outcomes. Only full-text articles in the English language were included.

RESULTS

This search yielded interventions from pharmacologic (n = 3), psychological (n = 7), lifestyle medicine (n = 10) and complementary and alternative medicine (CAM; n = 1) using a range of outcomes from physiologic to psychologic. While the pharmacologic and CAM studies were inconclusive, psychologic and lifestyle interventions showed improvements in asthma (quality of life, symptoms, asthma attacks) and psychological (anxiety, panic fear, depression) outcomes. Variations in selection methods, outcome measures and diagnostic criteria hindered a direct comparison of the studies. Most studies had small sample sizes, high attrition rates and short study durations.

CONCLUSION

There is limited evidence on best approaches for managing co-morbid anxiety and/or depression in patients with asthma. Psychological and lifestyle medicine interventions are promising with improvements in both asthma and mental health outcomes. Well-designed randomized controlled studies with larger sample sizes, standardized outcomes and longer durations, are needed to better understand the role of depression and anxiety in adults with asthma.

Association Between MTHFR rs17367504 Polymorphism and Major Depressive Disorder in Taiwan: Evidence for Effect Modification by Exercise Habits

BACKGROUND/AIM

Recent studies reported that folate supplementation has beneficial effects on major depression. The Methylenetetrahydrofolate reductase (MTHFR) enzyme is crucial in folate metabolism. This population-based study examined the association between MTHFR rs17367504 polymorphism and major depressive disorder based on exercise habits.

METHODS

Taiwan Biobank (TWB) provided demographic and genotype data between 2008 and 2015. The biobank participants were Taiwanese aged 30 to 70. Data on major depressive disorder (MDD) were obtained from the National Health Insurance Research Database (NHIRD).

RESULTS

A total of 636 individuals were identified with MDD, whereas 17,298 individuals were considered controls. The associations of MTHFR rs17367504 and exercise with MDD risk were estimated using logistic regression models. The distribution of MTHFR rs17367504 genotype frequencies differed significantly between the MDD and control groups. We found that, compared with the AA genotype, the GG genotype was associated with a significantly increased risk of MDD [adjusted odds ratio (aOR), 1.76; 95% confidence interval (CI), 1.05-2.94; p = 0.033]. We found an interaction (p = 0.04) between rs17367504 and exercise, a well-known protective factor for MDD. A substantial increase in the risk of MDD was found among those with GG genotypes who did not exercise (aOR, 2.93; 95% CI, 1.66-5.17; p < 0.001).

CONCLUSIONS

Our findings indicate that MDD is related to MTHFR rs17367504 and exercise, though the mechanisms remain to be determined.

Effect of Dental Environment Stressors and Coping Mechanisms on Perceived Stress in Postgraduate Dental Students

Aim and objective

To investigate the effect of dental environment stressors and coping mechanisms on perceived stress in postgraduate dental students.

Materials and methods

This cross-sectional study enrolled 250 postgraduate students from four dental colleges. Modified dental environment stress (DES) questionnaire was used to study the dental environment-related stressors, perceived stress score (PSS) to measure the extent of stress perception, and brief COPE (BC) scale to measure the use of various coping strategies deployed to combat stress. An independent T-test was used to determine the associations of these measures with gender and marital status and one-way ANOVA for associations with year of study. Hierarchical regression was used to determine the effect of demographic factors, career-related psychological background, health-related habits, DES, and BC score on PSS.

Results

“Synopsis, thesis, library dissertation” and “lack of adequate infrastructure” were reported as the highest stressors by the postgraduate students. Only 4.8% of respondents perceived low stress, while 65.2% perceived high stress. A high correlation between the DES score and PSS was observed. Active coping, acceptance, and positive reframing were the most commonly utilized coping strategies. Planning and use of emotional support were the only coping strategies that were significant negative predictors of PSS. Problem-focused coping strategies had a positive, but non-significant correlation with PSS, while emotion-focused coping strategies had a significant negative correlation with PSS.

Conclusion

Postgraduate dental environment causes a high-stress perception in students and reactive coping strategies have only a limited role in reducing stress perception.

How to cite this article

Sikka N, Juneja R, Kumar V, et al. Effect of Dental Environment Stressors and Coping Mechanisms on Perceived Stress in Postgraduate Dental Students. Int J Clin Pediatr Dent 2021;14(5):681–688.

Universal depression prevention: An umbrella review of meta-analyses

Depression is a disabling, highly prevalent, frequently chronic, and difficult-to-treat disorder with an immense cognitive, social, and economic burden. Given that many of the advances in other non-communicable disorders like cancer have been in prevention rather than treatment, the prevention of depression is currently an unmet public health priority. We sought to provide an overview of the meta-analytic literature through conducting a systematic umbrella review of universally delivered preventive interventions for depression. The search was conducted on March 18, 2021 utilising the following databases (all accessed through EBSCOHost); Allied and Complementary Medicine Database, CINAHL Complete, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete and APA PsychArticles. The following search terms related to depression, prevention, and trial study design. Two authors independently screened articles and a third resolved discrepancies. Eligibility criteria sought to identify meta-analyses that investigated the prevention of depression (i.e., reduced incidence) through intervention studies that were universal, in that they were designed to be delivered to entire populations Six meta-analyses on psychological interventions, two school-based meta-analyses, and one eHealth meta-analysis were included in this umbrella review. Findings indicated that all identified studies were of good quality and one was of fair quality. One previous meta-review that examined physical activity to prevent depression was included in results, comprising eight meta-analyses. Preventive interventions have primarily and successfully utilized psychological therapeutic components, delivered at the school, community, and workplace settings. Both school- and eHealth-based interventions hold some utility for depression prevention. There is meta-analytic evidence that physical activity is efficacious for depression prevention. However, universal prevention is inconsistently defined. There is a pressing need for well-designed randomized controlled preventative interventions for depression before recommendations can be universally accepted with convincing level of evidence.

Using the Intervention Mapping Approach to Develop a Mental Health Intervention: A Case Study on Improving the Reporting Standards for Developing Psychological Interventions

Replicating or distilling information from psychological interventions reported in the scientific literature is hindered by inadequate reporting, despite the existence of various methodologies to guide study reporting and intervention development. This article provides an in-depth explanation of the scientific development process for a mental health intervention, and by doing so illustrates how intervention development methodologies can be used to improve development reporting standards of interventions. Intervention development was guided by the Intervention Mapping approach and the Theoretical Domains Framework. It relied on an extensive literature review, input from a multi-disciplinary group of stakeholders and the learnings from projects on similar psychological interventions. The developed programme, called the “Be Well Plan”, focuses on self-exploration to determine key motivators, resources and challenges to improve mental health outcomes. The programme contains an online assessment to build awareness about one’s mental health status. In combination with the exploration of different evidence-based mental health activities from various therapeutic backgrounds, the programme teaches individuals to create a personalised mental health and wellbeing plan. The use of best-practice intervention development frameworks and evidence-based behavioural change techniques aims to ensure optimal intervention impact, while reporting on the development process provides researchers and other stakeholders with an ability to scientifically interrogate and replicate similar psychological interventions.

A Randomized Controlled Pilot Trial About the Influence of Kyusho Jitsu Exercise on Self-efficacy, Fear, Depression, and Distress of Breast Cancer Patients within Follow-up Care

Introduction

Breast cancer survivors are faced with several psychological issues. We report the influence on self-efficacy by a holistic orientated training schedule based on the “Kyusho Jitsu” martial art and explore the effects on self-efficacy, distress, fear, and depression.

Methods

Breast cancer survivors (N = 51) were randomly assigned to an intervention (n = 30) or control group (n = 21). The intervention group participated in a Kyusho Jitsu intervention twice a week over a period of 6 months, the control group received no intervention. Patients from both groups were measured at baseline, 3 and 6 months on level of self-efficacy (German General-Self-Efficacy Scale, SWE), stress (Perceived Stress Questionnaire, PSQ20), and fear and depression (Hospital Anxiety and Depression Scale, HADS).

Results

Analysis of the original data showed a significant difference between both groups regarding the subscale “joy” (P = .018). Several significant results within the intervention group were seen in self-efficacy (P = .014), fear (P = .009) and the overall score for fear and depression (P = .043). Both groups improved significantly within “worries” (intervention P = .006, control P = .019) and the PSQ20 overall score (both P = .005). The control group also significantly improved in the subscale for “demands” (P = .019).

Conclusion

To summarize, our pilot study showed that Kyusho Jitsu training is safe and feasible. Though, the intervention alone cannot be considered as being effective enough to help breast cancer survivors regarding relevant psychological issues, but might be an important supplement offer within follow-up care.

Sleep health mediates the relationship between physical activity and depression symptoms

PURPOSE

This study aimed to investigate cross-sectional associations between physical activity, sleep health, and depression symptoms using mediation models.

METHODS

Participants (N = 1576, M_Age = 39.3 years, 40% female) were recruited online from Amazon's Mechanical Turk crowd-sourcing service. Physical activity was measured using a single-item self-report measure and depression symptoms were reported using the Hospital Anxiety and Depression Scale. Sleep health was measured using the 6-question RUSATED Sleep Health survey V2.0.

RESULTS

Good sleep health (direct effect: β =  - .273, t =  - 13.87, p < .0001) and high levels of physical activity (direct effect: β =  - .092, t =  - 4.73, p < .0001) were both individually associated with fewer depression symptoms. Sleep health significantly mediated 19% of the association between physical activity and depression symptoms (indirect effect: β =  - .022, 95% CI [- .036 to - .008]), while physical activity significantly mediated 3% of the relationship between sleep health and depression symptoms (indirect effect: β =  - .008, 95% CI [- .014 to - .003]).

CONCLUSION

Physical activity and sleep health act as predictors and mediators of depression symptoms.

The impact of a single session of aerobic exercise on positive emotional reactivity in depression: Insight into individual differences from the late positive potential

Depression has been characterized by a broad disengagement from the environment, as reflected by dampened positive and negative emotional reactivity. Research has shown that acute exercise may enhance positive emotional reactivity in healthy adults. It is unknown whether it can alter positive emotional reactivity in depression. In the present study, positive emotional reactivity was assessed using the late positive potential (LPP) event-related potential before and after 30 min of moderate-intensity aerobic exercise in 43 adults with current or a lifetime history of depression (Mage = 32.74 years; Min/Max = 18/59) and 18 never-depressed healthy adults (Mage = 37.94 years; Min/Max = 21/61). Acute exercise increased the LPP for healthy adults; the LPP did not change among those with current or a lifetime history of depression. A secondary aim was to identify moderators of change in positive emotional reactivity among subgroups of adults with current depression. Compared to adults with impaired mood reactivity, those with intact mood reactivity had a pre-to-post increase in the LPP. The current study provides preliminary support for the LPP as a neural indicator of exercise efficacy and highlights individual differences in response to acute exercise in depression.

Spectrum, rate and unmet needs of sociomedical interventions in outpatient psychotherapy

OBJECTIVE

Psychological disorders often take a long-term course, resulting in impairment in daily life and work. Treatment must therefore target not only symptoms of illness but also capacity limitations and context restrictions, as outlined in the International Classification of Functioning, Disability and Health (ICF). This includes sociomedical and interdisciplinary interventions like coordination with other specialists, contact to employers and employment agencies, social support agencies, debt counselling, self-help and leisure groups. There are no data on the spectrum, rate and unmet needs of sociomedical interventions in outpatient psychotherapy.

METHOD

Following a semistructured interview schedule, 131 psychotherapists in private practice were asked to report on unselected patients. The interviewer assessed to what degree 38 predefined sociomedical interventions were applied so far or should be considered in the future.

RESULT

Reports for 322 patients were gathered. All sociomedical interventions were applied, depending on the sick leave status and course of illness. Cognitive behaviour therapists used more sociomedical interventions than psychodynamic therapists.

CONCLUSION

The data show that sociomedical interventions are a frequent part of psychotherapy. They are used preferably in patients with participation restrictions. Psychotherapeutic concepts and education should include sociomedical aspects.

Effectiveness of a psychological online training to promote physical activity among students: protocol of a randomized-controlled trial

Background

Many students in Germany do not meet recommended amounts of physical activity. In order to promote physical activity in students, web-based interventions are increasingly implemented. Yet, data on effectiveness of web-based interventions in university students is low. Our study aims at investigating a web-based intervention for students. The intervention is based on the Health Action Process Approach (HAPA), which discriminates between processes of intention formation (motivational processes) and processes of intention implementation (volitional processes). Primary outcome is change in physical activity; secondary outcomes are motivational and volitional variables as proposed by the HAPA as well as quality of life and depressive symptoms.

Methods

A two-armed randomized controlled trial (RCT) of parallel design is conducted. Participants are recruited via the internet platform StudiCare (www.studicare.com). After the baseline assessment (t1), participants are randomized to either intervention group (immediate access to web-based intervention) or control group (access only after follow-up assessment). Four weeks later, post-assessment (t2) is performed in both groups followed by a follow-up assessment (t3) 3 months later. Assessments take place online. Main outcome analyses will follow an intention-to-treat principle by including all randomized participants into the analyses. Outcomes will be analysed using a linear mixed model, assuming data are missing at random. The mixed model will include group, time, and the interaction of group and time as fixed effects and participant and university as random effect.

Discussion

This study is a high-quality RCT with three assessment points and intention-to-treat analysis meeting the state-of-the-art of effectiveness studies. Recruitment covers almost 20 universities in three countries, leading to high external validity. The results of this study will be of great relevance for student health campaigns, as they reflect the effectiveness of self-help interventions for young adults with regard to behaviour change as well as motivational and volitional determinants. From a lifespan perspective, it is important to help students find their way into regular physical activity.

Trial registration

The German clinical trials register (DRKS) DRKS00016889. Registered on 28 February 2019

A Longitudinal Evaluation of Risk Factors and Interactions for the Development of Nonspecific Neck Pain in Office Workers in Two Cultures

OBJECTIVE

To identify risk factors for the development of interfering neck pain in office workers including an examination of the interaction effects between potential risk factors.

BACKGROUND

The 1-year incidence of neck pain in office workers is reported as the highest of all occupations. Identifying risk factors for the development of neck pain in office workers is therefore a priority to direct prevention strategies.

METHODS

Participants included 214 office workers without neck pain from two cultures. A battery of measures evaluating potential individual and workplace risk factors were administered at baseline, and the incidence of interfering neck pain assessed monthly for 12 months. Survival analysis was used to identify relationships between risk factors and the development of interfering neck pain.

RESULTS

One-year incidence was 1.93 (95% CI [1.41, 2.64]) per 100 person months. Factors increasing the risk of developing interfering neck pain were older age, female gender, increased sitting hours, higher job strain, and stress. A neutral thorax sitting posture, greater cervical range of motion and muscle endurance, and higher physical activity were associated with a decreased risk of neck pain. The effects of some risk factors on the development of neck pain were moderated by the workers' coping resources.

CONCLUSION

Multiple risk factors and interactions may explain the development of neck pain in office workers. Therefore, plans for preventing the development of interfering neck pain in office workers should consider multiple individual and work-related factors with some factors being potentially more modifiable than others.

Protective Predictors Associated With Posttraumatic Stress and Psychological Distress in Chinese Nurses During the Outbreak of COVID-19

Background: The novel coronavirus disease 2019 (COVID-19) posed an unprecedented threat to Chinese healthcare professionals. Nevertheless, few studies notably focused on the mental health conditions of nurses and explored protective factors to prevent posttraumatic stress and psychological distress. This study aimed to explore the prevalence and the predictive factors especially defensive predictors associated with posttraumatic stress and psychological distress in nurses during the COVID-19 pandemic.

Methods: In this online study, 1,728 nurses (~77.5% came from the COVID-19 pandemic frontline) were included in the final analysis. Posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (PCL-5) and Self-Reporting Questionnaire (SRQ) was used to assess posttraumatic stress and psychological distress.

Results: The results demonstrated that the prevalence of posttraumatic stress and psychological distress in nurses throughout China between February 1, 2020 and February 13, 2020 was 39.12 and 24.36%, respectively. Multivariate logistic regression indicated that insomnia, high panic intensity, and high impact of the COVID-19 pandemic were risk predictors of posttraumatic stress and psychological distress in nurses. Married participants had a 1.58 times increased risk of having posttraumatic stress when compared with the single participants. Frontline medical staff were more likely to suffer from psychological distress. The adequate exercise was a protective predictor of psychological distress [adjusted odds ratio (AOR) = 0.655, 95% CI = 0.486–0.883], but not with posttraumatic stress. High-quality diet was a protective predictor of posttraumatic stress (AOR = 0.112, 95% CI = 0.037–0.336) and psychological distress (AOR = 0.083, 95% CI = 0.028–0.247).

Conclusions: Our study revealed the prevalence and factors associated with posttraumatic stress and psychological distress in nurses during the COVID-19 pandemic. Low panic intensity, low level of impact, satisfactory sleep, adequate exercise, and better diet were protective factors of posttraumatic stress and psychological distress. It indicated that the psychological status of nurses (particularly those from the COVID-19 pandemic frontline) should be monitored, and protective factors associated with posttraumatic stress and psychological distress should be increased.

Effectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: A systematic review

OBJECTIVE

To assess the effectiveness of physical activity interventions in improving objective and patient-reported outcomes in HNC survivors.

INTRODUCTION

Multiple guidelines recommend that head and neck cancer (HNC) survivors participate in regular physical activity. Physical activity is associated with improved outcomes and mortality in healthy individuals as well as in certain cancer populations. However, the effectiveness of physical activity interventions in HNC survivors is inadequately understood.

METHODS AND RESULTS

Our literature search through December 2018 identified 2,392 articles. After de-duplication, title and abstract review, full-text review and bibliographic search, 20 studies met all inclusion criteria. Inclusion criteria included any full-body physical activity intervention in HNC survivors that did not target discrete organ sites or functions (e.g. swallowing). Study cohorts included 749 predominantly male participants with a mean age range of 48-63 years. At their conclusion, physical activity interventions were associated with at least one significant improvement in an objective or patient-reported outcome in 75% of studies. Aerobic capacity and fatigue were the most commonly improved outcomes. None of the included studies evaluated associations with survival or recurrence. Although traditional aerobic and resistance interventions were more common, a greater proportion of alternative physical activity (yoga and Tai Chi) interventions demonstrated improved objective and patient-reported outcomes.

CONCLUSION

Physical activity interventions in HNC survivors often conferred some improvement in objective and patient-reported outcomes. Additional highly-powered, randomized controlled studies are needed to establish the optimal type, intensity, and timing of physical activity interventions as well as their impact on oncologic outcomes.

Effect of Nature Walks on Depression and Anxiety: A Systematic Review

The benefits of nature for our health have been an increasing research focus in recent years. In the context of a global increase in mental health diagnoses, the potential health benefits of nature have attracted attention. One practical nature treatment is to walk in nature. However, evidence for this practice on mental health has not been comprehensively appraised to date. This systematic review synthesized the effects of nature walks for depression and anxiety, and evaluated the methodological rigor of studies. Academic databases including ProQuest, PsycINFO, Science Direct, and Google Scholar were utilized to identify eligible articles, which were examined using the Newcastle–Ottawa Scale. Of 385 articles initially retrieved, 12 studies met all the eligibility criteria (nine pre-post within-subject studies, two quasi-experimental studies, and one experimental between-subjects study). These studies demonstrated that nature walks were effective for state anxiety but not generalized anxiety and the effects for depression were inconsistent. Findings indicate that nature walks may be effective for mental health, especially for reducing state anxiety. However, the quality of the included studies varied, and sample sizes were small, suggesting a need for more rigorous and large-scale research.